St. Clair County FAQs

As of 11.3.21

Legal Questions Answered by Fletcher Fealko Shoudy & Francis, P.C.

Learn more here.


Testing

Are rapid tests one of the tests used to positively identify those with COVID-19? I heard that the rapid tests are highly inaccurate and unable to differentiate between the flu and COVID-19.

While molecular tests (PCR tests) remain the gold standard when identifying COVID-19 cases, rapid tests (antigen tests) are FDA authorized and remain an important tool in augmenting testing efforts, especially in settings where molecular testing is limited or testing results are delayed. Depending on the symptoms present in the patient and knowledge of a recent exposure, a confirmatory PCR may be administered within 48 hours after a rapid test is done.

Furthermore, the sensitivity of antigen tests varies but is generally lower than most laboratory-based molecular tests. A highly sensitive test means that there are few false negative results, and thus fewer cases of disease are missed. The specificity of a test is its ability to designate an individual who does not have a disease as negative. The antigen level in specimens collected either before symptom onset, or late in the course of infection, may be below the tests’ limit of detection. This may result in a negative antigen test result, while a more sensitive test, such as most molecular tests, may return a positive result. Studies have shown that antigen tests have comparable sensitivity to laboratory-based molecular tests when viral load in the specimen is high and the person is likely to be most contagious. What this means is that the antigen tests are most likely to result in a FALSE negative test when the person is actually positive, especially when there is a high probability of the person having that disease (like during a High level of community transmission).

The specificity of antigen tests is generally as high as most molecular tests, which means that false positive test results are unlikely when an antigen test is used according to the manufacturer’s instructions. Despite the high specificity of antigen tests, false positive results will occur, especially when used in communities where the prevalence of infection is low – a circumstance that is true for all in vitro diagnostic tests. In general, for all diagnostic tests, the lower the prevalence of infection in the community, the higher the proportion of false positive test results.

Finally, rapid COVID-19 tests can distinguish between the COVID-19 virus and the flu.

Learn more here.

Does the St. Clair County Health Department do rapid COVID-19 testing for those that want to travel?

Due to limitations in testing supplies, the St. Clair County Health Department has suspended COVID-19 Rapid PCR testing for Canadian and other travelers. No new appointments or walk-ins will be accommodated.

A complete list of COVID-19 testing locations can be found here.


Vaccine

If someone who is vaccinated can pass, carry, and show symptoms, what is the point of getting the shot?

From the CDC’s discussion of vaccine breakthroughs, COVID-19 vaccines protect people against severe illness, including disease caused by Delta and other variants circulating in the U.S.

  • COVID-19 vaccines protect people from getting infected and severely ill, and significantly reduce the likelihood of hospitalization and death.

  • The best way to slow the spread of COVID-19 and to prevent infection by Delta or other variants is to get vaccinated.

  • For people who are vaccinated and still get infected (i.e., “breakthrough infections”), there is a risk of transmission to others. That is why, if you are vaccinated or unvaccinated and live or work in an area with substantial or high transmission of COVID-19, you – as well as your family and community – will be better protected if you wear a mask when you are in indoor public places.

  • People who are immunocompromised may not always build adequate levels of protection after an initial 2-dose primary mRNA COVID-19 vaccine series. They should continue to take all precautions recommended for unvaccinated people, until advised otherwise by their healthcare provider. Further, CDC recommends that moderately to severely immunocompromised people receive an additional dose.

Is it safe for me to get a COVID-19 vaccine if I would like to have a baby one day?

Yes. COVID-19 vaccination is recommended for everyone 12 years of age and older, including people who are trying to get pregnant now or might become pregnant in the future, as well as their partners. Currently, there is no evidence that any vaccines, including COVID-19 vaccines, cause infertility problems in women or men.

Learn more here.

Why should I trust that the vaccine is safe when it was developed so quickly?

FDA approves a vaccine for use only if it is proven safe and effective, after clinical trials have been conducted with thousands of people, and when its benefits outweigh any risks. The COVID-19 vaccine builds on years of scientific research and an unprecedented level of scientific investment and cooperation. Every study and every phase of every trial was carefully reviewed and approved by a safety board and the FDA. The process was transparent and rigorous throughout, with continual oversight and expert approval.

The identification of what is approximately a less than 2-in-a-million risk of a blood clotting disorder associated with the Johnson & Johnson vaccine is a sign that the nation’s safety monitoring system for COVID-19 vaccines is working. After any vaccine is successful in clinical trials and authorizes it for use, the FDA continues to monitor it for safety. The pause in the use of the J&J vaccine allowed scientists to evaluate each incident of the clotting disorder. They determined that the level of risk was very low and that the benefits of continued use of the J&J vaccine greatly outweigh any risk associated with it.

The likelihood of a medically significant reaction is extremely low. Temporary side effects like soreness, headaches, or a mild fever are signs that the body is responding and building an immunity to the virus. They typically go away in a day or two.

Learn more here.

How can I be sure the long-term side effects of the vaccine won’t be worse than having COVID-19?

The threat of COVID-19 is real and urgent, and the benefits of getting vaccinated far outweigh any risks. The risk of severe adverse events after any COVID-19 vaccination remains very low, and far lower than the risk of adverse health outcomes associated with contracting COVID-19. More than 600,000 people in the U.S. and millions worldwide have died from COVID, and we’re still learning about “long COVID” — symptoms and adverse health outcomes that continue to impact people long after the initial infection.

Learn more here.

What does it mean that the Pfizer vaccine has full FDA approval?

On August 23rd, the FDA issued full approval to the Pfizer COVID-19 vaccine, now known as Comirnaty. The vaccine has been fully approved for use in individuals age 16 and older, with a two-dose regimen spaced at least three weeks apart. The full approval by the FDA means that the Comirnaty vaccine now has the same level of approval as other vaccines routinely in use in the U.S., such as vaccines for hepatitis, measles, chicken pox, and polio.

On top of the rigorous testing and trials that went into Emergency Use Authorization of the Pfizer vaccine, the FDA analyzed additional and follow-up data from the ongoing clinical trial to determine the safety and effectiveness of Comirnaty, including:

  • The analysis of effectiveness data from approximately 20,000 vaccine recipients and 20,000 placebo recipients age 16 and older, which found that overall, the vaccine was 91% effective, with 77 cases of COVID-19 occurring in the vaccine group and 833 COVID-19 cases in the placebo group.

  • The analysis of safety data in approximately 22,000 vaccine recipients and 22,000 placebo recipients age 16 and older. More than half of participants were followed to monitor safety for at least four months after the second dose; approximately 12,000 vaccine recipients have been followed for at least 6 months.

  • Rigorous evaluation of safety surveillance data regarding myocarditis and pericarditis. Data demonstrated an increased risk for vaccine recipients, which was higher in males under 40, particularly males 12-17. Comirnaty prescribing information will include information about this risk, and in addition to these analyses, the FDA is requiring the company to conduct postmarketing studies to further assess the risks of myocarditis and pericarditis in vaccinated individuals. It is important to note that reports of these complications are rare, and most patients who received care responded well to treatment.

The vaccine also continues to be available for adolescents age 12 through 15 and for the administration of a third dose to specific populations.

Learn more here.

What is the difference between emergency use authorization and full approval?

Emergency Use Authorization (EUA) allows the FDA to authorize the use of yet to be approved drugs, or unapproved uses of approved drugs, for life-threatening conditions when there are no other adequate, approved, and available options and other conditions are met. In the case of COVID-19, the FDA issued EUAs for the Pfizer, Moderna, and Johnson & Johnson vaccines, and has now issued full approval for the Pfizer COVID-19 vaccine, now known as Comirnaty.

In an emergency when lives are at risk, like a pandemic, it may not be possible to have all the evidence that the FDA would usually have before approving a vaccine or drug. If there’s evidence that strongly suggests that patients have benefited from a treatment, the agency can issue an EUA to make it available. For the COVID-19 vaccines, FDA required two months of safety and efficacy data before the EUA was granted. That included clinical trials with tens of thousands of people and rigorous testing and review, and all the vaccines continue to be closely monitored. Compared to emergency use authorization, FDA approval of vaccines requires even more data on safety, manufacturing, and effectiveness over longer periods of time and includes real-world data.

Learn more here.


Masks

How effective are face masks in preventing the spread of COVID-19?

Because COVID-19 spreads from person to person via respiratory droplets, properly wearing a mask helps prevent the spread of the virus to others, including those at a higher risk of severe illness, especially when paired with other prevention tactics such as proper social distancing and frequent hand washing.

Learn more here.

Do masks raise your Carbon Dioxide (CO2) level?

Cloth masks and surgical masks do not provide an airtight fit across the face. The CO2 escapes into the air through the mask when you breathe out or talk. CO2 molecules are small enough to easily pass through mask material. In contrast, the respiratory droplets that carry the virus that causes COVID-19 are much larger than CO2, so they cannot pass as easily through a properly designed and properly worn mask.

Learn more here.


Isolation/Quarantine

What is the difference between isolation and quarantine?

Isolation and quarantine help protect the public by preventing exposure to people who have or may have a contagious disease.

  • Isolation separates sick people with a contagious disease from people who are not sick.
  • Quarantine separates and restricts the movement of people who were exposed to a contagious disease to see if they become sick.

Learn more here.

Why do vaccinated children not have to quarantine when exposed if they can still get sick and transmit the virus?

The data show that those who are vaccinated are much less likely to get sick with COVID-19. In instances of a breakthrough infection, including individuals infected with the Delta variant, those who are both vaccinated and unvaccinated can still transmit the virus. Like other variants, the amount of virus produced by Delta breakthrough infections in fully vaccinated people goes down faster than infections in unvaccinated people. This means fully vaccinated people are likely infectious for less time than unvaccinated people.

**Any fully vaccinated person who experiences symptoms consistent with COVID-19 should isolate themselves from others , be clinically evaluated for COVID-19, and tested for SARS-CoV-2 if indicated. The symptomatic fully vaccinated person should inform their healthcare provider of their vaccination status at the time of presentation to care.

Learn more here.


Data

Have the death tolls for COVID-19 been inflated?

COVID-19 remains a serious threat to public health, and there is no evidence that the reported number of COVID-19 deaths has been inflated. The CDC has tracked and reported COVID-19 fatalities from the start of the pandemic, with detailed data from the local and state level that originates with each individual death certificate. In fact, experts agree that the number of COVID deaths are probably undercounted because not everyone with COVID will have been tested and diagnosed.

The CDC’s report also gives a detailed account of something we’ve known since the beginning of the pandemic – having pre-existing conditions like diabetes, heart disease, or obesity greatly increases a person’s risk for life-threatening consequences from the infection. We also know that COVID-19 deaths can be caused by related complications, such as pneumonia or respiratory distress. The high rate of chronic illness in the U.S. (6 in 10 adults have a chronic disease) has contributed to the high number of COVID-19 deaths, but it is important to remember that even people with pre-existing conditions may have lived years longer if they had not been infected with COVID-19. For that reason, the cause of these deaths is COVID-19.

**St. Clair County data is obtained from the Michigan Disease Surveillance System. This data is provisional.

Learn more here.

Out of the kids who were quarantined during the 2020/2021 school year due to being a close contact of an infected individual, how many showed symptoms or tested positive?

Since the beginning of the pandemic there have been 2,539 cases of COVID-19 among individuals ages 0-18 years old per data as of 9/13/2021. Of those cases, 1,495 cases have a completed case investigation and 645 individuals or 43.1% of cases with a completed investigation reported that they were in quarantine when they became positive for COVID-19. Of the 1,495 cases with a completed case investigation, 1,258 individuals or 84.1% reported having COVID-19 symptoms.

It is unknown how many kids have been quarantined over the last year. The health department identifies close contacts by conducting case investigations but many case investigations were incomplete due to being unable to contact individuals, refusals to participate in the case investigation, or other factors such as high volumes of new cases. Even in cases where a case investigation was completed the individual my refuse to provide close contacts or be unaware of close contacts.

How many athletes tested positive in our county last year? Of those who were identified as close contacts of an infected individual, how many tested positive from this exposure.

Over the last school year the St. Clair County Health Department is aware of over a dozen outbreaks associated with sports teams with 93 known cases of COVID-19 associated with those outbreaks. It is unknown how many individuals were exposed.

How many deaths in the county were "with" or "from" COVID-19?

The death data posted by the Health Department is accurate and is the same data posted by MDHHS. It’s important to note that just because an individual was diagnosed with COVID-19 and died does not mean they are reported as a COVID-19 death. For example, an individual that is positive for COVID-19 but dies from a traumatic cause such as a car accident would not be counted as a COVID death. The criteria for a confirmed/probable death are:

Confirmed Deaths:

  • Confirmed cases of COVID-19 in the Michigan Disease Surveillance System (MDSS) that have been marked as deceased as identified through case investigation.

  • Decedents with a death certificate that lists a COVID-related term (in Part I or II) that are Confirmed cases in MDSS, but were not yet marked as deceased in MDSS.

  • Decedents with pending causes of death that are Confirmed cases in MDSS, but were not yet marked as deceased in MDSS.

  • Decedents with death certificates that do not specifically list a COVID-related term (in Part I or Part II) that are Confirmed cases in MDSS, but were not yet marked as deceased in MDSS IF they died within 30 days of symptom onset (or referral date if symptom onset not available) AND died in a manner of death deemed to be ‘natural’ on the death certificate.

Probable Deaths:

  • Death certificates that list a COVID-related term (in Part I or II) where there is no available evidence of a confirmatory test result (positive or negative).

These criteria are also posted on the “LEARN MORE” tab of the MDHHS COVID-19 Dashboard here.

How many of the COVID positive deaths in SCC also had underlying issues or contributing factors to the death?

This is a complicated question because we know that we do not have a complete picture of the underlying issues of all of our COVID-19 deaths and how those underlying issues contributed to the individual’s death. Based on the data that we currently have, approximately 12% of COVID-19 deaths had either no preexisting conditions or they had low risk underlying issues, such as individuals with controlled high blood pressure and no other medical issues. The CDC has good information on underlying medical conditions and COVID-19 deaths (link below). Per the CDC, age is the strongest risk factor for severe COVID-19 outcomes and the number of underlying medical conditions an individual has the greater their risk for severe disease.

Learn more here.

How many people who are testing positive now are fully vaccinated?

Between 6/1/2021 and 10/23/2021 there were 594 fully vaccinated St. Clair County residents that tested positive for COVID-19. During the same time period there were 3,270 unvaccinated St. Clair County residents that tested positive for COVID-19. As the number of people fully vaccinated differs from those unvaccinated we calculated a rate per 100,000 people to better compare the rate of new infections in both groups

Full vaccinated: 830 cases per 100,000 people
Unvaccinated: 3,734 cases per 100,000 people

Between 6/1/2021 and 10/23/2021 we had a significant difference in death rates among fully vaccinated and not fully vaccinated individuals. Below is the age-adjusted rates for each group.

Full vaccinated: 15.3 deaths per 100,000 people
Unvaccinated: 93.0 deaths per 100,000 people

All rates are per 100,000 people and age-adjustment was computed by the direct method, using the population of St. Clair County as the standard. The data in this report is provisional.

Helpful Resources:

Why aren’t natural antibodies being used in heard immunity numbers?

The science and technology of antibody detection, quantification, typing and the portative factors of these variables are still very fluid and unreliable. Further, natural immunity can be spotty. Some people can react vigorously and have a great antibody response, while others will not. Vaccine-induced immunity is more standardized and can be longer-lasting.

SCCHD and MDHHS follows CDC guidance in encouraging all eligible individuals to get vaccinated, including those who have had previous covid-19 infection.

The CDC states that:

“Antibody testing is not currently recommended to assess the need for vaccination in an unvaccinated person or to assess for immunity to SARS-CoV-2 following COVID-19 vaccination. Antibody tests currently authorized under an EUA have variable sensitivity, specificity, as well as positive and negative predictive values, and are not authorized for the assessment of immune response in vaccinated people. Furthermore, the serologic correlates of protection have not been established, and antibody testing does not evaluate the cellular immune response, which may also play a role in vaccine-mediated protection.

If antibody testing was performed following vaccination, additional doses of the same or different COVID-19 vaccines are not recommended based on antibody test results at this time. If antibody testing was done after the first dose of an mRNA vaccine, the vaccination series should be completed regardless of the antibody test result.”

Additional resources on testing:

CDC guidance:
Interim Guidelines for COVID-19 Antibody Testing | CDC

FDA: (Discusses both after vaccination and for non-vaccinated populations)
Antibody Testing Is Not Currently Recommended to Assess Immunity After COVID-19 Vaccination: FDA Safety Communication | FDA

For patient education, you can find some wording about vaccination for people who have had previous infection here:
Test for Past Infection | CDC

COVID-19_Vaccine_Public_FAQ_FINAL_710077_7.pdf (michigan.gov)

See also here under “If I have already had COVID-19 and recovered, do I still need to get vaccinated with a COVID-19 vaccine?”
Frequently Asked Questions about COVID-19 Vaccination | CDC

And here under “Natural immunity versus vaccine immunity”
Answering Patients’ Questions about COVID-19 Vaccination | CDC

Remember, the difference between vaccination and natural infection is the price paid for immunity.

How are the reported new cases being identified?

Case referrals may come from health care providers, local health departments, laboratories, Quarantine Stations, or from contact tracing systems (such as OMS or TraceForce).

Learn more here.


Treatments

What is monoclonal antibody therapy and who is eligible to receive it?

Monoclonal antibodies are laboratory-made proteins that mimic the immune system's ability to fight off harmful pathogens such as viruses.
The therapy is available upon request from a physician and must be administered within 10 days after a COVID-19 diagnosis.

The drug is the most effective when it is administered early in the infection. Those who test positive for COVID-19 should contact their primary care doctor as soon as possible to ask about the medication.

Learn more here.

If you get COVID-19, is ivermectin or hydroxychloquine an approved treatment?

Neither Ivermectin or Hydroxychloquine are FDA approved treatments for COVID-19.

For context, ivermectin is a medication used to treat onchocerciasis (river blindness) and intestinal strongyloidiasis. Topical formulations are used to treat head lice and rosacea. ivermectin is also used in veterinary applications to prevent or treat internal and external parasitic infections in animals. When used in appropriate doses for approved indications, ivermectin is generally well tolerated. During the COVID-19 pandemic, ivermectin dispensing by retail pharmacies has increased, as has use of veterinary formulations available over the counter but not intended for human use. FDA has cautioned about the potential risks of use for prevention or treatment of COVID-19.

Hydroxychloroquine is used to treat autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis, in addition to malaria. On July 8 2021, The National Institutes of Health (NIH) COVID-19 Treatment Guidelines Panel recommended against the use of hydroxychloroquine for the treatment of COVID-19 in hospitalized and nonhospitalized patients.


Miscellaneous

I’m tired of pandemic restrictions — isn’t it time we move on?

We understand that people are tired, but public health measures are not the enemy — they are the roadmap for a faster and more sustainable recovery. The pandemic has posed so many hardships, from the loss of loved ones, to job loss, to loneliness, to parenting in the context of virtual schooling. We’ve made progress in putting the pandemic behind us, but we risk the health of our communities and our economy if we declare victory too soon, particularly in the light of the high degree of contagiousness of the delta variant.

Many communities have made tremendous progress in protecting ourselves and our loved ones from COVID-19, but vaccination rates are still lagging. After months of decreasing in many places, COVID cases are increasing across the country, with infection rates highest in places where vaccination rates are low. The delta variant is roughly twice as contagious as the initial strain and is now the dominant strain in the U.S. and worldwide. Because of how contagious this variant is, it’s more important than ever for eligible adults and adolescents to get vaccinated, and for unvaccinated people to continue wearing a mask in public settings.

We’re all looking forward to a time when we can do all the things we love safely, and the way we get there is by getting vaccinated and following local guidelines.

We have been averaging around 10% of hospital beds being used for COVID, is that not an acceptable number? What percentage of beds used for COVID would be unacceptable and causing an unmanageable burden on our local hospitals?

This is a difficult question to answer as there are many variables to consider when talking about hospital capacity. Most hospitals have the ability to reroute resources and make additional beds available in times when there is a significant need. Meaning the number of beds available does not stay stagnant, and can change over time. However, those rerouted resources can still have an impact on community care as planned surgeries, screenings, and treatments could be delayed as a result.

Additionally, in order to care for people in those beds, hospitals and other medical facilities need staff. Each of our hospital systems have reported a shortage of nurses and other necessary personnel. Employees at those facilities also have frequent exposures to those with the virus and, if unvaccinated, may need to quarantine which can significantly impact the hospitals ability to accept and treat patients.

*In the event that the healthcare system cannot handle an influx of patients from the virus, they may resort to a “Crisis Standards of Care” which allows health systems to prioritize patients for scarce resources, based largely on their likelihood of survival, and even deny treatment. The decisions would affect both COVID and non-COVID patients. At this time, Alaska and Idaho have activated their “Crisis Standards of Care”, with some providers in Montana following suit. Hawaii’s governor has released health care workers from liability if they have to ration care.

Has the COVID-19 virus never been isolated?

SARS-CoV-2, the virus that causes COVID-19, has been isolated in a laboratory and is available for research by the scientific and medical community.

Learn more here.


Helpful Links

Local Data Dashboard
MI Safe Start Map
CDC COVID Data Tracker
Local School Guidance