Metro Detroit has become one of the nation’s COVID-19 hotspots. And experts predict the situation will get even more dire in the next several weeks.
The city of Detroit is a hotspot within the hotspot. As of Thursday, the city reported 888 COVID-19 cases, with 19 deaths so far.
Why is that? Public health and infectious disease experts say it’s difficult to tell because it’s a novel, fast-moving situation. There’s also a lack of some crucial data—and “we don’t know what we don’t know.” But some public health truisms, along with a basic understanding of historical social and health inequities, give us some glimpses of understanding.
Data: What we know, what we don’t
The state of Michigan is releasing daily statistics about the number of COVID-19 cases, broken down by county. Since the city of Detroit has its own health department, it reports its own numbers, so we have that information for the city specifically.
The state is also reporting some basic demographic information about COVID-19 cases, such as the distribution of cases by sex and age range. And as of Thursday, the state began publicly releasing numbers for COVID-19 testing—though they’re not entirely comprehensive, nor broken down geographically.
What we don’t know: the number of COVID-19 hospitalizations, though that information has been released piecemeal by some health systems. And we also don’t have information about the number of cases broken down by race and ethnicity. Nor do we have a full picture of how many people dying from COVID-19 have underlying health conditions, and what those health conditions are.
Jonathan Stillo, a medical anthropologist and assistant professor at Wayne State University, said some of the explanation for Detroit’s numbers in particular comes down to simple geography—densely-populated urban centers foster the spread of communicable diseases, and Detroit may just be a bit ahead of the curve compared to some other places.
“But we’re still nowhere near where we need to be in terms of seeing the whole picture,” Stillo said. “Right now, we’re only seeing little snapshots, and those are totally dependent on how much testing is happening.
“It makes the job of researchers, and folks who are trying to figure out what’s going on and make policy to address it, really hard. We’re flying blind, I think, in a lot of ways.”
Stillo said data on racial demographics would be helpful. So would data about whether groups of people who are disproportionately sick and dying have certain underlying conditions.
Although it’s difficult to tell whether specific racial groups such as African Americans might be at higher risk from COVID-19, Stillo said some basic public health and social science data tell us that’s probably the case.
“African American folks in Detroit have higher rates of asthma, they have higher rates of diabetes, they have higher rates of some of these conditions that we think may make outcomes worse,” Stillo said. “You’re sort of layering biological problems on top of already-existing social problems. Issues of lack of health care, lack of insurance, unstable housing, and things like that.”
The downside of “racializing” the data
Melissa Creary, an assistant professor at the University of Michigan’s School of Public Health, agrees with that.
“What we see with COVID-19 is just a reflection of our greater society,” Creary said. “So those that typically get left behind are going to continue to get left behind with COVID-19, unless we’re being very thoughtful about how we attend to equity.”
But Creary said because the pandemic is so fast-moving and “we don’t know what we don’t know,” it’s risky to draw too many conclusions from incomplete data. She also cautions that there’s a downside to “racializing” the data surrounding COVID-19.
“On the one hand, I think it’s super important to collect information around race when it comes to COVID-19,” Creary said.
“But given the history of the United States, it’s easy to see how the data around race could lead to more stigmatizing, and damaging effects down the line. When we think about the history of it all, then we have to be really mindful about the ways in which this data being attached to race could really do more harm than good.”
Jonathan Stillo said that while data and statistics are crucial to effectively dealing with any pandemic, they can also obscure the fact that, “every one of those numbers, every one of those confirmed cases and deaths, is someone who is loved and someone who is a human being.”
“All we can predict is that—and it’s sad, but it’s a safe bet—the most vulnerable people, the poorest people, are going to have worse outcomes. The suffering is going to be borne quite unevenly.”