SUMMARY • • • • • • • • • MICHIGAN STATE REPORT 10.11.2020 Michigan's success in controlling COVID-19 is being challenged by increasing cases due to incomplete compliance with mitigation measures and spreading outbreaks especially in the Upper Peninsula. Michigan is in the orange zone for cases, indicating between 51 and 100 new cases per 100,000 population last week, with the 34th highest rate in the country. Michigan is in the green zone for test positivity, indicating a rate at or below 4.9%, with the 38th highest rate in the country. Michigan has seen an increase in new cases and stability in test positivity over the last week. Hospitalizations have increased dramatically in the past three weeks. The following three counties had the highest number of new cases over the last 3 weeks: 1. Wayne County, 2. Oakland County, and 3. Macomb County. These counties represent 31.3% of new cases in Michigan. However, incidence is higher outside the Detroit CBSA. Multiple counties in the western Upper Peninsula report high and increasing cases in outbreaks that followed the upsurge of cases in a neighboring state; deaths are now increasing in these counties. Additional UP counties extending to the Mackinac Bridge (and now Emmet County on the LP side) are reporting increased cases. 16% of all counties in Michigan have moderate or high levels of community transmission (yellow, orange, or red zones), with 1% having high levels of community transmission (red zone). During the week of Sep 28 - Oct 4, 8% of nursing homes had at least one new resident COVID-19 case, 20% had at least one new staff COVID19 case, and 2% had at least one new resident COVID-19 death. Michigan had 78 new cases per 100,000 population in the last week, compared to a national average of 100 per 100,000. Current staff deployed from the federal government as assets to support the state response are: 12 to support operations activities from FEMA; 7 to support operations activities from USCG; and 1 to support operations activities from VA. Between Oct 3 - Oct 9, on average, 84 patients with confirmed COVID-19 and 115 patients with suspected COVID-19 were reported as newly admitted each day to hospitals in Michigan. An average of 95% of hospitals reported either new confirmed or new suspected COVID patients each day during this period. RECOMMENDATIONS • • • • • • • • • • • • We have included cases, test positivity, and deaths by month in the back of your packet to show the time sequence in Michigan and the country as a whole. These demonstrate the impact of comprehensive mitigation efforts when implemented effectively and that partial or incomplete mitigation leads to prolonged community spread and increased fatalities. Michigan has been very successful with limiting transmission and disease thanks to a well-designed set of gradated mitigation measures and enhanced disease control capacity, including expanded testing. The current upsurge can be controlled with increased mitigation and strong community support in implementing these social distancing measures. Public health measures to limit gathering sizes, require face coverings in public spaces, and limit capacity in stores, bars, and other public venues can help address the epidemic challenges. Continue to use testing and case investigations strategically to identify and mitigate these areas of increasing disease activity and the transmission venues. Use of rapid tests can be extremely helpful in doing this. The spread of the Upper Peninsula outbreaks after introduction of disease from Wisconsin is concerning given the limited healthcare resources in the region and evidence for continuing spread into the state. Recommend continuing to surge additional testing capacity and applying localized increased mitigation measures to control transmission as quickly as possible. Mitigation efforts should continue to include mask wearing, physical distancing, hand hygiene, avoiding crowds in public and social gatherings in private, and ensuring flu immunizations everywhere as well as tailored business and public venue measures for counties with increasing incidence. There is extreme concern for further increases in community transmission with increasing hospitalizations and deaths, given the continued spread among younger age groups, much of which is asymptomatic, as has been seen in “hotspot” counties generally (MMWR Early Release/October 9, 2020). Community transmission is frequently occurring in smaller gatherings of family and friends where masking and social distancing recommendations are not followed. Encourage outdoor activities and ensure mask and physical distancing messages for all residents, both in public and private spaces. With weather conditions increasingly forcing activities indoors, recommend increased messaging regarding the need to take these measures, especially given the element of prevention “fatigue.” Localized, more intense mitigation measures in high incidence jurisdictions are recommended, including maintaining or increasing restrictions on indoor gathering sizes to help limit the superspreader events that disproportionately contribute to increased or maintained epidemic spread. This is especially important in the next few weeks given the recent increased transmission with larger numbers of infectious individuals. Public education and enforcement measures to increase compliance with gathering restrictions should be enhanced. Continue testing programs in long-term care facilities, with prompt testing of all residents in any facility with an active case and repeat testing for all staff. Utilize point-of-care testing platforms to facilitate rapid COVID-19 case identification. Continue to implement plans to increase surveillance for community spread using the Abbott BinaxNOW now that supplies have begun to arrive (or using other antigen tests), especially to protect the elderly and other vulnerable populations. Establish weekly surveillance to monitor degree of community spread among K-12 teachers; staff working at nursing homes, assisted living, and other congregate living settings; prison staff; and first responders as tests become available. The increased rates of infection seen among long-term care facility workers indicate significant transmission in their communities and those transmission settings must be identified and mitigated. Ensure university students continue their mitigation behaviors to ensure no further outbreaks on or off campus as symptomatic cases and cases identified through surveillance testing decline. Ensure all hospitals are aware that COVID-19 antivirals and antibodies, when available, work best when used early in the course of infection. Specific, detailed guidance on community mitigation measures can be found on the CDC website. The purpose of this report is to develop a shared understanding of the current status of the pandemic at the national, regional, state and local levels. We recognize that data at the state level may differ from that available at the federal level. Our objective is to use consistent data sources and methods that allow for comparisons to be made across localities. We appreciate your continued support in identifying data discrepancies and improving data completeness and sharing across systems. We look forward to your feedback. COVID-19 COVID-19 MICHIGAN STATE REPORT 10.11.2020 STATE, LAST WEEK STATE, % CHANGE FROM PREVIOUS WEEK FEMA/HHS REGION, LAST WEEK UNITED STATES, LAST WEEK NEW COVID-19 CASES (RATE PER 100,000) 7,825 (78) +18% 67,586 (129) 327,190 (100) VIRAL (RT-PCR) LAB TEST POSITIVITY RATE 3.8% +0.1%* 5.4% 5.8% 241,005** (2,413) +1%** 1,414,080** (2,691) 6,936,223** (2,113) COVID-19 DEATHS (RATE PER 100,000) 95 (1.0) +17% 638 (1.2) 4,908 (1.5) SNFs WITH ≥1 NEW RESIDENT COVID-19 CASE (≥1 NEW STAFF CASE) 8% (20%) +3%* (+1%*) 10% (23%) 10% (21%) 2% +0%* 4% 4% TOTAL VIRAL (RT-PCR) LAB TESTS (TESTS PER 100,000) MOBILITY SNFs WITH ≥1 NEW RESIDENT COVID-19 DEATH * Indicates absolute change in percentage points. ** Due to delayed reporting, this figure may underestimate total diagnostic tests and week-on-week changes in diagnostic tests. DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/9/2020; last week is 10/3 - 10/9, previous week is 9/26 - 10/2. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7, previous week is 9/24 9/30. Mobility: Descartes Labs. This data depicts the median distance moved across a collection of mobile devices to estimate the level of human mobility within a county. The 100% represents the baseline mobility level prior to the pandemic; lower percent mobility indicates less population movement. Data is anonymized and provided at the county level. Data through 10/7/2020. SNFs: Skilled nursing facilities. National Healthcare Safety Network. Data are reported separately for cases among residents and staff. Last week is 9/28-10/4, previous week is 9/21-9/27. COVID-19 MICHIGAN STATE REPORT 10.11.2020 COVID-19 COUNTY AND METRO ALERTS* Top 12 shown in table (full lists below) METRO AREA (CBSA) LAST WEEK LOCALITIES IN RED ZONE LOCALITIES IN ORANGE ZONE LOCALITIES IN YELLOW ZONE 1 1 Marinette ▼ (-1) 2 ▼ (-1) Dickinson ■ (+0) 2 Houghton Iron Mountain ▲ (+2) 6 COUNTY LAST WEEK Houghton Iron ▲ (+1) 10 Kalamazoo-Portage Flint Battle Creek Escanaba South Bend-Mishawaka Mount Pleasant Change from previous week’s alerts: ▼ (-2) ▲ Increase Macomb Kalamazoo Genesee Calhoun Delta Cass Isabella Newaygo Iosco Mackinac ■ Stable ▼ Decrease * Localities with fewer than 10 cases last week have been excluded from these alerts. Note: Lists of red, orange, and yellow localities are sorted by the number of new cases in the last 3 weeks, from highest to lowest. Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. DATA SOURCES – Additional data details available under METHODS Cases and Deaths: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/9/2020; last week is 10/3 - 10/9, three weeks is 9/19 - 10/9. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7. COVID-19 MICHIGAN TESTING NEW CASES STATE REPORT 10.11.2020 TOP COUNTIES Top counties based on greatest number of new cases in last three weeks (9/19 - 10/9) DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/9/2020. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. COVID-19 TOTAL DAILY CASES Top 12 counties based on number of new cases in the last 3 weeks DATA SOURCES – Additional data details available under METHODS Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/9/2020. Last 3 weeks is 9/19 - 10/9. COVID-19 MICHIGAN STATE REPORT 10.11.2020 CASE RATES AND VIRAL LAB TEST POSITIVITY DURING THE LAST WEEK NEW CASES PER 100,000 DURING THE LAST WEEK VIRAL (RT-PCR) LABORATORY TEST POSITIVITY DURING THE LAST WEEK WEEKLY CHANGE IN NEW CASES PER 100,000 WEEKLY CHANGE IN VIRAL (RT-PCR) LABORATORY TEST POSITIVITY DATA SOURCES – Additional data details available under METHODS Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: State values are calculated by aggregating county-level data from USAFacts; therefore, the values may not match those reported directly by the state. Data is through 10/9/2020. Last week is 10/3 - 10/9, previous week is 9/26 - 10/2. Testing: CELR (COVID-19 Electronic Lab Reporting) state health department-reported data through 10/7/2020. Last week is 10/1 - 10/7, previous week is 9/24 - 9/30. COVID-19 National Picture NEW CASES PER 100,000 LAST WEEK NATIONAL RANKING OF NEW CASES PER 100,000 LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND SD MT WI UT ID IA WY OK TN AR KY KS NE MO AK MN MS AL IN SC IL NC RI NV NM National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State TX DE CO VA FL OH GA MI WV LA MD PA NJ MA DC AZ CA OR NY WA HI CT NH ME VT NEW CASES PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Cases: County-level data from USAFacts through 10/9/2020. Last week is 10/3 - 10/9; the week one month before is 9/5 - 9/11; the week two months before is 8/8 - 8/14; the week three months before is 7/11 - 7/17. COVID-19 National Picture VIRAL (RT-PCR) LAB TEST POSITIVITY LAST WEEK NATIONAL RANKING OF TEST POSITIVITY LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State NE MT ID UT CA SD WI OK OR MO IA KY KS SC NV ND MS TN AL AR TX IN NC AK VA GA National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State MN FL IL NM LA AZ WY WV PA MD CO MI HI OH WA NJ DE CT NH RI NY DC MA ME VT VIRAL (RT-PCR) LAB TEST POSITIVITY IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Testing: Combination of CELR (COVID-19 Electronic Lab Reporting) state health department-reported data and HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) through 10/7/2020. Last week is 10/1 - 10/7; the week one month before is 9/3 - 9/9; the week two months before is 8/6 - 8/12; the week three months before is 7/9 - 7/15. COVID-19 National Picture NEW DEATHS PER 100,000 LAST WEEK NATIONAL RANKING OF NEW DEATHS PER 100,000 LAST WEEK National Rank 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 State ND AR SD MO TN FL MS SC GA KS AL IA TX LA MT ID HI IL IN NV WI NC MA OK WV VA National Rank 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 State RI MN CA UT PA NE KY MI DE OR CO OH AZ NM DC NH WA MD CT NY AK NJ ME VT WY NEW DEATHS PER 100,000 IN THE WEEK: ONE MONTH BEFORE TWO MONTHS BEFORE THREE MONTHS BEFORE DATA SOURCES Note: Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. Deaths: County-level data from USAFacts through 10/9/2020. Last week is 10/3 - 10/9; the week one month before is 9/5 - 9/11; the week two months before is 8/8 - 8/14; the week three months before is 7/11 - 7/17. COVID-19 METHODS STATE REPORT 10.11.2020 COLOR THRESHOLDS: Results for each indicator should be taken in context of the findings for related indicators (e.g., changes in case incidence and testing volume). Values are rounded before color classification. Dark Green Light Green Yellow Orange Red ≤4 5–9 10 – 50 51 – 100 ≥101 Percent change in new cases per 100,000 population ≤-26% -25% – -11% -10% – 0% 1% – 10% ≥11% Diagnostic test result positivity rate ≤2.9% 3.0% – 4.9% 5.0% – 7.9% 8.0% – 10.0% ≥10.1% Change in test positivity ≤-2.1% -2.0% – -0.6% -0.5% – 0.0% 0.1% – 0.5% ≥0.6% Total diagnostic tests resulted per 100,000 population per week ≥2001 1001 – 2000 750 – 1000 500 – 749 ≤499 Percent change in tests per 100,000 population ≥26% 11% – 25% 1% – 10% -10% – 0% ≤-11% COVID-19 deaths per 100,000 population per week ≤0.1 0.2 – 0.4 0.5 – 1.0 1.1 – 2.0 ≥2.1 Percent change in deaths per 100,000 population ≤-26% -25% – -11% -10% – 0% 1% – 10% ≥11% Metric New cases per 100,000 population per week Skilled Nursing Facilities with at least one resident COVID-19 case, death 0% 1% – 5% ≥6% Change in SNFs with at least one resident COVID-19 case, death ≤-2% -1% – 1% ≥2% DATA NOTES • • • • • • • Some dates may have incomplete data due to delays in reporting. Data may be backfilled over time, resulting in week-to-week changes. It is critical that states provide as up-to-date data as possible. Cases and deaths: County-level data from USAFacts as of 17:35 EDT on 10/11/2020. State values are calculated by aggregating county-level data from USAFacts; therefore, values may not match those reported directly by the state. Data are reviewed on a daily basis against internal and verified external sources and, if needed, adjusted. Last week data are from 10/3 to 10/9; previous week data are from 9/26 to 10/2; the week one month before data are from 9/5 to 9/11. Testing: The data presented represent viral COVID-19 laboratory diagnostic and screening test (reverse transcription polymerase chain reaction, RT-PCR) results—not individual people—and exclude antibody and antigen tests, unless stated otherwise. CELR (COVID-19 Electronic Lab Reporting) state health department-reported data are used to describe county-level viral COVID-19 laboratory test (RT-PCR) result totals when information is available on patients’ county of residence or healthcare providers’ practice location. HHS Protect laboratory data (provided directly to Federal Government from public health labs, hospital labs, and commercial labs) are used otherwise. Some states did not report on certain days, which may affect the total number of tests resulted and positivity rate values. Because the data are deidentified, total viral (RT-PCR) laboratory tests are the number of tests performed, not the number of individuals tested. Viral (RT-PCR) laboratory test positivity rate is the number of positive tests divided by the number of tests performed and resulted. Resulted tests are assigned to a timeframe based on this hierarchy of test-related dates: 1. test date; 2. result date; 3. specimen received date; 4. specimen collection date. Resulted tests are assigned to a county based on a hierarchy of test-related locations: 1. patient residency; 2. provider facility location; 3. ordering facility location; 4. performing organization location. States may calculate test positivity other using other methods. Last week data are from 10/1 to 10/7; previous week data are from 9/24 to 9/30; the week one month before data are from 9/3 to 9/9. HHS Protect data is recent as of 13:41 EDT on 10/11/2020. Testing data are inclusive of everything received and processed by the CELR system as of 19:00 EDT on 10/10/2020. Mobility: Descartes Labs. These data depict the median distance moved across a collection of mobile devices to estimate the level of human mobility within a locality. The 100% represents the baseline mobility level prior to the pandemic; lower percent mobility indicates less population movement. Data is anonymized and provided at the locality level. Data is recent as of 17:33 EDT on 10/11/2020 and is through 10/7/2020. Hospitalizations: Unified hospitalization dataset in HHS Protect. This figure may differ from state data due to differences in hospital lists and reporting between federal and state systems. These data exclude psychiatric, rehabilitation, and religious non-medical hospitals. In addition, hospitals explicitly identified by states/regions as those from which we should not expect reports were excluded from the percent reporting figure. The data presented represents raw data provided; we are working diligently with state liaisons to improve reporting consistency. Data is recent as of 18:19 EDT on 10/11/2020. Skilled Nursing Facilities: National Healthcare Safety Network (NHSN). Data report resident and staff cases independently. Quality checks are performed on data submitted to the NHSN. Data that fail these quality checks or appear inconsistent with surveillance protocols may be excluded from analyses. Data presented in this report are more recent than data publicly posted by CMS. Last week is 9/28-10/4, previous week is 9/21-9/27. County and Metro Area Color Categorizations • Red Zone: Those core-based statistical areas (CBSAs) and counties that during the last week reported both new cases at or above 101 per 100,000 population, and a lab test positivity result at or above 10.1%. • Orange Zone: Those CBSAs and counties that during the last week reported both new cases between 51–100 per 100,000 population, and a lab test positivity result between 8.0–10.0%, or one of those two conditions and one condition qualifying as being in the “Red Zone.” • Yellow Zone: Those CBSAs and counties that during the last week reported both new cases between 10–50 per 100,000 population, and a lab test positivity result between 5.0–7.9%, or one of those two conditions and one condition qualifying as being in the “Orange Zone” or “Red Zone.”