Lansing Lines is presented in cooperation with MIRS, a Lansing-based news and information service.
School Outbreaks, Sports Guidance
The number of ongoing COVID outbreaks in school settings went up for the fourth week in a row, according to numbers released by the state Feb. 8.
With 32 new outbreaks among the 131 overall the first week of February, that eclipses the 105 from last week, the 70 from Jan. 25, and the 60 the week before that.
The 32 new outbreaks in schools were down from the 35 new ones reported the prior week, however. Before that, the numbers had been on the rise, up from the 26 from the week of Jan. 25, which was up from the nine reported from the week of Jan. 18. There were three reported the week of Jan. 11.
Youth Sports
Youth sports are back on, but the state is encouraging athletes to refrain from pre- or post-game handshakes, hugs, fist bumps, high fives, or other celebrations involving contact.
The Michigan Department of Health and Human Services issued its COVID-19 guidance for resuming youth sports after Gov. Gretchen Whitmer said competitions were a go starting Feb. 8.
As announced in early February, the newest order allowing sports requires masks to be worn during practices and competition, and that if they cannot be worn, participants must be regularly tested for COVID-19 consistent with guidelines issued by DHHS.
According to the guidance for unmasked activities, those sports can only take place with a negative antigen test within the preceding 24 hours or a negative RT-PCR test within the preceding 72 hours of the unmasked practice or play.
Other parts of the guidance include encouraging athletes to use their own gear and equipment and minimize sharing equipment, and to use separate towels. The DHHS also suggested that if masks are off during a break, participants should be six feet apart from each other.
Gov, Insurers Waive Out-Of-Pocket COVID Expenses
Whitmer and the Michigan Department of Insurance and Financial Services have announced the state has secured agreements from nearly all of the state’s health insurers to extend their commitments to waive all out-of-pocket costs for COVID-19 testing, vaccinations, and treatments, covering more than 92 percent of the commercial health insurance market in Michigan.
As an extension of previous agreements, consumers with individual and group health plans will not be charged cost-sharing, including copays, deductibles, and coinsurance for medically appropriate COVID-19-related medical treatment, such as primary care visits, diagnostic testing, emergency room visits, ambulance services, and approved medications and vaccines, according to the Governor’s office.
Among the insurers who have agreed to waive cost-sharing include Aetna; Blue Cross Blue Shield of Michigan, Blue Care Network; HAP, Alliance Health; McLaren Health Plan; Meridian Health Plan; Molina Healthcare Michigan; Oscar; Physicians Health Plan (PHP); and Priority Health, Priority Health Insurance Co.
Ananich Bill Would Get MI Stockpiling For Next Emergency
A new Senate bill embodies the lessons learned from the bidding war that erupted between state governments for COVID-19 protection and survival devices by proposing the creation of the “MI supply infrastructure facility” to keep emergency equipment readily disposable. States spent more than $7 billion on personal protective equipment (PPE) and inflated the demand on medical devices like ventilators in the spring of 2020, with Michigan spending the 10th highest amount at nearly $137 million.
According to Associated Press, Chinese electric vehicle maker BYD sold $930 million in masks and sanitizers, and two-thirds of them went to California, where Gov. Gavin Newsom paid the Chinese company $3.30 per N95 mask, that “might have cost around 50 cents” before the COVID-19 pandemic.
“It was literally kind of a bidding on life-saving equipment when we used to make things like that here, and I think we could easily do it again—we’re the arsenal of democracy, we could be the arsenal of emergency preparedness,” said Senate Minority Leader Jim Ananich (D-Flint).
SB 0097 will create a board responsible for creating, staffing and operating the aforementioned facility, where PPE, ventilators, flood remediation supply and “other emergency equipment” will be assembled and distributed from.
“I had envisioned working with community colleges so they (can) expand their existing training programs,” Ananich said, explaining that students could get trained, make equipment within the state and Michigan could “stock up.”
As for the price tag on such an ambition, Ananich said building or retrofitting a facility would obviously cost resources. However, he said “there’s a lot of manufacturing in Michigan, we could contract with existing manufacturing facilities.”
“I think if we partner right, the upfront costs will be little—not astronomical by any means because a lot of folks kind of moved into this during the pandemic and they were doing that largely from a volunteer standpoint,” he said. “Often we deal with an issue that if you’re in the middle of an issue like a flood or a pandemic or something of that nature you deal with the most pressing thing first, which is the here-and-now, my bill would deal with the future,” Ananich said. “I don’t think the biggest problem will be getting people to understand the importance of it—but convincing my colleagues to have the rationale for focusing on it.”
Gov: Science Says High School Sports Can Begin Play
Gov. Gretchen Whitmer Feb. 4 said her administration is continuing to follow the science as she announced the state would allow youth sports to compete as soon as Feb. 8, roughly two weeks sooner than previously announced.
Whitmer left the ban on youth sports competition in place when the last epidemic order issued was set to expire Feb. 21. Feb. 4, a new one was issued by the Michigan Department of Health and Human Services allowing those youth contact sports to start as soon as Feb. 8, provided athletes wear masks during competition.
Asked what changed between last week and this week, DHHS Director Elizabeth Hertel cited remarks from Chief Medical Executive Dr. Joneigh Khaldun about the state’s continued improvement in COVID metrics like hospitalization rates.
The overall case rate of the state “has been in solid decline for 24 days,” according to the DHHS. The current positivity rate of 4.9 percent is the lowest it’s been since mid-October, and the hospital capacity dedicated to COVID patients is in a 10-week decline. In early February, the state reported 1,358 more cases and 74 deaths, bringing cumulative totals to 565,251 cases and 14,778 deaths in Michigan.
With the high school sports advocacy group launching a lawsuit this week against the continued ban on sports and planning a press conference Feb. 4 “highlighting how the state’s contact sports ban is increasing racial and financial disparities among Michigan students,” Whitmer was asked how much of Let Them Play’s efforts—including the Capitol rally at the end of January–factored into the decision.
The governor began with one word: “None” and then added, “I’ve been very clear throughout this crisis that we are going to follow the science and that’s what we have been doing.”
Let Them Play Michigan attorney Peter Ruddell credited Hertel’s “efforts to move this important issue forward in a timely manner,” and that the group would “review the details of the order,” and, “after review, and if appropriate, we will take necessary action to dismiss the lawsuit” the group announced early in February.
Beyond the high school sports advocates, Republican lawmakers have also been echoing the let them play call, while at the same time rejecting Whitmer’s appointments and advancing a COVID relief bill that looks different from her proposal to use mostly federal dollars.
Asked if allowing high school sports earlier than previously announced was an attempt to reach out to Republicans—and what she expected in return if it was–Whitmer again said she’s been clear she’s going to follow the science and listen to public health experts.
However, she did say later that “there certainly are perspectives that I think are important and we are always interested in making sure that we take those into consideration and listen to them.”
Rep. Luke Meerman (R-Coopersville), however, said in a statement that it’s “clear she is referencing no scientific data or statistical information in her decision making.”
But House Speaker Jason Wentworth (R-Clare) said the governor had “finally put politics aside, and she listened to science and data and to anguished parents and students—and reopened high school sports.”
Senate Majority Leader Mike Shirkey (R-Clarklake) said the day was “a victory for students, parents and school officials who have been pleading with the governor for weeks to let them play.”
The state said it would be issuing testing guidance Feb. 7 on contact sports that cannot remain masked, and Shirkey said Senate Republicans’ optimism on the sports policy “largely depends upon the guidance that is yet to be issued by the administration. We are expecting clear and uncomplicated guidance for youth sports to be able to start their seasons, quickly.”
Under the new order today signed by Hertel, contact sports will be allowed to resume Feb. 8, and the order will remain in effect until March 29.
If masks cannot be worn during games, athletes “must be regularly tested for COVID-19 consistent with guidelines issued by” the state, according to the press release outlining the DHHS epidemic order.
Dr. Tina Kerr, executive director of the Michigan Association of Superintendents & Administrators, said the “decision around winter sports emphasizes the track record districts have in making sure schools maximize safety and minimize the spread of COVID-19.”
The order also provides for spectators of up to 250 people in stadiums that seat fewer than 10,000 and up to 500 people at venues that seat more than 10,000 people.
Water parks, nightclubs and workplaces where work can be done at home are to remain closed under the latest order. No other adjustments to existing restrictions on industries were mentioned as changing under the new order.
Lower Prescription Drug Costs Emerges As Theme
Lowering prescription drug costs emerged from the Jan. 27 State of the State address as a priority for Gov. Gretchen Whitmer going into 2021, on the back of task force recommendations made on ways to accomplish that goal.
Transparency reports from drug manufacturers and state licensure for pharmacy benefit managers were two suggestions from Gov. Gretchen Whitmer’s Prescription Drug Task Force announced in late January.
But maybe more significant is the proposal for hospitals to hold accountable those profiting from skyrocketing prices.
The drug transparency piece has the support of the Michigan Association of Health Plans, which note that almost 20 percent of Michigan residents’ health care premium is used to pay for prescription drugs “and that percentage continues to soar.”
The Centers for Medicare and Medicaid Services reported a 5.7 percent increase in 2018-19 drug pricing and 33 percent of U.S. patients are not taking their prescriptions due to high costs.
“Affordable, accessible prescription drugs are a key component to our overall public health efforts in Michigan,” said Sen. Winnie Brinks (D-Grand Rapids), a member of the task force. “We cannot move forward as a society without first addressing the fact that there are people struggling to decide between medications or putting food on the table for their families each month.”
Senate Health Policy Committee Chair Curt VanderWall (R-Ludington), also a member of the Task Force, said the state has an opportunity to look at the whole health policy situation when it comes to transparency and drug prescriptions.
He’ll continue to support ideas on lowering drug costs, but he said he has not seen proof that the Governor is interested in working with his committee on similar cost-cutting measures.
“I will say this, we’ve got a lot of work to do,” VanderWall said. “When we talked about healthcare and accessibility and savings to the citizens of the state, she had a perfect opportunity to lead into that, unfortunately she didn’t.”
Introducing more transparency into drug prices – including a licensure requirement for pharmacy benefit managers – was the subject of a bill package that cleared one House committee last session but didn’t go further.
Gordon Died On The Hill For Continued Restrictions
Former Department of Health and Human Services Director Robert Gordon may have signed the order to allow restaurants and bars to reopen on Feb. 1 with restrictions, but he allegedly didn’t like it and his disapproval helped lead to his eventual departure, MIRS has learned.
Sources tell MIRS Gordon wasn’t convinced the data showed that opening bars and restaurants—where individuals inevitably need to take off face coverings to consume food and drink—was safe in the era of COVID-19.
Gov. Gretchen Whitmer and other members of her team, sensing a need to show some flexibility to an industry severely hurting from state government’s recent restrictions on indoor entertainment, saw it otherwise.
Jan. 26 COVID numbers showed 1,476 cases and 79 deaths, continuing a slow decline since November and December, when new COVID cases hit more than 9,000.
While the governor hasn’t answered if Gordon was forced out, sources tell MIRS the answer to the question is beside the point. It was no longer a good fit, with Gordon plowing forward on strictly data-driven decisions, while the governor was seeing a need to show some flexibility on the business restrictions.
Also, the word is the highly intelligent, but politically tone deaf Gordon never seemed to fully empathize with the angry masses whose livelihoods were upheaved by the state shutting down businesses.
The protests outside his house deeply disturbed him as legislators spent hours grilling him during oversight hearings.
Publicly, he presented all the warmth of a large boulder. The word inside DHHS wasn’t much different. One source described morale within the department as “low and getting lower.”
So, with the election cycle shifting to gubernatorial politics and President Donald Trump no longer in office to kick around, Whitmer needed a DHHS head who was amenable to a nuanced philosophy in which winning the battle against COVID wasn’t necessarily about whether the numbers show Michigan is winning . . . it’s whether people feel as if they’re winning.
What Counts As A COVID-19 Death?
Let’s say someone gets COVID-19, but dies after a heart attack. What’s the official cause of death?
According to Dr. Teena Chopra, professor of medicine within the division of infectious diseases at Wayne State University, the virus would still be listed as a probable cause of death because COVID-19 contributed to the heart attack.
“Anytime COVID is listed on the death certificate, it should be counted in the COVID death” column, she said.
That’s because it’s known that COVID-19 can cause “multi-organ failure” and that patients with underlying heart disease are more likely to have severe outcomes from having COVID-19, she said.
Chopra said if COVID-19 is listed anywhere on a person’s death certificate, that’s going to count toward the overall coronavirus death toll, even if the terms “probable” or “presumed” are used.
“So, they will be counted every time, even if it is not a direct cause of death but it is a probable cause of death,” Chopra said.
MIRS sought to get at the question of what, exactly, counts as a COVID-19 death, as it’s been said the total COVID-19 death toll could be both underreported and overreported.
The experts MIRS spoke with both said the deaths are most likely underreported, a similar conclusion reached by this study from the University of Minnesota.
As for whether the deaths are overreported, that was suggested by former President Donald Trump on Twitter, which was rebuffed by Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, in an interview.
Dr. Joneigh Khaldun, the state’s chief medical executive, was asked by MIRS in December about how the state advises medical professionals about establishing a cause of death for someone with multiple underlying conditions, but who also tested positive for COVID-19.
“If someone has a cause of death, even if they have something like diabetes or high blood pressure, if they do have a positive COVID-19 test that’s associated with their time of death, that is counted as a COVID-related death,” she said.
In September 2020, Khaldun had mentioned at a press conference that a 2-month-old boy succumbed to COVID-19. While the boy’s death certificate listed COVID-19 as a cause of death, he also had gastroschisis, a birth defect in which a baby’s intestines develop outside the body, according to Bridge Michigan.
It’s the Centers for Disease Control and Prevention (CDC) that’s responsible for setting the standards on these types of things. Dr. Allecia Wilson, director of autopsy and forensic services at the University of Michigan, said the guidelines issued by the feds on COVID-19 death classification matches the standard practices for other types of diseases.
“What I like about this is following our routine practice guidelines for how we do death certification,” she said, who also said it’s the treating physician overseeing the patient who makes the call on certifying the causes of death, Wilson said.
The first part of the death certificate is where the main cause of death is listed. If the positive test of COVID-19 is what the physician believes “set everything in motion” for death, that’s where COVID-19 would be listed, Wilson said.
The second part of the death certificate is where other conditions are listed that may have contributed to the death, Wilson continued. COVID-19 would go there if it was a case where the virus just made another condition worse, such as chronic obstructive pulmonary disease (COPD), Wilson said.
Back to the hypothetical case of a COVID-positive person who dies after a heart attack, Michigan Department of Health and Human Services (DHHS) spokesperson Lynn Sutfin said the person would count as a COVID-19 death if:
– The person had a positive COVID-19 test and are listed in the Michigan Disease Surveillance System, or MDSS, as deceased.
– The person was identified as a confirmed case in MDSS and has a death certificate with COVID-19 listed as the cause of death.
– The person dies within 30 days of onset of COVID-19 infection and has a death certificate which classified the manner of death as natural.
If someone had COVID-19, but the physician doesn’t believe it contributed to the death of a person, then it wouldn’t go on the certificate, Wilson said, giving the hypothetical example of someone getting hit by a bus who happened to have COVID-19.
“You’re going to have people who are going to have a positive test, where it’s never on the death certificate, because it didn’t cause their death,” she said.
As to whether COVID-19 deaths are underreported or overreported, both Chopra and Wilson agreed they’re most likely being under-counted.
Wilson said not everyone who dies is tested for COVID-19. And Chopra raised the issue about people dying at home earlier in the pandemic before a COVID-19 test could be done on them.
89% Of Nursing Homes Report At Least One Staffer Out With COVID
COVID-19 infections are back on the increase in nursing homes, according to AARP Michigan.
The advocacy group for older Americans released a survey today showing 61.4 percent of responding nursing homes have at least one resident with a confirmed COVID case. Another 89 percent of homes have at least one staffer out with the virus.
The rates of COVID-19 cases and deaths in Michigan’s nursing homes have gone from less than 1 case per 100 residents in September to 11 per 100 residents in December. Confirmed cases from staff is up from 1.5 per 100 residents in September to 10.6 per 100 residents.
Deaths among residents is also up, .06 per 100 residents to 2.17. Personal protective equipment shortages are down 30.5 percent, but staffing shortages are still an issue.
AARP is reporting 42.2 percent of facilities with a shortage, up from 34.3 percent in September.
“While vaccines will not make nursing home residents safe overnight, this dashboard underscores the urgency of vaccinating residents and staff as quickly as possible,” said AARP Michigan Director Paula Cunningham.
The number of COVID-19 vaccines administered in Michigan increased to 368,844 Jan. 14 from the 332,139 that were recorded as administered Jan. 13.
The vaccines distributed by the state stood at 831,150 doses according to the state’s vaccine dashboard, the same reported Jan. 13.
For COVID-19 cases, the state reported another 2,968 cases and 139 deaths, bringing cumulative totals to 531,004 cases and 13,672 deaths.
Meanwhile, the Health Care Association of Michigan and SEIU Healthcare of Michigan are teaming up to promote vaccinations in nursing homes across the state as a way to protect nursing home workers and the most vulnerable residents.
Nursing home employees are in the phase 1A distribution portion of the state’s vaccination plan.
To date, the association reports 5,038 nursing home residents and 65 staff have died due to COVID-19 in long-term care facilities.
Health Care Association of Michigan President/CEO Melissa Samuel stated that no significant safety concerns were identified in development of the vaccine, and residents and staff can be very confident in its safety and effectiveness.
“The dedicated caregivers in Michigan’s nursing homes have been on the front lines of this pandemic, and their sacrifices have been extraordinary and inspiring,” said Samuel. “I am grateful they were made a top priority to be vaccinated as they continue to care for our state’s most vulnerable population.”