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.
Case Numbers Increase, MHA Members Release Consensus Statement on Vaccination
In response to the rapid spread of the COVID-19 delta variant, Michigan hospitals and health systems released a consensus statement Aug. 5 that reflects the urgent need for individuals to be vaccinated. The statement notes that currently available vaccines are effective against the delta variant and could prevent the loss of thousands more loved ones, urging people to get vaccinated now. The Detroit Free Press and MiBiz both published stories that included the statement.
As in the rest of the nation, new COVID-19 cases and hospitalizations are rising in Michigan. The state reported more than 3,960 new cases from Aug. 4-6, bringing the daily average cases to about 1,321 – far exceeding June and July daily averages. Hospitalizations for confirmed or suspected cases of COVID-19 are also slowly increasing, with 600 hospitalizations statewide, 10 of which are pediatric.
The state has indicated that roughly 90 percent of samples recently sequenced were confirmed to be the delta variant, demonstrating its rapid spread in Michigan. Nearly half the counties in the state are now urged to have residents wear masks indoors, regardless of vaccination status.
The MHA is continuing to monitor the data and stay in close communication with state officials. Members with data questions may contact Jim Lee at the MHA.
Full FDA Approval of Pfizer Vaccine Likely to Come in Early September
The Food and Drug Administration (FDA) officials recently told media outlets that the rapid spread of the delta variant of the coronavirus has led them to commit more resources to the approval review process for the Pfizer vaccine. This is accelerating the timeline, and the vaccine is now expected to be approved by early September.
A recent national poll by the Kaiser Family Foundation found that about 30% of unvaccinated people would be more likely to get the vaccine if it were fully approved by the FDA.
Vaccination rates have increased again in recent weeks with increased spread of the virus. The country reached President Joe Biden’s goal of 70% adult vaccination Aug. 2. Although just under 64% of Michigan’s 16 and older population had received at least one dose as of Aug. 5, first doses administered in the state have increased by several thousand doses per week since July 24 compared to the several weeks prior.
The MHA does not have new information on when vaccines are expected to be authorized for children under 12 but will keep members apprised of any announcements on vaccine approval or new authorizations as they become available. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.
AHA Video Highlights Back-to-school Check-ups as Opportunities for COVID-19 Vaccines
The American Hospital Association (AHA) Aug. 6 launched a video encouraging families with children 12 and older to add COVID-19 vaccinations to their back-to-school preparations. This video is part of the AHA’s continuing effort to encourage vaccine confidence. Additional resources and answers to common vaccine questions are available online.
The president signed the American Rescue Plan March 11, establishing as law the latest legislation to address the many areas of loss the country has suffered due to the COVID-19 pandemic. It includes $8.5 billion in funding for eligible rural healthcare providers to offset expenses and lost revenues attributable to the pandemic (see related article). 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.
Mass Vaccination Site to Open at Ford Field as Vaccination Eligibility Expands
In a March 11 address, President Joe Biden instructed states to open vaccine eligibility to all adults no later than May 1. The federal government expects a significant increase in vaccine doses in the coming weeks and will make a website available to help anyone find a vaccine appointment near them.
In response to the president’s directive, Gov. Gretchen Whitmer announced that Michigan will open eligibility to adults ages 16 through 49 with certain preexisting conditions March 22 and to any adults 16 and older April 5. This is in addition to all adults ages 50 through 64 becoming eligible March 22. This news is reflected in the state’s official Prioritization Guidance document posted on its vaccine webpage. Officials expect weekly allocations to continue to increase to help meet the increased demand. The MHA will keep members apprised of any additional information relating to the expanded eligibility.
Members are encouraged to prepare for increased calls and website traffic as vaccine eligibility broadens and to provide their communities with details on who they will be able to vaccinate and how to make appointments.
The governor also announced that a mass vaccination site will open March 24 at Ford Field in Detroit. It will have the capacity to administer 6,000 vaccine doses each day to serve residents in the broader southeast Michigan region. The Biden administration, in partnership with the Federal Emergency Management Agency (FEMA), selected southeast Michigan for this major new community vaccination site.
The site, which was selected according to the Centers for Disease Control and Prevention’s priority tool to help those hardest hit and most vulnerable, will operate from 8 a.m. to 8:30 p.m., seven days a week, for eight weeks under the federal government’s vaccination pilot program. The facility will be managed by the state of Michigan with support from FEMA, Wayne County, the City of Detroit, Ford Field, Meijer, Henry Ford Health System and the Detroit Lions.
Federal efforts under development also include a Centers for Disease Control and Prevention (CDC) “equity index” that will rank states based on equity of access/administration of the vaccine in addition to the existing rankings that are based on doses given, speed, etc.
In addition, the CDC will be sending allocations directly to a list of federally qualified health centers across the nation, including those in the Michigan cities of Inkster, Pontiac, Brimley, Gladwin, Flint, Saginaw, Cassopolis, Kalamazoo, Centreville, Ann Arbor and Detroit.
CDC Issues COVID-19 Recommendations for Fully Vaccinated People
The CDC issued new recommendations March 8 for individuals who have been fully vaccinated against COVID-19. The agency considers people to be fully vaccinated two weeks after their second dose of the Pfizer and Moderna vaccines or two weeks after Johnson & Johnson’s Janssen single-dose vaccine.
The recommendations state that those meeting the full vaccination parameters may gather indoors with other fully vaccinated individuals without wearing a mask. In addition, they can gather indoors with unvaccinated people from one other household without masks, unless any of those people or anyone they live with has an increased risk for severe illness from COVID-19.
Fully vaccinated individuals who have been near someone who has the disease are no longer asked to avoid others or get tested unless they have symptoms. However, vaccinated people who live in a group setting and have been in contact with someone who has COVID-19 should quarantine for 14 days and get tested, even if they don’t have symptoms.
Because authorities do not yet know the extent to which vaccines mitigate the transmission of COVID-19, the CDC continues to recommend precautions that include wearing a mask, staying at least six feet apart from others, and avoiding crowds and poorly ventilated spaces. Anyone who has symptoms of COVID-19 should be tested and stay away from others.
The MHA will keep members apprised of any changes in these recommendations. Questions on the COVID-19 vaccine may be directed to Ruthanne Sudderth at the MHA.
COVID-19 Variants in Michigan More Transmissible than Original Virus
The Michigan Department of Health and Human Services (MDHHS) Bureau of Laboratories identified on March 8 the first Michigan case of the COVID-19 variant B.1.351 in a male child living in Jackson County. Case investigation is underway to determine close contacts and whether additional cases are associated with this case.
Cases caused by this variant, which originated in South Africa, were first reported in the United States at the end of January. It is believed to be more contagious, but there has been no indication that it affects the clinical outcomes or disease severity compared to the SARS-CoV-2 virus that has been circulating across the United States for the past year. Scientists are evaluating how well COVID-19 vaccines work against this newer variant, which has been identified in at least 20 other states and jurisdictions in the U.S.
The MDHHS has also provided information about the characteristics of the B.1.1.7 variant that was first discovered in the United Kingdom. This variant has now been identified in multiple Michigan communities after having first been detected in an isolate from a Washtenaw County case Jan. 16. It is approximately 50 percent more transmissible, leading to faster spread of the virus and potentially increasing numbers of cases, hospitalizations and deaths. Members should refer to the MHA’s COVID-19 alert sent Friday, March 12, for details and recommendations on managing variants.
The MHA and the MDHHS are closely monitoring case numbers, positivity rates and hospitalizations. The association will keep members apprised of any concerning data trends related to the variants. Members with data questions may contact Jim Lee at the MHA.
New Regulatory Flexibility Approved for Sharps Containers
The Department of Environment, Great Lakes, and Energy March 9 approved an MHA request to provide regulatory flexibility for hospitals facing a shortage of sharps disposal containers. State regulation currently requires hospitals to replace sharps containers every 90 days or when full, whichever is sooner. Through July 31, 2021, hospitals will now be exempt from the 90-day rule, meaning sharps containers will only be required to be replaced when full. The shortage is due to a production facility fire and increasing demand for the containers due to vaccinations; some MHA members had already received similar exemptions. The MHA will work with state government if additional flexibility is needed. Members with questions may contact Sean Sorenson-Abbott at the MHA.
State Provides Vaccine Communication and Administration Materials
A variety of vaccine materials are available for hospitals and other providers on the MDHHS Provider and Partner webpages for communication and administration purposes. These include toolkits for communicating with patients and communities regarding the safety and effectiveness of the vaccines, which are in the “COVID-19 Vaccine Communication Materials” section of the Partner page; Johnson & Johnson materials, including a Standing Order form for this vaccine; and more.
MDHHS Announces 22 Awardees in State’s Vaccine Pilot Program
The MDHHS and the Protect Michigan Commission have awarded 35,800 doses of COVID-19 vaccine to 22 pilot projects to help enhance the state’s vaccine equity strategy. Three of the awards went to Henry Ford Health System, MidMichigan Health and Schoolcraft Memorial Hospital, and the remainder went to health departments, community-based clinics, agencies on aging and other vaccinators.
The pilot program is designed to help 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. Participating providers that have additional capacity in their projects may expand vaccination to include people ages 50-59 with disabilities or underlying conditions. The awardees were chosen from more than 70 applications. Additional details on the program are available in the MDHHS news release.
As of Feb. 10, the state’s COVID-19 Vaccine Dashboard indicated nearly 1.5 million doses of vaccine have been administered in Michigan to protect residents from the disease. While the virus continues its assault across the globe, the MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
The Executive Budget Recommendation presented to the Michigan Legislature Feb. 11 fully protects hospital and healthcare priorities and includes new funding for pandemic-related needs including testing, vaccine operations and more (see related article).
Vaccination Supply Shortages Discussed
The MHA continues to host monthly calls with the Michigan Department of Health and Human Services (MDHHS) and supply chain leaders at member hospitals. During the Feb. 8 call, the groups discussed a shortage of some types of vaccination supplies and efforts at the state level to address them. The MDHHS reminded hospital leaders that it has a limited supply of syringes available to assist with administering the sixth dose of the Pfizer vaccine that is sometimes available in a vial. A shortage of sharps containers is expected to continue for a few months. Hospitals that need additional vaccination supplies are encouraged to contact their local healthcare coalitions.
The group also discussed an alert from 3M about counterfeit N95 masks that have been found in several states. Members are encouraged to check their inventory and contact 3M at (800) 426-8688 if they have the counterfeit masks. Facilities that face a significant N95 shortage due to this fraud should contact their healthcare coalition to help fill emergency supply gaps. Members with questions may contact Adam Carlson at the MHA.
Federal Pharmacy Vaccine Program Adds Doses to State Supply
Through a federal program announced Feb. 2, COVID-19 vaccine is being sent directly to Meijer and other pharmacies to administer doses to priority populations. The doses being sent to these pharmacies are in addition to states’ existing allocation sent to hospitals and health departments. The additional doses are being sent to community pharmacies as an additional access point and are separate from the pharmacy program responsible for vaccinating long-term care facility residents/staff. The federal government has also announced it will begin sending some doses directly to federally qualified health centers.
The MHA has communicated with the state about the need to ensure any pharmacy receiving vaccine directly from the federal government is following state prioritization guidelines. State officials will work with their federal partners to communicate these priority group requirements to any pharmacy receiving vaccine directly from the federal government.
All vaccine providers in Michigan are expected to follow current priority groups for vaccinations. The vaccines should currently be administered to the following population groups:
Phase 1A (healthcare workers and long-term care residents).
Phase 1B groups A and B (first responders, pre-K through grade 12 educators, childcare workers, corrections workers and workers in other congregate care settings).
Phase 1C group A (residents age 65 years and older).
The state is also working to vaccinate veterans. Providers should not yet begin to vaccinate those under 65 with underlying conditions (phase 1C group B). The state’s vaccine prioritization document provides complete details about these categories. The priority groups follow federal guidance closely and are unlikely to be changed.
Vaccination Data Required
It continues to be important for providers to enter and update data on employee and patient COVID-19 vaccinations in the state EMResource portal each Wednesday. In addition, members should report race and ethnicity data on those receiving vaccinations in the Michigan Care Improvement Registry, as a primary goal for the state is to ensure there is no disparity in vaccination rates across races and ethnicities. Members facing challenges in collecting this data or with other data-related questions should contact Jim Lee at the MHA.
State Changes Hospitals’ Share of Vaccines Distributed
The Michigan Department of Health and Human Services (MDHHS) has adjusted the number of COVID-19 vaccine doses available to each type of vaccination provider.
Although the MDHHS considered shifting to an allocation model of 70% of vaccines going to health departments and 30% going to hospitals, the department confirmed Feb. 4 that it will continue the allocation process it implemented the week of Feb. 1, with 60% of the available vaccine going to health departments and 40% to hospitals, until further notice. The MHA and members have advocated against moving a large allocation away from hospitals, which have administered more than a half million doses to Michigan residents. The MHA will also continue to identify and assist the MDHHS in using the most equitable sources of data to determine vaccine allocations. Member hospitals are encouraged to build partnerships with their local health departments to share resources and vaccine allocations to best serve their communities.
The MDHHS has developed a weekly survey for hospitals and health departments to guide the department’s decision-making on vaccine issues. The survey requests information about COVID-19 vaccine events hosted in the past week, the eligible populations the events targeted, where they were held and more. The hospital survey will be distributed each Friday, and responses to the first survey are due by 5 p.m. Feb. 8. If possible, the survey should be completed for individual facilities rather than at the health system level.
Members who would like assistance in fostering relationships with their local health department, have questions on the new vaccine survey or would like more information on the COVID-19 vaccine should contact Ruthanne Sudderth at the MHA.
FDA Considers EUA for New Vaccine, Revises Authorization for Convalescent Plasma
Johnson & Johnson subsidiary Janssen Biotech has requested emergency use authorization (EUA) from the Food and Drug Administration (FDA) for its COVID-19 vaccine. If approved, the vaccine will be the first single-dose immunization available to fight the pandemic.
The FDA is scheduled to meet Feb. 26 to discuss the EUA request for this vaccine, which trials have shown to be 66% effective in preventing overall moderate to severe COVID-19. The company said the vaccine demonstrated complete protection against COVID-19 serious enough to require hospitalization and was 85% effective in preventing severe forms of the disease.
This vaccine also presents far fewer logistical and cold chain challenges than the Pfizer and Moderna vaccines, as it is estimated to remain stable for two years at minus four degrees Fahrenheit (minus 20 degrees Celsius) and can be stored for three months under standard refrigeration at 36 to 46 degrees Fahrenheit (two to eight degrees Celsius). Johnson & Johnson initially will provide 2 million doses to the U.S., followed by 100 million doses by midyear.
In addition, the FDA recently updated its EUA for convalescent plasma as a COVID-19 treatment. The revision reflects new data regarding the treatment’s efficacy and application and has been included in the agency’s provider fact sheet.
The new EUA for COVID-19 convalescent plasma limits the authorization to the use of plasma with a high concentration of antibodies for the disease, known as “high titer” COVID-19 convalescent plasma. It is authorized only for the treatment of hospitalized patients with COVID-19 early in the disease course and those hospitalized patients whose bodies cannot produce an adequate antibody response. According to the latest data, plasma with low levels of antibodies has not been shown to be helpful in COVID-19. Therefore, low titer COVID-19 convalescent plasma is no longer authorized under the EUA.
Monoclonal Antibody Treatment Encouraged; Mi-COVID19 Initiative Webinar to Discuss
The educational webinar series from the Mi-COVID19 Initiative will continue from noon to 1 p.m. Feb. 10 on the topic Approach to Monoclonal Antibody Treatment. Speakers include Dr. William Fales from the MDHHS and Drs. Tejal Gandhi and Lindsay Petty from Michigan Medicine. Registration is available online, as are recordings from previous events in this series.
Members are encouraged to use monoclonal antibodies as eligible cases of COVID-19 present in their facilities and to consider posting information on the COVID-19 sections of their organizations’ websites for interested and possibly eligible patients. The MDHHS recently issued a letter with information on this type of treatment and sends weekly alerts from the Michigan Health Alert Network about how to request a supply of the antibodies. Members with questions may contact Rob Wood.
Epic Scheduling Loophole Under Investigation
Beaumont Health announced Feb. 1 that an individual had used unauthorized “backdoor” access to Beaumont Health’s Epic patient portal to schedule a COVID-19 vaccine appointment, then shared the pathway publicly. The breach resulted in more than 2,700 unauthorized appointments being made, all of which have now been canceled. Beaumont Health shared the information to help other hospitals ensure a similar issue does not occur in their systems. The health system has contacted Epic and is working to safeguard the system against future unauthorized accessibility. No medical records were compromised due to the incident, and no valid vaccine appointments were affected. Members with questions or concerns about their Epic platform may contact Jim Lee at the MHA.
Moderna Vaccine Doses Thought to be Compromised are Deemed Viable
The Centers for Disease Control and Prevention has notified the MDHHS that Moderna vaccine shipped to Michigan in mid-January and thought to be ruined by a temperature excursion have been determined to be viable and can be used to vaccinate residents. McKesson Corp., which is responsible for shipping the vaccine, completed an internal investigation and determined the cause and lower limit of the cold excursion in these shipments. Based on data provided as part of that investigation, Moderna agreed that the vaccine in this shipment was viable upon arrival and remains viable under either of the following circumstances:
Doses are confirmed to have been stored in quarantine at -20C.
Doses are confirmed to have been stored in quarantine at 2-8C and the doses were placed in refrigerated storage within 30 days.
Developments with the novel coronavirus are occurring quickly, as the first shipments of the Pfizer COVID-19 vaccine have gone out and the federal government continues to grapple with legislation to assist American businesses and residents. The MHA keeps members apprised of pandemic-related developments affecting hospitals through email updates and the MHA Coronavirus webpage. Important updates are outlined below.
Healthcare Community Urged to Contact Congress on COVID-19 Relief
As the 116th U.S. Congress is entering its final weeks, a COVID-19 relief package is still being negotiated. A bipartisan group of senators led by Sens. Joe Manchin (D-WV) and Mitt Romney (R-UT) is proposing more than $900 billion in aid for state and local governments, small businesses and healthcare providers. Transportation, unemployment, education, vaccine distribution, and testing and tracing are also included in the package. Funding for healthcare providers includes $35 billion allocated to the Provider Relief Fund (PRF), with $7 billion for rural providers and $1 billion for tribes, tribal organizations, urban Indian health organizations and health service providers to tribes. The plan also includes improvements to PRF reporting guidelines, such as clarification that PRF can be used for staffing, including child care staff, and health systems are allowed flexibility to move targeted PRF distributions within their system. It is possible the bipartisan package could be formally introduced Dec. 14.
Hours before funding for the federal government expired Dec. 11, Congress approved a one-week funding extension to Dec. 18. The extension provides negotiators with several more days to agree to a Continuing Resolution for all government funding and a COVID-19 relief package. Members are asked to contact their U.S. House representative and Michigan Sens. Debbie Stabenow and Gary Peters to encourage the following support for hospitals in the end-of-year package:
Provide more COVID-19 relief, including additional money for the PRF, federal liability protections, support for front-line healthcare workers, coverage for the uninsured, and accelerated payment forgiveness.
Eliminate cuts to the Medicaid disproportionate share hospital program in the next fiscal year.
Extend the congressionally enacted moratorium on the application of the Medicare sequester cuts until the public health emergency ends.
Members are also asked to urge that the following provisions be excluded from any package that reaches the House or Senate for a vote:
Problematic proposals under consideration related to surprise medical billing, including any “agreement” that takes money from providers without protecting patients.
Any provisin that would require new, unrealistic and burdensome Occupational Safety and Health Administration standards.
With strong advocacy from the healthcare community, Congress could pass a COVID-19 Relief Package before adjourning for the year. For more information about end-of-year federal activity, members may contact Laura Appel at the MHA.
Pfizer Vaccine Approved and Being Shipped, Priority Groups Finalized
The U.S. Food and Drug Administration (FDA) issued an emergency use authorization determination for the Pfizer COVID-19 vaccine late Dec. 11 and shipments began leaving Kalamazoo Dec. 13.
The MDHHS is following the recently issued Centers for Disease Control and Prevention recommendations for prioritization of distribution and administration of COVID-19 vaccines. CDC recommendations are based on input from the Advisory Committee on Immunization Practices (ACIP). In addition, multiple health systems and the MHA took part in a stakeholder meeting in November to provide input on Michigan’s priority groups.
Phase 1A includes paid and unpaid individuals serving in healthcare settings who have direct or indirect exposure to patients or infectious materials and are unable to work from home, as well as residents of long-term care facilities.
Phase 1B includes some workers in essential and critical industries, including workers with unique skill sets such as nonhospital or nonpublic health laboratories and mortuary services.
Phase 1C includes people at high risk for severe COVID-19 illness due to underlying medical conditions and people 65 years and older.
Phase 2 is a mass vaccination campaign for all adults.
The MDHHS vaccination plan includes additional prioritization guidance within these categories. It was stressed that vaccination in these phases will likely overlap. The timing of the start of vaccination in a phase is dependent on guidance from the CDC and the ACIP, the supply of vaccine from the manufacturer, how vaccine is allocated from the federal level to Michigan and the capacity to administer the vaccine to populations.
The MHA will continue to provide updates on vaccine distribution as they become available. Members who receive updates directly from the MDHHS are encouraged to share that information with the MHA for vetting or broader distribution. Members with questions and information may contact Ruthanne Sudderth at the MHA.
MDHHS “Pause” Extended to Dec. 20
The MDHHS announced Dec. 7 that it was extending to Dec. 20 its Nov. 18 emergency order limiting indoor gatherings and requiring mask wearing. Previously set to expire at midnight Dec. 8, the extended order slightly relaxes some of the previous order’s restrictions; for example, it allows for in-person instruction of certain trade/vocational programs, with protections in place.
The MDHHS announcement comes on the heels of the MHA’s Dec. 7 letter, published on behalf of MHA-member chief medical officers, urging the state to continue some degree of protection so that the slight progress in hospitalizations achieved since Nov. 18 does not regress. The MHA also issued a statement recognizing the order extension following the MDHHS announcement and has conducted media interviews with outlets from across the state. Links to some of the media coverage is available in a related article.
Data Tracking COVID-19 Patients, New Reporting Requirements
Hospitals have asked for clarification on how to count patients who are no longer in COVID-19 isolation for reporting into the state’s EMResource portal or the national TeleTracking portal. According to guidance from the U.S. Department of Health and Human Services (HHS), COVID-19 patients should continue to be counted in the COVID-19 daily census and COVID-19 ICU census regardless of their isolation status or change in location (e.g. transferred out of a COVID-19 unit). Once a patient has been identified as COVID-19-positive, they should always be counted in your daily COVID-19 census until discharged or expired. Only the data field that pertains to hospital onset COVID-19 patients should take into account the change in COVID-19 isolation status.
The HHS recently released new COVID-19 reporting guidance for hospitals. The influenza data fields will be mandatory (except psychiatric and rehabilitation facilities) starting Dec. 18. In addition, beginning Jan. 8, 2021, new therapeutic fields will be mandatory each Wednesday. These fields will be designated with generic identifiers (currently using only the letters A and B) to provide flexibility to the HHS on new therapeutics. Therapeutic A has been designated for Casirivimab/Imdevimab and therapeutic B has been designated for Bamlanivimab data collection.
Members with questions on data should contact Jim Lee at the MHA.
COVID-19 Webinar Series Available for All Hospitals
A weekly Mi-COVID19 webinar series began Dec. 9 that aims to continue collaboration and share COVID-19-related lessons learned with stakeholders and experts across multiple disciplines to support Michigan hospitals and providers in caring for COVID-19 patients. The series is hosted by the Mi-COVID19 Initiative, part of the Michigan Hospital Medicine Safety Consortium.
These webinars will be held from noon to 1 p.m. each Wednesday and are currently scheduled through Feb. 24. Webinar topics and registration information are available online.
CME/CE credit is being offered for each webinar. The University of Michigan Medical School is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. The University of Michigan Medical School designates this live activity for a maximum of 1 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
An additional series of education webinars for providers on COVID-19 vaccine is available from the MDHHS. Three 30-minute presentations will be offered from noon to 12:30 p.m. on the following dates and can be joined via the appropriate link: