Michigan health workers must receive "implicit bias" training tied to their professional licensure under a directive issued Thursday by Gov. Gretchen Whitmer, who said the mandate will help address the coronavirus pandemic's disproportionate and deadly impact on people of color.
The Democratic governor also said she would soon announce steps to ensure compliance with Michigan's mask-wearing requirement in indoor public spaces. The state has the nation's 12th-lowest rate of COVID-19 infections over the past two weeks, but it has had an uptick of late — with an average of 494 new cases over the last seven days, which is 200 more than the rolling average on June 24, according to Johns Hopkins University.
If K-12 schools are going to open in eight weeks, she said, "masking up is so important. We're asking every Michigander to do their part. We've got to get the politics out of this conversation and just do what we know to be the right thing."
Whitmer's order exempts violators of the mask requirement from a misdemeanor and fine, unlike people who do not socially distance, who attend outdoor gatherings of more than 100 in much of the state or — in the case of certain business owners — reopen. The restrictions are rarely enforced, however, and Whitmer said the last thing she wants is "to be doling out lots of penalties."
"Right now it is required, and for some reason people don't seem to know that," she said. "You're supposed to be wearing a mask. That is the law of the land."
The executive directive requires the state Department of Licensing and Regulatory Affairs to create rules to mandate implicit bias training standards as part of the knowledge and skills necessary for 368,000 health professionals to renew or get a new license or registration. Only those in veterinary medicine will be exempt.
The agency must consult with relevant industry groups by Nov. 1. Once the rule-writing process begins, it will take six months to a year to complete.
Black people make up 14% of Michigan's population but account for nearly 40% of its 6,271 confirmed or probable COVID-19 deaths. Although underlying conditions that exist at higher rates in the African American community — heart disease, obesity, diabetes and asthma — make Black people more susceptible to the virus, officials said implicit bias is a factor in health care, too.
"We need to realize that implicit medical bias can be interjected at any point when someone has to make a choice or a decision," said Lt. Gov. Garlin Gilchrist II, who is Black.
Randolph Rasch, dean of the Michigan State University College of Nursing, said implicit bias is someone's unconscious, negative classification of individuals or groups of people based on physical attributes.
"Because of how you think of someone, (it) unconsciously shapes how you decide what physical examination to do, how you decide which tests to run, how you decide what plan of care you develop for that person," he said. Requiring the training "is actually a support for you to provide better care."
Meanwhile Thursday, a coalition of major hospitals, companies and unions announced plans for a multimillion-dollar advertising campaign urging adherence to safety practices. It cited polling that shows residents are less concerned about the virus than before.
"The combination of rising case counts and declining vigilance by many is placing our state at a tipping point in our battle with this disease," said Wright Lassiter III, president and CEO of Henry Ford Health System in Detroit.
Dr. Joneigh Khaldun, the state's chief deputy health director and chief medical executive, said the Grand Rapids region's 45 daily cases per million people is the highest among Michigan's eight regions. Outbreaks have been identified at food-processing plants, bars, a casino, religious gatherings and congregate-care settings, she said, but "there's also evidence of general community spread."
Whitmer on Thursday updated a workplace safety order to include specific rules for meatpacking plants.
Hospitalization and death rates have not increased, but there is a lag of several weeks after cases are confirmed, Khaldun said. Testing is up — to 18,000 a day statewide — while positive tests are now 3% instead of 2%.
In Detroit, Mayor Mike Duggan said the city lately has been recording 20 to 30 new cases a day, compared to 10 a few weeks ago. Many people who have been testing positive have not had symptoms.
"Eighty percent of this is wear a mask. ... You're going to be wearing a mask in October. You're going to be wearing a mask in December. That's just the truth," Duggan said.