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

Coronavirus Update March 26th for Detroit Michigan: Can you be Immune to the Coronavirus?

Coronavirus Update March 26th for Detroit Michigan

The Coronavirus continues to spread in Michigan. As of today at 2 pm, the Michigan Department of Health and Human Services has reported that there have been 60 deaths and 2,856 cases. That is a mortality rate of 2.1% as of today.

The Coronavirus is concerning for so many reasons, but the two biggest reasons are the rate of transmission and the mortality rate. The Coronavirus spreads, on average, to 2.5 to 2.9 people once an individual is infected. Also, the global mortality rate has been in the 3 to 4% range. Compared to the Flu, these numbers are staggering. The Flu has a rate of transmission of 1.3 and a mortality rate of 0.1%. That makes the Coronavirus 30 to 40 times more deadly than the flu.

Below are the number of cases by Health Department here in Michigan and the number of deaths by Health Department. Detroit is within Wayne County, but it has its own health department, so those numbers are separate from Wayne County Cases.

How Many People Have Tested Positive and How Many People Have Tested Negative?

The State of Michigan today released their data regarding positive tests and negative tests.

• 30 of 744 outpatient tests have been positive, or a rate of 4.03% at the doctor’s office

• 1866 of 5261 hospital-based tests have been positive, or a rate of 35.4% at the hospital

• 557 of 3104 health department cases have been positive, or a rate of 17.9% at the health department

This tells us that if you’re well enough for your doctor to test you at the office and send you home, you are unlikely to have the Coronavirus. It also tells us that if you’re sick enough for your doctor to direct you to the hospital and you meet the testing criteria at the hospital (fever, cough, potential exposure), then you have a good chance of testing positive at 35.4%. This information can be found on the MDHHS Website.

Data from the Michigan Department of Health and Human Services showing the number of positive and negative tests in the State of Michigan as of 03/25/2020.

Hospital Beds are Filling up in Detroit

According to this article in the Detroit Free Press, the Beaumont Hospitals in Detroit and West Bloomfield are filling up with patients.

The health system is "facing limitations and nearing capacity with our testing, personal protective equipment and mechanical ventilators," said Beaumont Health Chief Operating Officer Carolyn Wilson. “We are taking steps to increase our capacity, such as converting some of our operating rooms into intensive care units.

“We have been actively transferring COVID-19 patients within our system to other Beaumont hospitals, as appropriate, if one hospital has more capacity than another."

According to this article in the Detroit News, Henry Ford Health System is facing the same challenges.

"Today our capacity is quite full at those two hospitals — West Bloomfield and Henry Ford Hospital in Detroit," said Dr. Betty Chu, associate chief clinical officer and chief quality officer. Chu is leading the health system's coronavirus response. 

"We fortunately have the luxury right now of having additional capacity at some of our other campuses."

This is concerning because there are a limited number of staff, beds, and equipment to adequately are for Coronavirus patients here in the Detroit and Metro Detroit area.

As beds fill up and as our hospital personnel are stretched thin, we may be in a situation where doctors have to pick who lives and who dies simply based on issues of capacity. This is truly a terrible situation and one that we want to completely avoid.

That is why it’s so important to stay at home and avoid any unnecessary contact with people, by which you may become infected.

City of Detroit Will Begin Offering Free Coronavirus Testing Tomorrow

Unfortunately, the City of Detroit has been hit hard by the Coronavirus. But, Mayor Mike Duggan and the City of Detroit will begin testing people at the State Fairgrounds at 8 mile and Woodward to hopefully stem the tide. The aim is to test 50 people every hour and 400 people every day with this drive-through testing.

Testing is important because it can help us track the spread of infection and it can help people prevent the spread by self-quarantine if they find out that they are infected. You can learn more about this testing via the City of Detroit, here.

How Can I Become Immune to the Coronavirus?

Yes, you can become immune to the Coronavirus. When you get infected with the Coronavirus, your body will produce antibodies or immunoglobulins to the Coronavirus. First you’ll make IgM, and then IgG. This will confer long-term immunity to you.

Scientists estimate that you’ll be immune for 1 to 3 years based on previous infection and immunity rates from other Coronaviruses. This is why you can’t get re-infected by COVID-19. Once you have the virus, you’ll be immune to future infection.

This is important for several reasons. Over the next few weeks to the next few months, there will be a test of immunity. It will likely be a finger-stick blood test, using a drop of blood to measure the immunoglobulins like IgM or IgG to make sure folks are immune.

This will be especially important for doctors, nurses, hospital workers, and other critical staff. If we know that these folks are immune to Coronavirus, they can go back to treating patients with minimal risk of infection going forward. This test is pending as of now.

HOw will the Coronavirus Pandemic End?

The Coronavirus pandemic will end when we reach a Herd Immunity. Herd Immunity means that enough people in the population are immune to the Coronavirus, which will greatly limit its spread.

This Herd Immunity can be achieved in a few different ways. First, once a number of Americans get the Coronavirus, they will fight off the infection and become immune, limiting the spread of the virus once they recover. Second, once a vaccine is developed, many more people will become immune through vaccination.

Just like being vaccinated for the influenza virus or for Measles, Mumps, and Rubella, once you’re vaccinated for these viruses, your body creates immunoglobulins or antibodies to help protect you from infection from these viruses.

Unfortunately, the Coronavirus or COVID-19 vaccine will take 18 months to 2 years to develop, so this option will take a long time to achieve.

This image demonstrates Herd Immunity. The left hand panel shows what we’re dealing with right now with the Novel Coronavirus or COVID-19. No one is immune to this COVID-19 yet. The right hand panel shows Herd Immunity. The yellow figures are immune to the virus, so the spread of the virus will be limited. Herd Immunity defined: the resistance to the spread of a contagious disease within a population that results if a sufficiently high proportion of individuals are immune to the disease, especially through vaccination.

Thanks for reading and watching. Please stay safe and healthy in this time,

-Dr. Paul Thomas with Plum Health DPC

Single Largest Jump in Coronavirus Cases in a 24 Hour Period

Coronavirus Update: United States sees the single biggest increase in cases in a 24 hour period

Unfortunately, the United States has just witnessed the single largest increase in Coronavirus cases of any country in a 24 hour period. Over the last 24 hours, there have been 14,550 new cases reported in the United States according to this website.

Why is the Coronavirus Spreading so quickly in the United States?

It comes down to the concept of R⌀.

R⌀ is the average number of people that an infected person transmits the virus to.

If R⌀ is <1, the epidemic will burn out.

If R⌀ = 1, then epidemic will continue at a steady pace.

If R⌀ >1, the epidemic will increase exponentially.

Current estimates put R⌀ at about 2.5 to 2.9 (Peng PWH et al, 2/28). In plain English, this means that the average person with the Coronavirus will give the virus to 2.5 to 2.9 other people. This transmission rate is a bit higher than seasonal influenza. R⌀ is a reflection of both the virus and also human behavior. Interventions such as social distancing and improved hygiene will decrease R⌀.

Control of spread of COVID-19 in China proves that R⌀ is a modifiable number that can be reduced by effective public health interventions. The R⌀ on board the Diamond Princess cruise ship was 15 – illustrating that cramped quarters with inadequate hygiene will increase R⌀ (Rocklov 2/28).

The Coronavirus started with a single infected person, and it spread to roughly 2.5 to 2.9 other people. Once infected, those people passed the Coronavirus to another 2.5 to 2.9 people each. This is how a virus can exponentially spread. The Coronavirus spread has been hard to diminish because people have a relatively long incubation period or they have the virus and they don’t show symptoms of having the virus for a relatively long period of time, like 5 days to 10 days.

What should I be doing during the Coronavirus pandemic?

Definitely stay at home as much as possible. If you must go outside your home, practice social distancing and act as though you have the virus. Essential tasks done outside the home include buying groceries, making visits to the doctor, and picking up medications from the pharmacy.

How do I protect myself when I go outside?

First, avoid going outside unless you’re going for a walk or otherwise exercising in your neighborhood. If you must go outside, wear disposable latex gloves when you touch high-risk surfaces. For example, when you pump gas at the gas station, put on a pair of latex gloves during the credit card use, key pad entry, and handling the gas pump. Then, dispose of the gloves responsibly in a nearby trash can. Use hand sanitizer once you’re back in your car. Don’t touch your eyes, nose, or mouth after touching potentially contaminated surfaces. You can also use this routine of wearing latex gloves when grocery shopping or when handling a grocery cart.

Is it safe to get food delivered?

Yes, it’s safe to have food delivered and it’s safe to get take-out food. The best practice is to wash your hands after touching any packaging and to wash your hands again before eating. For instance, if you get your food in a brown paper bag, take your food out of the brown paper bag, recycle or discard the brown paper bag, and wash your hands before touching the food or individually wrapped food. Then, transfer the food to a plate or glass bowl and microwave the food for 30 seconds. This will kill any germs or bacteria in or on the food. Wash your hands again prior to eating.

What can you do to boost your immune system?

Many people want to know what they can do to boost their immune system to protect themselves from the Coronavirus. You can do the following to boost your immune system:

• Sleep 7 to 9 hours each nigh

• Eat nutritious and healthy foods

• Drink plenty of fluids, mostly water

• Exercise for 1 hour each day

• Meditate to keep your stress levels low

When we’re stressed out, we tend to produce more cortisol, a steroid hormone that can weaken our immune system. That’s why it’s important to meditate, sleep well, and exercise.

What are good exercises during the Coronavirus quarantine?

You definitely want to exercise every day during the Coronavirus quarantine. Exercise will be good for your physical health, immune system, and emotional wellbeing. The best exercises will be to go outside of your house for a walk, jog, run, or bike ride. This is one of the few exceptions to the “stay at home” rule above. When you exercise, make sure that you’re keeping your distance from other people by at least 6 feet. You can exercise in your neighborhood or a nearby park. Avoid mall walking or any exercise where you’ll have to open a door/use a door handle for entry. That’s why we recommend folks avoid gyms and pools because there are just too many surfaces that could harbor the Coronavirus and potentially spread the infection. Therefore, exercise at home: lift weights, do floor exercises, do yoga or pilates. Fortunately, several health and fitness companies are giving free 30 day trials of home exercises - take advantage of these programs.

What can you do to slow down the Spread of Coronavirus?

Stay at home.

Act as though you have the virus and any interaction is a potential to spread the virus to a vulnerable person. People who are the most vulnerable are older adults or those with pre-existing medical conditions like lung diseases or cardiovascular diseases.

Do not visit nursing homes or elderly relatives, even if you feel well. You could be an asymptomatic carrier of the coronavirus and you could potentially endanger or kill the older adults that you visit.

Should you be sitting on a stockpile of extra medical supplies and equipment, please donate it to your nearest hospital or primary care physician office. If you have new and unused N95 masks or gloves, please donate them to these healthcare facilities.

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

-Dr. Paul Thomas with Plum Health DPC