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Open letter to state executives

Dr. Robert Lorinser, medical director, Marquette County Health Department

Dear Gov. Whitmer, Director Hertel and Chief Medical Executive Khaldun, I am one of many dedicated medical directors within our local health departments, working with talented professionals to protect and prevent illness and suffering for those we serve. Thank you for your leadership as our governor, director of MDHHS, and as our chief medical executive of our great state of Michigan. I speak on my own behalf and not for my fellow health officers or medical directors. I write to you intending to help and with respect. Please accept my comments as constructive.

We haven’t known a respiratory virus that behaves like COVID-19. Why was Michigan recently stricken so hard while next-door Wisconsin is spared? The reasons are unknown. This virus is unpredictable. We lack a complete understanding. There is more uncertainty than certainty. There is no definite explanation for surges–when they start or how they end.

Pandemic fatigue, vaccination levels, variants, and individual behaviors can’t explain the state-to-state contrasts. Neither does compliance with mitigation (masking, social distancing, and hygiene) or the use of governmental nonpharmaceutical interventions. Despite Michigan being a leader in vaccination rates with multiple state-directed interventions, our COVID death rate is no different than many other states.

We can agree that we have limited known effective measures, with the star being the COVID-19 vaccines. Vaccines should be our number one goal.

Currently, vaccine hesitancy is Michigan’s most critical issue.

Borrowing from the knowledge of my University of Minnesota colleague Dr. Osterholm, if each of us who are vaccinated reaches out to two people per week who are not vaccinated and assists them to get vaccinated, this will make a difference with its weekly exponential growth. It’s like the story of the grain of rice/wheat on the chessboard from centuries ago. One or two doses of vaccines and one dose of humility with scientific integrity are what is needed.

I have concerns regarding the process and plan of the MI VACC to Normal Challenge. Respectfully, I am disappointed that local health department medical directors and health officers are not an integral part of the planning. We have the unique position of being the trusted medical and administrative leaders for our local health departments and all of Michigan’s counties. We are invaluable allies and it’s highly prudent we are not neglected.

I humbly ask government administrators to consult with us, your public health leaders, and ask for our expertise when making critical decisions for our patients. We shouldn’t be in a situation of getting calls, texts, and e-mails with questions about a program of which we did not know–nor have input on–before reading or listening to the same media releases to which citizens are privy. We can’t answer questions or address their concerns. It creates a difficult situation and, as I have been told several times recently, “an embarrassment to MDHHS and the governor’s Office” for not reaching out to local public health leaders for their input before making your decisions.

I alo have concerns for the plan itself– concerns that could have been mitigated if we were part of the process. We could have improved the plan or possibly lead to an alternative implementation. I wonder:

What if we pause for weeks and months without increasing our vaccination rates despite low death rates, hospitalizations, and the number of COVID-19 cases?

Will the public tolerate the continuance of pandemic orders and MIOSHA regulations despite an acceptable level of risk even if vaccination rates are not met?

What is the plan if either of the above happens? Will the state continue with restrictions despite decreasing harm if we don’t reach our vaccine goals?

Are our governmental nonpharmaceutical interventions of proven benefit?

Is the goal the prevention of unnecessary suffering and death, or vaccination rates?

What if herd immunity is reached with a lower vaccination rate secondary to natural immunity from an infection?

Understanding the Upper Peninsula has distinct attributes compared to more densely populated metropolitan areas in the state, citizen-for-citizen, the concerns and health of rural Michiganders ought to carry equal weight when making decisions for an entire state. Despite the recent recommendations, schools and sports in my county remained open, our restaurants appreciated no change, and we stayed with a 10-day duration of the quarantine.

Still, our COVID-19 case rates decreased, seemingly faster than most places in the state. Similar to the ravaging surge in November and December, our rates decreased without governmental interventions. As stated above, so much is still unknown about when, where, and why surges occur or why they end.

I am happy and honored to continue supporting my governor and MDHHS as a local leader if I can be assured of my community’s questions, I extend to you after they were asked to me this morning immediately following your press release.

Thank you for your attention and leadership in these difficult times. I look forward to working with you as we all strive to be assets to our communities and eradicate this deadly, unforgiving virus.

Editor’s note: Dr. Robert Lorinser serves as medical director of the Marquette County Health Department.

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