Munson Healthcare has moved to level red in its pandemic response plan, the first time in the hospital system's history it has moved into its most serious stage. Level red is characterized by an "overwhelming number of local cases beyond capacity of the healthcare system" and means COVID-19 care will be prioritized, some services (like elective surgeries and sleep disorders) will be scaled back, and operational hours may change. The move comes as a surge continues to batter northern Michigan, with Grand Traverse County climbing from an average of 29 new daily COVID-19 cases in September to 49 in November and 24 patients dying at Munson hospitals in the last two weeks.

While COVID-19 numbers are generally on the decline across the country, the opposite is true in Michigan. Positivity rates and hospitalizations continue to steadily increase, while northern Michigan’s positivity rate is even higher than the state average, Munson Healthcare Chief Medical Officer Christine Nefcy said in a press conference Tuesday. Munsons's 14-day average testing positivity rate is 17.9 percent, while the statewide rate is 13 percent. Nefcy said a crucial difference between the current surge and previous surges is that in the past, surges "were pretty quick...this one has been longer and a little bit flatter, which is obviously impacting the healthcare organization pretty significantly.” Munson experienced a 22.2 percent testing positivity rate on Sunday, the highest it has been at any point in the pandemic.

In the last two weeks, the number of patients hospitalized at Munson Healthcare has increased from 71 to 99 – including 56 patients currently hospitalized at Traverse City’s Munson Medical Center. “We made the decision to move our pandemic response stage to red…not only because of COVID cases, but the high acuity we're seeing of other patients as well as staffing restraints,” Nefcy explained. Nefcy said children returning to schools was a significant driver of new cases, with up to 20 percent or higher of new cases originating in kids. While Munson Medical Center Pediatrics provided 100 hours of inpatient care in October 2020, that number ballooned to 900 hours in October 2021. There are "more patients, staying longer than they did a year ago," according to Nefcy.

Two weeks ago, Traverse City Area Public Schools (TCAPS) had 134 school-related cases to date for the school year, a number that included both students and adults and reflected a handful of duplications, as a positive individual who visits multiple buildings is counted as an exposure at each of those buildings. That figure has climbed to 189 school-related cases of this week, including 11 new cases Tuesday. Statewide, there have been more than 201,000 confirmed COVID cases in ages 19 and younger as of last week, and 20 deaths reported in ages 10 to 19. More than 450 children under the age of 12 become infected with the virus every day. The University of Michigan School of Public Health found that viral spread is 62 percent higher in schools without mask mandates than those with masking requirements.

Nefcy said vaccines becoming available this month to children ages 5-11 is "exciting" news in fighting the surge, adding that local appointments are already "filling very quickly." Vaccines for kids, which contain one-third the dose of an adult vaccine, are available at many pediatrician offices and the Grand Traverse County Health Department, which quickly booked out its first slate of appointments for this week but plans to open another 400 appointments online Wednesday at 10am. The Health Department has a target goal of offering 1,200 total appointments to ages 5-11 before Thanksgiving, according to Health Officer Wendy Hirschenberger. Pharmacies including CVS, Meijer, and Walgreens are also booking appointments for children, and Munson is accepting names on a waiting list for pediatric immunization clinics at 231-935-8125.

Hirschenberger said the Health Department is seeing similar surge numbers as Munson, including a 40 percent increase in cases in the last eight days. In September, the average number of new county cases per day was 29; that figure climbed to 37 in October and is at 49 for November. "We're seeing a little bit more of a dramatic increase right now for Grand Traverse County," Hirschenberger said. "So far November is actually heading more toward the highest numbers we saw, which were back in April of 2020. So we are not going in the right direction right now at all." The county's testing positivity had remained in the 10-12 percent range for several weeks, Hirschenberger said, but is now approaching 15 percent.

Vaccination rates for Grand Traverse County are now at 68.6 percent initiated and 64.4 percent completed. Fully vaccinated rates are generally highest in the oldest populations and lowest in the youngest populations. For example, 88.13 percent of residents in the 75+ age group are fully vaccinated, while only 50.11 percent of those in the 12-15 age group are fully vaccinated. Hirschenberger noted that countywide vaccination percentages overall have slightly dipped because the Health Department is now including the 5-11 age group in vaccination demographics.

At Munson, close to 80 percent of staff and 90 percent of providers are now vaccinated, according to Chief Communications Officer Dianne Michalek. She noted that due to new federal guidelines being released last week regarding vaccine mandates for large employers and healthcare providers, Munson is accelerating its deadline for employees to receive their first vaccine dose or else face termination from January 7 to December 5. She added that a deadline has also been extended for employees to apply for exemptions, requests that will be reviewed by a panel of experts on an individual basis. “We’ll be working this month to see how much more we can move the needle on that (employee vaccination rate),” Michalek said.

When asked why northern Michigan is experiencing a surge when much of the rest of the country is seeing a decline in cases, Dr. Christopher Ledtke – infectious disease specialist with Munson Healthcare – noted that “geographic pockets” have experiended surges throughout the pandemic and cited the high transmissibility of the Delta variant as fueling the current surge. Other healthcare experts have theorized that states including Florida and Texas experienced summer surges as people moved indoors to escape intense heat, while Michigan is now experiencing a similar surge as residents move indoors for fall and kids return to school.

While unvaccinated individuals accounted for 93.1 percent of COVID cases, 90.7 percent of hospitalizations, and 90.5 percent of deaths in Michigan between January and October, Ledtke noted that waning vaccine immunity is a “legitimate” issue that could also be affecting case numbers. Ledtke encouraged any residents eligible for booster vaccines to get them, saying that studies have shown they significantly decrease breakthrough cases. He predicted that booster availability will be expanded nationally in the coming weeks. “Certainly before the holidays, it’s going to be something that any adult can get,” he said. Health experts Tuesday also encouraged residents to get their flu shots as soon as possible. A possible severe flu season could be ahead, according to the CDC, with many more Americans traveling and gathering this year than in 2020 and protocols like masking and social distancing “just no longer in place,” Nefcy said.