By LISA EISENHAUER
May 19, 2020
The effort by Trinity Health and its Saint Joseph Mercy Health System to expand COVID-19 testing in some places in and around Detroit where the virus has taken an especially high toll is personal for Tawana Nettles-Robinson.
Cars line up at a tent set up at the SAY Detroit Family Health Clinic in Highland Park, Michigan, where clinicians from Trinity Health offer free screenings and testing for COVID-19.
Nettles-Robinson is director of medical services-Detroit market for Trinity Health and in charge of a testing site that opened May 4 outside a clinic in Highland Park, a separate city of about 11,000 that is surrounded by Detroit. She has lost a close relative to the virus.
"I really feel like if we had gotten early testing for her the outcome could have been different," Nettles-Robinson said.
Nettles-Robertson
She is hopeful that the free testing Trinity and several community partners are offering in a tent site outside the SAY Detroit Family Health Clinic can save lives. Anyone who drives or walks up to the tent will get screened; and, if they have symptoms of the virus, they will be tested. Until the site went up, there was no place in Highland Park for its largely low-income African American residents to get tested.
Diving into the data
On its first day, Nettles-Robinson said the partners behind the testing effort were expecting about 25 people. More than 100 showed up. Of those, 35-40% tested positive. "We're going to have to do some contact mapping and hotspot data assessment to see why we're seeing these kinds of numbers," Nettles-Robinson said.
Trinity Health is the managing partner on the site, which it is committed to running for at least six weeks. It is providing staff and protective gear.
People who test positive for COVID-19 will be alerted within two days and urged to self-quarantine and contact their doctor for follow-up care. For those who don't have a primary care doctor or a place to self-isolate, Nettles-Robinson said the testing site partners can direct them to state and local resources for assistance. In addition to testing, the operators of the site are collecting health and demographic information and sending it to a statewide task force that is studying the spread of the virus.
"We are going to make sure that we have all the data that we can to give the statewide team to see why this is happening and how it can be addressed," Nettles-Robinson said.
Social determinants and testing
It was data collection from a similar testing site at St. Joseph Mercy Ann Arbor Hospital in Ypsilanti, Michigan, that prompted that hospital to partner with several agencies to set up pop-up testing sites in two ZIP codes in Ypsilanti. The people who live in the ZIP codes are mostly minorities and low income.
Glabach
Meghan Glabach is regional director of the radiology and neuroscience service line at Trinity's Saint Joseph Mercy Health System. She said the need for the testing sites was clear when data from the curbside testing site that opened at the hospital March 18 was compared with data from Washtenew County health officials. The comparison showed a high prevalence of patients with COVID-19 in the two ZIP codes but also that few people from those areas were coming to St. Joseph Mercy's testing site.
"This provided us information as to what was happening in these communities," said Glabach, who leads the clinical services unit within the incident command structure that Saint Joseph Mercy Health System has set up in response to the pandemic. "With guidance from community leaders, we identified that many of these patients did not have the ability to come here on campus for their testing."
As at Highland Park, the screening and testing at the Ypsilanti pop-up sites is free to patients. In addition, everyone who comes to the sites will be given a needs assessment. "As a mission driven health system, we wanted to be sure that we were not only testing these vulnerable patients in our communities, but that we were also able to connect them to the resources that they might need to keep themselves and their families safe," Glabach said.
Those resources, being provided by the health system and its partners, include opportunities to self-isolate at local hotels, access to cleaning supplies to sanitize their homes and masks to shield themselves from germs, and offers of free food. "We understand and want to confront the disparities that are happening in our communities and help be part of the solution," Glabach said.
'A transforming influence'
The racial disparities in the incidence of the virus are evident from data being kept by Michigan officials, which show that of the almost 4,600 people who had died of COVID-19 as of May 12, 41% were black or African American. Census data says 14% of the state's population is black or African American.
Spivey
David Spivey, vice president of community health and well-being for Trinity Health Michigan, said several factors probably account for the disproportionate number of deaths among African Americans. One factor is the high incidence in minority populations of underlying health conditions that make people more susceptible to complications and bad outcomes if they contract the virus that causes COVID-19. In addition, in the highly impacted ZIP codes, many of the residents live in dense housing and in multigenerational households, two factors that contribute to the infection rate.
"Those are issues that confront the health care delivery system and our society every day pre-COVID, and so as COVID spread, it impacted these communities more so," Spivey said.
He said that being part of the effort to target the spread of the infection in areas that have been particularly hard hit and that have had limited access to testing is a continuation of Trinity's efforts to care for the disadvantaged.
"This is a reflection of our mission as a health care organization, to try to be a transforming influence within the communities we serve and to serve the most vulnerable," Spivey said.