Breathing 'Rheum' in COVID-19 Hotspots: Detroit juggles poverty, protests, and possible resurgence
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The COVID-19 pandemic, in places like Detroit, with a large working-class population, can highlight the gap between the rich and the poor. It can demonstrate how political unrest can impact the response to a critical situation. Moreover, it can show how health care workers can face both personal and professional challenges in managing an outbreak of this magnitude.
Detroit sits in Wayne County, Mich., which has seen 19,292 cases of COVID-19 and more than 2,200 associated fatalities. As protests against the lockdown continue and calls to reopen the state for business grow louder, experts fear an uptick in both counts.
Cathy Patty-Resk, MSN, RN-BC, CPNP-BC, president of the Rheumatology Nurses Society and a pediatric nurse practitioner at Children’s Hospital of Michigan, addressed the personal, the professional and the politics of the situation in a wide-ranging interview with Healio Rheumatology.
Q. As a rheumatology nurse practitioner, what are some of the biggest hurdles you are facing with COVID-19?
Patty-Resk: Patient management through telehealth has been a challenge. All of the sudden, someone just hit the brakes on our usual clinical approaches. We just were not very well prepared for it at all. Then we have some patients who do not have computers, so we have to figure out how to do visits through their phones. A smart phone visit, as you can imagine, is suboptimal; it is hard to determine if someone’s arthritis is active, for example. But we have even had a patient who was unable to do video through her phone.
On the flip side, we have also had to determine which patients we absolutely need to see in the clinic because we have to put our hands on them. We are seeing lupus patients in the clinic, and kids with vasculitis, because they are some of our most brittle. Of course, we have had to create a separate entrance, and do all kinds of social distancing in the office — there have been a lot of logistics to work out.
Q. How has COVID-19 impacted your personal and professional life?
Patty-Resk: When all of this started, my husband was in Hungary on business; he got in at midnight the night they were closing the borders to Europe. He then had to self-quarantine for 14 days. A few days into that quarantine, he developed a cough, which, of course, triggered a quarantine for me at work.
Early on in this, I was working from home for 2 weeks, and I ended up getting tested because of a cough, as well. It was a very difficult time. It was frustrating, not knowing if we were infected. My husband and I are both working from home now, and, right before this started, we had re-homed a 10-month-old puppy, which has brought on a whole new set of challenges.
Q. How has all this impacted your practice?
Patty-Resk: There was a high no-show rate for a few weeks, so it took us some time to figure out how we were going to see new patients who absolutely needed to be seen. We decided to see them in the morning along with any established patients who needed to be seen in person. The rest are seen via telehealth in the afternoon, while I am at home. Through telehealth, I can determine if the patient needs to be seen in the clinic. It also gives us the opportunity to explain our safeguards to patients and families. We hoped this would increase the show rate, which it has a little, but most patients are still very reluctant to come into the clinic.
We are doing all of the CDC recommended social distancing measures that others are also doing. Only one patient at a time is allowed in the waiting room, and only one parent can accompany the child to their visit. Everyone is given masks when they come in the door, hand sanitizer is available and social distancing is practiced at registration. They may not see another patient their entire time in the office.
Q. Moving away from clinical issues, what is it like on the streets?
Patty-Resk: In the beginning, traffic was down quite a bit, and the only people you would see walking on the streets were people alone or with their family out for a walk. You did not see kids playing together or congregating on the corner as you normally would. But even so, it has been cold up here, so everyone has been stuck in the house. When it first started warming up, you would occasionally see kids throwing a baseball with gloves on.
Now that our stay home orders have been extended a couple times, people are getting restless. We are seeing more people out and about in groups that are clearly not household members. It seems many people are trying to do their best with social distancing, but not everyone. I was in Meyer recently, which is a Walmart-type store, and I was shocked that less than half of the people were wearing masks, with several customers who looked to be in their 50s or older. So, we have a way to go.
Q. Do you see any association between this and the fact that Michigan has become a focal point of the protests against the lockdown?
Patty-Resk: The people who you see protesting are not, generally, the people I know and see. That is not the feeling I get when I talk to parents of my patients, or my friends. I am not sure who those protestors are or where they are from. I hear that people are protesting that they are unable to buy gardening equipment — it was still snowing for a few days [in April], why do you need gardening equipment?
They are also protesting that golf courses are closed. Detroit is poor. If you open a golf course, you need staff to cut the lawn, you need staff to work in the clubhouse, or in the restaurants, you need people to clean bathrooms. When you have all of these people working, the risk for transmission increases. But that is just part of the problem. When you open a golf course, you tell the poor people of Detroit that if you have more money, you have more rights.
Q. Is anyone trying to explain this to the protestors?
Patty-Resk: Governor Gretchen Whitmer has been trying. It is a matter of looking at the big picture, and at the transmissibility of this infection. She has said you can’t have motorboats, and there have been objections to this. Recently, there was an unfortunate accident involving a man and his 9-year-old son on a boat. Both have gone missing. They found the dad, but they have not found the son yet.
When you have situations like this, or any boating accident, you are increasing exposures among rescue staff; you have to have a dive team come out. If the people survive the accident, you are taking up precious space in the hospital or the emergency department that could be used for COVID patients. The governor is just trying to keep people safe and keep the mortality rate down.
Q. Could you speak to how all of this impacts you as a nurse?
Patty-Resk: I did volunteer at a hospital that has been in the news — Sinai Grace — to work in the emergency department. The night I was there, it did not seem too busy. The staff said it was the best night they had had in months, but I had never seen so many respiratory patients in the ED. There were many patients who were still being held in the ED for days because there were no beds available on the COVID floors. Luckily, these were not ICU or ventilator patients.
Q. So, is that positive news, that there are nights that are relatively quiet?
Patty-Resk: Not necessarily. Nurses were resigning because of the working conditions and the volume of patients, without sufficient help. They were upset that the morgue at the hospital was full, even in the viewing areas — there was no place to put any more bodies. What nurses are able to do with patients is amazing, not just in terms of medical intelligence, but emotional intelligence, to help patients through distress. But the problem with the current situation is that the families are not there to help and offer emotional support. It is really taking a toll on the nurses.
Q. How can this be rectified, if at all?
Patty-Resk: Health care personnel, including nurses, were not prepared for a wartime event, which is essentially what this is. Had they been prepared with this mindset from the beginning, that this was going to take all of our energy and resources, I think many of those nurses would have been able to handle it.
They would be able to compartmentalize what is going on, where they could address the current situation in the short-term and separate it from their normal work. They would not be resigning. They were trained to work in a health care system with the best support and the best equipment in the world. They were not trained to work in third-world conditions, which are the conditions in many hospitals in Detroit and around the country. – by Rob Volansky
For more information:
Cathy Patty-Resk, MSN, can be reached at 3950 Beaubien St. Fl. 3, Detroit, MI, 48201; email: cpatty-r@dmc.org.
Reference:
- Wayne County COVID-19 Resources. https://www.waynecounty.com/departments/hhvs/wellness/novel-coronavirus-information.aspx.
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