I think his axe already through Miko.
Page 18, look at his hand/axe handle position.
Page 19, the axe illustrated like it's moving OUT.
But yeah, IT NOTICE HER (or maybe notice she's under protection of mountain bell shrine)
Edit: Interesting theory from mr nobody!
Hmm, my two cents are
1. The deformed spirit is spirit that has grudge or have something left unresolved.
2. Miko's dad and cat guy's wife most likely accept their death sincerely thus can retain their sanity/real image.
3. The spirit that eat another spirit near MD alley... I thought it's a... last gate for spirit. Maybe the 'went to heaven' things.... I thought it's literary eating spirit like the legendary antagonist of chapter 11 the kimono man, but the eater did not change... didn't it...?
4. I can't explain why the grotesque 'god'. But the ugly or beautiful face we see is from human standard. Maybe that is the spirit standard.