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Michigan's chief doctor wants a school mask mandate. So why won't the state do it?

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Michigan Department of Health and Human Services
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Michigan’s chief medical executive revealed Wednesday she’s urged Governor Gretchen Whitmer’s administration to reinstate a universal mask mandate for schools, but that the state has opted instead to continue leaving the question up to local districts. 

That’s despite a stark presentation today from the Michigan Department of Health and Human Services’ (MDHHS) lead epidimiolgoist, predicting as many as 400 children could be hospitalized and up to 6,000 residents could die between now and November if current COVID-19 trends continue.  

“I have recommended that if a mandate were in place and it were followed, it would likely decrease the spread of COVID-19 in schools,” Dr. Joneigh Khaldun, the state's chief medical executive and chief deputy health director said on a call with reporters Wednesday morning.

That was after multiple questions about the lack of a mask mandate were initially met with long silences or a refusal to answer. 

No straight answers from state officials

But neither the governor nor MDHHS Director Elizabeth Hertel offered a clear response as to why they aren’t following Khaldun’s guidance. Until now, Whitmer’s administration has made Khaldun the face of its pandemic response, directing medical questions her way at press conferences, and deferring to her expertise as a decorated emergency medicine doctor and the former director for the Detroit Health Department. 

Asked why a statewide mask mandate for schools wasn’t being implemented, officials instead restated the importance of masks in schools. Bobby Leddy, a spokesperson for Whitmer, said in an email Wednesday:

“As Dr. Joneigh Khaldun said, these smart public health protocols are only effective if everyone works together to protect each other. That’s why school districts and local health departments should work together to put in place universal mask policies to keep students safe and ensure that in-person learning can continue this year. Right now, nearly 60 school districts have made the choice to have face coverings this school year, which accounts for more than 250,000 students across the state. We know what works to slow the spread of COVID-19 and ensure that we can all safely get back to normal.”

“We recently strengthened our school guidance to strongly recommend a universal mask mandate in schools along with other CDC-developed prevention strategies,” said MDHHS spokesperson Lynn Sutfin.

“Some local health departments and school districts have already moved forward to require masks in schools; we applaud their efforts and encourage all Michigan districts to follow their lead. We continue to work closely with school administrators and local health departments to advise on masking and prevention strategies and will continue to monitor the school population closely."

Khaldun would not offer any insights into the Whitmer administration’s response to her recommendations. 

“No, I cannot speak to that,” she said. “I do know that my lane is to provide public health guidance, but I also recognize that there are many other things that have to be considered when it comes to implementing a mandate.”

Asked to offer specifics, Khaldun said she couldn’t. 

“I cannot at this time. I would defer to the director.” 

The risk to kids: 400 could be hospitalized by November, models predict  

If Michigan’s current trends in vaccination rates and social contacts continue, then a fall surge “potentialy of similar size to the spring” is likely, said Sarah Lyon-Callo, state epidemiologist and director of the Bureau of Epidemiology and Population Health. 

From March through June 2021, some 4,400 residents died from COVID. Total projected deaths between now and November range from 3,900 to just over 6,000, according to models from researchers at the University of Michigan. 

If those models are correct, that would mean as many as 428 kids under age 17 would be hospitalized during that period, with overall hospitalizations ranging from 12,000 to 25,000. The predictions come at a time when the US is seeing record high pediatic hospitalizations (even though Michigan’s are currently fairly low). 

“I think it's important to understand that almost half of those children that were admitted in the nation had no underlying medical condition,” Lyon-Callo said. “Looking at states that had... gotten hit with delta earlier than we have, multiple states here [like] Florida and Texas...are having extremely rapid surges in pediatric hospitalizations. And we could have a similar experience here, if we do not make use of mitigation measures.”

It’s misguided to hope the state’s spring surge might provide some natural immunity that, combined with an almost 60% vaccination rate for those 12 and older, might inoculate Michigan from a fall crisis, Lyon-Callo said. In Puerto Rico, she said, 75% of the population had been vaccinated or previously infected. It wasn’t enough to curb the spread of the delta variant. 

“However, Puerto Rico did see a very rapid surge with a peak similar to what they experienced in the spring,” she said. “And they've reached CDC's high transmission levels. So mitigation will still be important.”

Widespread mask-wearing gives schools more time to stop an outbreak 

The good news, she said, is the continued effectiveness of vaccines and masking, particularly within schools.

 

“The vast majority of cases, hospitalizations and deaths occur to people who have not been fully vaccinated,” Lyon-Callo said. “And again, less than one percent of people who are fully vaccinated get infected with COVID-19.” 

But as community transmission increases, breakthrough cases are happening as expected. Some 12,000 Michigan residents have tested positive for COVID after being fully vaccinated. Which sounds like a lot, but is less than 1% of people who’ve been fully vaccinated in the state. Of those cases, some 700 were hospitalized, and 247 died (217 deaths were people age 65 or older). 

Still, the effectiveness of vaccinations is clear from the data. “A larger proportion of those who become cases (98%), are hospitalized (95%), and died (95%) from COVID are unvaccinated,” the state’s presentation said.

And masking can offer powerful protection for schools, if enough students and staff wear them. University of Michigan researchers found that if one infectious child brings the delta variant into a classroom of 25 other kids, then it’s a matter of time until there’s a 50% risk of transmission to another child or teacher. But how much time, depends on how many people are wearing masks.

For elementary schools, it would take about three hours if no one’s wearing a mask. If most kids are wearing a mask, then it’s closer to 24 hours. And if almost everyone is wearing a mask, then elementary schools have 120 hours (or 5 days) before the risk of transmission hits 50%, the researchers found.

“Our strategies should be applied and strengthened as our transmission levels get higher,” Lyon-Callo said. “We know what to do to help protect our children and those most vulnerable, so that we can have the best school year possible, and we can reduce the burden of COVID-19 on our healthcare system.”

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