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Coronavirus magnifies Detroit’s racial, socioeconomic disparities

Greektown, a popular casino and restaurant area of Detroit, sits deserted during evening rush hour on April 6, 2020.

Michael Wayland / CNBC

The streets of downtown Detroit are desolate. Its factories are shuttered. A city that for the first time in a lifetime was showing strong signs of a resurgence has been brought to a standstill due to the coronavirus pandemic. 

While the Motor City is known for its toughness and grit, it also has widespread poverty, which makes it harder for many residents to get the health care and medications they need. Despite a thriving downtown for the first time in decades, Detroit’s rapid rise as a nationally recognized hot spot for the pandemic has magnified the city’s racial and socioeconomic inequities and made the jobs of doctors and nurses caring for patients with COVID-19 more complex.

Hot spot

There are roughly 1,400 new coronavirus cases in the Detroit metro area every day, White House officials said Wednesday. Roughly 26{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f} of residents who get tested for COVID-19 are positive. President Donald Trump cited Detroit, New Orleans and other metropolitan areas as hot spots where coronavirus cases “started low and slow” before shooting up. The cause of the outbreak in Louisiana is pretty obvious; cases started to rise shortly after Mardi Gras. But the reasons cases have started to skyrocket in Detroit are far different, and they break down along race and economic lines. 

“They don’t have a lot of access to health care under good circumstances,” said Dr. Howard Markel, a professor of the history of medicine at the University of Michigan. There are more marijuana dispensaries in Detroit than pharmacies, he said. “That says a lot.”

Many of the coronavirus patients in Detroit already had serious health conditions before becoming infected, making their chances of survival all the more grim. A handful of doctors and nurses who spoke to CNBC described dire scenarios as coronavirus cases in the Detroit-area have climbed and resources — from employees to personal protective equipment and ventilators — grew scarce

“We know that if things continue to go in the same direction, there is going to be a point where we do have to start selecting who gets the ventilator,” said one resident of internal medicine at Henry Ford Health Systems in Detroit. He said the hospital is constantly evaluating policies and protocols in an attempt to avoid such a scenario.

Dr. Steven Kalkanis, CEO of Henry Ford Medical Group, on Thursday told reporters that COVID-19 cases are projected to “peak in the next few days” in Detroit. 

The hospital has deployed between 300 and 400 employees in areas they don’t typically work to handle the influx of COVID-19 patients, he said. And they’ve had luck in getting more patients off ventilators, freeing up the life-saving device that’s in short supply across the U.S.

With more than 21,500 confirmed cases, including at least 1,076 fatalities, Michigan ranks third in the U.S. for COVID-19 cases, only trailing New York and New Jersey. Metro Detroit accounts for a vast majority of those cases, led by nearly 6,100 confirmed cases and at least 275 fatalities in the city, according to the Michigan Department of Health and Human Services.

Racial disparities

Black people make up about 14{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f} of Michigan’s population, but 33{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f} of its coronavirus cases and 40{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f} of all COVID-19 deaths, according to state health data and the most recent U.S Census Bureau. In Detroit, African Americans comprise 75{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f} of all coronavirus fatalities, according to the city’s health department. 

“The African American community is being hit and destroyed by this disease,” U.S. Rep. Brenda Lawrence, D-Mich., said during a press conference with Detroit Mayor Mike Duggan on Thursday. “The black community must step up more than anyone else because we are being attacked at an unprecedented level.”

Earlier in the day, Michigan Gov. Gretchen Whitmer announced a coronavirus task force to address how the coronavirus has impacted the African American community. 

Prior to the announcement, Henry Ford officials disputed that Detroit’s poverty and racial and socioeconomic disparities contributed to the city’s rise as a hot spot. They cited the area’s international airport, the “resurgence of Detroit” and a dense population as reasons for the spread of the disease.

“I don’t think it’s because people aren’t observing stay-at- home policies or because there’s some innate problem with Detroit,” Kalkanis said.

Dr. Betty Chu, associate chief clinical officer and chief quality officer for Henry Ford, also cited the amount of COVID-19 cases in the “more affluent suburbs.”  

Kalkanis said hospital officials have spoken with Vice President Mike Pence who’s leading the U.S. coronavirus response at least twice this week, including discussing clinical trials being done by the hospital regarding malaria drug hydroxychloroquine as a preventative medication for COVID-19.

‘Bad days’ coming

Duggan this week said the pace of fatalities in the city is slowing, however on Tuesday he warned “really bad days” are ahead: “We’re going to lose a lot of our neighbors in the coming days.” He said the outbreak will get worse before it gets better, “but we can beat this if we keep doing what we’re doing.” 

Duggan, who ran the region’s largest health care provider the Detroit Medical Center for about eight years before running for mayor, cited the “racial health gap” and high rate of coronavirus cases among African Americans across the nation.

Markel described the city’s health-care system as “rudimentary, almost non-existent” compared to cities such as New York. More than a third of Detroit’s residents are living in poverty with a median income of $29,481 in Detroit, compared with $54,938 for the state, according to the most recent U.S. Census data. And many, Markel said, have pre-existing health conditions such as emphysema, heart disease and hypertension.

Hospitals in the city and tri-county area around Detroit have been inundated with coronavirus patients for weeks. They’re also running low on space and personal protective equipment, also known as PPE, to care for patients.

“We’ve got hospitals that are already at capacity, we don’t have enough personal protection equipment,” Whitmer said Sunday on Fox News Sunday, calling the state a “hot spot” that needs assistance.

The TCF Center in downtown Detroit, which will be used as a field hospital, displays messages of encouragement on a large video board outside of the convention center on April 6, 2020.

Michael Wayland / CNBC

The growth in cases in Detroit, which Whitmer doesn’t expect to peak for several more weeks, pushed the Federal Emergency Management Agency to take over Detroit’s largest convention center to create a field hospital that’s expected to begin housing COVID-19 patients this week.

Whitmer declared a state of emergency on March 10, when the state only had two confirmed COVID-19 cases. That was followed by a stay-at-home order on March 23.

Detroit is among the first cities in the U.S. to launch rapid testing kits for COVID-19 that produce results in about 15 minutes

Fears, long hours

Residents and nurses in the Detroit-area describe weeks of long hours and some fears of running out of protective gear as well as exposing themselves and their loved ones to the disease.

“It was generally a hectic day to begin with, but there wasn’t ever fear about patient care,” said a first-year medical resident at Henry Ford Health Systems in Detroit. “COVID came by so suddenly that people were afraid. Patients, staff, everyone was like ‘What’s going to happen?’ because generally our hospital runs pretty full to begin with.” 

The Henry Ford doctors, as well as other Detroit health-care workers who spoke to CNBC, requested anonymity because they did not have permission to speak to the media.

The main entrance to Henry Ford Hospital in Detroit, where hundreds of staff members have tested positive for COVID-19.

Michael Wayland/CNBC

Henry Ford is one of the hardest hit hospitals in the city — not just in the volume of cases, but in the number of staff members who have become sick with COVID-19. The hospital’s Dr. Chu said Thursday that 872, or about 2.5{3c4481f38fc19dde56b7b1f4329b509c88239ba5565146922180ec5012de023f}, of Henry Ford’s more than 31,600 employees throughout the system have tested positive for the disease. That’s in addition to more than 4,000 patients testing positive as of Wednesday. More than 700 remain hospitalized, according to the hospital. 

Henry Ford’s five-hospital system has 2,305 beds, including 877 at its Detroit location. 

Influx of cases

The influx of cases has changed the typical rhythms and routines of the hospital, the first-year medical resident said. Hospital leaders led demonstrations of how to safely take off protective gear, such as gowns, masks, gloves and eye shields. Team meetings at the hospital became virtual. Hospital visitors were prohibited. Hospital leaders told everyone, even in unrelated specialties, like neurology and psychiatry, that they’d be tapped to help with coronavirus care, especially since some doctors and nurses might have to quarantine themselves because of exposure or stay home as they became sick.

Initially, the hospital planned to dedicate a unit to COVID-19 patients, but as numbers kept growing, hospital floors usually dedicated to neurology or orthopedic care were opened up to coronavirus cases, the first-year resident said. Open clinics were converted into patient rooms, too.

The internal medicine resident at Henry Ford said the days have started to “blend together” but he has on average cared for five COVID-19 patients per day and more than 100 total, including “quite a few” who have died.

“A lot of them will, if they’re going to pass, do it in the ICU,” he said. “A couple of them haven’t made it there. A couple of them have come in and said they don’t want to be intubated.”

A man in a face mask and gloves walks from a bus depot in downtown Detroit amid the coronavirus pandemic on April 6, 2020. Much of the city’s downtown was vacant, during what would be rush hour traffic, however the public transit hub was one of the busier areas.

Michael Wayland / CNBC

Less than 10 miles away from Henry Ford at a Detroit Medical Center hospital, a group of night shift emergency room nurses and attending physicians reportedly staged a sit-in to demand more support to treat a surge of COVID-19 patients.

Health care workers said each nurse is single-handedly tending to 20 or more patients at a time and forced to continuously wear the same personal protective equipment for 24 hours, according to The Detroit News.

At hospitals outside the city, the circumstances aren’t much better. A registered nurse with Beaumont Health, the state’s largest hospital system, in suburban Royal Oak described unprecedented situations of reassignments, 60-hour work weeks and fears of contracting the disease, which many have.

The hunt for PPE

The hospital, in an email to CNBC, said it is taking measures to support its staff. Beaumont Health infectious disease specialist Dr. Nick Gilpin said Beaumont is “encouraged by improvements made to our PPE stock needs thanks to community donations and new vendors and suppliers.”

About 1,500 workers of the eight system’s 38,000 employees are not working because they have symptoms consistent with COVID-19, according to the hospital

Beaumont said it has cared for 4,456 coronavirus patients, including 3,390 patients who were discharged and 312 who died. It currently has 1,066 COVID-19 patients, according to data through Thursday afternoon. The hospital has more than 3,400 beds as of 2018, nearly a third of which are at its Royal Oak location.

Beaumont spokesman Mark Geary said the hospitals have more than three days of N95 masks and other medical gear on hand as of Wednesday. However, he said Beaumont continues to “need assistance from the state government, federal government and manufacturing community to continue to support the growing needs” for the supplies.

“We have a robust pipeline of orders in the queue that might or might not materialize,” he said in an emailed statement. “Also, no one knows when or if a surge will occur or how long we will need to treat large numbers of COVID-19 patients. Therefore, we are continuing to work with our current suppliers and more than 200 new suppliers, around the clock, to get more PPE.”

Slow the spread

Health care officials in Detroit are not alone in their sacrifice and efforts in the fight against COVID-19. Like many areas across the country, they are attempting to save lives while potentially risking theirs as well as their loved ones due to a lack of planning, supplies and knowledge about COVID-19.

Many of those who spoke with CNBC as well as other confirmed registered nurses and healthcare workers are pleading on social media with people to stay home to help slow the outbreak.

“Everybody should assume that you have it even if you don’t have symptoms,” said the internal medicine resident at Henry Ford.

He and others, including an employee at a suburban hospital for Henry Ford in Macomb County, described a “sense of community” and working for a greater cause when it comes to the coronavirus pandemic.

A street leading to General Motors’ world headquarters in downtown Detroit is vacant amid the coronavirus pandemic on April 6, 2020. The top of the main building is illuminated with a white ribbon to show support for healthcare workers.

Michael Wayland / CNBC

It’s “a lot of high stress,” said the employee at Henry Ford in Macomb County. That person was recently reassigned to work with coronavirus patients. “There is a sense of community with us. Good teamwork.”

The first-year resident at Henry Ford said he’s been amazed by how colleagues have stepped up and supported one another.

“Nobody signed up to be running a hospital or taking care of patients in a pandemic where the patient you are taking care of can influence the health of your family or your friends,” the first-year resident said. “Through all of this, there has been a sense that we all have each other.”

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