Before coronavirus arrived, Detroit was a public health accident waiting to happen. It was one of the poorest cities in the US and many of its residents were in ill health and lived far away from medical facilities and food stores.
As a result, there was no shortage of explanations for Detroit’s emergence as a hotspot of the outbreak in the US. Michigan, which counts Detroit as its biggest city, ranks fourth among US states in terms of coronavirus cases, just behind California, which has nearly four times as many people.
Dr Paul Kilgore, a public health and infectious disease expert at Wayne State University, pointed to poverty as a factor in the outbreak, noting that many areas of Detroit have no health clinics, doctor’s offices or grocery stores. Early in the crisis, some residents who had failed to pay their bills lacked running water, making it hard for them to observe basic hygiene, he said.
“Some 30 per cent of the population of Detroit is in fair or poor health, and they [often] lack access to basic healthcare, healthy food and transportation,” Dr Kilgore said. “There is a high proportion of patients with underlying health conditions.”
Detroit is a city of 673,000 people, nearly four-fifths African-American and more than a third living in poverty. It has suffered from a flight of people and businesses to the mostly white suburbs since the race riots of 1967. In 2013, Detroit declared bankruptcy. Since then, the city had begun to recover, but progress could be jeopardised by the coronavirus pandemic, local officials say. As of Monday, Detroit had reported 1,804 Covid-19 cases and 50 deaths.
“Every one of us has interacted with someone who has Covid-19 in southeastern Michigan,” Mike Duggan, Detroit mayor, told a press conference last week. “We are getting to the point where we all know people who have tested positive.”
The city’s police chief is infected, nearly a quarter of the police force is in quarantine and two have died. Auto companies have stopped making cars so they could instead produce face masks and ventilators, and the Detroit auto show has been cancelled to turn the venue into a field hospital. Hospitals are near capacity and are drawing up rules on how to ration care, if necessary.
A local historian contacted for his observations about the outbreak, emailed back: “I am recovering from coronavirus. And my mother died last night from the disease.”
“We are . . . worried about Detroit,” Anthony Fauci, head of the US National Institute of Allergy and Infectious Diseases and a member of the White House coronavirus task force, said at the weekend. “Detroit is starting to show some signs that they’re going to take off.”
Michigan case numbers are rising partly because of increased testing — a drive-through test site opened Friday and new tests are about to arrive that will give results in five minutes, Mr Duggan said on Monday.
But the mayor also warned residents to maintain social distancing and avoid gatherings. “The numbers are going to continue to grow,” he said. “This pandemic is controlled by one thing: your behaviour. If you see groups, call the police; we’ll break them up.”
Isaiah McKinnon, Detroit’s former chief of police, now sheltering in place in the city, said quack medical theories were also causing problems on the streets. “One of the things that disturbs me is that there was a rumour that African-Americans couldn’t catch this,” he said. “Unfortunately we had some people who believed this.”
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Some Detroit residents have no choice but to go out. Kevin Chastang, 60, a disabled Detroit resident, said he has to leave home every day for his job delivering test tubes to hospitals for Covid-19 tests. At first, he took blood directly into labs for testing, but that became too dangerous because of his age and health. Now, he delivers empty tubes to the hospital front door.
“When I get home, I gargle with salt water to get the virus out of my throat and then I spend 15 minutes over a pot of hot water in case I inhaled anything. I have only one N95 mask and I’m waiting to wear it until things are worse. I hope I’ll survive long enough until I really need it,” he said.
Rita, 50, a government employee who declined to give her surname and is quarantining at home with her 25-year-old daughter, said she was planning to use old-fashioned remedies to sanitise groceries because she has no disinfectant.
“You can use vinegar, you can use alcohol. I grew up with my grandmother, she grew up during the Depression and she taught me these things,” she said. “The Depression was their traumatic experience and now this is our generation’s traumatic experience.”
Glen Anderson, another disabled Detroiter, said he was staying mostly at home caring for a cousin just diagnosed with uterine cancer, but went out last week because “she had a taste for spice cake”.
As is the case in other places hit by the pandemic, fears are rising that medical facilities could be overwhelmed. One local hospital drew up policies for how to ration ventilators, if necessary. The document, leaked on social media, caused an uproar. It said that “patients who have the best chance of getting better are our first priority . . . dying patients will be provided with comfort care”. The hospital said this policy was not now in force and was an “absolute worst-case scenario”.
Dr Joel Fishbain, medical director of infection prevention at Beaumont Hospital, Grosse Pointe, which is just outside Detroit, said his hospital was “pretty much full”. He said the facility was transferring patients to other hospitals and doubling up patients in some intensive care rooms, though each had their own ventilator.
“We are seeing patients live the first day and then calling them on the room telephone for subsequent check-ups” to save on the use of scarce personal protective equipment such as masks, gowns and face shields, he said. Some equipment were being reused: “Face shields can be cleaned, I use the same one, and I have an N95 (mask), I put it in a paper bag and continue to use it for four to five days.”
His hospital is “nowhere near” having to ration ventilators, he said, adding: “I think it’s highly unlikely we will get there, I think the lockdown is working — even though some people still have no clue what’s going on. The $20m question is what happens in 2021. I think it smoulders all year and then comes back.”