This article is part of State of Health, a series about how Michigan communities are rising to address health challenges. It is made possible with funding from the Michigan Health Endowment Fund.

In March 2020, life as Michiganders knew it changed. Shut-downs, social distancing, masks, and quarantines turned simple routines upside down. Shortages and job losses hit the most vulnerable hard. Some businesses closed for good. Worst of all was the loss of life – especially among families of color.

Despite the tragedy, COVID-19 in Michigan is also a story of people rallying, innovating, protesting, and collaborating to meet needs for food, housing, medical care, education, and equity — and in the process making change that will hopefully move the state forward towards a better future for all. Over the past year, Second Wave Media's State of Health series has covered many of these efforts – and in this special report concluding our past year of coverage, we're taking a look back at how COVID-19 has changed health care in Michigan for the better.

Michigan's first responders, educators, food systems, and health care systems turned on a dime. Virtual became the new reality. State government not only mandated safety measures but also issued executive orders addressing the systemic racism that was putting people of color at higher risk. A deadly virus was in the air, but so was change. 

Telehealth comes into its own

By May of 2020, telehealth use had surged in Michigan with tremendous benefits. Health care visits conducted by phone or videoconference became the safest way for both behavioral health and medical care providers to meet with their patients, including those served by the Michigan Department of Health and Human Services (MDHHS).

"Before, telehealth was very limited, mainly in rural areas. Now it is available for the majority of services we provide in the public system," says Pam Werner, manager of MDHHS recovery-oriented systems of care. "When COVID-19 hit, our Michigan Medicaid expanded telehealth as a covered service for our population of people who could not leave their homes or did not feel safe going out."

Pam Werner.
Other examples include federally qualified health center (FQHC) Cherry Health, which was conducting more than 800 virtual visits a day in May. Auburn Hills-based Easterseals Michigan increased staffing for its behavioral telehealth programs for children and adults from 20 to 300. Grand Rapids-based Arbor Circle's mental health providers were handling 80% of their 4,000 open cases via phone and videoconference. Blue Cross Blue Shield of Michigan saw numbers of providers offering telehealth rise from 10% to 82%.

When the MDHHS rolled out a number of virtual mental health supports, the numbers were equally impressive. From April 2020 through March 2021, the Michigan peer warmline for people living with serious mental illness or substance use challenges received 23,585 calls. Another 1,627 people have used the Michigan Crisis Text Line. From May 2020 through March 2021, the Michigan Stay Well counseling line received 5,452 calls and Michigan's Stay Well website has recorded more than 170,000 views. From January through March 2021, 202 Michiganders attended virtual support groups for COVID-19 distress.

"We have a younger population that is very connected," Werner says. "I believe they are going to want to continue to get telehealth options."

While in-person health care visits remain necessary for certain health issues, those without access, or others who are uncomfortable with virtual care, the advent of virtual technologies has improved the delivery of health care and created new ways to address health care inequities. 
 
Michiganders' mental health: "Let's not go back under the rock"

When stay-home orders led to relaxed federal and state regulations that allowed mental health providers to use telehealth and virtual sessions with patients, providers wasted no time in taking advantage of that new flexibility — especially in the face of increasing numbers of children and adults struggling to cope with the mental health issues incubated by the pandemic.

"COVID-19 has had a significant impact on our behavioral health," says Kevin Fischer, executive director of the National Alliance on Mental Illness Michigan (NAMI). "We've seen an increase in mental health challenges across the board in all age groups and specifically for adolescents. This virtual learning environment has been very difficult. Social distancing and not being able to interact directly with friends has had an impact on young people's behavioral health. It's had an impact on stress and anxiety for their parents, specifically moms. We've seen a significant increase in substance use issues, and unfortunately, an increase in suicide attempts. There's going to be a long-term impact."

Kevin Fischer, executive director of the National Alliance on Mental Illness Michigan.
On the bright side, COVID-19 has brought mental health out into the open, reduced stigma around getting care, and made services more easily available through the expansion of virtual options.

"The emergence and acceptance of telehealth and teletherapy has been a very bright surprise. [People] are keeping appointments, sticking to their treatment plans more," Fischer says. "From the perspective of an advocate who recognizes that stigma is the leading barrier that prevents people from getting help, because so many people have been impacted in the last year, I think that stigma has been reduced to some degree. People are realizing, more and more, that either themselves, a child, or spouse are experiencing mental health challenges, and they are more willing to get that help."

Fischer warns that virtual mental health services are not a "silver bullet" for everyone — and has harsh words for payors who have cited telehealth as a reason to cut reimbursement rates.

"I hope we take what we've learned during COVID and continue to build on it, to build on the use of telemedicine, and build on the fact that you're not alone," he says. "Many people experience mental health crises and we need to encourage them to seek the help that they need. Let's not go back under the rock."

Michigan local food saves the day

The COVID-19 pandemic has also made it easier than ever for Michiganders to get nutritious, local food. When stay-home orders and social distancing measures prevented business as usual, Michigan farmers and farmers markets began offering sales online, expanding their customer bases. Farmers supplying restaurants shifted to offer community supported agriculture (CSA) shares. Disruptions in the supply chain highlighted the need for a stronger local food economy and inspired some farmers to sell meat, dairy, and produce directly to consumers. Food banks, food rescues, and charitable food pantries innovated to feed more Michiganders than ever before.

"Something we forget is that charity and emergency food organizations have power. When we use our financial resources to invest in the local food system, we are keeping that money local, supporting growers and producers who are also our neighbors, many of whom are interested in increasing people's access to fruits, vegetables, and fresh food," says Erin Skidmore, good food systems director for Access of West Michigan. "When we charitable and emergency food providers invest in local farms, it's saying a lot about how we value the people in our community."

Erin Skidmore, good food systems director for Access of West Michigan.
While COVID-19 strengthened Michigan's local food economy, it also uncovered the food system's racist roots. At the pandemic's onset, African-Americans living in neighborhoods without access to healthy food experienced disproportionate rates of COVID-19. Migrant and immigrant farm and food workers also saw alarming infection rates as they lacked the protections that most other frontline workers enjoyed.

"I would like to see less and less people reliable on a charitable food system that has been sustained for too long, especially for those who have been marginalized — our Black, brown, and Indigenous people," Skidmore says. "From a systems level, I would love to see people increasing their ability to grow their own food and having space to do that. I would love to see cities and the state support policies that increase available growing space and green space."

Equity makes the headlines

COVID-19 and last summer's uprisings in the wake of George Floyd's murder shone a spotlight on racism and inequity in the U.S. When Michigan Gov. Gretchen Whitmer established the Michigan Coronavirus Task Force on Racial Disparities in April 2020, Black people represented more than 29% of COVID-19 cases and 41% of COVID-19 deaths in Michigan, despite being only 15% of the state's population. Thanks in part to the task force's actions, they made up 8% of cases and 10% of deaths by the end of September.

"The data demonstrated that we saw a clear decline in disparities," says Renee Canady, CEO of the Michigan Public Health Institute and member of the task force's Equity Workgroup.

Renee Canady, CEO of the Michigan Public Health Institute and member of the task force's Equity Workgroup.
The task force's COVID-19 Testing Workgroup shifted test sites to neighborhood churches, community centers, and other trusted organizations where neighbors felt more comfortable, and sought to eliminate language and cultural barriers to make testing even more accessible.

"We did a rapid response initially in which we were able to fund numerous health systems, small nonprofits, and a variety of entities to carry out their mission and their vision," Canady says. "For some, it was food insecurity. For others, it was transportation to doctors' offices. Other organizations were dealing with a unique population, [people with] special learning needs, [people who are] visually impaired, or [people who speak] English as a second language."

Following the task force's recommendation, Whitmer signed an executive order in July requiring the state's licensed and registered health care professionals to complete implicit bias training.

"What it took to get us here, it will take to keep us here," Canady says. "We have to be vigilant in recognizing that not treating all people the same, but treating people based on their needs, is the way we eliminate inequities. The lessons learned through the task force will be important when we get back to business as usual."

Collaborations make it work

Equity has also been a common goal for many of the new collaborations health organizations have built to better serve Michiganders over the past year. In Washtenaw County, a collaboration among the 5 Healthy Towns Foundation (5HF), Michigan Medicine, St. Joseph Mercy Chelsea Hospital, and Washtenaw County Community Mental Health is creating transformative upstream change to produce better health and well-being for all. Corrections and law enforcement agencies, behavioral health and medical providers, state of Michigan partners, philanthropic organizations, and social workers are collaborating to provide better options for Michiganders with opioid abuse disorders in eight Michigan counties. Collaborations among medical providers and Michigan's health departments have also streamlined response to the pandemic.

Ronald Taylor, president and CEO of the Detroit Area Agency on Aging (DAAA), says collaborations are at the heart of all of DAAA's work – and the pandemic pushed DAAA and other organizations to form even more partnerships. During the pandemic, collaborations with private donors increased the amount of meals served to older adults by 300%. Partnerships with Gleaners Community Food Bank, local restaurants, the U.S. Department of Agriculture, and local farmers literally brought more food to the table. State funding helped provide emergency meals and masks. And relationships with Community Wellness Service Centers kept agency staff in touch with the community.

"The resources and partnerships which came forward during COVID allowed us to effectively serve those who were in need and came from outside of our normal operations," Taylor says.  "These collaborations were critical in allowing us to meet the need that was created because of the pandemic. They allowed us to leverage resources and serve a larger number of individuals." 

Ronald Taylor, president and CEO of the Detroit Area Agency on Aging.
Taylor notes that the pandemic laid bare many disparities in Michigan's health system that had existed long before anyone ever heard of COVID-19. But he says he believes that change will force Michigan health organizations to continue working together to better address those systemic problems.

"It's like that old adage says, 'Two heads are better than one.' Effective collaborations really help leverage additional resources and expand the depth and width of the ability to respond and serve the community," Taylor says. "We are stronger and we are better when we do work together."

A freelance writer and editor, Estelle Slootmaker is happiest writing about social justice, wellness, and the arts. She is development news editor for Rapid Growth Media and chairs The Tree Amigos, City of Wyoming Tree Commission. Her finest accomplishment is her five amazing adult children. You can contact Estelle at Estelle.Slootmaker@gmail.com or www.constellations.biz.

Graphic design by Jermaine Dickerson.

Pam Werner and Renee Canady photos by Roxanne Frith. Kevin Fischer photo by Doug Coombe. Erin Skidmore photo by Adam Bird. Ronald Taylor photo by Nick Hagen.