hen the first covid-19 cases appeared in Detroit, there was a broad but nonspecific panic, and emergency departments across southeastern Michigan were flooded with coughing people who were more worried than ill. In the past week, that flood has abated; the patients who are coming in now are sicker, and often in immediate need of oxygen. Most visitors to hospitals have been banned and many departments emptied of patients, and so physicians report a spooky juxtaposition between the crisis atmosphere of the expanded I.C.U.s and the bureaucratic calm of the rest of the building. “I used to occasionally do employee rounds on the midnight shift, and you would see these usually busy, wide hallways, your main thoroughfares, just empty, and it would always be such a strange feeling,” Bob Riney, the chief operating officer of Henry Ford Health System, told me. “And now you see that in the middle of the day.”
The coronavirus pandemic has had a way of turning even the most prestigious hospitals into community-health operations. Henry Ford Hospital, in downtown Detroit, one of the largest teaching hospitals in the country, is building a unit for forty-eight skilled-nursing-facility residents who no longer require hospitalization for covid-19 but whose facilities refuse to take them back. Rana Awdish, who runs the hospital’s pulmonary-hypertension program and practices critical-care medicine, normally spends her days seeing patients who travel to her clinic from across the Midwest. But, since the first coronavirus patients arrived, about three weeks ago, the helicopters and ambulances that transfer patients have stopped almost entirely. The patients filling the covid-19 units are coming from Detroit.
We are just beginning to see demographic data on those who’ve died of covid-19, but African-American communities around the country may be especially vulnerable. Black Americans have increased rates of high blood pressure and diabetes, conditions which seem overrepresented in covid-19 patients who grow critically sick, and in pockets of concentrated poverty those rates can be higher still. In Detroit, where seventy-nine per cent of the population is black and thirty-six per cent is below the poverty line, the diabetes rate is roughly twice the national average. Southeastern Michigan has become a national epicenter of the outbreak, and though African-Americans are just fourteen per cent of the state’s population they represent forty-one per cent of its covid-19 victims. (On Monday evening, Louisiana released an even starker set of statistics: African-Americans make up roughly thirty-two per cent of the state’s population, but have accounted for seventy per cent of its coronavirus deaths.) Awdish and her colleagues are on the front lines in two senses: in Detroit, the pandemic is escalating in intensity, and poverty and poor health may be changing its shape.
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