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

MHA Covid-19 update

MHA Covid-19 updateMichigan is once again among the states with the highest numbers of COVID-19 cases in the nation, with the New York Times reporting that Michigan and Minnesota lead the country in cases per capita. On Nov. 19, there were 3,424 adults hospitalized with confirmed cases of COVID-19, in addition to 50 children. Meanwhile, 60.3% of Michiganders aged 5 and older had been fully vaccinated as of Nov. 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.

FDA Amends EUA to Allow Booster Shots to Fully Vaccinated People Aged 18 and Up

The Food and Drug Administration (FDA) amended the COVID-19 vaccine emergency use authorizations (EUAs) Nov. 19 to allow all individuals 18 years of age and older to receive booster shots of both the Pfizer and Moderna vaccines. The Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) was scheduled to meet later that day to discuss additional clinical recommendations.

In its news release, the FDA said the expanded authorization for the booster doses is based on its analysis of immune response data that supported use in the previously authorized populations for boosters. Groups previously included in the EUAs were fully vaccinated individuals who are 65 years of age and older and who are 18 through 64 years of age at high risk of severe COVID-19 and/or experience frequent exposure to the coronavirus through living situations or workplaces.

Prior to the FDA announcement, Gov. Gretchen Whitmer encouraged residents to plan to get the booster doses as soon as they are authorized. The governor noted that more than a million booster doses have been administered within the state and urged everyone to get vaccinated and receive the booster shot.

Booster doses should be administered at least six months after the second dose of either the Pfizer or Moderna vaccine and at least two months following the single-dose Johnson & Johnson vaccine. Updated information for both the Pfizer and Moderna vaccines are available on the FDA website that provide details on the booster shots.

Members with questions on vaccines may contact Ruthanne Sudderth at the MHA.

MDHHS Announces Face Mask Advisory for Holiday Season

As both COVID-19 and influenza cases rise throughout the state, the Michigan Department of Health and Human Services (MDHHS) will issue a face mask advisory and offer guidance to prevent the spread of respiratory diseases during the holidays.

The department’s news release indicates it recommends everyone over the age of 2 wear a face mask at indoor gatherings regardless of their vaccination status. Establishments are also urged to implement policies to ensure that customers, employees and visitors wear masks. The advisory will remain in effect until further notice.

During a Nov. 19 news conference, MDHHS Director Elizabeth Hertel, Chief Medical Executive Natasha Bagdasarian, MD, and others also urged Michigan residents to get vaccinated against COVID-19 and the flu as soon as possible. The two vaccines can be administered simultaneously. Darryl Elmouchi, MD, MBA, president of Spectrum Health West Michigan, shared information about the unprecedented numbers of patients hospitals are seeing. He said Spectrum Health has 370 patients hospitalized with COVID-19, 86% of whom are unvaccinated against the disease.

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 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 June 14

MHA Covid-19 update

MHA COVID-19 UpdateNearly 61 percent of Michiganders ages 16 and over had received a COVID-19 vaccine as of June 17, supporting the state’s decision to rescind public health orders related to slowing the spread of the disease (see below). Experts continue to urge the public to use caution, especially when around those who have not been vaccinated.

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.

COVID-19 Public Health Orders Ending June 22

Gov. Gretchen Whitmer announced June 17 that COVID-19 public health orders originally established to prevent the spread of COVID-19 will be rescinded June 22. The recission of emergency orders issued by the Michigan Department of Health and Human Services (MDHHS) includes the statewide mask mandate, limitations on gathering capacities, hospital visitor requirements and mandated hospital testing protocols for staff. However, hospitals continue to have the ability to enforce infection control practices within their facilities that require such items as screening upon entry, visitor limitations and mask requirements. In addition, the mask requirement for healthcare employees remains in effect under existing rules of the Michigan Occupational Safety and Health Administration. Hospitals may want to refer to existing CDC guidance on masking in healthcare facilities when reviewing or developing visitor policies.

The MHA issued a statement supporting the announcement, stressing the important role that the COVID-19 vaccine has played in reducing transmission and illness. In addition, the statement specifies that hospitals will continue protocols in their facilities to prevent the spread of infectious disease.

Members with questions may contact Adam Carlson at the MHA.

U.S. Supreme Court Upholds the Affordable Care Act

The U.S. Supreme Court issued a ruling June 17 on California v. Texas that upholds the Affordable Care Act (ACA). In response to the opinion, the MHA issued a statement to media statewide that describes the ruling as a “victory for all who believe in expanding access to healthcare.” The value of the ACA to Michigan is shown in the increase in enrollment for the Healthy Michigan Plan, which has grown over the past year by more than 250,000 beneficiaries who would otherwise have been uninsured at some time during the pandemic.

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 May 10

MHA Covid-19 update

MHA COVID-19 UpdateAs the spring surge of COVID-19 cases continues to recede in Michigan, the state has surpassed the 55% mark in adults ages 16 and older receiving at least one dose of the vaccine to prevent the disease. In addition, the Michigan Department of Health and Human Services (MDHHS) has launched its “Vacc to Normal” tracker that reports both state and federal data on vaccination rates, providing markers for reopening the state’s economy.

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.

Press Conference Urges Youth Vaccinations

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) voted late May 12 to recommend use of the Pfizer COVID-19 vaccine in children ages 12 to 15. The MDHHS and the Protect Michigan Commission, with assistance from the MHA, held a press conference May 13 promoting this expansion of eligibility and urging parents to get their kids vaccinated as quickly as possible.

Because research has shown that children are more likely to get vaccinated if their parents are vaccinated, the MHA encourages members to begin their outreach on the vaccine eligibility of this age group with adults already vaccinated by their hospitals/health systems.

Pfizer’s studies have proved its vaccine is safe and effective for 12- to 15-year-olds, for whom it is 100% effective in preventing COVID-19. In addition, the CDC announced that COVID-19 vaccines may now be given in conjunction with other vaccines. It was previously recommended that two weeks pass between getting a COVID-19 vaccine and any other inoculation. With this change, providers are encouraged to offer other recommended immunizations when administering COVID-19 vaccine to young teens to help offset the decreased rate of childhood vaccinations during the pandemic.

The MDHHS is also urging all primary care physicians (PCPs), especially pediatricians, to enroll as COVID-19 vaccine program participants to ensure all families with a PCP can access the vaccine. Hospitals that wish to transfer vaccine to any primary care office settings must verify the office setting is enrolled and has a redistribution agreement in place to ensure the vaccine supply is tracked appropriately.

The state’s Vacc to Normal economic reopening plan will not include the numbers of vaccinated 12- to 15-year-olds toward easing public health measures and gathering capacity limits, as the plan ties vaccination rates of adults 16 and older to those events. The newly eligible age group, which comprises approximately 498,000 kids in Michigan, will be included in the regular data tracking on the state’s vaccine dashboard. On May 10, Michigan reached the milestone of 55% of adults having at least initiated vaccination, which will allow office workers to return to their places of employment May 24.

Vaccine Now to Be Ordered via Michigan Care Improvement Registry

The MDHHS has announced a change in the way COVID-19 vaccines are allocated. Providers must now electronically request their desired doses through the Michigan Care Improvement Registry (MCIR), including both first and second doses. Orders will not be automatically approved; local health departments (LHDs) will review requests and approve allocations accordingly. Providers should ensure they are following LHD guidance prior to placing an order in MCIR.

Providers should plan operationally to order second doses within the MDHHS MCIR order timing recommendations to ensure they arrive before patients’ second dose appointments. The MDHHS has provided a tip sheet on how to place orders; a recording and slides from a May 11 webinar detailing the process; and additional ordering information and resources on its website. It will add other materials as they are created throughout the transition.

The state has also received an allocation of the Moderna vaccine in the new 14-dose (maximum 15-dose) vials. Both the 10- and 14-dose vials may be ordered via MCIR.

Comprehensive resources for COVID-19 vaccination efforts are available on the MDHHS COVID-19 Vaccine Provider Guidance webpage. Members with vaccine questions may contact Ruthanne Sudderth at the MHA.

CDC Updates Guidance, Michigan Lifts Mask Requirement for Fully Vaccinated Individuals

CDC Director Rochelle Walensky, MD, announced May 13 revised guidance allowing fully vaccinated individuals to participate in any indoor or outdoor activity without masks. Walensky cited several factors that influenced the decision, including published literature on the safety of the COVID-19 vaccine and its effectiveness on the original virus and its variants circulating in the United States; the low risk of transmission from vaccinated individuals; and universal access to vaccines. The recommendations specifically apply to individuals in nonhealthcare settings. The CDC stated that healthcare settings can continue infectious disease practices that require masks within their facilities.

The following day, Gov. Gretchen Whitmer announced the MDHHS would update its Gathering and Mask Order to align with the updated CDC guidance, effective May 15. Under the updated order, Michiganders who are outdoors will no longer need to wear a mask regardless of vaccination status. Residents who have not completed their vaccinations must continue to wear a mask or face covering indoors to protect themselves and others. After July 1, the broad indoor mask mandate will expire.

While the MDHHS order has been updated, the Michigan Occupational Safety and Health Administration (MIOSHA) emergency rules for workplace safety remain in effect. Among other things, the rules stipulate screening and tracking of visitors and employees, mask wearing and other social distancing measures. The MHA has been in contact with the MIOSHA and expects the emergency rules to be significantly revised in the coming days (see below).

Process to Approve MIOSHA Permanent COVID-19 Workplace Rules Continues

The MIOSHA continues to pursue permanent workplace COVID-19 rules, even though Michigan is making progress vaccinating eligible residents. Because the state recently reached the 55% vaccination benchmark in the governor’s MI Vacc to Normal plan, in-person work will no longer be prohibited where it is feasible for the employee to work remotely, beginning May 24. All other workplace regulations that govern the use of personal protective equipment, physical distancing, contact tracing and other pandemic-related modifications would be required under the rules.

The MHA submitted comments to the MIOSHA expressing disagreement with the proposed permanent COVID-19 rules as written, because they fail to address concerns on cementing rules into the administrative code that do not reflect the rapidly changing environment related to the pandemic. The MHA recommended the rules be updated to address, at a minimum, two main concerns:

  1. Any new standard should be promulgated in a manner that would allow future updates, based on current CDC guidance, to be made automatically.
  2. A sunset clause for the rules to expire after the MDHHS declaration of emergency has ended.

The MIOSHA will host a public hearing at 9 a.m. May 26.

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).