Black residents have borne a disproportionate share of Michigan's COVID-19 cases and deaths, but in recent weeks those disheartening numbers have begun to turn around. Over the course of the entire pandemic, Black people represented 29% of COVID-19 cases and 41% of COVID-19 deaths in Michigan, despite being only 15% of the state's population. But in the last two weeks of September, they made up just 8% of cases and 10% of deaths.
Those declines can be attributed to a variety of factors, but the Michigan Coronavirus Task Force on Racial Disparities has been leading the way in eliminating racial disparity in the virus' impact on the state. The task force was created in April by Gov. Gretchen Whitmer's Executive Order No. 2020-55. Whitmer appointed 23 individuals to the task force, including community organizers, doctors, and public health experts.
Task force member Renee Canady, CEO of the Michigan Public Health Institute (MPHI), is encouraged by the dialogue the group is having — and even more encouraged that Whitmer and the state's executive branch have acted swiftly upon task force recommendations.
"The task force is having an impact on the disparities. They are decreasing and we are seeing improvement in the metrics," Canady says. "In terms of measuring, evaluation is sometimes challenging. It's pretty clear that the number of things we've been doing as a task force are making a difference in the outcomes."
"I would hope that any reduction in numbers in terms of people of color is because of aggressive marketing that all of us have done across the state," said Maureen Taylor, state chair of the Michigan Welfare Rights Organization, in the task force's Sept. 11 meeting. "I am going to hang that victory on the work that we have done across the state."
Workgroups making change
Since May, the task force has focused on improving testing, connecting people of color with primary care, contact tracing and isolation strategies, promoting safe reengagement, and the Flint water settlement.
"It was really clear from the first meeting that we didn't want to be a task force that sat around, waxed philosophical, and, at the end of several weeks or months, write out some glossy report. It was very clear that we were going to be informing and advancing action," Canady says. "What we've done has convened a group of people that are not only invested in the issue but are passionate about the issue. When we listen to our lieutenant governor talk about 23 people in his immediate circle dying because of COVID-19, this is not just the item of the day, but deeply personal and sobering."
The task force assembled five workgroups: Strategic Testing Infrastructure, Primary Care Connections, Environmental Justice, Centering Equity, and Telemedicine.
Responding to Whitmer's directive to "reduce medical bias in testing and treatment," the task force's Testing workgroup prioritized testing and contract tracing for high risk groups – for example, expanding testing to include asymptomatic household members of people with symptoms. The workgroup facilitated shifting testing sites to neighborhoods and making use of churches, community centers, and other trusted organizations where neighbors felt more comfortable being tested. A focus on eliminating language and cultural barriers also made testing more accessible. In Detroit, Wayne State University and the Ford Motor Company are collaborating in a mobile testing pilot that expands testing even further, including to homebound residents.
Plans were put in place to not only provide follow-up care for all residents testing positive but to also connect everyone tested with a primary care provider. This addresses another one of Whitmer's instructions, to "remove barriers to accessing physical and mental health care."
"It's clear that many of the individuals that contract COVID-19 and those that became hospitalized and succumbed were not necessarily connected to a regular primary care provider. That's one of the underlying things people need to be healthy, to be connected to a medical home," says Jametta Lilly, task force member and CEO of the Detroit Parent Network. "The primary care workgroup is looking at ways to use testing sites and messaging that says, 'Get testing. Get healthy. Get to a primary care provider.'"
Lilly also heads up the task force's Telemedicine workgroup. She notes that telemedicine has come of age during the pandemic, filling the gap when accessing in-person care became a risk. While not appropriate for all health complaints, telemedicine has had extremely positive results. Lilly and her workgroup are discussing its efficacy, assessing patients' experiences, and exploring what standards are needed to make it more effective in the future. One huge barrier to its effectiveness is access.
"We really have to be talking about internet for all," Lilly says. "Senior citizens should be able to have access to broadband to have an online visit for therapy or physical check-ups. They need to get a device and become digitally literate on that device."
As the workgroup looks at ways to bridge the digital divide, its members have discovered huge digital deserts in Michigan's rural areas where internet is not available, as well as in rural and urban areas where the cost of service is prohibitive for low-income residents.
"How do we get businesses and corporations behind this goal to make sure the most vulnerable have access at a reasonable cost and also have devices and training to use the tools?" Lilly asks. "Otherwise, we are leaving tens of thousands of our citizens and children behind."
"Michigan is absolutely doing it right."
Canady, who leads the Centering Equity workgroup, has spoken about the pandemic and health disparities with colleagues from many states. She sees the task force as a model that more states need to adopt. She says "Michigan is absolutely doing it right."
"All of us are thinking, 'How can we leverage the social capital we've developed by being so fully connected to community on the solutions we are implementing?' At some point COVID-19 is going to have to stabilize," Canady says. "How do we apply these lessons for future needs and future response?"
While recent data reflect significant progress in eliminating the virus' disparate impact on people of color, Robert Gordon, director of the Michigan Department of Health and Human Services, raised concerns in the Sept. 11 meeting about the season ahead.
"Overall, what we see statewide is that we have been on an elevated plateau, but lower than most other states. Now that it's fall, people are moving inside and there's lots of pressure on those numbers to go up," he said. "We have to stress the importance of the basics around wearing masks and social distancing."
Although the task force is tentatively scheduled to wrap up its work 90 days after declared states of emergency or disaster have expired, task force members hope their work will create long-lasting impacts that ensure improved health equity for all Michiganders. The task force's final charge, according to Whitmer's order, is to "develop and improve systems for supporting long-term economic recovery and physical and mental health care following a pandemic."
"We have an administration that acknowledges that racism is a public health issue. How are we going to do it differently as we unbundle this cancer?" Lilly says. "This is what I would call the sunshine side of COVID-19. We need to be smarter about addressing the things we know are broken. To hell with the roads. It's people's health and wellness that we've got to focus on."
This article was originally published by Second Wave Michigan, October 8, 2020.