As of June 22, there were 714 adults and 27 children in Michigan with confirmed or suspected cases of COVID-19, with new cases averaging 1,780 per day the previous week. Over 100 hospitalized adults were being cared for in intensive care units. According to the state’s vaccine tracker, 67.4% of Michigan residents had received at least one dose of a COVID-19 vaccine as of June 22.
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 Ages Six Months Through Five Years Eligible for COVID-19 Vaccine
The Michigan Department of Health and Human Services (MDHHS) announced June 21 that all Michiganders ages six months and up are now eligible for a COVID-19 vaccine. The pediatric vaccine, which received emergency use authorization for this age group from the Food and Drug Administration, was recommended by the Centers for Disease Control and Prevention’s (CDC) Advisory Committee on Immunization Practices June 18. The MHA released a media statement following the CDC recommendation, which makes 500,000 more Michigan children eligible for vaccination.
The MDHHS is recommending providers begin vaccinating children ages six months and older as soon as possible. The Moderna series is two doses given 28 days apart for ages six months through five years. For children six months of age through four years, the Pfizer series is three doses, with the first two given three weeks apart and the third dose administered at least eight weeks after the second dose. For ages five and older, the Pfizer series is two doses given 21 days apart.
COVID-19 hospitalizations in Michigan have been rising in recent weeks, with 875 adults hospitalized with confirmed or suspected cases on May 11; 77 of that number were in intensive care units. In addition, 36 children were in the hospital with confirmed or suspected cases on that date. A daily average of over 2,700 cases were confirmed from May 5 through 11.
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 Shares Updated FDA Guidelines for Johnson & Johnson COVID-19 Vaccine
The Michigan Department of Health and Human Services (MDHHS) has reminded providers of updated guidelines from the Food and Drug Administration (FDA) for use of the Johnson & Johnson/Janssen COVID-19 vaccine. The new guidelines essentially limit use to individuals 18 and older who cannot or will not take one of the other approved vaccines. The risk of thrombosis with thrombocytopenia syndrome (TTS) warrants limiting the authorized use of the vaccine. TTS is a syndrome of rare and potentially life-threatening blood clots in combination with low levels of blood platelets. Members are encouraged to review the provider guidelines. For more information regarding vaccines, contact Ruthanne Sudderth at the MHA.
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Healthcare providers have unique opportunities to increase the number of children who are up to date with childhood vaccinations to keep them safe from a multitude of diseases. Motivated by that fact, the I Vaccinate initiative has launched a new provider toolkit website to help healthcare providers educate Michigan parents about the safety and effectiveness of childhood immunizations.
To help reach the goal of raising Michigan’s childhood immunization rates to national levels or above within five years, the I Vaccinate Provider Toolkit will help providers prepare for conversations, navigate and track difficult questions, and improve their ability to ensure their young patients are vaccinated on schedule or help them catch up on missed immunizations.
More than 1,700 healthcare providers have given feedback on the new website and more than 60 medical doctors and pediatricians have participated in pilot testing and review of the site. The toolkit addresses nearly a hundred questions, including those about COVID-19 vaccines, and supplies additional resources to facilitate conversations between vaccine-hesitant families and healthcare professionals.
Providers can access the toolkit by clicking on “Request Access” on the login page and submitting their name, email, organization and title. More information about the development of this resource is available from the I Vaccinate Provider Toolkit Look Book and the Walkthrough Video. Members with questions may contact Ruthanne Sudderth at the MHA.
As the number of new cases and hospitalizations due to COVID-19 begin to diminish in Michigan, both Pfizer and Moderna have launched trials for vaccines targeting the omicron variant of the coronavirus. The variant is estimated to make up 99% of the current cases in the United States.
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.
CMS Vaccine Requirement for Healthcare Workers Began Jan. 27
The Centers for Medicare & Medicaid Services (CMS) requirement that healthcare workers be vaccinated against COVID-19 took effect Jan. 27. Employees are required to have received a first dose by that date and a second dose — if getting a two-dose vaccine — by Feb. 28.
The Michigan Department of Health and Human Services (MDHHS) issued a letter to all providers detailing the requirements of the CMS rule and provided implementation tools for providers to execute the policy internally. These include FAQs, education materials and more. MHA members are encouraged to use these tools as necessary to comply with the mandate.
The 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.
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.
According to the Centers for Disease Control and Prevention (CDC) COVID Data Tracker, the omicron variant of COVID-19 is now the dominant strain across the U.S. The CDC’s model indicates that more than 95% of cases in the nation as of Jan. 1 may be due to omicron.
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.
President Announces Updated Testing and Military Personnel Strategy
President Joe Biden Dec. 21 announced the federal government will make 500 million at-home rapid tests available to Americans and will deploy roughly 1,000 military personnel to hospitals across the U.S. to help ease the stress the current COVID-19 surge has placed on providers.
The rapid tests will be free of charge and available via an online request form, after which they will be delivered to residents’ homes. The plan also includes opening new federal testing sites and sending out hundreds of federal vaccinators. These tactics will begin in January according to the White House fact sheet on this effort.
Members are encouraged to review the entire fact sheet, which discusses other elements of the plan, including the distribution of more ventilators, production increases for supplies, federal testing sites and more.
The MHA will keep members apprised as more information becomes available about what assistance will be directed to Michigan as a result of this announcement. Members with questions about federal actions may contact Laura Appel at the MHA.
Boosters Expanded to 12- to 15-year-olds; Waiting Period Shortened
The federal Food and Drug Administration (FDA) and the CDC have announced that children aged 12 to 15 may now receive booster doses of the Pfizer and Moderna COVID-19 vaccines.The agencies also approved a shortened waiting period from six months to five months to receive a booster following a primary series of either of the two vaccines. In addition, certain immunocompromised children aged 5 to 11 are eligible for a booster and may receive it 28 days after the completion of their initial series.
The two-month booster interval recommendation for people who received the Johnson & Johnson vaccine has not changed.
The FDA reached its decision after reportedly reviewing data from Israel, which included information on 6,300 people ages 12-15 who received a booster shot at least five months after their initial two-dose series. The data showed no new cases of two possible side effects that had been observed in some young people who received the vaccine — myocarditis and pericarditis.
Urge Senate to Support Healthcare Staffing Funds
The MHA issued an action alert before the holidays, urging all members to contact their state senators and ask that they support critical healthcare staffing funding, which passed the state House with bipartisan support in December. As lawmakers prepare to return to session the week of Jan. 10, it is important to continue advocacy efforts.
House Bill 5523 would appropriate $300 million for healthcare retention and recruitment, which could help hospitals and other providers navigate the serious worker shortages that currently exist amid a pandemic surge. The MHA Legislative Action Center provides key messages on this issue and contact information for senators. Members with questions may contact Adam Carlson at the MHA.
The state’s coronavirus webpage indicates there were an average of 9,222 new COVID-19 cases per day Dec. 2 and 3, bleakly demonstrating the current surge of the disease in Michigan. However, 55.6% of Michiganders ages 5 and older were fully vaccinated as of Dec. 3, and more than 1.6 million residents had received booster shots as of that date.
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.
Collaborative Efforts Urge Public to Take Precautions, Get Vaccinated
As the omicron variant, the latest version of the evolving coronavirus, begins to appear in the United States, the MHA, its members and public health agencies are urging the public to be particularly mindful of precautions they can take to guard against infection.At this time, there is no evidence to indicate omicron is present in Michigan. However, the MHA will remain in close contact with the State Department of Laboratories as it sequences samples and will keep members apprised of any developments.
The Michigan Department of Health and Human Services (MDHHS) and the MHA issued a joint press release Dec. 2 using a new set of infographics developed by the association. These images show the percentages of vaccinated versus unvaccinated COVID-19 hospitalizations, those in ICUs and those on ventilators. The release urged the public to get vaccinated to not only protect their own health, but the health of healthcare workers and to avoid additional strain on the state’s healthcare systems.
MHA-member health systems provided the data for this effort. The release included the following messages:
Three out of four COVID-19 patients are unvaccinated (76%).
87% of COVID-19 ICU patients are unvaccinated.
88% of COVID-19 ventilator patients are unvaccinated.
Members are encouraged to share these figures along with their organizations’ local data to maintain the public’s awareness. Members with questions may contact Ruthanne Sudderth at the MHA.
In addition, the MHA published a consensus statement Nov. 22 to statewide media on behalf of the chief medical officers of its member hospitals urging the public to take action to help slow COVID-19 growth throughout the state and educate them about the serious nature of the current surge and hospital capacity issues. MHA members are encouraged to use this statement locally or use it as a template for an organization-specific update to their communities. This message has been widely broadcast throughout the state (see related article).
Members with questions about vaccines and COVID-19 precautions may contact Ruthanne Sudderth at the MHA.
CMS Delays Enforcement of Healthcare Worker Vaccine Mandate as Courts Issue Injunctions
Although Michigan was not impacted by the Nov. 29 preliminary injunction against enforcement of the Centers for Medicare & Medicaid Services (CMS) healthcare worker vaccine mandate in 10 states, a separate preliminary injunction issued Nov. 30 does affect Michigan by placing a hold on the mandate in all other states. The federal government has appealed each order to the U.S. Court of Appeals in their respective circuits and asked the appellate courts to set aside the district courts’ preliminary injunction pending appeal.
Subsequently, the CMS issued a memorandum Dec. 2 confirming that it will not enforce its vaccine mandate while the court orders are in effect. The memo states that the CMS has “suspended activities related to the implementation and enforcement of this rule pending future developments in the litigation.” It also states that “while these preliminary injunctions are in effect, surveyors must not survey providers for compliance with the requirements of the” mandate.
The document does not state what the CMS would do when and if the preliminary injunctions are removed, such as setting new compliance dates.
The federal mandates do not impact hospitals’ ability to implement their own organization-based staff vaccine requirements if they choose to adopt such a policy.
MHA members are encouraged to follow the American Hospital Association (AHA) blog authored by Sean Marotta, a partner at Hogan Lovells and outside counsel for the AHA. The blog will be updated regularly as new developments occur. The MHA will also keep members apprised of developments. Members with questions may contact Amy Barkholz at the MHA.
Medicaid Coverage Expands to Cover Authorized In-home COVID Test Kits
The MDHHS recently released concurrent proposed and final policies to expand Medicaid coverage of COVID-19 testing to include home testing kits authorized by the U.S. Food and Drug Administration when administered consistent with recommendations by the Centers for Disease Control and Prevention. The expanded coverage for dates of service on and after Aug. 30, 2021, is contingent upon approval by the CMS. Approved testing kits must be prescribed or ordered by a Medicaid-enrolled participating pharmacy. Coverage will continue through 15 months following the end of the federal public health emergency. Comments should be submitted by Jan. 4. Questions may be directed to Vickie Kunz at the MHA.
Adam Carlson provides testimony before the House Appropriations Committee.
Hospital leaders from around the state testified Dec. 1 before the House Appropriations Committee, chaired by Rep. Thomas Albert (R-Lowell). They discussed the current challenges Michigan’s hospitals face as they near the statewide record for COVID-19 hospitalizations while having more COVID-19 patients in the ICU than at any point during either of the last two surges.
Those providing testimony were Michael McKenna, MD, chief medical officer, McLaren Health Care; Ane McNeil, chief human resources officer, Trinity Health; Chad Tuttle, senior vice president of hospital and post-acute operations, Spectrum Health West Michigan; and Adam Carlson, senior vice president of advocacy, MHA.
“We are seeing high numbers of patients with other medical conditions requiring care. Collectively, the statewide average ICU occupancy exceeds 85%. This combination is straining or exceeding the capacity of emergency departments and hospitals across the state,” said Carlson.
In addition to the latest hospital data on COVID-19 hospitalizations and ICU admissions, the group provided evidence that the best defense against the virus continues to be vaccination. “Vaccines have been a very effective mechanism at preventing the illness. Without vaccination we would be in a situation five times worse.” said McKenna. Monoclonal antibodies were presented as the next best option, which help reduce the severity of the illness and prevent hospitalizations.
Recruitment and retention of personnel was another major issue discussed during the committee hearing. Across the state, resilient and dedicated healthcare workers in hospitals stand ready to care for emergency medical needs, but the reality is most hospitals throughout the state have more patients in their emergency departments than they do available rooms and staff to care for them. “Today, we are in a healthcare giver crisis. The risk is limiting our services that we make available to our community,” said McNeil.
Support from the state or federal government is vital, as staffing costs continue to far exceed budget expectations with no signs of slowing down. The MHA will continue to work with elected officials to advocate on behalf of Michigan hospitals and health systems for funding and support to end the pandemic. Members with questions should contact Adam Carlson at the MHA.
Michigan 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.
MHA CEO Report — Change to Our Behavioral Health System Can’t Wait
