COVID-19 updates: Underserved communities hit hard by pandemic

With an estimated 90% of his hospital’s general medicine floor occupied by COVID-19 patients, Richard Bryce, DO, says the pandemic is unlike anything he or any other health care professionals have ever seen in their careers.

“This is very unique and not, as some have said, like the flu,” Dr. Bryce said, who notes that his COVID-19 patients are needing intubation for much longer than his flu patients typically do.

Over the last month, The DO has been speaking with osteopathic physicians on the front lines of COVID-19, including an infectious disease-focused family physician in Connecticut, an infectious disease specialist in Oregon, an emergency physician outside of Philadelphia, and another who works in the city.

If you are a physician and would like to be featured in an interview as we continue our COVID-19 coverage, please email abrown@osteopathic.org.

This week we continue with Dr. Bryce, a family physician and the chief medical officer at Community Health and Social Services Center in Detroit. He also serves as a Faculty Advisor for Street Medicine Detroit and Detroit Street Care, student organizations affiliated with Michigan State University College of Osteopathic Medicine and Wayne State University School of Medicine.

Reports are emerging that the pandemic is hitting underserved communities and populations hard in the U.S., and Dr. Bryce has found that to be the case in Detroit. In this edited Q&A, he discusses how COVID-19 is affecting the city’s homeless and underserved populations, the severe symptoms he’s seen in COVID-19 patients and how his hospital is managing its PPE supply.

What are you seeing in patients who are hospitalized for COVID-19?

We’re seeing the fever, cough and shortness of breath. But we’re seeing some GI symptoms as well, like nausea and diarrhea.

What’s most unique, though, is how rapidly some patients decompensate. They are doing fine, and they get admitted to the hospital and they’re on two liters of oxygen. Then I see them, and they’re breathing a little bit fast, like maybe 25 respirations in a minute.

You tend to notice they’re not really uncomfortable, but then next thing you know, their oxygen starts to drop, and you put them on four liters, then six liters, and then they’re intubated. I’ve seen that scenario play out a few times a day, especially with those that are really really sick.

Anybody with lung issues, I can’t say which patients are going to decompensate, but I would definitely say, just in my observational opinion, people with COPD or a long history of smoking seem to decompensate worse with COVID-19.

What additional challenges have underserved communities in Detroit been facing?

Challenges that come with the patients we see who may be underserved, or have some economic disadvantages, is that they have a lack of resources and a lack of medical education or literacy. There’s a lot of confusion about when you need to get evaluated. Of course that can be even more challenging for someone who’s uninsured or homeless.

One of the challenges for the homeless population is that, normally throughout the city, there are one or two soup kitchens open every day somewhere. I know from talking to many people who are facing homelessness, they’re very concerned about going into a room with a group of people when they have co-morbidities, on top of being homeless, and could be exposed.

This past couple weeks, with Street Medicine, we’ve been doing less medicine and more ‘what do you need?’ We bring lots of food with us. This helps people if they don’t want to go to the soup kitchen and they prefer to get food from somewhere else. We love to help them, and it’s been pretty successful.

What is the status of your hospital’s PPE supply?

In one week’s time early on, we went through the normal allotment of six months’ worth of PPE, because we used them so many times, and kept having to change it all out. You don’t need PPE all the time on a general medicine floor, usually. So you can sense the difference.

This past week, we had enough and are doing OK in general, but we can sense that the supply is very limited. You can sense the vulnerability. There’s got to be many places in this country where people are saying, “yeah we’re good for today, but where are we going to be in a few days. What if a shipment doesn’t come, what happens then?”

How is your staff doing?

We’ve had some staff get sick with COVID. Some of our nurses have needed intubation. Fortunately, the people on our floor are doing much better and are no longer intubated. But we had a nurse who died a few days ago in our health system, so that’s all scary.

What do you want more people to understand about this pandemic?

From what I can see, there’s such a high percentage of people who don’t have symptoms that can carry it and pass it to others. The people who have it don’t know they do, or pass it on before they even consider getting tested.

People should be aware that in many areas, it’s going to be quite some time before we stop losing patients to COVID-19.

Also, a lot of people are talking about trying these medications like hydroxychloroquine or azithromycin. At my hospital, we’re doing a study on hydroxychloroquine, which is great, but the data is only strong enough to start studies. There are huge side effects, and you can die from taking it. We want these drugs to make a difference, but we also want them to be safe.

Related reading:

Navigating HIPAA and telemedicine during COVID-19