On Wednesday, September 16, the Michigan Department of Health and Human Services released Interim Local Health Department and School District Guidance for Increasing and Decreasing Intensity of In Person Instruction in Michigan School Districts, a non-binding decision making guidance document to support to local health departments "in advising school districts of public health risk while making decisions about opening/reopening schools." The document outlines a four step process for collecting data and applying a decision-making matrix.

While the "determination concerning the method for delivering pupil instruction remains with the district" as provided in MCL 388.1698a(1)(g), it is worth understanding the broad strokes of the process outlined in the MDHHS guidance document. If you find yourself in a position of needing to make a decision about closing, reducing student density, or reopening schools, we strongly recommend closely reviewing the whole document (warning, the font is tiny), but here's a quick overview...

The Four Step Process

Step 1: Determine what phase the region is in and what learning modalities are permitted.
As a reminder, here are the phases and the modalities permitted during each:
Phase 5: Schools open for in‐person instruction with moderate required safety protocols
Phase 4: Schools open for in‐person instruction with more stringent required safety protocols
Phase 1‐3: Schools do not open for in‐person instruction and instruction is provided remotely

Step 2: Local health department identifies the County Risk Level.
There are six risk levels and the risk level is determined at the county level (not the MERC region level) using a combination of cases per million residents and the percentage of positive tests. These are the same risk levels used on MISafeMap.org (low, medium, medium-high, high, very high, and highest) and – according to the guidance document – the risk level identified on that map is the default risk level for the county.

Step 3: Determine school building and district spread indicators.
The local health department works with the local district to determine whether there are any known cases among staff or students and whether there is any evidence of ongoing transmission. "Ongoing transmission in a building is defined as multiple cases (3 or more) among students or staff with onsets within a 14‐day period, who are epidemiologically linked, do not share a household, and were not identified as close contacts of each other in another setting during standard case investigation or contact tracing."

Step 4: Use the matrix.
The local health department applies the data from steps 1-3 to the sample matrix (see below).

The Matrix

The sample matrix provided by MDHHS has several footnotes, denoted by letter and reproduced below the image of the matrix. We've linked the image below to a full sized version so you can pull it up separately and zoom in. We acknowledge that reading this matrix will be a challenge on a mobile device.

MDHHS School Decision Matrix

Notes:
(A) The guidance in these columns is for consideration by the local health official and school superintendent. School district may take into account operational factors, such as staff and student absenteeism, to make decisions about level of instruction.
(B) The epidemiologic risk level indicator from MiSafeMap.info is the default County Level Risk Determination as described in Step 2 above.
(C) Work with local health department on contact tracing; appropriate closure for cleaning and disinfection
(D) Work with local health department to consider short suspension of in person instruction (2‐5 days) in the building or affected portion of building to ensure contact tracing and determine if ongoing transmission. Review mitigation measures and strengthen if any gaps in implementation are identified.
(E) Work with local health department to consider up to a 14‐day suspension of in‐person instruction in building or affected portion of building to break transmission. Review mitigation measures and, address gaps in implementation and strengthen mitigation measures where possible.