Coronavirus Update for Detroit Michigan

My name is Dr. Paul Thomas and I'm a Family Medicine Doctor in Detroit, Michigan with Plum Health DPC and this is my update for the Coronavirus as of Saturday April 4th.

Which Counties Nationwide Have been Impacted the Most by Coronavirus?

From the perspective of the number of cases and the number of deaths, the following Counties have been impacted the most by the coronavirus:

• New York City (Queens, Bronx, Manhattan, Brooklyn, Staten Island)

• Wayne County, Michigan

• King County, Washington

• Orleans County, Louisiana

• Cook County, Illinois

• Oakland County, Michigan

• Bergen County, New Jersey

This comes from the Johns Hopkins Coronavirus Resource Center and it's notable that Michigan has two neighboring counties in the top 6 hardest hit counties - Wayne County and Oakland County.

What are the current number of cases and deaths from Coronavirus in Michigan?

Currently, there's 12,744 Coronavirus cases in Michigan and 479 deaths from the Coronavirus in Michigan. What's most troubling about this is the rapid and almost exponential growth of cases here in Michigan. We've seen cases doubling every 2 to 4 days, and that trend does not look like it's slowing down any time soon. That's why it's so crucial that we socially distance our selves to stop the spread of the coronavirus from person to person.

The alarming increase in new cases is also why the CDC now recommends face masks for individuals in the community.

Why Has Michigan and Southeast Michigan Been Hit So Hard by the Coronavirus?

Bridge Magazine wrote an excellent article on this and I agree with their assessment with one addition that we haven't been talking about.

In the article, Bridge Magazine talks about the following factors causing Michigan to be more susceptible to the virus:

• Automotive trade with suppliers in Wuhan China

• Detroit Metro Airport with Direct Flights to Wuhan, China

• Michigan’s March 10th Presidential Primary

• Ties between Detroit and Italy via Fiat Chrysler (FCA)

In addition to these factors, I would want to add a few others, including higher rates of overweight and obesity in Detroit and Michigan - rate of overweight is 47.5% in Detroit (34% in NYC) and rate of obesity is 34.6% in Detroit (22% in NYC).

All of these factors have lead to a higher case fatality rate here in Detroit and Michigan than the national case fatality rate:

• National Case Fatality rate is 2.47%

• Michigan Case Fatality rate is 3.75%

• Detroit Case Fatality rate is 3.29%

What are the Comorbid Conditions Increasing the Risk of Mortality in Covid-19 positive patients?

This week, I spoke with a physician colleague at one of the nearby regional hospital systems and we discussed the conditions that lead to a higher mortality rate. These comorbid conditions are as follows:

• Cardiovascular disease (High blood pressure)

• Diabetes

• Pulmonary Disease

• Obesity

• Cancer

These factors that we discussed were similar to those studied in Wuhan China.

Why are African Americans disproportionately affected by Coronavirus?

African Americans in Detroit and Michigan have been disproportionately affected by the coronavirus. Even though African American people make up only 13.8% of the population in the State of Michigan, 35% of the Coronavirus cases and 40% of the Coronavirus deaths have been experienced in the African American community.

Coronavirus Cases by Race in Michigan. This according to Michigan.gov/Coronavirus. Note the higher rates of infection and mortality in the African American community relative to the population. African Americans make up 13.8% of the population in the State of Michigan.

While it’s still too early to state exactly why this is the case, I have a few theories. First, African American folks have higher rates of diabetes, hypertension, and obesity than their white counterparts here in Detroit and in Michigan. As we stated above, these are risk factors for higher mortality from the Coronavirus. Next, African American people may be more likely to depend on low and minimum wage jobs that put them at a higher risk of contracting the Coronavirus.

What is the Hospitalization Rate for Covid-19?

Currently, the hospitalization rate for Covid-19 is about 20% or only 1 in 5 people who get the coronavirus will require hospitalization. However, the rates of hospitalization increase with age, meaning that the older the patient, the more likely that they’ll need to be hospitalized for the Coronavirus. That’s why it’s so important to avoid visiting elderly and vulnerable residents in our community.

The older the patient, the more likely it is that they’ll require hospitalization for management of their Coronavirus infections.

Unfortunately, there is a very high mortality rate once a patient needs to be placed on a ventilator. According to studies out of Wuhan, China, the Mortality rate from Coronavirus is 62% among critically ill patients with COVID-19 and the Mortality rate from Coronavirus is 81% among those requiring mechanical ventilation. That means that if you require mechanical ventilation, only 1 in 5 Covid-19 positive patients will come off of the ventilator.

Limited Availability of Ventilators in Michigan Hospitals

The rapid increase in the number of coronavirus patients and the increasing demand for ventilators is putting hospitals, doctors, and nurses in a terrible situation. We’ve now reached the point where doctors are having to decide who lives and who dies from Coronavirus based on ventilator availability. I spoke with a colleague at a large hospital in the Detroit area who relayed that there were only two ventilators for the hospital remaining and that treatment decisions were being made based on comorbidities.

This is a very sad day because we should have never gotten to this point. If we had a functioning Federal Government with a coordinated response and if we had forward-thinking hospitals with greater capacity for disasters like this, we in the medical community wouldn’t have to be making these terrible life and death decisions based on lack of supplies and equipment.

Should I Wear a Mask to Prevent the Spread of the Coronavirus?

Yes, the CDC now recommends that all Americans wear a mask when in a place where they have a higher chance of contracting the Coronavirus, like grocery stores. This can be a cloth or fabric mask. Please wash these each day if you wear them. Please do not horde surgical or N95 masks as these are needed at hospitals at this time.

What can you do to slow down the Coronavirus?

• Stay at home

• Donate extra supplies to hospitals or your primary care doctor’s office

  • Unused N95 Masks

  • Unused Nitrile Gloves

• Donate Blood

• DO NOT congregate in large groups

• DO NOT visit elderly or vulnerable relatives, even if you feel fine

• Act as though you have the virus

Thanks for reading and watching, and have a wonderful day,

-Dr. Paul Thomas with Plum Health DPC