Combating the Novel Coronavirus (COVID-19): Weeks of June 28 and July 5

MHA Covid-19 update

MHA COVID-19 UpdateAccording to a new report from The Commonwealth Fund, the country’s rapid rollout of COVID-19 vaccines and continuing vaccination efforts have saved about 279,000 lives and avoided 1.25 million hospitalizations in the United States. Approximately 67% of Americans had received at least one dose of vaccine as of July 7.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Children’s Health Leaders to Discuss Vaccines for Children in July 16 Webinar

The MHA will host a 45-minute webinar and discussion on COVID-19 vaccines for children, as well as the status of other scheduled vaccines for children, from 7:30 to 8:15 a.m. July 16 featuring remarks from several leaders in children’s healthcare in Michigan. The MHA has extended an invitation to this conversation to the Michigan Academy of Family Physicians and the Michigan chapter of the American Association of Pediatrics.

The agenda will include:

  • Brief overview of polling data related to individuals’ personal physicians as the trusted voice on vaccine choices.
  • COVID-19 vaccines for children, as well as comments on side effects and multi-inflammatory syndrome in children (MIS-C).
  • Status of other regularly scheduled vaccines in children, which have significantly declined during the pandemic.
  • Feedback and questions from participants.

The goal of the webinar is to increase awareness and preparedness with as many clinicians as possible before patients younger than 12 are eligible for COVID-19 vaccines and before school resumes and children are behind on other vaccines.

Members who have not yet registered may contact Ruthanne Sudderth at the MHA for registration instructions. Questions may be directed to Ruthanne or Laura Appel at the MHA.

Regulatory Flexibility for Sharps Containers Extended Through Oct. 31

The Department of Environment, Great Lakes, and Energy (EGLE) recently approved an MHA request to extend regulatory flexibility for hospitals facing an ongoing sharps container shortage. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Hospitals will continue to be exempted from the 90-day rule through Oct. 31, 2021; this will allow hospitals to replace sharps containers only when they are full.

The shortage was created by a production facility fire and increased demand for the containers due to vaccinations. The regulatory relief for MHA members was set to expire July 31 but was extended by EGLE for an additional three months.

The MHA will continue to monitor the situation and work with members to determine if additional exemptions should be requested. Questions on the extended exemption can be directed to Sean Sorenson-Abbott at the MHA.

State COVID-19 Data Dashboard Updates Will Occur Twice a Week

The state recently announced that its COVID-19 data dashboards will now be updated only on Tuesdays and Fridays instead of the former practice of updating them five days per week. However, providers are still required to enter their COVID-19 data into EMResource every day.

The state is reporting that, as of July 9, there are 211 confirmed adult COVID-19 hospitalizations and nine confirmed pediatric COVID-19 hospitalizations. More than 62% of adults 16 and older in Michigan had received at least one dose of vaccine as of July 9.

Michigan Announces Financial, Scholarship Prizes for Vaccinated Residents

Gov. Gretchen Whitmer June 28 announced the “MI Shot to Win Sweepstakes,” which may be entered by residents who get a COVID-19 vaccine. The sweepstakes includes $5 million in cash prizes for residents 18 and older and nine $55,000 college scholarships for vaccinated residents ages 12-17.

The goal of this public private partnership — also supported by the Protect Michigan Commission, Meijer, the Michigan Chamber of Commerce and the Michigan Association of United Ways, among others — is to help Michigan get at least 70% of residents vaccinated as soon as possible. Other states that have implemented similar prize programs have seen significant growth in vaccination rates. As the delta variant spreads in the U.S., reaching herd immunity levels is critical to preventing further outbreaks and deaths. In recent weeks, an average of 45,000 individuals in Michigan have initiated vaccination each week. As of July 7, 62 percent of state residents 16 and older have been given at least one dose.

The cash prizes for adults will be awarded via a $1 million drawing, a $2 million drawing, and 30 days of daily $50,000 drawings to anyone who has gotten at least one dose of the vaccine and registers for the contest.

The MHA will keep members apprised of the success of this incentive program. Members with questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of June 21

MHA Covid-19 update

The COVID-19 vaccines appear to be effective in protecting against serious illness from the more contagious delta variant of the virus. However, the variant continues to infect many in regions throughout the world, with news reports of renewed lockdowns in Australia and New Zeeland and increasing numbers of cases in U.S. states including Missouri, California, Florida and Texas, where fewer residents are vaccinated. Meanwhile, Michigan’s vaccine dashboard shows more than 61% of residents ages 16 and older have received at least one dose of a COVID-19 vaccine, with nearly 9 million doses administered.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Emergency Orders Rescinded Effective June 22

Several emergency public health orders that have been in place for much of the last 15 months are rescinded as of 12:01 a.m. June 22. The orders rescinded and the dates on which they took effect are:

  1. Gatherings and Face Mask Order (June 1, 2021)
  2. Temporary Restrictions for Entry into Congregate Care and Juvenile Justice Facilities (Oct. 29, 2020)
  3. Mandatory Testing for Michigan Department of Health and Human Services' Juvenile Justice Facility Staff (Sept. 18, 2020)
  4. Mandatory Testing for Michigan Department of Health and Human Services Hospitals and Centers Staff (Sept. 14, 2020)
  5. Exceptions to Temporary Restrictions on Entry into Congregate Care and Juvenile Justice Facilities (June 29, 2020)
  6. Exceptions to Temporary Restrictions on Entry into Certain Facilities (June 3, 2020)
  7. Safe Housing for Housing Unstable Individuals (May 12, 2020)
  8. Handling of Bodily Remains (May 4, 2020)
  9. Safe Housing for Michigan Homeless (April 28, 2020)

While the rescission of the facemask and hospital visitor restrictions would seemingly allow hospitals to stop screening visitors and make their own determinations about masking, the Michigan Occupational Safety and Health Administration (MIOSHA) announced new rules June 22 that essentially defer to the OSHA at the federal level. The OSHA rules currently in place still require healthcare facilities to screen visitors and require masks for employees. However, some exceptions are outlined by the OSHA for well-defined areas where employees are fully vaccinated; a flowchart on the OSHA website provides details. The OSHA also refers healthcare facilities to Centers for Disease Control and Prevention recommendations that continue to urge mask requirements for visitors. The MHA is reviewing the OSHA complete set of rules.

Because the MIOSHA adopted the OSHA rules by reference, the OSHA effective and compliance dates apply. The OSHA COVID-19 Emergency Temporary Standard (ETS) is effective June 21, 2021. The compliance date for the ETS is July 6, 2021, with a few exceptions. Compliance with paragraphs (i) Physical Barriers, (k) Ventilation, and (n) Training is required by July 21, 2021.

As an interim final rule, the new OSHA standard is open for comment. The MHA will submit comments on behalf of its members after a more thorough review of the rule, and members are encouraged to share content for the MHA comment letter with Laura Appel. The MHA will continue to advocate with the MIOSHA for consistency in state and federal rules for healthcare settings and keep members apprised of any developments on this issue. Members with questions may contact Adam Carlson at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the Michigan Department of Health and Human Services Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of April 26

MHA Covid-19 update

Gov. Gretchen Whitmer announced during an April 29 news conference that future epidemic order actions will be based on four vaccination-based milestones that will enable the state of Michigan to return to normalcy. Dubbed the “MI Vacc to Normal” challenge, the program’s goal is to reach a point where 70% of adults in the state are vaccinated and broad mitigation measures are lifted unless unanticipated circumstances arise. Meanwhile, Michigan’s hospitalization rates, testing positivity rates and other important measures are improving, although relatively high levels of acuity and pediatric admissions continue to cause high levels of stress on hospital staff and resources.

The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Administration of Johnson & Johnson Vaccine Resumes

The Centers for Disease Control and Prevention Advisory Committee on Immunization Practices (CDC ACIP) voted April 23 to recommend that providers resume vaccinations using the Johnson & Johnson (J&J) single-dose COVID-19 vaccine for anyone 18 and older. The CDC issued an updated Morbidity and Mortality Weekly Report April 27 providing the most recent recommendations for use of the J&J vaccine. The Michigan Department of Health and Human Services (MDHHS) also issued an alert advising providers to resume use of the vaccine.

The J&J vaccine was placed on a pause April 13 while experts conducted a thorough safety review after reports of a rare blood clotting syndrome in some people. The CDC and the Food and Drug Administration (FDA) confirmed that 15 cases of the blood clots have been reported to the Vaccine Adverse Reporting System, including the six cases originally reported, and that all occurred in women between the ages of 18 and 59. Due to the unique treatment required for these adverse events, the agencies also ensured providers and clinicians were made aware of their potential and could properly recognize and manage them. Shipments of the J&J vaccine are scheduled to resume during the week of May 3.

Both the Janssen COVID-19 Vaccine Fact Sheet for Healthcare Providers Administering Vaccine and the Fact Sheet for Recipients and Caregivers have been revised to include information about the risk of the blood clotting syndrome and should be reviewed prior to administration of the J&J vaccine.

CDC and MDHHS Provide Updated Vaccine Information

The CDC has issued updated interim clinical considerations for COVID-19 vaccines authorized for use in the United States. Providers are encouraged to review these considerations, as they cover such topics as interchangeability of vaccines, people vaccinated outside the U.S., antiviral therapy and vaccination, vaccination of pregnant or lactating individuals, and much more.

In addition, the MDHHS issued an alert on several updates to Moderna vaccines, including vaccine vial fill volume, updated labeling, and storage and handling modifications.

A recent emergency use authorization (EUA) revision indicates the Moderna vaccine will be available in two different vials by early May. Shipments of the new vials could occur as early as May 3, including the current maximum 11-dose vial and a new maximum 15-dose vial. Details about these new vials and packaging are available in the updated Moderna EUA fact sheet for providers.

Updated guidance for storage and handling of the Moderna COVID-19 vaccine have also been issued that include changes to time frames. The MDHHS clarified vaccine temperatures and storage time frames with the manufacturer, and an updated storage and handling summary and preparation/administration Moderna documents are available online.

Share Children’s Hospital Clinical Collaborative Open Letter on MIS-C

Leaders from a group of children’s hospitals and hospitals with extensive pediatric care programs together penned an open letter to clinicians and families across Michigan to raise awareness of multisystem inflammatory syndrome in children (MIS-C) as the spring surge continues to recede. These clinicians warn that Michigan could see children across the state experiencing MIS-C symptoms two to five weeks following the surge’s peak as children are exposed to the virus.

The letter offers details of the symptoms to be aware of, when to seek medical care, and links to appropriate treatment guidelines for clinicians. The MHA is distributing this letter on behalf of this group of pediatric clinical leaders from across the state and thanks them for their leadership around this critical issue.

Member hospitals and health systems are encouraged to distribute this letter to their physicians and ambulatory or primary care practices. The association will also share it on its social media channels to promote greater awareness among Michigan residents, especially families with children.

Members with questions may contact Laura Appel at the MHA.

Recording Vaccines on Michigan Care Improvement Registry is Important Step

Because increasing numbers of patients are seeking second doses at providers other than the one that provided their first dose, members are encouraged to review the proper procedures for looking up and recording vaccinations in the Michigan Care Improvement Registry (MCIR). The MDHHS has shared that it is receiving growing numbers of incorrect or duplicate vaccination records and wants to ensure an accurate reporting of the populations that have been vaccinated. Several detailed training guides are available online that vaccination teams can review at their convenience.

When patients present without their COVID-19 vaccine card, vaccination providers are urged to check MCIR to confirm the date and brand of their first dose to avoid medication errors that impact the effectiveness of the vaccine and other issues. Patients should also be encouraged to keep their vaccine card in a safe place and take a photo of it in the event it is misplaced.

Vaccinating Those Who Have Recovered from COVID-19

Although previous guidance recommended waiting 90 days before administering a vaccine to someone who recently had COVID-19, providers are now advised to vaccinate patients as soon as their symptoms have subsided and they are well enough to receive a shot. The change is due to the vaccine no longer being in limited supply.

However, patients who received monoclonal antibody (mAb) treatments for COVID-19 should not be vaccinated until 90 days after treatment, per CDC and MDHHS recommendations. It is not yet known how effective vaccines are in those who have previously received an antibody treatment for a COVID-19 infection or whether the antibody treatment could interfere with the body's immune response to a vaccine.

The MHA recently cohosted a webinar with the MDHHS on mAb therapies and how to execute a successful mAb therapeutics clinic. A recording of the webinar is available online for those who were unable to participate.

Vaccination Rates Declining

As of May 1, more than 6.9 million doses of COVID-19 vaccine had been administered in Michigan, resulting in more than 4 million Michiganders having received at least one dose and more than 3 million getting all recommended doses of vaccine. Nearly 50% of adult residents have received at least one dose. However, the number of vaccinations administered in Michigan in the last week has dropped significantly, and supply has outpaced demand for the vaccines.

Because Black and Hispanic residents are being vaccinated at a slower pace than white Michiganders, the Protect Michigan Commission continues to make vaccine equity a high priority and has engaged partners to assist with doing door-to-door sign-ups, education and more. MHA members that are working with community partners are encouraged to ensure some of those partners are focused on reaching people of different races, ethnicities and cultures where they are in their communities.

Members with questions regarding vaccines should contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of April 12

MHA Covid-19 update

A somber milestone was reached April 17 when, according to Johns Hopkins University data, the global number of deaths caused by COVID-19 surpassed 3 million. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

MHA Board of Trustees Focuses on COVID-19 Data, Vaccines

The MHA Board of Trustees held a virtual meeting April 14, where much of the agenda focused on COVID-19 as the spring surge continues to challenge Michigan communities and health system resources (see related article). Board members heard presentations on hospitalization and other surge-related COVID-19 data, which may be starting to show signs of improvement as growth rates and emergency department visit rates begin to slow and plateau. Despite these encouraging signs, healthcare providers must continue to urge their communities to stay vigilant in preventive actions.

Board members also discussed vaccine-related issues, including the Johnson & Johnson pause and how it may impact conversations around equity, hesitancy, safety/effectiveness and more. They also discussed efforts health systems can pursue to encourage as many employees as possible to be voluntarily vaccinated. For more information on the board meeting, contact Amy Barkholz at the MHA.

Board members also met April 12 via Zoom with U.S. Sen. Gary Peters (D-West Bloomfield), who expressed interest in the experience of hospitals and health systems during the current surge of infection. Members shared the damage the pandemic has done to staffing capacity by causing exhaustion and early retirements; the need for post-COVID-19 care for brain health including seizures, anxiety and depression; and the younger average age of hospitalized patients. Peters announced his Committee on Homeland Security and Governmental Affairs is doing a complete after-action study of the COVID-19 pandemic to improve preparedness and communications for future long-term crises. For more information about federal advocacy and policy, members may contact Laura Appel at the MHA.

J&J Vaccine Paused While Investigation Continues on Six Blood Clot Events

The Centers for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), out of an abundance of caution, issued a statement April 13 that providers should halt administration of Johnson & Johnson (J&J) COVID-19 vaccines while they investigate six instances of blood clots in previously vaccinated individuals. More than 6.8 million J&J vaccines have been administered to date nationally, meaning these instances are extremely rare. All those affected were women between the ages of 18 and 48, and their symptoms developed six to 13 days after vaccination.

The CDC Advisory Committee on Immunization Practices (ACIP) met April 14 to discuss and review these incidents and, after several hours of debate, concluded that it would take additional time to review the cases and make a final recommendation for continued use of the vaccine. A decision is expected by the end of April.

Because the ACIP is an advisory committee, it is permissible, but highly unlikely, that the CDC and FDA would advise providers to resume use of the vaccine without a new recommendation from the ACIP. In the meantime, providers should continue to only use Pfizer and Moderna vaccines, and store/label J&J vaccines as instructed by recent alerts from the Michigan Department of Health and Human Services (MDHHS). The department stated, in part, “Clinics that are scheduled to administer J and J vaccine should be rescheduled to use a different vaccine. If you have inventory of this vaccine, please separate in your storage unit, mark do not use and store appropriately until further notice.”

The MHA will keep members apprised of recommendations as they become available. Members with questions on vaccines may contact Ruthanne Sudderth at the MHA.

Pfizer Requests Emergency Use Authorization for Younger Children

Pfizer recently asked the FDA to grant expanded emergency use authorization (EUA) of its COVID-19 vaccine for use in adolescents between the ages of 12 and 15. The request is based on data from Pfizer’s late-stage trial of the vaccine in children in this age group with or without prior evidence of COVID-19 infection, which demonstrated 100% efficacy and robust antibody response after vaccination.

The participants tolerated the vaccine with the incidence of side effects similar to adults, and Pfizer continues to monitor these adolescents. The company is also confident the vaccine will deliver long-term protection for as long as two years after the completion of dosage, although currently available data supports at least six months of protection. Since the vaccine is currently allowed to be used for anyone ages 16 and older, young Michiganders are urged to get vaccinated with the Pfizer vaccine as quickly as possible to prevent further spread among this age group, as well as illness, hospitalization and death.

Given the speed at which the expanded EUA could take effect, making 12- to 15-year-olds eligible for vaccination, health systems are encouraged to educate their family practice/pediatric care settings on administration of the Pfizer vaccine. The MHA will work with the Michigan Association of Family Physicians and the Michigan Chapter of the American Association of Pediatrics to coordinate messaging and resources. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

FDA Recommends Moving Away from Decontaminated N95 Respirators

The FDA recently issued guidance recommending that healthcare personnel and facilities transition away from crisis capacity conservation strategies for N95 respirators. Due to an increased supply of respirators approved by the National Institute for Occupational Safety and Health, the FDA believes there is a sufficient domestic supply to allow organizations to transition away from decontamination or bioburden reduction and reuse of respirators intended as single-use items. The guidance does not specify a “days on hand” calculation for when the recommendations should be implemented; it simply references moving away from the crisis capacity strategy.

To date, the Michigan Occupational Safety and Health Administration (MIOSHA) has not issued guidance or statements on how it will interpret this FDA letter in Michigan. The MHA will continue to advocate with state leaders for organizational flexibility in determining their supply needs and crisis capacity strategies.

Organizations that have concerns about their supply of personal protective equipment (PPE) should contact the appropriate Regional Health Care Coalition. Members with questions or concerns on PPE may also contact Adam Carlson at the MHA.

MIOSHA Issues Permanent COVID-19 Workplace Rules

The MIOSHA released draft rules that would make permanent workplace regulations governing the use of PPE, physical distancing, contact tracing and other pandemic-related modifications. The MHA participated in a work group on the development of the permanent rules, but its suggestions to allow the rules to be flexible for updated CDC guidelines and to set an end date to the rules were not adopted in the draft rule set. The association followed up by submitting its recommendations to the MIOSHA in writing.

Emergency rules already in place on this topic were slated to expire April 14 and are expected to be extended to Oct. 14, 2021. The MHA hosted a webinar in December on that rule set for members, and the association will review the renewed emergency rules when they are available. The MHA will compile additional recommended changes to the permanent rule set prior to a public hearing being scheduled. Members with questions on the emergency or permanent MIOSHA rules may contact Adam Carlson at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Michigan’s Medicaid Work Requirement Rescinded

The Biden administration informed the state of Michigan April 6 it had withdrawn approval of the state’s community engagement requirement for some adult beneficiaries of the Healthy Michigan Plan, also known as the work requirement. In a 64-page letter, the Centers for Medicare & Medicaid Services (CMS) issued a finding that the requirement to work, job train, attend certain types of education or participate in substance use disorder treatment “risks significant coverage loss and harm to beneficiaries.”

Michigan’s work requirement began in January 2020 but was halted by court order in March 2020. The Families First Coronavirus Response Act, which grants states an additional 6.2 percent federal match for the Medicaid program during the COVID-19 pandemic, prohibits reducing the enrollment of Medicaid beneficiaries effective March 2020. Michigan continues to accept the additional 6.2 percent funding, which is in force at least through the end of calendar year 2021, depending on the end of the declaration of the federal public health emergency.

Even without the requirements related to the extra federal Medicaid funding, the CMS determined that requiring work or other community engagement as a condition of eligibility for Medicaid is not likely to promote the objectives of the Medicaid statute. The authority to impose a work requirement is withdrawn immediately and applies beyond the time frame of the public health emergency. For more information about the CMS action to end Michigan’s Medicaid work requirement or the Healthy Michigan Plan, contact Laura Appel at the MHA.

Combating the Novel Coronavirus (COVID-19): Week of April 5

MHA Covid-19 update

MHA COVID-19 UpdateMichigan hospitals are quickly reaching inpatient capacity as coronavirus variants spread throughout the state and contribute to a severe surge in COVID-19. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Chief Medical Officers Urge Michiganders to Help Prevent COVID-19 Spread

The MHA released a media statement April 9 on behalf of Michigan’s hospital/health system chief medical officers urging people to protect those who cannot be vaccinated by taking the responsible, proven preventive measures. The statement provides context on the increased transmission and risks of the virus and associated complications for children.

In addition, Gov. Gretchen Whitmer held a news conference April 9, which also featured Tina Freese Decker, Spectrum Health president and CEO and MHA board chair-elect, outlining Michigan’s COVID-19 caseload and the need to stop the spread of the virus. The governor is urging federal agencies to redirect resources, including a large influx of vaccine, to Michigan as soon as possible. Her administration has indicated it is focused on getting more vaccine supply to providers/mass vaccination clinics where it can be administered most quickly to stop viral spread.

The Protect Michigan Commission is also planning regional press events, some of which will include hospital/health system participants, to promote the need for everyone eligible to get vaccinated as soon as possible. The MHA will keep members apprised and share any messaging or materials that hospitals can use on their own platforms to amplify the message.

Questions on COVID-19 vaccines should be directed to Ruthanne Sudderth at the MHA.

Testing and Vaccination Key to Curtailing Viral Spread

The Michigan Department of Health and Human Services (MDHHS) is offering free, on-site rapid COVID-19 testing in partnership with Michigan's intermediate school districts, local school districts and local health departments for residents returning from spring break travel. These fully staffed events are open to students, educators, district staff and community members, and will be scheduled prior to classes restarting. The current list of locations is available on the MDHHS website. Members with questions on testing sites should contact Laura Appel at the MHA.

As part of a virtual session with MHA staff April 5, U.S. Rep. Elissa Slotkin (D-Holly) outlined two strategies hospitals can follow to help address vaccine hesitancy in their communities. She encourages hospitals and health systems to use every patient interaction as an opportunity to discuss the COVID-19 vaccine, regardless of the reason for the visit. In addition, she suggested facilities provide vaccine educational opportunities in the form of webinars, town halls and other events that feature physicians and can reach vaccine-hesitant groups.

As the vaccine becomes more widely available, hospitals are encouraged to revisit offers to vaccinate employees who declined vaccines when first made available to them. Some may have wanted to wait for a single dose vaccine or a more convenient time, were reluctant to get the vaccine while pregnant, or faced other circumstances that may have since changed. In addition, as the state receives media requests, it is expected to begin sharing data on healthcare personnel vaccination rates. To ensure healthcare organizations are accurately represented in any data sharing that occurs, members are urged to confirm their employee vaccine data is up to date in the state’s EMResource portal.

MDHHS Reinstates 14-Day Quarantine, Reminds Providers to Use Michigan EUA Fact Sheets

Due to increasing case rates and variant spread in Michigan, the MDHHS is reinstating a 14-day quarantine for anyone who experiences close contact with a COVID-19-positive person, removing the option for a 10-day quarantine. The department’s COVID-19 public health frequently asked questions document has been updated to reflect the change.

The department also reminds vaccinators that they need to provide the Michigan versions of the emergency use authorization (EUA) fact sheets available on the MDHHS website. Each fact sheet has been updated and includes information on the Michigan Care Improvement Registry.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).

Combating the Novel Coronavirus (COVID-19): Week of Feb 22

MHA Covid-19 update

Progress is being made on both the economic and vaccine fronts in the battle against COVID-19. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Urge Congress to Provide COVID-19 Relief for Hospitals

The American Hospital Association (AHA) issued an action alert Feb. 23 on President Joe Biden’s $1.9 trillion COVID-19 relief legislation that the House passed early Feb. 27. Additional action is expected in the Senate, which will likely make changes to the House legislation as it tries to pass the package under reconciliation.

The next few weeks will be critical to ensuring that Congress includes important provisions in the legislation to support hospitals and health systems and their heroic front-line teams. The AHA has asked hospitals to contact their senators and representatives and ask them to include hospitals and other healthcare providers in the legislation. The votes in both the U.S. House and Senate will be close, and Michigan members of Congress can influence the final content of the legislation. Members are urged to ask their House member and Sens. Debbie Stabenow and Gary Peters to include:

Members with questions about the AHA action alert may contact Laura Appel at the MHA.

Additional efforts have been initiated to ask Congress to provide critical resources for hospitals and health systems as they battle COVID-19. The AHA is a founding member of the Coalition to Protect America’s Health Care, which has launched a multimedia campaign including advertisements on television, radio and social media.

The cost of providing care for millions of Americans with COVID-19 has significantly strained the finances of the nation’s hospitals and health systems. Supplies and modifications to keep staff and patients safe, hiring staff to care for the increased number of patients and to relieve those who fell ill have taken a toll on healthcare resources. The campaign asks Congress to provide support for fighting the pandemic and vaccinating Americans against the coronavirus.

The coalition is also activating its 2.4-million-member community to contact their members of Congress, asking them to prioritize patients by funding hospitals and health systems in the next COVID-19 relief package of legislation.

For more information on the campaign, visit the Coalition to Protect America’s Health Care website.

Vaccine Delivery to Increase

Participants in the Feb. 22 regional COVID-19 vaccination call with representatives from the Michigan Department of Health and Human Services (MDHHS), hospitals and county health departments were told the state expected to receive 99,000 doses of the Pfizer vaccine and 98,000 doses of the Moderna vaccine during the week. That is an increase of approximately 20,000 doses from what Michigan had been receiving. The state expects the allocation to remain steady over the coming weeks and will continue to be split, with 60% of the allocation to county health departments and 40% to health systems and hospitals.

The MDHHS distributed on Feb. 25 a three-week forecast for the number of first doses facilities can expect to receive, which will allow more informed planning efforts. The document does not contain information about second doses, and there is a potential for changes to occur. Members are urged to continue to use emails they receive from the MDHHS and/or vaccine manufacturers to confirm weekly allocations of first and second doses.

FDA Issues Emergency Use Authorization of Johnson & Johnson Vaccine

The U.S. Food and Drug Administration (FDA) issued an emergency use authorization for the Johnson & Johnson COVID-19 vaccine Feb. 27, and the Advisory Committee on Immunization Practices (ACIP) planned to meet Feb. 28 and March 1 to make its final recommendation and set prioritization for the vaccine. The MHA issued a media statement noting that the addition of the new vaccine is a significant step toward ending the pandemic.

The association expects that the state will distribute the first allocations of this vaccine during the first week of March. The MDHHS will offer a webinar for provider education on the new vaccine, and the MHA will share webinar details when they are available. Hospitals should continue to monitor the MDHHS provider materials on its Provider Guidance website as it makes updates to include the new vaccine.

Race Data Now on State COVID-19 Vaccine Dashboard

The MDHHS is now posting data on the race of those being vaccinated at both the state and county levels. As of Feb. 23, race data had been collected from roughly 56% of vaccine recipients, with current information reflected on the state’s COVID-19 vaccine dashboard website under the “State Level Metrics” tab. The state has made it a top priority to have no discrepancy in access to the vaccine across races and ethnicities. Data indicates that race had not been noted for more than 40% of those receiving vaccines as of Feb. 23.

The MHA urges hospitals and health systems to collect race and ethnicity of all vaccine recipients and include this in the information being transferred from electronic health records (EHRs) to the state.

Providers reporting vaccinations directly into the Michigan Care Improvement Registry (MCIR), rather than transferring data from the hospital’s EHR system, can enter race and ethnicity data into a dedicated field in MCIR. The MDHHS has created instructions for doing so and for viewing race and ethnicity data in MCIR.

Apply by March 1 for Pilot Program Addressing Vaccine Barriers for Vulnerable Patients 60+

Michigan providers that are federally enrolled to administer COVID-19 vaccines are encouraged to apply to a pilot program announced Feb. 23 by the MDHHS and the Protect Michigan Commission. The program aims to remove barriers to vaccine access for Michiganders ages 60 and older who live in communities with a high Social Vulnerability Index (SVI) and high COVID-19 mortality rates. Applicants accepted into the community outreach pilot project can request up to 2,500 doses.

Applicants will help to identify the barriers in their communities and the specific strategies they will take to address those barriers, including, but not limited to:

  • Transportation.
  • Language.
  • Access related to sensory, cognitive, emotional or physical disabilities.
  • Vaccine hesitancy.
  • Other barriers experienced by underserved and minority populations.

Letters of application must be emailed by 5 p.m. March 1. An external panel will select awardees by March 8, with the intent to have vaccine doses to the chosen providers no later than March 10. The vaccine doses must be administered within two weeks of receipt. Questions about the application should be submitted to the MDHHS.

Hospital Lab Representatives Receive State Updates

During a telephone conference with hospital laboratory representatives Feb. 22, the state indicated it has numerous CareStart rapid (10-minute) antigen tests available that use a nasopharyngeal swab test. Hospitals that would like to receive some of these test supplies should complete the online request form.

During the call, questions were also raised about the use of testing for student athletes and school-related personnel. The state provides webpages with testing guidance focused on both the general school audience and on school-aged sports. The guidance is voluntary for school districts except for the sport of wrestling, which requires testing because it does not include masking.

In response to questions about the location of COVID-19 variant strains in Michigan, the state Bureau of Laboratories (BOL) recommended that chief medical officers, hospital epidemiologists, lab directors and others consult the information available on the Nextstrain website. The Michigan BOL is not providing sequencing results to hospitals or regions. The BOL confirmed that the COVID-19 variants B1351 and P.1 had not yet been found in Michigan and that the state ranks highly in terms of sequencing variants. To connect with lab information from state government or to share information on lab issues, contact Laura Appel at the MHA.

CMS Extends Guidance Limiting Hospital Surveys

The Centers for Medicare & Medicaid Services recently extended until March 22 its guidance limiting the hospital survey process during the COVID-19 public health emergency. Among other provisions, the guidance limits on-site surveys to immediate jeopardy complaint allegations.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).
 

Combating the Novel Coronavirus (COVID-19): Week of Feb 15

MHA Covid-19 update

MHA COVID-19 UpdateDespite winter weather delaying vaccine delivery during the week of Feb. 15, nearly 1.8 million doses of the COVID-19 vaccine have been administered in Michigan as of Feb. 18, according to the state’s COVID-19 Vaccine Dashboard. The MHA continues to keep members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Vaccine Distribution Continues, New Groups Eligible for Vaccination

While the Michigan Department of Health and Human Services (MDHHS) had hoped the winter storm that hit much of the nation would not delay vaccine deliveries in Michigan, there was ultimately a reduction in the number of doses that arrived during the week of Feb. 15 at hospitals, county health departments and other vaccination centers in the state due to shipping difficulties. Moderna’s distribution center in Memphis was particularly impacted, and no vaccine was shipped from there Feb. 15-17. The Centers for Disease Control and Prevention (CDC) is working with McKesson and its shipping partners to resume operations and clear the expected backlog of orders when the weather clears and the vaccines can be safely delivered. The MDHHS is communicating with the CDC and will provide further updates when available. Members with questions may contact Laura Appel at the MHA.

Meanwhile, the CDC has updated its vaccine system to reflect the sixth dose of vaccine available in vials from Pfizer. The state is also updating the Michigan Care Improvement Registry (MCIR) to reflect the sixth dose. Providers who are unable to draw a sixth dose from a vial should mark that dose as lost or wasted in MCIR. The Pfizer vaccine is now being shipped with the appropriate number of syringes to extract the sixth dose from each vial.

In a Feb. 15 news release, the MDHHS announced it is opening COVID-19 vaccine eligibility to additional categories of residents. Details on these efforts will be released in an upcoming frequently asked questions document from the department. Additional essential workers who are eligible include mortuary service workers and food manufacturing/processing workers. The MDHHS also will allocate vaccine to federally qualified health centers for administration to underserved and minority populations age 65 and over.

The state is launching an effort to reach certain vulnerable populations age 60 and up, especially those high on the social vulnerability index, using part of Michigan’s allocation for the effort. Providers that wish to vaccinate these groups should create and document by March 1 specific strategies and tactics to reach the most vulnerable populations. The MDHHS will issue a notice to providers about the process details to participate in this effort.

The MDHHS has advised all providers to label vaccines as first or second doses upon arrival to ensure second doses aren’t misused. Providers with questions or concerns on the receipt of second doses should contact Terri Adams at the MDHHS.

The state has made no official changes in isolation protocols for patients with the B.1.1.7 COVID-19 variant. Providers and health departments should aggressively pursue existing public health practices such as contact tracing, case investigation and more for known cases of infection with variants of the virus.

Federal Government Distributes Additional Vaccine

The federal government continues to supply certain vaccination providers with vaccine, independent of the vaccines overseen by the MDHHS.

Skilled nursing facilities in the state have completed first dose clinics and 90% of second dose clinics. Other long-term care facilities are conducting clinics with a variety of pharmacy partners.

The recently implemented retail pharmacy program is continuing with weekly distribution of small quantities to retail pharmacy locations. These locations have been instructed by the federal government to target vulnerable populations.

The CDC has begun to distribute vaccines directly to federally qualified health centers (FQHCs). These vaccines are provided in addition to those the state is distributing to FQHCs. The CDC will keep the MDHHS informed about these allocations to ensure coordination and awareness of what these locations are receiving.

Johnson & Johnson Vaccine Review to Begin

The Food and Drug Administration’s Vaccines and Related Biological Products Advisory Committee will convene Feb. 26 to discuss the emergency use authorization (EUA) application by Johnson & Johnson (J&J) for its single-dose COVID-19 vaccine candidate. Initial results from J&J show that the vaccine is 72% effective in the United States and 66% effective overall at preventing moderate to severe COVID-19 28 days post-vaccination. More importantly, it is 85% effective overall in preventing severe disease and demonstrated complete protection against COVID-19-related hospitalization and death 28 days post-vaccination.

Because the J&J vaccine is less effective than the Pfizer and Moderna vaccines at preventing moderate to severe COVID-19, there is growing sentiment among the public that the J&J vaccine is inferior. It is important that providers begin planning to address the concerns of patients now and to stress that, once approved, the J&J vaccine is an effective tool at preventing serious illness, hospitalization and death from COVID-19. The single-dose option should also prove valuable when targeting harder-to-reach populations.

Once an EUA is granted, the CDC’s Advisory Committee on Immunization Practices will review the data and make recommendations on how the vaccine should be used. Following approval by the CDC director, the J&J vaccine can be distributed publicly.

CDC Updates Interim Clinical Considerations for COVID-19 Vaccines

The CDC recently released updates to the Interim Clinical Considerations for Use of mRNA COVID-19 Vaccines. It is important to review these updates and bookmark the clinical considerations guidance, as it provides important information on the recommendations and use of the mRNA COVID-19 vaccines. Complete details are in the guidance regarding the following changes in the document, which was updated Feb. 10:

  • Updated recommendations for preventing, reporting and managing mRNA COVID-19 vaccine administration errors (Appendix A).
  • Clarification on contraindications and precautions.
  • Updated information on delayed, local injection-site reactions after the first mRNA vaccine dose.
  • Updated quarantine recommendations for vaccinated persons.
  • Information and updated recommendations for testing for tuberculosis infection.

Behavioral Health Grants Available for COVID-19 Healthcare Workers

Front-line healthcare workers impacted by the COVID-19 health crisis can apply for copayment assistance through a new HealthWell fund for behavioral health treatments. HealthWell will provide up to $2,000 in financial assistance over a 12-month period for out-of-pocket treatment copayments for prescription drugs, counseling services, psychotherapy and transportation to manage COVID-19-related behavioral health issues. Healthcare workers who have annual household incomes up to 500% of the federal poverty threshold are eligible. HealthWell, an independent nonprofit organization, provides financial assistance to underinsured adults and children when gaps in their insurance result in out-of-pocket medical expenses.

MDHHS to Conduct Virtual Town Hall Feb. 25

The state of Michigan is hosting a COVID-19 vaccine virtual town hall focused on minority communities from 4 to 5 p.m. Feb. 25 through Facebook Live on the MDHHS Facebook page. It will be moderated by Lt. Gov. Garlin Gilchrist and will feature a variety of speakers, including Dr. Joneigh Khaldun, chief medical executive and chief deputy director for health at the MDHHS. This event is part of a series of virtual town halls that provide residents the opportunity to hear about the safety, efficacy and importance of the COVID-19 vaccine for safely opening Michigan. The subject of the Feb. 25 town hall supports the state vaccine strategy goal to eliminate disparity in vaccination rates across racial and ethnic groups or by social vulnerability index. Participants are encouraged to submit questions on this topic prior to the discussion.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC).
 

Combating the Novel Coronavirus (COVID-19): Dec. 21 through Jan. 8

MHA Covid-19 update

MHA COVID-19 UpdateDuring the holiday season and into the new year, activity has continued related to the novel coronavirus and vaccines to protect against it, including the emergency use authorization and subsequent distribution of the Moderna vaccine. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Legislation, Policies Enacted to Fight COVID-19

The Michigan Department of Health and Human Services (MDHHS) announced Jan. 6 that additional Michiganders can be vaccinated against COVID-19 beginning Jan. 11, including residents 65 and over; police officers, first responders, front-line state and federal workers and jail and prison staff; and pre-K-12 teachers and childcare providers. The MHA issued a media statement following the announcement.

Joneigh Khaldun, MD, the state’s chief medical executive, advised that seniors and essential workers should contact their local health department (LHD) to seek an appointment for the vaccine. Hospitals that have operational capacity and enough vaccine to vaccinate seniors are encouraged to do so, as many LHDs lack the capacity to serve this large population. The MHA advises all hospitals to issue local media/social media information making clear whether they will vaccinate seniors and essential workers and any details on how to make an appointment to receive the vaccine.

In a Jan. 8 news conference, Gov. Gretchen Whitmer announced that her administration would like all Michigan K-12 schools to prepare to offer in-person learning on or before March 1. A rationale document was issued as part of the announcement, which includes explanations of the risks and safety of in-person learning, impact on those kept at home and their parents/guardians, and more. Members should be aware of this policy change as it may positively impact staffing challenges.

The governor signed Senate Bill (SB) 748 Dec. 30, providing supplemental appropriations for various priorities. While the governor vetoed some items, the MHA’s priorities on healthcare funding were approved. The items the governor and Legislature agreed upon included $10 million to reimburse Michigan hospitals for temporary staffing needs during COVID-19, $17 million to reimburse hospitals for the high cost of remdesivir treatments for patients, and $3.3 million to reimburse hospitals for holding and caring for nursing home patients beyond when they need hospital care. The MHA will work with policymakers as these funding items are implemented and keep members informed on how they may access these reimbursements.

The governor also signed into law two bills the MHA supported and advocated for during the legislative lame-duck session. SB 1258 amended Public Act 238 of 2020 to provide additional flexibilities regarding updated federal guidelines on timing for COVID-19-positive employees and potential exposures. The MHA will continue to seek further clarification from the MDHHS regarding similarities between COVID-19 symptoms and vaccine side effects. SB 1021 makes permanent in state law the flexibilities that allow Canadian health professionals to practice in Michigan.

The period for the governor to sign several bills reforming Michigan’s Certificate of Need (CON) process expired Jan. 6, effectively vetoing the bills. The legislation included several reforms that would have increased covered capital expenditures from $3.3 million to $10 million, added two members to the commission, and removed air ambulance as a covered service in June 2021. The MHA took a neutral position on an additional provision that was vetoed, which would have removed inpatient psychiatric services from CON in counties with populations less than 40,000. Members with questions on state legislation should contact Adam Carlson at the MHA.

Vaccine Distribution Updates

Vials of the Pfizer vaccine often contain a sixth dose that can be used to protect against COVID-19. However, the initial supply kits provided with the vaccine contained only five needles, which has caused some hospitals to experience needle shortages. The American Hospital Association has advised Operation Warp Speed (OWS) officials of these shortages, and OWS plans to increase the number of needles, syringes and other supplies in the kits to correspond with the available dosages in the vials. Members experiencing vaccine supply kit shortages should contact Adam Carlson at the MHA for assistance.

In an apparent response to a letter from the governors of eight states, including Michigan, the transition team for President-elect Joe Biden said it plans to release to states most of the COVID-19 vaccine being held by the federal government once Biden’s administration is in place after Jan. 20. The current stance of the U.S. Department of Health and Human Services and the Centers for Disease Control & Prevention is to hold back 50% of all vaccine supply to later ship second doses to providers. The Biden team states that it will work with manufacturers to ensure second doses are available for Americans. The MHA will work with its state and federal partners and elected officials to identify how this will affect hospitals’ vaccine allotments in Michigan and procedures for ordering doses. The association will provide updates as it obtains more information.

The MDHHS recently indicated that hospitals wishing to set up vaccine clinics at external venues need to follow the guidelines of the Centers for Disease Control and Prevention for quality assurance, storage, electrical, etc. Hospitals do not need to submit COVID-19 vaccine provider enrollment applications for sites that afford space to run mass vaccination efforts, such as hospital-owned/affiliated parking lots or properties or community-based venues. Any off-site clinic should provide guidelines that allow hospitals to do the required data entry, maintain cold storage and prevent wasted vaccine.

The MHA is working with the state and other partners to help hospitals overcome barriers and use opportunities in the vaccination process. To support those advocacy efforts, members are urged to complete a five-minute vaccine barrier survey by 5 p.m. Jan 11. Each hospital’s vaccine coordinator who leads the organization’s COVID-19 vaccine efforts should complete the survey.

The MHA is working daily with state officials to improve vaccine communication, information, transparency, coordination of roles and more. In addition, the association will work more closely with the Michigan Association for Local Public Health to ensure information is consistent across all health departments and hospitals/health systems. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members:

Combating the Novel Coronavirus (COVID-19): Week of Dec. 14

MHA Covid-19 update

As hospitals across Michigan and the nation begin vaccinating their personnel against COVID-19, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.

Hospitals Immunizing Staff Against COVID-19

Pfizer began shipping its COVID-19 vaccine from its global warehouse in Michigan Dec. 14 and continued to deliver it to hospitals across the country throughout the week. Healthcare providers began inoculating staff members soon after the vaccine arrived. The MHA joined Gov. Gretchen Whitmer and the Michigan Department of Health and Human Services (MDHHS) in recognizing the start of this significant step and thanking healthcare workers for being first in line to receive the vaccine.

As the Pfizer vaccine was being delivered to hospitals, the Food and Drug Administration continued its process toward of evaluating the Moderna vaccine. The second vaccine was approved for emergency use the evening of Dec. 18, and initial shipments to hospitals began Dec. 20. Inoculations with the new vaccine could begin as soon as Dec. 21.

However, the MHA and its members were disappointed to learn that the U.S. Department of Health and Human Services (HHS) will reduce the originally announced allocations of the Pfizer vaccine to many states, including Michigan, during its second week of distribution. The MHA issued a media statement Dec. 18 relaying the negative impact of the delay on Michigan hospitals and will continue to seek more timely and accurate information from the HHS, as well as additional vaccine.

The MDHHS clarified Dec. 18 that hospitals will be able to request both Pfizer and Moderna vaccine. The state will continue to send weekly surveys to hospitals to determine the amount of vaccine needed the following week, which will allow hospitals to request both types of vaccine. The MHA has created a side-by-side comparison of some of the key storage, shipment and administration features of the Pfizer and Moderna vaccines, and the state will continue to post updated resources and tools on its provider education webpage, as well as additional details on its provider information document. The CDC has posted a webpage with tools and information on the Pfizer product, including interim clinical considerations. A key CDC recommendation is that the vaccine be administered alone and that providers allow 14 days between administering this vaccine and other vaccines.

While the vaccinations are widely seen as the beginning of the end of the pandemic, it will take time to inoculate everyone who wants a vaccine. Michiganders are urged to continue to mask up, practice social distancing, get their flu shots and practice hand hygiene as they await their opportunity to be vaccinated. The state provides a COVID-19 Vaccine Dashboard with information about how many providers in each county are enrolled in the vaccine program, where shipments have gone and more, with a time delay of about 24 hours.

Members with questions on matters relating to COVID-19 vaccines should contact Ruthanne Sudderth at the MHA.

Congress Agrees on National COVID-19 Relief Package

News outlets reported the evening of Dec. 20 that congressional leaders had reached bipartisan agreement on providing financial relief to U.S. residents and businesses struggling due to the pandemic, including making grants available to healthcare providers. The legislative text was still being crafted that night, and voting is expected to take place Dec. 21.

MHA Requests Order Allowing HCP Experiencing Vaccine Side Effects to Work

The MHA sent a letter Dec. 17 to MDHHS Director Robert Gordon and Chief Medical Executive Joneigh Khaldun, MD, urging them to issue an order that ensures healthcare personnel (HCP) who recently received COVID-19 vaccines are not unnecessarily removed from the workforce because of vaccine side effects that mimic COVID-19 infection. The letter requested the order exclude known vaccine side effects from the definition of COVID-19 symptoms Public Act (PA) 238 of 2020, which requires that employees displaying the principle symptoms of COVID-19 not report to work until 10 days after the principal symptoms of COVID-19 first appeared. The principle symptoms of COVID-19 include known side effects of both the Pfizer and Moderna vaccines. PA 238 further gives the director or chief medical executive of the MDHHS the power to issue an order modifying the definition of COVID-19 symptoms. The MHA noted that, without an order from the MDHHS exempting symptoms from a known vaccine administration, there could be unnecessary staff absences due to the inoculations.

The MHA encouraged the state to consider recently issued official CDC guidance on handling HCP who have received COVID-19 vaccines and experience mild side effects as it makes decisions on this issue. The CDC guidance urges healthcare facilities to evaluate any personnel who have symptoms but recently received vaccine and allow HCP to continue working as appropriate, depending on the nature and severity of the symptoms. This guidance applies only to symptoms such as fever and fatigue and not to those that are not known side effects of the vaccines, such as cough and loss of taste/smell.

MDHHS Order Relaxed but Extended to Jan. 15

The MDHHS announced Dec. 18 that it is extending to Jan. 15 a public health order that will keep restaurants and bars closed to indoor dining, but will reopen many other indoor venues where patrons can wear masks while inside. The governor and the MDHHS indicated the orders that have been in place since November have contributed to an improvement in Michigan’s COVID-19 year-end surge.

The new order reopens in-person learning at high schools and indoor entertainment venues. Casinos, bowling centers and movie theatres will be allowed to reopen with total capacity capped at 100; food and drink concessions closed; and social distancing requirements in place. The order takes effect Dec. 21.

OBRA Electronic System Again Delayed

The MDHHS Office of Specialized Nursing Home/Omnibus Budget Reconciliation Act (OBRA) Programs recently announced an additional delay in changing the submission of forms 3877 and 3878 from a paper process to an electronic one. The “go live” implementation date of the online system has been delayed from Jan. 19 to at least April 2021 (see related article).

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpage. Questions on COVID-19 and infectious disease response strategies may be directed to the MDHHS Community Health Emergency Coordination Center (CHECC). Members with MHA-specific questions should contact the following MHA staff members: