Long-term care settings emerge as leading source of Michigan's COVID outbreaks

Beth LeBlanc
The Detroit News

Almost a quarter of Michigan’s recorded COVID-19 outbreaks during a seven-week stretch over July and August occurred in long-term care facilities, making it the leading source of virus flare-ups over those summer months, according to state data.

Nursing homes have been a flash point between the Whitmer administration and state legislators because of the Democratic governor’s policy allowing for the separation of infected and uninfected seniors in the same regional hub facilities and not in separate facilities. The policy is under a federal civil right investigation. 

Social gatherings such as funerals, weddings and parties were the second biggest source of outbreaks during the seven-week period at 19% of the outbreaks, according to state data.

A sign at the Ingham County Medical Care Facility points to the "COVID entrance & exit" on Friday, June 5, 2020.

While bars and restaurants were initially feared to be a potentially big source of coronavirus outbreaks, they are less likely to happen there than at workplaces. Job sites comprised 16% of the 589 outbreaks across the state compared with 9% for restaurants and bars, according to data released by the state of Michigan to The Detroit News. And bars only accounted for 2% of the overall 9% of the restaurant and bar outbreaks.

The Michigan Department of Health and Human Services defines an outbreak as two or more cases "with a link by place and time indicating a shared exposure outside of a household," spokeswoman Lynn Sutfin said. The state gets the outbreak data through weekly reports from Michigan's county  health departments.

The data from July 2 through Aug. 20 are missing details that would make it more reliable, but it does serve as one of the first publicly available data points indicating which activities have contributed to COVID-19 spread, said Nigel Paneth, a distinguished professor in Michigan State University’s Department of Epidemiology & Biostatistics. 

The data should be supplemented by a denominator to better understand what percentage of a given category of facilities or activities are prompting outbreaks, Paneth said. Circumstances around the outbreak also matter.

“Often it depends on the duration of time you’re there: How long are you at the funeral or wedding compared to a bar?” Paneth said

"It’s self-evident that most of these situations, it’s the degree of masking, care for hand washing, social distancing” that determines outcome, he added.

For industries seeking data to understand continued state-required closures, the outbreak numbers may serve as a window, however small, into the decision making in Whitmer’s office. 

The bar and restaurant industry has been seeking the data on outbreaks for some time, said Justin Winslow, CEO for the Michigan Restaurant and Lodging Association. He understood the limitations of the data, but said the industry is hungry for any information regarding case incidences since they are restricted to operating at half capacity.

“If this doesn’t provide enough context yet, then what is the context that would allow this industry to move forward?” Winslow said of the outbreak data.

But Whitmer’s Department of Health and Human Services, like Paneth, warned against over-reliance on the outbreak numbers. A single outbreak could range from two people to the nearly 200 people infected at Harper’s Bar in East Lansing in June. 

At the state level, there’s no way to know how many people were affected by a single outbreak because Michigan doesn’t require local health departments to report the number. Plus, some categories of facility or activity — such as larger gatherings — do not lend themselves to good outbreak reporting. 

Ultimately, state decisions are made on more criteria than outbreaks alone — they include case incidence per capita, positivity rates, deaths and hospitalizations.

Nursing homes to grad parties

State health officials this week provided outbreak data to The Detroit News stretching back to May 12, but the charts prepared prior to the week starting July 2 were limited in the types of outbreaks tracked with most of the focus placed on long-term care facilities. 

It wasn’t until the week ending July 9 that the state outbreak records became far more detailed, breaking out long-term care facilities, agriculture, bars, restaurants, schools, child care, workplaces, jails, health care, shelters, community exposure points and social gatherings. At the end of July, the state became even more elaborate, breaking those categories into more detailed activities and differentiating between outbreaks among bar and restaurant employees versus customers.

A television advertisement informs viewers about Michigan's contact-tracing program for trying to stem the spread of COVID-19.

In the seven weeks between July 2 and Aug. 20, long-term care facilities — including nursing homes, assisted living facilities and group homes — accounted for 134 outbreaks, or 23% of the overall outbreaks, a fact that didn't surprise Paneth. 

“It follows roughly what we would expect,” the MSU epidemiologist said. “Everything travels like wildfires through nursing homes. Historically, they’ve always been breeding grounds for every type of infection.”

About 32% of Michigan’s over 6,400 COVID-19 deaths have been nursing home residents — something into which the U.S. Department of Justice is conducting an investigation in Michigan and three other states. Whitmer has labeled the probe “"nothing more than election year politics."

The outbreak data serve as further proof that Michigan's nursing home orders weren't doing enough to contain the virus, said State Sen. Pete Lucido, R-Shelby Township. 

"Ready to change your policy, Governor?" Lucido said. "I’m at a loss because I don’t have the executive power or authority to do it. I’m at a loss because I can’t help the most vulnerable people in Michigan.

"The science does not support nor does the data, what she's doing," he said.

On Friday, Whitmer extended a prior executive order that places what she calls "limited and temporary restrictions" that bar visitors into health care facilities, residential care facilities, congregate care facilities and nursing homes. The Democratic governor said the move protects "Michigan's most vulnerable populations."

 “Federal leadership on this issue has been absent, which is why I created a nursing home task force to ensure Michigan has coordinated and steady leadership on this critical issue," Whitmer said in a statement. "I look forward to hearing their recommendations and working closely with them to ensure the continued protection of nursing home residents and staff.” 

Social gatherings

Social gatherings such as birthday and graduation parties, weddings and funerals were the second highest outbreak category, accounting for 113 outbreaks, or 19% of the state total. 

In early August, the health departments of Oakland, Livingston and Genesee counties reported a more than five-fold spike in COVID cases among teenagers in a two-week period that they said resulted from graduation parties and “prom-like events.”

Workplaces — from manufacturing to construction to office spaces to retail – have accounted for 94 outbreaks between July 2 and Aug. 20, or 16% of the total outbreaks. 

The outbreaks came as state regulators began to crack down on businesses skirting COVID precautions amid a five-fold monthly increase in complaints to the state. 

Last week, the Michigan Occupational Safety and Health Administration fined six businesses a total of $33,400. United Shore Financial Service in Pontiac was fined after more than 50 employees contracted the virus, and the agency alleged workers failed to wear face masks in shared office spaces and met in large groups of more than 120 without face masks. 

Activities that each accounted for 5% or lower of the outbreaks statewide during the seven-week window include agricultural or food processing centers, child care and youth programs, prison facilities, health care facilities, homeless shelters and community events such as concerts, rallies or protests. 

The United Shore building of United Wholesale Mortgage in Pontiac.

As of Thursday, the Department of Health and Human Services had received no report of a COVID-19 case, let alone an outbreak, related to a protest, Sutfin said.

The department spokeswoman noted the outbreak data are often weighed against other testing data, death rates and hospitalizations, to get a comprehensive view of Michigan's situation. And there are imperfections in the data collected. 

“The data is reliant on people getting tested and people being willing to answer questions during case investigations to identify locations where they may have been during their incubation period,” Sutfin said.

From July 10 through Aug. 20, a quarter of the people contacted in contact tracing efforts either weren't able to be reached or didn't want to answer questions, the department said.

Restaurants to gyms

The caveats to some data and the absence of other numbers have raised concerns among industry experts, who are frustrated with what they see as unclear benchmarks from the governor’s office. 

Bars accounted for about 2% of reported outbreaks from July 2 through Aug. 20, while restaurants accounted for 7%. From July 23 through Aug. 20, when data were broken out by employees compared with customers, bar and restaurant employees accounted for the majority of the outbreaks. 

Restaurants and bars have been operating at about 50% capacity through most of the summer and largely have been making ends meet even with the restrictions, Restaurant and Lodging Association CEO Winslow said. But he’s concerned what will happen when summer crowds disperse and colder weather prevents facilities from serving people outdoors.  

"We’ve got four to six weeks of that left before that is not a viable option," Winslow said. "The season is changing, and that is going to have a dramatic impact on this industry.”

Paneth was surprised by the low percentage of outbreaks traced to bars, which he said were inherently riskier because drinking patrons are likelier to lower inhibitions that would usually prevent the spread of the virus. The relatively low percentage might be evidence that state rules surrounding the industry are working, said Paneth, who opined that restrictions were more practical than complete shutdowns. 

"Some say shut it all down," he said. "Others say figure out ways to move around safely — masking, distancing and so forth. I must say that I’m more in that school because, in fact, we have to live.

"You can’t shut people down again," Paneth said. "They just won’t do it.”

Initially, the rules allowing for bars and restaurants to reopen had looser restrictions about mask use, social distancing and dance floors, likely contributing to outbreaks such as  June's nearly 200-person infection at Harper's in East Lansing, said Ingham County Health Officer Linda Vail. 

But the restrictions put in place afterward — which included forcing customers to wear masks to their table, staying seated and closing dance floors — helped to curb those outbreaks, Vail said.  

"When those were codified in that executive order, if you ask me, those were the very things that needed to happen to control spread at bars and restaurants," she said.

Gyms, movie theaters and bowling alleys in lower Michigan have argued they could open safely like their counterparts in northern Michigan, but Whitmer has yet to lift the restrictions and is keeping them shuttered. 

In a Tuesday press conference, Whitmer said she wouldn’t be “bullied” into opening the facilities, apparently in reference to a letter last week from the state’s leading business groups urging the governor to reopen the businesses with responsible restrictions. 

“We’re going to continue to make decisions based on facts and data and recommendations from health experts like Dr. Khaldun and the University of Michigan Public Health,” Whitmer said, referring to her chief medical executive.  

Michigan Governor Gretchen Whitmer, left, speaks as Chief Medical Executive and MDHHS Chief Deputy for Health Dr. Joneigh Khaldun listens during a press conference, Tuesday, August 25, 2020.

The governor said she was unsure whether northern Michigan gyms had seen any case increases after they were allowed to reopen, but said some lower Michigan gyms that had opened in violation of her orders had reported outbreaks. 

Community exposure sites — comprised of salons, gyms, religious services and public pools — made up 40 of the outbreaks statewide between July 2 and Aug. 20, or about 7% of outbreaks. It’s not clear how many of those cases were associated with gyms as opposed to salons, spas or public pools.

Two of the 40 outbreaks occurred in Regions 6 and 8, which are comprised of Northern Michigan and the Upper Peninsula and were allowed to open those locations earlier this summer.

MIOSHA earlier this month fined a Saginaw gym that was open in violation of the governor’s office for alleged face mask, social distancing and other violations. The health department had requested the agency investigate after 20 positive cases had been traced to the gym, the agency said.