Michigan Governor Gretchen Whitmer Press Conference Transcript July 9

Gretchen Whitmer: (00:00) So today I am joined by a Lt. Governor Garlin Gilchrist, Dr. Joneigh Khaldun, Orlene Hawks, the director of LARA, Dr. Randolph Rasch Dean of the Michigan State University College of Nursing and Dr. David Spahlinger executive vice Dean for clinical affairs at the University of Michigan Medical School. Over the past week we have seen an uptick in COVID-19 cases in Michigan. And over the holiday weekend we saw countless Michiganders gather in large groups to celebrate 4th of July without a mask. I think a lot of people saw this video footage from Cass County Diamond Lake. I want to be very clear, right now the law requires that anyone in an enclosed public space has to wear a mask. And that means every store you're going into. And we are reviewing that requirement and considering whether or not we need to take this a step further to strengthen compliance, because we cannot let our guard down. Gretchen Whitmer: (01:04) We cannot afford to play fast and loose with the rules and just look at what's happening with Florida. It took less than two weeks for Florida to go from 100,000 to 200,000 positive cases. And the cases there are still climbing. Last weekend they reported over 11,000 cases in one day. That can happen very quickly anywhere in this country if we drop our guard. Statewide one in five cases are patients that are between the ages of 25 and 34. So youth will not protect you from carrying and spreading this virus to your friends and family and neighbors. We've got to all work together to protect one another. And that means wearing a mask. Masks can reduce the chance of spreading COVID-19 by about 70%. Our heroes on the front lines of this crisis, the men and women who have stayed out there and put their health in jeopardy to take care of the rest of us they deserve the respect, the rest of us masking up. Gretchen Whitmer: (02:15) They wear their masks every day we should be wearing ours as well. We owe it to them every time we make a trip out to the grocery store or the pharmacy. If we let our guard down, we could see a rapid increase in cases and deaths here in Michigan. That means more people getting sick. And that means more people dying from this disease. For the sake of your loved ones, for the sake of our economy, please mask up when you go out. As we continue to save lives and work to avoid a second wave, I want to again thank those who have stepped up to manufacturer and donate PPE. Last month I worked with the Kingdom of Jordan to secure a shipment that included overalls, masks, goggles. In total the kingdom of Jordan donated 650,000 surgical masks, 10,000 medical overalls, and 10,000 sets of eye goggles to the state of Michigan and we are grateful. Gretchen Whitmer: (03:19) In this challenging time our global friendships are crucial in combating and eradicating this pandemic and to all others who have stepped up thank you, thank you. PPE is crucial to protect the heroes on the front lines of this crisis and to help us avoid a second wave as we safely re-engage sectors of our economy. As we all know COVID-19 has had a disproportionate impact on communities of color in Michigan and across the country. Black Michiganders represent about 14% of our state population, but they represent 40% of confirmed COVID-19 deaths. COVID-19 is over four times more prevalent among black Michiganders than among white Michiganders. Michigan has led the way into identifying and addressing this problem. We were one of the first states to report COVID-19 data by race and ethnicity. And when the impacts of the virus is having this kind of an impact on communities of color and it became clear, we created the COVID-19 taskforce on racial disparities, chaired by the Lt. Governor Garlin Gilchrist. Gretchen Whitmer: (04:35) There's a lot of work that remains. This virus has shined a light on the staggering health disparities black Michiganders have faced long before COVID-19 ever hit our state. This was something that I discussed earlier this year in my state of the state. The national healthcare disparities record report concluded that white patients received care of higher quality than black, Hispanic, indigenous and Asian-Americans. The premature death rate from heart disease and stroke is highest among black Americans. And black women are nearly four times as likely to die during childbirth than white women. That's why I announced that I'm working with Michigan's medical community to address this. I've asked our medical partners and universities to incorporate implicit bias training into their curriculum so that as people of color seek healthcare, they'll be treated with equal dignity and respect, which will yield better outcomes. Gretchen Whitmer: (05:38) Dr. Rasch will be heading up the suffer. And today I signed an executive order requiring all health care professionals to undergo implicit bias training to obtain or to renew their licenses. Specifically, the order directs the department of LARA to begin implementing rules and to include implicit bias as a part of the knowledge and skills necessary for licensure in Michigan, for registration and renewal of licenses and registrations of health professionals in our state. COVID-19 has had a disparate impact on people of color due to a variety of factors. And we've got to do everything we can to address this. There's no doubt that our healthcare workers have been heroes, bearing risks and saving lives. The evidence shows that training and implicit bias can make a positive difference. So today we are taking action to improve racial equity across Michigan's healthcare system. In fact, this training has value for everyone in every profession. Which is why I have arranged training for myself, the executive office and state government. Gretchen Whitmer: (06:50) My administration will continue to work around the clock to enact real change in these areas and work with experts like Dr. Khaldun and Dr. Rasch to help reach our goals. We have an opportunity to make Michigan a national leader in addressing health disparities. As chair of the Michigan COVID-19 task force on racial disparities Lt. Governor Garlin Gilchrist is working with Dr. Khaldun and other leaders in healthcare and in our communities to address this issue head on and protect communities of color in the future. We're going to work every day and night to show the rest of the country how we can improve access to quality care for people of color. And right now as we continue working to protect our families, we have an opportunity to prove that Michigan has what it takes to contain this virus. Michiganders are tough. We stepped up, we took aggressive action against COVID-19 and we led the nation in bending the curve and saving lives. Gretchen Whitmer: (07:53) We've done hard work and made great sacrifice to get to that point. We cannot let it go to waste. Every one of us has to continue to do our part. To those of you who are watching, tell your family and your friends and your loved ones and your neighbors to mask up when they leave the house. Spread the word on social media. It's going to take every one of us working together to turn this around and to make sure that we are able to lead. We did at one point, we know what it takes and we've shown we've got what it takes. Let's muscle up mask up and double down on doing what we need to do to lead. With that I'd like to hand it over to the Lt. Governor Garlin Gilchrist. Garlin Gilchrist: (08:49) Thank you governor and good afternoon everyone. I also want to thank and acknowledge Dr. Joneigh Khaldun for her continued service and leadership as part of our pandemic response. And also want to thank the guests who have joined us in today's announcement, director Orlene Hawks, Dr. Randy Rasch and Dr. Spahlinger from the greatest university in the history of the world, the University of Michigan. I also want to thank all of the members of the coronavirus task force on racial disparities here in Michigan. And also the people who've participated in the weekly meetings that we have on Fridays, what we call the community action stakeholder table. The task force itself has 24 of the state's sharpest minds. It includes doctors, public health experts, scientists, community organizers, faith leaders, academics, civil rights advocates, and labor leaders. We have an opportunity to use this very diverse and representative taskforce to introduce policies, practices and programs that can have a positive impact on the lives and on the social determinants of the health of Michigan's residents. Garlin Gilchrist: (09:53) After Michigan saw its first confirmed cases of COVID-19 on March 10th, we had to make quick decisions about what data to collect and what data to report. We were one of the first and sadly remain one of the few states that does report out our cases and deaths by race and ethnicity. That is in part because our state understands and recognizes the need to make informed decisions driven by the best data and information. I'm a computer engineer, I'm a scientist by training. And I knew that before stepping into government, I know that the facts have the power to tell us when there's a problem how we can solve it. If we didn't collect data in a comprehensive way, we wouldn't even be positioned to be able to find comprehensive solutions to address the problems. And that is one of the ways how racial disparities continue to persist. Garlin Gilchrist: (10:45) We know that generations of racial disparities and inequities have had a detrimental impact on the lives of people of color across the country. The coronavirus pandemic has shown that this inequity is particularly and dangerously true especially in the black community where the health of our friends and family have been disproportionately impacted. This has visited me personally that unfortunately I've lost 23 people in my life to this virus. As governor alluded to in Michigan's upscale 40% of the cases, 40% of the deaths excuse me have been amongst black Michiganders representing just 14% of the population. Other states are experiencing this similarly disturbing trend in their data. And that is why we have been taking immediate action as a task force to deal with this racial injustice and also hopefully serve as a national model how we can connect the short term interventions to longterm action to reduce these disparities. Garlin Gilchrist: (11:40) The struggle, the challenges that we are facing in this pandemic, the systems that have led to those struggles they don't have to be here. They were not ordained by God instead they were designed. They are the result of the decisions and the choices that people have made over years, including indifferent to the challenges that communities of color face. But what this does mean is that we have an opportunity those of us who are working and living and leading today, we have the opportunity to be that different set of people that make a different set of choices. That establish a new set of systems and a different framework and a different paradigm that can lead to a different set of more equitable outcomes. We have the ability to challenge and change systems and overcome and eliminate these disparities, the inequities and the struggles that too many people face. Just like every other challenge that the people of Michigan have faced throughout the years, we can force change and come together to create solutions. Garlin Gilchrist: (12:37) I want to specifically address again the communities of color who have been fighting this so hard and who have been hit the hardest in our state. I talked about the personal loss that I've experienced, but the personal nature of that is something we need to remember when we're making decisions. People who pass away are not numbers. They are stories, they are husbands, wives, sisters, brothers, nieces, nephews, friends, colleagues. Their legacies were cut short, but there's something that we can do about it that we can work in their name. While black people have been disproportionately impacted by racial disparities for generations, but we can't solve this discrimination overnight. We do however have a responsibility to act right now. And when our government takes the health and safety of all people seriously, we have a good shot to make tremendous progress. This begins with recognizing and treating every person. When you look at treatment, we need to realize that implicit medical bias can be interjected at any point when someone has to make a choice or a decision. The task force took immediate action to make sure that medical providers were aware of how this disease is impacting racial and ethnic minorities. And one of the first actions was a letter from Dr. Joneigh Khaldun, which recognized that all of us as she said, have implicit biases and the difficulty is that we don't realize when we have them. Assumptions about individuals and groups can cause medical providers to not use a patient's individual circumstances or objective data to guide clinical management. This simple reminder can help save lives immediately. So the families like the Gambrel family in Detroit or the Bradley family in Grand Rapids, wouldn't be turned away from the testing, the treatment or the care that they so desperately needed. Garlin Gilchrist: (14:24) The existing health disparities highlighted during the coronavirus pandemic have made it clear that there is more work to be done to ensure that people of color have the same access to quality care as everyone else. So today we're taking that reminder statewide by directing the department of licensing regulatory affairs to begin developing rules to include implicit bias training and the licensing and registration of healthcare professionals across the state of Michigan. And by providing that awareness to healthcare workers on how to recognize and Medicaid this implicit bias, we will help them carry out that mission of providing the best healthcare to every single patient that they serve. Under the leadership and frankly- Garlin Gilchrist: (15:03) ... that they serve. Under the leadership and frankly the partnership of Dr. Khaldun and Governor Whitmer, Michigan has been recognized as a leader among states in this crisis. I hope that our leadership shown by establishing and implementing the recommendations of this Racial Disparities Task Force and continuing its work going forward will be a beacon of light for other states to emulate so that they too can address the disparities that exist in their respective communities. Garlin Gilchrist: (15:27) We've already recommended a great deal of actions that the state has taken thus far to reduce the risk of infection and mortality rate in communities of color. That includes expanding the testing protocol and availability in ways informed by ethnic and racial community impact as well as using the social vulnerability index. That also means enacting a nondiscrimination policy for treatment by emergency executive order. That's included scaling innovative models for delivering care, such as flexible mobile testing units in partnership with Ford, Wayne State, and ACCESS, and also using navigators and other volunteers to connect people to primary care and other services and programs as they await COVID-19 tests or test results. Garlin Gilchrist: (16:12) This is not something we can solve overnight, as I said before, but we must do something right now because more and more lives are still being lost here in Michigan and everywhere around the country. The task force is diving into more issues such as expanding internet access for safe delivery of a wide array of medical and other services. We're looking at how environmental factors such as air pollution must be addressed to improve resilience to COVID-19, but also to improve overall health outcomes. Now we're taking a broad look at how state tools and programs can be refocused and optimized to address and overcome the systemic racial injustices that have baked inequality into the reality of too many Michiganders. Garlin Gilchrist: (16:56) This is our generation's opportunity to confront and right historic wrongs. Doing so will not only enable us to survive COVID-19, but in the name and the memory of those who we've lost, we can design new systems that truly serve all of our communities. That is our mission and that is our charge. Garlin Gilchrist: (17:15) And with that, I'd like to thank you all for being here. And I would now like to welcome Dr. Joneigh Khaldun to the podium for an update. Dr. Khaldun: (17:20) Well, good morning. Thank you, Governor and Lieutenant Governor. As a black woman and a practicing emergency medicine physician. I am proud to stand here today with Governor Whitmer, Lieutenant Governor, Director Orlene Hawks, and as a member of the Racial Disparities Task Force to announce the governor's executive directive for implicit bias training to be a part of healthcare professional licensure requirements. Dr. Khaldun: (17:57) We've seen as has been discussed today and many times the disproportionate impact that COVID-19 has had on people of color in Michigan, and particularly black people. Black people have been disproportionately infected by and are dying from COVID-19 in Michigan and across the country. This is the sad truth, but it's in no way a surprise. Black women are three to four times more likely to die from a pregnancy-related condition than a white woman. A black baby is two to three times as likely to die before their first birthday as a white baby in the state of Michigan. Health care disparities and inequitable access to opportunities to be healthy are unfortunately something that has existed in this country for centuries. These disparities cannot be explained simply by differences in skin color or genetics. A disproportionate number of people of color live in poverty due to historically discriminatory policies in this country, and during the COVID-19 pandemic, this means they've had to disproportionately leave their homes to go to work because they were deemed essential. People of color are more likely to live in multi-generational homes or crowded housing where isolation and quarantine are more difficult to do. Dr. Khaldun: (19:07) And there's data that shows as we've discussed that implicit bias exists and it has an impact on the quality of care that people of color receive. Whether it's not offering the same treatment plan, dismissing a patient's complaints, or not being sensitive to cultural differences, implicit biases absolutely show up in medical interactions and then can lead to negative health outcomes. So this implicit bias training is a simple but impactful way that we as healthcare providers in Michigan can strive towards being a state where regardless of where someone seeks medical care, a dentist's office, a pediatrician's office, an optometrist, or an emergency department, clinicians are aware of the biases they may have and they have the tools necessary to address them. And I look forward to working with LARA Director Orlene Hawks on this important effort. Dr. Khaldun: (19:56) Now let's talk about where we are with COVID-19. As of yesterday, Michigan has 67,237 confirmed cases of COVID-19 and 6,015 total deaths. Yesterday, we also announced 610 new cases, the highest number of new cases reported since May. Cases have been increasing overall in the state for the past three weeks with some areas seeing higher numbers than others, and I'll go through that now. Dr. Khaldun: (20:27) The Grand Rapids region has had three weeks of increasing rates of cases and they now have 45 cases per million people per day, the highest of any region in the state. The Detroit, Lansing, and Kalamazoo regions all have over 20 cases per million people per day, and the Traverse City, Jackson, and Upper Peninsula regions all have under 20 cases per million people per day, but they have also all seen a steady increase in cases for the past two to three weeks. It's important to note here that the Upper Peninsula, which had previously seen consistently low levels of cases, is now seeing the highest rate of cases seen throughout the entire pandemic. Our local health departments, as I discussed before, they continue to work diligently to respond to these cases and investigate outbreaks. Some of the locations associated with these outbreaks include food processing plants, bars, a casino, religious gatherings, and congregate care facilities. Dr. Khaldun: (21:29) But there's also evidence of general community spread. So far, our hospitalization and death rates have not increased, but to be clear, what we have seen in other states is that hospitalizations and deaths tend to increase several weeks after the cases are identified, so we still have to watch this data very closely, and it's very likely that these numbers will go up in the upcoming weeks. Dr. Khaldun: (21:54) But the good news is that we are continuing to increase our testing across the state. Over the past week, we actually had an average of over 18,000 tests done per day, and that's actually 3000 more tests than the previous week. Michigan's now testing more than we have throughout the entire outbreak, but this is not the only reason for the increase in cases that we are seeing. The percent of tests done that are coming back positive has also slowly increased from two to three percent. And what this implies is that we are also seeing increases in cases because there's true spread of the disease. So right now, the data is not looking so good. Dr. Khaldun: (22:36) While we are certainly not in the extreme situation we were in this past spring, we really do need to get back on track and in the right direction again, and we all have our role to play. So please, as the governor said, wear your mask if you are leaving your house and going to a public space. You're not only protecting yourself and your loved ones, you're protecting the lives of our frontline healthcare workers, the heroes and sheroes of this pandemic who every day are risking their own lives to take care of patients. Maintain six feet of distance between yourself and others and do not gather in large groups. Several of the outbreaks that we are seeing across the state are because people are just not being smart about this and they are taking unnecessary risks. Dr. Khaldun: (23:22) As we fight a resurgence in cases, continued expansion of testing will be critical to rapidly identifying cases and containing the spread of COVID-19. And we still want everyone who needs to get a test to get a test, so if you're working outside the home, I'll say this again. If you're working outside the home, if you're interacting with people outside of your household, you should get tested. If you or someone you've come in close contact with is sick, you should get tested, and you can go to our website at www.michigan.gov/coronavirustest to find a site nearest you, and you can also because of our partnership call 211 and they can help you get tested as well. Contact tracing is also one of our most important tools we have during this pandemic, and I've talked about that before. Our local health departments have worked tirelessly to investigate every COVID-19 case and identify who they may have come in contact with. So every time we identify a positive case, our contact tracers have been successful about 80% of the time in making an initial attempt to contact someone within 24 hours of identifying that positive test. We are successfully able to reach someone, meaning that they actually pick up the phone when we call, about 60% of the time, so we've made great strides in building a team of contact tracers, over 10,000 volunteers that have signed up to assist and hundreds of paid staff across our local health departments who are making these calls every day. Dr. Khaldun: (24:46) But our greatest challenge right now with our contact tracing is that our public health staff often do not have the correct telephone number or people who we are calling are simply not answering the phone. So I can't express enough how important it is for you to give healthcare providers accurate information at the time you're getting a test. And if someone from your state or local health department calls you, please answer the phone. If you've tested positive, it's important that we understand who you've been in contact with, and we may be calling to tell you that you've been exposed and you need to get a test or you need to quarantine. This is such an important part of our strategy in how we'll slow the spread of the disease. Dr. Khaldun: (25:27) Michigan is in a different place than we were a few weeks ago. Cases are rising, but there is still time for us to keep this curve down and not see the resurgence that we're seeing in so many other parts of the country. Wear a mask, don't gather in large crowds, and wash your hands frequently. Do it for yourself, do it for your loved ones, and do it for your community. I think we can beat COVID-19. I know we can, but it's going to take everyone working together and doing their part. And with that, I'll turn it over to LARA Director Orlene Hawks. Dir. Hawks: (26:10) Thank you, Governor, Lieutenant Governor, and Dr. J. for your leadership on this critical health issue. A key part of the mission of the Department of Licensing and Regulatory Affairs is to protect people. COVID-19 has brought that mission into clear focus as we continually work to protect those who rely on our licensed health professionals. Our department is grateful to be a part of the implementation of this executive directive to expand that protection even further. Likewise, it's been an honor to serve on the Michigan Coronavirus Task Force on Racial Disparities, a wonderful, insightful group of people dedicated to making recommendations in real time to reduce the immediate risk of exposure and disparate mortality rates of COVID-19 on communities of color. While the work of the task force is far from over, LARA is ready to begin the process of working with Michigan health professionals to confront this issue head on. Dir. Hawks: (27:11) Our department licenses and regulates nearly two million entities and individuals. This includes 26 occupations which are governed under the public health code and corresponding administrative rules. Our role as a state agency is to ensure that licensees are adequately prepared to practice their occupation in a manner that upholds public trust and safeguards public health, safety, and wellbeing. Accordingly, we are committed to working with our respective licensing boards to establish new rules requiring all health care professionals to receive training on how to recognize and mitigate implicit bias. This truly will be a collaborative endeavor that is purposed to enhance the knowledge base and skills necessary for health professionals to be licensed in this state. I have full faith in Michigan's healthcare workforce. They are as dedicated a profession as any, and we are proud of the world class care that they deliver every single day. Dir. Hawks: (28:18) Some of Michigan's healthcare systems have identified this need and are already addressing implicit bias in the healthcare setting, LARA supports these efforts and the leadership that is being demonstrated on this important issue. We know healthcare providers and professionals strive to deliver the best care to their patients, and this step is our way of supporting their vocation. Dir. Hawks: (28:43) Understanding while technical knowledge and clinical skills should always be held to the highest of standards, it is equally important that health professionals understand the ways in which they view and interact with communities that they serve. It is our expectation that these efforts will ultimately underscore the commitment of the healthcare workforce to understand and address implicit bias. As a result, we anticipate improvements in quality of care, relationships with communities, and ultimately better health outcomes. The implementation of new rules is not a silver bullet, and we understand that. However, it has become clear that this is a significant step that we can take to promote health equity and eliminate health disparities amongst Michigan's communities of color. Dir. Hawks: (29:37) Again, I want to thank the leadership of the lieutenant governor, the governor, and Dr. J. Our LARA team looks forward to working with and engaging with stakeholders and licensees as we come up with solutions to make important changes in the way that we deliver care to all Michiganders. Thank you. Garlin Gilchrist: (30:09) Good morning. First of all, I want to say what a privilege it is to be here, and I want to thank governor Whitmer and Lieutenant governor Gilchrist for the leadership that they've done for our state. You heard what we are like compared to other states. The particular leadership- Speaker 1: (30:28) [inaudible 00:30:28] yourself please. Garlin Gilchrist: (30:28) Oh, I'm Randy Rash. I'm Dean of the College of Nursing. Sorry. But the leadership that they've shown has put Michigan at the forefront, not only in looking at how we protect our citizens in terms of the infection, but particularly the emphasis on a vulnerable population, the African American population. I think the other thing that's really noted is as a scientist, myself, the importance of gathering data so that we know what we're dealing with. One of the things you might not know though, is an important thing with that is what questions are being asked in the first place. And implicit bias can impact what those questions are. Garlin Gilchrist: (31:13) So, I want to tell you a little bit about what implicit bias is. One of our problems with getting a hold and a grasp on implicit bias is the misunderstandings that we have about it. So, I'm going to say what it is. What it is is an unconscious, negative classification of individuals or groups of individuals based on some physical attribute. What we normally hear more about is race, but it can be gender, it can be what we perceive the body weight should be, it can deal with what we think is attractive and not attractive. And then the key piece is that based on that unconscious thought about how we think of people, we make a decision, we make decisions, and we act on those decisions, not recognizing that it's based on something that we don't really understand. Garlin Gilchrist: (32:14) What it is not, and this is part of the problem that we have when people hear the term implicit bias, because it's so frequently associated with race, it has the implications of thinking that you're accusing someone of being a racist. But the key to implicit bias is that it's unconscious. But because it's unconscious, still, it doesn't prevent negative thoughts, unconscious thoughts, and actions based on this. Garlin Gilchrist: (32:50) The importance of implicit bias is that, by nature, all human beings have implicit bias, and we all make based on that. Part of the reason is ... I'm going to say a word. Evolutionary. It's how we protect ourselves from danger. But I want to give you some examples of what it means that we all have implicit bias. And so, I'm going to share some personal ones. Garlin Gilchrist: (33:17) You can see that I'm a black male. I've always been one. Years ago, I remember walking down the street after work. I always did that as exercise. And I saw a young black male ahead of me. I remember it now. It was a gift for this to have happened to me, because when I saw him, I crossed the street. And several moments after I crossed the street, I thought, "What is that about?" And in that moment, I realized that I had crossed the street because I was afraid of him. It was something that I developed unconsciously, because growing up, I know that African American males are some of the most loving, affectionate people on earth, but I had learned, unconsciously, to fear him. And at that point, I went back across the street. But it began this journey for me. that's what the issue is for all of us as human beings, but especially as healthcare providers, in terms of implicit bias and the work that we do. It is a journey because I just recently ... Well, five years ago, returned to my home state of Michigan, because I lived my adult life in the South. You probably don't recognize it, but we have a certain way of speaking, and we have an accent that we all grow up to learn and love. It's what we grow up with. I had spent my adult life in the South. When I came back to Michigan, it was a shock. When I interacted with people, when they spoke, I literally felt like I had been attacked. I had to remember, "Oh no, I know these people. That's not what this is about." And I began to realize I was making an unconscious decision about that. So, the importance of implicit bias, and especially for healthcare providers, is it is important for us to be aware of our biases. The problem is that it's unconscious. Garlin Gilchrist: (35:28) I shared my story because I was privileged early on to realize that, but most of us don't, and I still have blind spots that I'm probably biased about and just don't know them. What implicit bias training does is it trains you to know what those are and begin to look within yourself about those kinds of biases that you have. A part of that training, though, also are surveys you complete that help you specifically see what your biases might be. Once you see that, then you can begin to, on your own and with support, begin to deal with those biases. And for us, it's especially important in how we gather history, how we do physical examination, how we make decisions about that data, and how we use that to work with patients to develop the best healthcare that they need. Garlin Gilchrist: (36:29) I say it specifically that way, because implicit bias means that because of how you think of someone unconsciously, shapes how you get that history, 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. So, it is extremely important for healthcare providers, but I want to say it's so important for people to understand that requiring this training as a part of re-licensure is actually a support for you to provide better care and to make sure that the data that you're collecting is objective data and that your decision making is based objectively. Garlin Gilchrist: (37:18) So, it is important very much right now in this crisis to pay attention to racial disparities, because you heard the numbers and you've heard of what that means. But the other piece of that means that for every patient that you care of, you become aware of your biases for those people. Garlin Gilchrist: (37:39) So I want to say a little bit more. You've heard about the impact in the African American community in terms of these biases. This begins with access to testing, and it has to think about who folks are? Where do they live? All those kinds of things. People who are primarily have a socioeconomic statuses less than what we would prefer, and are considered essential workers, have to go to work. They often don't have their own vehicles, which means they have to get on a bus or other accommodations. To get the healthcare, that's true as well. We have communities where to get to a primary career provider can involve an entire day. And so, that becomes a barrier for those kinds of care. That's especially true right now with this pandemic. So, access to testing is an issue. Garlin Gilchrist: (38:33) Access to care, both whether or not you can get to it, but once you get there, whether or not you have access to the quality and standard of care that all patients should get. I think that the story of a registered nurse who she and her husband had symptoms of COVID-19 and they went to the same facility to be ... For intake. They were separated. She was admitted. Her husband, who was not a healthcare provider and was probably sicker than she was, was sent home by himself, and she could see the difference, and probably part of it was they knew she was a nurse. They were both black. They knew she was a nurse. She got a different level of care, but that doesn't always happen. But it's a prime example of what happens when you get to the site for care, the decision that is made about whether or not you continue on to get the quality and standard of care that would be expected, or whether you get a sub standard of care. Garlin Gilchrist: (39:38) Other issues that black people and people of color face is living conditions. So, they may not be able to afford to live in a place where they can follow the CDC guidelines. What does it mean to socially isolate when you're living in a house or an apartment where you're trying to provide housing for folks that you know who don't have it? One of the things we see, and I'm privileged to be on the coronavirus racial disparities task force, but one of the discussions is what does it mean to be homeless? We have people who are homeless, but technically don't appear to because their friends, neighbors, and loved ones let them stay in the house with them. They may sleep on the sofa and go someplace else. Think about what that means if they've been exposed and they're now in a home that isn't necessarily designed to house them, but out of the goodness of their heart, family and friends are housing them. Garlin Gilchrist: (40:41) So, all of those issues with CDC guidelines and all of those sort of things. And then you heard, of course, the issues of preexisting conditions. I started my career as a public health nurse in Benton Harbor, Michigan, and I have to give a shout out to the Berrien County Health Department, because what I've been privileged to learn as a part of the task force is the important work that they and other members of our health departments are doing. But I started my career there. Many of the disparities that we are looking at now were in place then, many years ago in the 70s. That's how old I am. In the 70s. We were making some progress, we have slipped. And so, those larger issues in terms of healthcare, pre-exposed conditions, are exacerbating our communities of color when they're exposed to the virus, when they contract the disease, and the course of their experience with that disease. Garlin Gilchrist: (41:43) The last thing I would like to say is that when we are in a situation of a pandemic, it's a great time to realize that we are all in this together. We don't live in a country where people from different groups are totally isolated from people of other groups. So, probably the way the virus got into African American communities was it was brought from the far East and from Europe. And the people who brought that were not the people who ended up being exposed to it. It's an example of how we're linked, because when one segment of the population experiences this infection, what happens is we are all exposed. It is about the health of all of us. So, it's not ... I would say it's not a selfish thing, from my perspective, being a black male, to focus on the African American community, because in the end, the health of that community and communities of color has an impact on the broader health of all of the community. Thank you. Dave Spahlinger: (43:09) I guess it's good afternoon. Thank you for being here today. I am Dave Spahlinger. I am President of the University of Michigan Health System and Executive Vice Dean of the medical school. I was invited here to talk about our experience in implicit bias training. Implicit bias training is designed to examine our unconscious bias and how it can affect our perceptions, our decisions, and our interactions. It's an educational tool designed around the fact that an unconscious mind is a powerful intrinsic force that ultimately shapes our behavior, our actions, and our everyday lives. Dave Spahlinger: (43:54) At Michigan medicine, we have had unconscious bias or implicit bias training now for a little over two years. I am happy to say it is not mandatory at this time, but we support the directive that is being proposed here, but we have had 14,000 of our 28,000 faculty and staff go through the training, and another 4,000 who have gone through bystander intervention training. Dave Spahlinger: (44:26) Through this course, our community has learned to examine their backgrounds and identities to interact more authentically with coworkers, patients, and the community. We discuss how the brain functions to understand how unconscious bias is a natural function of the human mind, identify patterns of bias that influence important decision making processes in our health system, and we confront internal biases and practices and with conscious awareness, practice strategies to create and systemically change the workplace. Implicit- Dave Spahlinger: (45:03) Change the workplace. Implicit bias raises self-awareness and sparks conversations among the participants. And along with other interventions to address behaviors, it enhances professional and personal effectiveness both on and off the job while positively influencing personal and organizational culture. Understanding and mitigating bias is a lifelong journey. Implicit bias training is a first step in that journey. We fully support this measure being proposed, and we thank Governor Whitmer and Lieutenant Governor Gilchrist for their leadership in trying to address the disparities in health equity in our society. Thank you. Gretchen Whitmer: (45:59) Well, thank you. I really appreciate that, Dr. Spahlinger. Thank you Dr. Rash, Director Hawks, Dr. Khaldun and Lieutenant Governor Gilchrist. Appreciate that, and of course, always appreciate the rivalry between Michigan and Michigan state that the Lieutenant Governor infuses into all of our engagements. But it doesn't matter if you are a Spartan or a Wolverine or a Laker or a Bronco or anyone else, a warrior. Mask up and mask up with your school pride, whatever team you're on. We all got to be a part of the same team in terms of fighting COVID-19. So with that, be happy to open it up for some questions. Speaker 2: (46:41) Governor, you talked about the mask wearing, people not wearing masks. Why not implement penalties for making the stores and restaurants mandate them? Gretchen Whitmer: (46:52) Right now we do actually have penalties under the law. The problem, of course, is making sure that we are enforcing and have compliance. And, of course, that relies on assistance at the local level. And I think as we see our numbers continue to rise that locals are going to get more active in assisting on this front. I also know that I've heard from a number of employees, whether they're in grocery stores or in retail shops or restaurants who are fearful. And so as employers, the owners of these establishments have a vested interest in ensuring that their workforce, as well as their patrons feel comfortable coming in. We know that consumer confidence is critical to economic growth. Every step that we take for re-engagement has to be commensurate with the heightened level of activity on the part of these business people to ensure that they're taking every action to keep people safe. Gretchen Whitmer: (47:52) So we know, I had a call with a number of the Midwestern governors. As you recall, I created this group that regularly has conversation about where we are and where we're headed. And our numbers comparatively are a lot better. It still doesn't mean that we're not headed in the right direction. We're just moving at a less concerning pace, I guess, but we have every reason to be concerned. But I'll say this, they are actively engaging in promulgating more broad masking requirements, like what we have done here. And we're actively looking at how do we maybe take additional steps to increase compliance here in Michigan. Gretchen Whitmer: (48:32) Human behavior is the thing that is going to determine what direction we're headed in. We will do everything we can to encourage the right choices. But at the end of the day, it's on all of us to do our part, to educate the people around us, whether it's in the store or it's in our household, or it is in our neighborhood or in our workplace. We've got to implore one another to step up and to do the right thing. And Michiganders are smart. We're tough. We can figure out how to do it politely, but also forcefully because it's on all of us. If we're going to get our kids back in school in eight weeks, we've got to at least stay in phase four, if not moving to phase five. And on the trajectory we're on, it's very much in question. Yes. Speaker 3: (49:18) Do we have a timeline or a date that we can expect to see the rules that outlined the implicit bias training for healthcare workers? Gretchen Whitmer: (49:26) Director Hawks, I believe that it is a matter of months, but I think I'll ask the director to come up and chat with you. Dir. Hawks: (49:38) Thank you for that question. The process is about six to 12 months. There are multiple steps that are within that timeline, and there are also dedicated times for each step to occur. So we anticipate six to 12 months for the rules to be done, but as it relates to the executive order, there is the first part of engaging stakeholders first. And so we would like to do that, to get people at the table, to hear from everyone. And then, obviously, the rulemaking process will then commence. Gretchen Whitmer: (50:14) And I would just add, as you've heard from the head of the University of Michigan Medical System, implicit bias is something that a lot of leaders are already undertaking. And so the rulemaking process doesn't mean that there aren't places where this is already well underway, and I think that's something that is really positive. And just talking about it, and just staking the course for what we're going to be headed in Michigan will increase the activity on that front. So we anticipate immediate benefits from it as well. Era. Rod: (50:41) Governor, in terms of stepping back or rolling back, what is the line of demarcation? What would happen in the state of Michigan that we would regress, and what would that be? Deaths? Cases? And what would that look like? Are we looking at going back to phase three? What are the triggers? What does it mean? You discussed schools, but can you expand on that please? Gretchen Whitmer: (51:02) Yeah, so Rod, this is the question that we have a discussion on every single time we do a press conference. People want to know, is there a specific number we get to before we make the next step, or we take a step backward? And I understand that. That's a question people want to understand. There's so much uncertainty. There's so much anxiety. There's so much unknown with this novel virus. And yet here's what we do know. We are watching case counts every single day. We have ramped up our testing as Dr. Jay said, we are now doing about 18,000 tests a day. That's an improvement. The more testing we can do, the better handle we'll have on how prevalent COVID-19 is, but the tracing is absolutely essential. So when we look at those positive numbers, 600 additional cases, that is a concerning development considering we were steady around two to 300. Gretchen Whitmer: (51:53) It's the biggest number we've had since May is what Dr. Jay said. So if this trajectory continues then we're going to have to pull back in a certain way, and that's why I've always talked about a dial, right? As the numbers are going down, we can think about taking additional steps of re-engagement. If the numbers continue to go up, we're going to have to dial back. And we know what stepping back looks like because we've been there in those phases. The reason we can't give you a magic number for turning that dial one direction or another's because context matters. 140 cases associated with Harper's in East Lansing, where we can trace and isolate people, is a scenario that is much different than 140 cases that are totally random, where you don't know what's happening and it's community spread, that is unchecked and untraceable and thus hard to isolate. Gretchen Whitmer: (52:45) And so that's why that context overlay is really important. We are in daily assessment of where our numbers are. We know that what is going on in other parts of this country is incredibly concerning. We know that in Florida, when they report 11,000 cases in a day, and at our height, we were at about 1,800. If we got anywhere close to where Florida is, it would be devastating to our economy, to our healthcare systems, to the people in terms of how many additional fatalities we would experience and hospitalizations. Gretchen Whitmer: (53:22) And so those hospitalization numbers, we're watching the trends. And right now the trend of where we're headed is concerning. I'm not announcing a step back today. I'm certainly not announcing a step forward today. But if we want to be in a position in eight weeks from now, where we can get our kids back in in-person education, this trend can't continue. And that's why masking up is going to be so important. And that's why we'll be announcing additional steps toward encouraging compliance, but that we're asking on every Michigan or to do their part. We got to get the politics out of this conversation and just do what we know to be the right thing. We have pushed our virus curve down. We know what it takes to be successful here. We just got to do it. Okay, Eric. Eric: (54:08) Now you mentioned schools in eight weeks, especially schools in phase four, right now, they have to plan for three, four, and five. Would there be some sort of deadline for them to... For you to make a decision how they start school so they can have any path to go towards? And once school starts, could it change just as easily? Gretchen Whitmer: (54:27) Well, all districts have to have a plan for phase three, phase four and phase five. If we're in phase three, it's distance learning. So we're not back in the classroom. If we're in phase four, then there are real more strict requirements to be in person that need to be followed and districts are writing these plans right now. The issue with a novel virus that is spread as contagious as COVID-19 is, is that a phase can change. And we can't predict precisely where we're going to be, because if we keep seeing events like we saw at Diamond Lake or at Harper's, or in that barbershop called The Man Cave, we know that a couple of places that aren't enforcing can dramatically change our numbers and our outlook as a state. And that's why it's going to be really important that every one of us continues to do our part. Gretchen Whitmer: (55:21) What the timing looks like in terms of when a district will need to know which phase they're in. I mean, we're going to do our best to make sure that we are sharing information. If it's a sustained increase, we're all going to know what phase we're in. If it is flattening out, that's a good thing. And that means that we might have to be nimble between phases five and four. But if it's a question between three and four or three or less, then it's going to be very concerning and we're going to have to adjust accordingly. To increase the odds that we're back in school, this is the best, most important thing we can do is mask up, wash our hands, and not congregate in big groups. Speaker 4: (56:02) Governor, we've got time for one or two more questions. Gretchen Whitmer: (56:04) Okay. Rick. Rick: (56:05) You've talked a number of times about considering further measures about getting people to wear a mask. Is that based on analyzing the stores or the businesses or the owners, or is it individual enforcement? I know you've suggested that we gently nudge people in the store, but that's all a lot easier said than done. Gretchen Whitmer: (56:28) I know it is. And I feel for businesses that are doing all the right things and for their clerks, the store clerks at the front door, or who are confronting or being confronted by customers who are unhappy about the mask requirement. And yet these businesses are also asking for tougher rules so that they can point to it and say, "This is the law of the land." Right now it is required. And for some reason, people don't seem to know that. And that's why I wanted to reiterate that today. It is required that people wear a mask if you're going into a place of accommodation, public accommodation that is inside. You're supposed to be wearing a mask. And that is the law of the land. There are perhaps additional steps that we can take. And I would anticipate you'll be aware of what those are in the coming day or few. Speaker 4: (57:26) Okay, last question. Gretchen Whitmer: (57:26) All right. Emily. Emily: (57:26) Is one of those additional steps you're considering penalties for individuals who don't wear masks? Because I've heard from local law enforcement that right now without a misdemeanor or civil infraction you really can't do anything if someone's not wearing a mask. Gretchen Whitmer: (57:38) So we are looking at enhanced... We do have the ability for a misdemeanor and a fine, but right now we are determining what is going to be most helpful to encourage compliance. You know, last thing I want to do is be doling out lots of penalties. What we're trying to do is get people to do the right thing for the right reasons. And the right reasons are a mask is, without a vaccine, without a cure, a mask is the safest way to protect yourself from the spread of COVID-19, to protect your family from the spread of 19, to protect your neighbors and coworkers, and to protect our economy from another potential step backwards. None of us wants to see that I know we are not unanimous in a lot of things, but I think we're unanimous in the fact that no one wants to take that step backwards. So if everyone does their part, we won't have to. And that's what we're asking for. Make a mask. Make a mask with a political statement saying I hate masks if you want, but just wear it. That's all I ask. That's the kind of thing that can really make a difference. So thank you, everybody. Stay safe. Have a good one.