Combating the Novel Coronavirus (COVID-19): Week of Jan. 31

MHA Covid-19 update

MHA Covid-19 updateThe number of hospitalizations in Michigan due to confirmed and suspected cases of COVID-19 was the lowest since early November during the week of Jan. 31. However, with 2,882 adults and 70 children hospitalized Feb. 4 with confirmed and suspected COVID-19, some facilities in the state continue to be filled to or near capacity.

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.

Application for Long-term Care Facilities to Care for COVID-19 Patients Extended

As a result of MHA advocacy, the state recently issued new guidance extending the application period for long-term care facilities to care for COVID-19 patients through Feb. 28. The guidance will ease the process of discharging COVID-19 patients from hospitals to nursing facilities. Additionally, in a change from previous policy, long-term care facilities that applied last year and remain in good standing are authorized to retain their status through the new application deadline.

The COVID Recovery Center and the COVID Relief Facility (CRF) programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for COVID-19 under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies.

Michigan now has 54 Tier-2 CRFs able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate the patient, up from just 27 CRFs in late 2021. Members with questions may contact Adam Carlson.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions 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 Jan. 10

MHA Covid-19 update

MHA Covid-19 updateThe state of Michigan held a press conference Jan. 11 to discuss the rapid rise in case numbers, hospitalizations (especially pediatric hospitalizations) and positivity rates. Speakers urged all residents who are eligible to be both vaccinated and boosted as quickly as possible. Representatives from Children’s Hospital of Michigan joined the event to discuss the concerning rise in childhood case rates and hospitalizations.

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.

SCOTUS Upholds CMS Vaccine Mandate, Enforcement Proceeds

The U.S. Supreme Court issued decisions Jan. 13 on the Centers for Medicare & Medicaid Services (CMS) and Occupational Safety and Health Administration (OSHA) vaccine mandates. As expected, the court blocked the Biden administration from enforcing the vaccine or test mandate issued under OSHA, but upheld the ability of the CMS to enforce the healthcare worker vaccine mandate.

The Supreme Court has repeatedly upheld the constitutionality of state vaccine mandates in a variety of settings, as well as mandates by private employers. These challenges were different because they presented the question of whether Congress had authorized the executive branch to institute the requirements through the agencies of OSHA and the CMS/Department of Health and Human Services.

Michigan was not one of the 26 states covered by the court injunction to the CMS mandate, and Michigan has no other state-issued prohibitions on enforcing federal or private vaccine mandates. Hence, the mandate and enforcement move forward. The currently posted deadline for completing the first required vaccine dose is Jan. 27, and the second dose is required by Feb. 28. Boosters are currently not part of the mandate.

The MHA responded to a number of media inquiries following the Supreme Court announcement, including from The Detroit News, Detroit Free Press and MiBiz. The association reiterated its long-standing position that mandates of this kind should be left up to local healthcare decision-makers and that hospitals and the MHA have always urged every resident who is eligible to get vaccinated to protect themselves and others. The MHA also stressed that, while the small number of hospital workers who have already ended their employment due to an organization’s mandate did not necessarily worsen the existing staffing shortages, the timing of a nationwide mandate amid this omicron surge could not be worse, as the shortages are more serious than ever. The association assured reporters that hospitals will proceed with compliance and that the MHA and its members will continue to strenuously advocate for staffing assistance from federal and state partners.

Members with questions about deadlines, enforcement or other elements of the mandate are encouraged to review the posted CMS guidance to ensure their organizations are prepared to comply.

MIOSHA: Hospitals May Currently Use CDC Quarantine Guidance Without Penalty

The MHA has continued to work with state regulators on securing updated guidance for hospitals and health systems as it relates to worker quarantine periods. Federal Occupational Safety and Health Administration (OSHA) rules have not yet been fully rescinded to allow for healthcare settings to confidently follow new, less restrictive Centers for Disease Control and Prevention (CDC) quarantine guidance.

However, the Michigan Occupational Safety and Health Administration (MIOSHA) has stated it was told OSHA is in the process of withdrawing the relevant rules and the state agency is preparing to update its rules to align with the revised federal rules. MIOSHA also indicated that, until updates are made at the federal and state levels, it will not issue citations specifically regarding quarantine and isolation requirements if an employer were following the Dec. 23, 2021, updated CDC guidance for healthcare personnel.

An existing OSHA provision recognizes the CDC’s ‘‘Strategies to Mitigate Healthcare Personnel Staffing Shortages.’’ This guidance allows elimination of quarantine for certain healthcare workers as a last resort if the workers’ absence would mean there are no longer enough staff to provide safe patient care, specific other amelioration strategies have already been tried, patients have been notified, and workers are using additional personal protective equipment at all times.

The MHA will continue to keep members apprised of developments on this issue. Members with questions may contact Laura Appel at the MHA.

Long-term Care Facility Capacity for COVID Care Increases

Michigan now has 50 Tier-2 COVID-19 Relief Facilities (CRFs) able to take COVID-19 patients from hospitals at discharge if their normal nursing facility isn’t able to accommodate them. This is an increase from just 27 CRFs late in 2021 and includes an Upper Peninsula facility in Hancock.

In addition, Michigan now has nine facilities designated as Care and Recovery Centers (CRC)s, including one in Escanaba in the Upper Peninsula.

The CRC and the CRF programs were established under Michigan Public Act 231 of 2020. These programs were designed to ensure Michigan’s nursing homes were prepared to provide care to individuals who have tested positive for coronavirus under transmission-based precautions within the guidelines and best practices from the Centers for Disease Control and Prevention. Michigan’s nursing homes must be reviewed by the Michigan Department of Health and Human Services (MDHHS) to ensure they meet the minimum criteria outlined within the legislation and associated MDHHS policies. Members with questions may contact Paige Fults at the MHA.

Red Cross Declares First Ever National Blood Supply Crisis

The American Red Cross declared a national blood supply shortage and operational crisis Jan. 10. This is the first time such a crisis has been declared, and it could impact hospitals’ ability to provide certain types of care or transfusions in the coming days and weeks. This is a result of the current COVID-19 surge causing canceled donation appointments, Red Cross staffing shortages and more.

The Red Cross chief medical officer sent a notification directly to hospital transfusion leaders outlining these operational challenges and how to plan for expected shortages. The Red Cross also urged the public to donate blood as soon as possible.

The MHA will be amplifying to the public the need for blood donors through its social and traditional media channels.

Michigan Sees Surge in Unemployment Fraud

Michigan has seen a recent surge in unemployment fraud claims, according to the MHA Unemployment Compensation Program (MHA UCP). The increase in unemployment fraud is related to identity theft that occurs when the state Unemployment Insurance Agency (UIA) system is penetrated. Over the past several weeks, the MHA UCP has seen fraud in about 15 to 20% of all new claims for its clients.

The MHA UCP has worked closely with the UIA on this issue and has mitigated the impact for clients, who have not been assessed charges on these claims. To learn more about the services available through the MHA UCP, contact Neil MacVicar at the MHA.

Additional information on the COVID-19 pandemic is available to members on the MHA Community Site and the MHA COVID-19 webpageQuestions 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 19

MHA Covid-19 update

Michigan continues to make good progress vaccinating our adult eligible population as Michigan exceeded over six million COVID-19 vaccine doses administered April 16, displaying significant progress in Michigan’s effort to achieve the goal of vaccinating at least 70% of Michigan adults. 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.

MDHHS Issues Multiple Vaccine-Related Alerts

The Michigan Department of Health and Human Services (MDHHS) issued multiple vaccine-related provider communications in the past week.

  • Vaccine Administration Error Guidance: The MDHHS sent providers several resources and reminders about how to proceed when questions arise about restarting the vaccine process if the second dose timeframe is missed and more. In short, providers should not “start the vaccine process over” with an additional first dose if the second dose timeframe is missed. Please reference guidance from the Centers for Disease Control and Prevention (CDC) for instructions on this and other administration error issues.
  • Bamlanivimab FDA EUA Revoked: The U.S. Food and Drug Administration (FDA) revoked April 16 the emergency use authorization (EUA) for bamlanivimab, when administered alone, to be used for the treatment of mild-to-moderate COVID-19 in adults and certain pediatric patients who are at high risk of disease progression or hospitalization. MDHHS stated that REGEN-COV as well as bamlanivimab and etesevimab (administered together) continue to be available under EUA.

Sites that are administering monoclonal antibodies can order bamlanivimab and etesevimab, etesevimab to pair with the current supply of bamlanivimab that the site has available, or REGEN-COV from the authorized distributer using the direct ordering process. The MDHHS continues to encourage all providers to consider offering antibody treatments to prevent severe COVID/COVID hospitalizations and is working on additional offerings to assist providers in this effort.

Additional Vaccine Updates

  • State leadership reported to the MHA a slight improvement in Michigan’s vaccination speed, but a desire to continue to lessen vaccine supply on hand to ensure resources from federal partners remain in place. As of April 23:
    • 2.7 million Michiganders, or 33% of the eligible population, have received complete schedules of COVID-19 vaccines either through two doses of an mRNA vaccine or one Johnson & Johnson dose.
    • 6.3 million doses have been administered in total.
    • 3.8 million people have initiated vaccination, or 47% of the eligible population.
    • 65% of people 65 and older are now fully vaccinated.
  • Hospitals and health systems are encouraged to consider working with local employers, local industries such as hospitality businesses, or local colleges/universities to offer specific clinics to employees or students of those organizations. Because some employers’ work or shift hours can be irregular, partnering with them to offer clinics at times when their employees are available could improve access for those individuals. The MHA will continue to pursue conversations with the trade groups representing such stakeholders to identify any opportunities for statewide or regional coordination.

There is also still a need for increased vaccine access for homebound individuals. As a reminder for any clinic offering, many local transit authorities around the state have offered free rides to vaccine clinics for individuals in need of transportation. If you’d like to arrange transportation to your clinics, please contact your local transit authority.

  • The state announced it is seeking vendors to execute mobile vaccinations. Awards will be based on the ability to provide services to one or more of the six site types and multiple awards may be issued. Contractors will also be responsible for rapid response to provide vaccinations (and potentially testing) at locations and community locations when COVID-19 outbreaks occur. Members that may be interested in this contract should review the full announcement for other details about expectations, and be aware that bids are due Wednesday, May 12 by 3 p.m. RFP No. 210000001690 is posted on the SIGMA Vendor Self-Service at Michigan.gov/SIGMAVSS.
    • On a related note, the state shared some entities in Michigan are using their Meals on Wheels operations via their Area Agency on Aging to deliver vaccinations out in the community and/or to homebound individuals. Members are encouraged to consider these partners if they haven’t already and have capacity to do so.
  • Pfizer continues to work on smaller quantity packages of their vaccine, to allow smaller provider settings to use their product without risk of waste or storage issues. Those smaller quantities are not yet available; we will keep members apprised of any updates.

Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

Care and Recovery Centers Remain Available for Patients

Hospitals are reminded that the MDHHS has established Care and Recovery Centers (CRC) to care for confirmed COVID-19 positive patients discharging from a hospital requiring isolation until Transmission-Based Precautions are discontinued. Currently, the MDHHS has 14 designated nursing facilities with approximately 300 beds across the state serving as CRCs. Within each CRC exists a designated unit to properly isolate and care for confirmed COVID-19 positive individuals. Hospitals are encouraged to coordinate with CRCs as part of their discharge planning process of confirmed COVID-19 positive hospital patients. Patients admitted directly from the hospital do not need to meet MDHHS Nursing Facility Level of Care. Members with questions may contact Kelsey Ostergren.

mAb Webinar Recap and Recording

The MHA and MDHHS this morning hosted a webinar for health system and hospital leaders to learn more about the overall benefits of, and operational considerations for, increasing the administration of monoclonal antibody therapies for eligible COVID-19 patients.

The webinar highlighted what resources, time, space and support is needed to administer mAb treatment and what the state has in place to assist. Earlier this week, the MDHHS issued an alert on the Michigan Health Alert Network to hospitals and health systems that included the following resources. The MDHHS has set a goal of at least 50% of people who are eligible to receive mAb therapy receive the treatment within 10 days of symptom onset.

  • A memo from MDHHS Chief Medical Executive Joneigh Khaldun, MD, encouraging hospitals and health systems to increase use of mAb treatment to prevent hospitalizations/death from COVID-19;
  • A summary of current recommendations;
  • FAQs for clinicians;
  • A summary of current evidence;
  • And considerations for hospitals.

A recording of the webinar can be found online. Members with questions may contact Laura Appel.

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).