A doctor at Detroit’s Wayne State University School of Medicine has published new findings of a trend in older patients who are severely ill with COVID-19 and also test positive for Clostridioides difficile — a bacteria sometimes referred to C. diff or CDI. The CDI bacteria causes life-threatening diarrhea and is usually a side effect of taking antibiotics, according to the CDC. Wayne State’s observations offer the inaugural CDC journal report of CDI infections in COVID-19 patients. “This is the first report highlighting COVID-19 patients who presented with diarrhea and were found to have both C. diff and diarrhea as a co-infection,” says Dr. Teena Chopra, who is also a professor of infectious diseases at the WSU School of Medicine and corporate medical director of infection prevention hospital epidemiology and antibiotic stewardship at WSU and the Detroit Medical Center. “Most of these patients were very sick and had a higher mortality. COVID-19 can present as diarrhea, and a lot of these patients are getting unnecessary antibiotics. We always think of C. diff when we have patients who have diarrhea, and now we have to think of COVID-19 in these patients, too.”

Stephanie Hartwell, College of Liberal Arts and Sciences dean, Sheryl Kubiak, School of Social Work dean, and Ijeoma Nnodim-Opara, assistant professor of internal medicine and pediatrics, wrote an article for The Conversation about how COVID-19 has disproportionately hit lower-income areas and communities of color. “Nowhere is this discrepancy more evident than in prisons, jails and homeless shelters – made up disproportionately of poorer, black and Latino men and women. Here, COVID-19 cases have mushroomed due to dormitory-style living conditions and the inability of people, often with underlying health issues, to practice social distancing. As the virus rages on, comprehensive COVID-19 testing for these populations remains elusive. As experts on jails, health disparities and how to help former prisoners reintegrate into society, we believe that missteps in how we transition incarcerated individuals back to the community would only put this vulnerable populace at greater risk of getting and transmitting COVID-19.”

Michigan Governor Gretchen Whitmer has introduced a 6-step plan to re-start businesses that have been shut down during the coronavirus pandemic. It aims to balance the desire to revive the economy against the need to prevent a resurgence of COVID-19. A new study says states can do both if they prioritize industries where workers can keep their distance from each other or work remotely. Wayne State University researchers Shooshan Danagoulian, Zhe Zhu and Philip D. Levy wrote the report. Danagoulian, an assistant professor of economics, says professional services such as accounting are best-suited to resume safe operation. “Accountants work in separate offices, which precludes the spread of the virus, but they can also do their work from home fairly effectively,” Danagoulian says. By contrast, factory workers can’t do their jobs from home. But manufacturers can take steps to help workers maintain their distance. “We suggest giving priority to industries where — if people can’t work from home — they can operate effectively while minimizing the spread of the virus,” Danagoulian says. “It would provide a bigger boost to the economy should production resume in those industries.”

Dr. Teena Chopra, professor of infectious diseases at Wayne State University and in charge of infection control at Detroit Medical Center, and Dr. Anita Chopra, board-certified in internal medicine and sees patients at the University of Washington Neighborhood Shoreline Clinic in Seattle, wrote an op-ed for Bridge. “As front-line medical workers, our battle with COVID-19 is personal. We are physicians and sisters, waging war against an enemy that caught us defenseless. As we helped our communities plan for battle in two U.S. hotspots, we’ve drawn strength from reminiscences of our childhoods. We are inspiring each other to relentlessly protect the well-being of our patients and communities. One in Seattle, which saw the first COVID-19 case in the United States in a situation that escalated quickly, and the other in Detroit, which has faced a tsunami of cases and become one of the nation’s epicenters.”

Researchers at Wayne State University have completed an analysis that studied specific industry characteristics to guide industry openings in a way that lowers contagion risks and maximizes economic benefits until broader COVID-19 testing becomes available and immunity testing becomes efficient and reliable enough. “With protective gear and testing still in limited supply, there is a need to find the safest way to open and operate businesses to avoid a resurgence of the virus,” says Dr. Phillip Levy, professor of emergency medicine and assistant vice president for translational science and clinical research innovation at WSU, and chief innovation officer for the WSU Physician Group. “It is critical that we look at alternatives to lower contagion risks and maximize economic benefits. Using specific industry characteristics to guide industries in their reopening efforts will be key to lowering the further spread of the virus.” Shooshan Danagoulian, assistant professor of economics, led the research. Levy and Zhe Zhu, assistant professor of economics, also worked on it. The scope for physical distancing and remote work will vary by industry and region. The team focused on Michigan and metro Detroit.

Just when you think you understand COVID, it changes. It's a very deceptive virus; to keep up with it, it is a challenge,” says Dr. Teena Chopra, corporate medical director for Hospital Epidemiology and Infection Control at Detroit Medical Center and a Wayne State University professor. “And particularly, it is manifesting differently by age, by race, by sex. Very early on, we were able to understand that, particularly in the city of Detroit.” One set of her COVID patients, especially the younger ones, are developing pulmonary embolisms – blood clots that get stuck in the lungs and can be deadly. “They are manifesting as sudden onset shortness of breath,” Dr. Chopra says. “And some of them are showing higher mortalities than others.”  Meanwhile, patients coming from nursing homes (a big part of DMC’s patient population) may not even appear to have COVID during a first examination, says Dr. Chopra. They may not have a fever or chills. “These older patients do not have the same symptoms,” she says. “They don't mount up the same immune response.” Yet many of them are testing positive for the virus. “We are beginning to test every patient coming from a nursing home, whether they have symptoms or not, because we want to assume they have it.”

Detroit residents waited for hours on Tuesday to get free COVID-19 tests at a new facility that for the first time offered testing to people who did not already have symptoms of the disease and a doctor's authorization for the test. Tuesday's tests were the start of a free program for Detroit residents, said Dr. Phillip Levy, professor of emergency medicine at Wayne State University. Even those without symptoms can get tested with a nasal swab for the virus as well as have their blood drawn to test for antibodies. "Detroit is one of the hardest hit areas in the country. It's got some of the highest case loads, some of the highest death rates, so it's really important that we get testing out into the community," Levy said in a telephone interview. "If you're thinking about restarting the economy, it's important to know you are not acutely infectious and you have evidence of immunity," he added. Michigan has been one of the worst hit states, but officials have said the infection rate is dropping. As of Monday, Michigan had reported more than 38,000 COVID-19 cases and 3,407 deaths. Detroit made up the largest portion of those with almost 8,700 cases and 950 deaths. The Wayne State program expects to test as many as 400 people on Tuesday and hopes to do the same every day for the next six to eight weeks, working closely with Michigan as it ramps up its own testing efforts, Levy said. In the Detroit program, the tests are administered by Garcia Laboratories using Abbott Laboratories instruments, Levy said.

City employees make critical visits to the Detroit health department for a coronavirus test. On the other side of the long cotton swab: medical students in protective gear who have volunteered to be on the front line of the fight. “We’ll just go in about an inch, swirl around a couple times,” Michael Moentmann calmly explained before swabbing the nostril of water department employee Leon Wheeler. Moentmann, 23, had planned to watch surgeries as a medical student at Wayne State University in Detroit, but then a highly contagious virus disrupted everything this spring. So he signed up in one of America's hardest-hit communities, testing police officers, firefighters, bus drivers and others who keep the city running. “What better way to launch a medical career than helping with a pandemic? We couldn't do this without them," said John Zervos of Henry Ford Health System in Detroit, who recruited roughly 80 students from medical schools at Wayne State, the University of Michigan and Michigan State University. Lucia Luna-Wong, a fourth-year student at Wayne State, said she didn't hesitate when offered a chance to join a “crash course in public health.” She wants to specialize in infectious diseases. “This is so valuable, from bedside manners to learning about health disparities in the city. This is just an unbelievable experience for me. I'm going to be a better doctor,” said Luna-Wong, 38, a native of Peru.

Safely reopening Michigan’s economy requires widespread coronavirus testing, which is why Gov. Gretchen Whitmer is pushing for expanded testing and, recently, urged the state’s essential workers to get tested regardless of whether they have symptoms. But if you’re among the 49 percent of the state’s workforce that counts as an essential worker, don’t bank on getting one. Seven of 12 large Michigan health systems queried by Bridge Magazine said they are not yet testing asymptomatic essential workers, largely because they still lack enough supplies — particularly the nasal swabs used to collect samples — to expand beyond testing people who show symptoms such as coughing, fever or respiratory distress.  “We would like to test asymptomatic employees, but it’s not something that currently we are able to do,” said Dr. Teena Chopra, a professor of infectious disease at Wayne State University, who is also in charge of infection control for the Detroit Medical Center’s eight hospitals. “We need swabs, we need reagents, and we need the testing kits that we use to process the samples.” DMC is testing some asymptomatic employees who have had direct contact with COVID-19 patients, and some high-risk asymptomatic patients, such as those being treated for cancer who come in for procedures like bone marrow biopsies. With more  supplies, Chopra said, “the sky is the limit” in how many people the Detroit-based health system would like to test. Gov. Gretchen Whitmer is “right in making the statement that asymptomatic essential workers should get tested, she’s absolutely right,” DMC’s Chopra said.

Change is often difficult. And when it is abrupt and massive, like the changes being wrought by the coronavirus pandemic, variation from the normal is even harder to accommodate. With face-to-face counseling sessions canceled because of social-distancing rules, mental health professionals in Michigan are resorting to online video sessions. But the full impact of the crisis on mental health is still emerging. “Here, we have a very rapid, immense, huge transition from one style of living to another," said Dr. Arash Javanbakht, assistant professor of psychiatry and behavioral neurosciences at Wayne State University. "It has affected all the different areas of life. And the transition was not planned. It just happened.” Add uncertainty over who is carrying the contagion and who is not, and how long the pandemic will last. Compound it with such a lack of control that staying at home is the only remedy, and conditions for mental health concerns like anxiety and depression are rampant, Javanbakht and other practitioners said. “Today, I was in the virtual clinic and people are stressed,” said the psychiatrist who specializes in trauma, stress and anxiety. His practice has moved online, like many others.

The 2020 graduating class of medical students has been anticipating this season for years. Instead, a spring that traditionally brings recognition and celebration has become a time of stark uncertainty. For students that matched with residency programs in-state, they have watched Michigan rise to be among the top 10 in the nation for known coronavirus cases — a pandemic hot spot, particularly in southeast Michigan. Incoming residents are grappling with an eagerness to join the front lines of COVID-19 care while experiencing some relief that they have a moment to prepare themselves before doing so. “We sit in this limbo,” explains fourth-year Wayne State School of Medicine student Andrew El-Alam, “we’re overqualified students, but underqualified physicians.” El-Alam, who matched in emergency medicine at Henry Ford Hospital, hopes that by his July start the incoming coronavirus cases are at a more manageable level. “I’ve come to terms that this is likely going to be here for a long, long time. But hopefully not at this level,” he said. The vice dean of Medical Education at Wayne State University School of Medicine, Dr. Richard Baker, has confidence in the class of 2020.“This is a heroic time. They will be heroes, whether they want to or not. It’s scary,” Baker said, adding, “This experience for this cohort of students going to residency will probably change them forever. But they’re up to the task.”

Wayne State Associate Professor of Psychiatry Arash Javanbakht and University of Michigan Doctoral Candidate Cristian Capotescu co-wrote a piece regarding the response to COVID-19. “More U.S. citizens have confirmed COVID-19 infections than the next five most affected countries combined. Yet as recently as mid-March, President Trump downplayed the gravity of the crisis by falsely claiming the coronavirus was nothing more than seasonal flu, or a Chinese hoax, or a deep state plot designed to damage his reelection bid. The current U.S. administration’s mishandling of the coronavirus threat is part of a larger problem in pandemic management. Many government officials, medical experts, scholars and journalists continued to underestimate the dangers of COVID-19, even as the disease upended life in China as early as mid-January. The results of this collective inertia are catastrophic indeed. The U.S., along with Italy, Spain, Iran and the French Alsace, is now the site of humanitarian tragedies, the kind we see erupting in the aftermath of natural disasters or military conflicts.

Arash Javanbakht, director of the Stress, Trauma, and Anxiety Research Clinic and a professor of psychiatry at Wayne State University, talked about the venting and complaining while quarantined at home during the coronavirus epidemic.

With government officials debating how and when to reopen the economy, a fundamental question about the coronavirus pandemic remains unanswered: Just how deadly is this disease? The “case fatality rate” of covid-19 varies wildly from country to country and even within nations from week to week. Without widespread testing to find out how many people have been infected, it remains impossible to determine precisely the lethality of the virus in any given community or demographic group. Researchers know that many infections result in no symptoms. “You need to do more testing,” said Teena Chopra, professor of medicine at Wayne State University’s division of infectious diseases. Without testing, she said, public health experts are forced “to live in an unknown world, and an unknown environment.”

Teena Chopra, a professor of infectious diseases at Wayne State University who leads infection control for the Detroit Medical Center’s eight hospitals, tied many of its COVID-19 deaths to a high rate of elderly patients sickened at area nursing homes. DMC does not publicly report the number of COVID-19 cases and deaths. "We are seeing a lot of nursing home populations brought to us very sick, and coming to us with severe illness," she said. Underlying health issues may make the symptoms of COVID-19 more difficult to detect in nursing home populations, she said, because "their biological age is different from their physical age." "They have very subtle symptoms, because their immunity is lower and they may not mount a fever like others can," she said. It may be several days before caregivers suspect a COVID-19 infection "and by then it's too late.” Although the city of Detroit has begun a project to test nursing home staff and residents, Chopra expressed frustration that it hadn't happened sooner and also said it shouldn't be limited to Detroit. "We need to test everybody in a nursing home and separate the positive cases from the ones who are negative," she said.

Experts acknowledge there are still enough unknowns about the virus and its impact on pregnancy to keep expectant mothers – and their doctors – up at night. Many U.S. hospitals now require that all incoming patients have their temperatures taken and symptoms screened at the door. As tests for the virus become more available and in more common use at metropolitan hospitals, some doctors urge they should be standard practice everywhere. “This is a hot topic among hospitals now,” said Char-Dong Hsu, chair of the Wayne State University Obstetrics and Gynecology Department. Similarly to the population at large, as many as eight out of ten pregnant women who have covid-19 may be asymptomatic yet contagious, he noted, meaning they could pose an extra danger to other women and providers if they aren’t identified.

There are indications that Michigan’s coronavirus case count may be leveling off, prompting even Gov. Gretchen Whitmer to start thinking about how the state will begin to ease the stay-at-home order and other social distancing measures implemented to contain the outbreak. Since April 3, when the state reported nearly 2,000 new cases, new positive cases have started to decline. The executive order mandating stay-at-home expires April 30. One of Whitmer’s criteria for at least partially reopening the state involves testing and that could be problematic, according to health officials. Dr. Teena Chopra, a professor of infectious diseases at the Wayne State University School of Medicine, said testing in Michigan is very limited and not sufficient to understand the true burden of disease. “I would recommend the state to start universally testing all high-risk individuals including (the) elderly, obese, diabetics, immunocompromised etc., regardless of symptoms,” she said. “Once life reopens it won’t be like a switch on, it will be from darkness to dimness,” said Chopra. “We would need to have a structured restart. I would still advise to keep a distance from others and wear a mask while (shopping) for groceries.” Even as the social distancing measures are modified or lifted, Chopra said that the virus will still be placing demands on health officials, the government and the public. “Pease remember we are still in the mitigation phase of the pandemic and we need to plan for the other phases now. All of this planning and further planning to prevent future pandemics should be done now,” she said.

As weeks of distancing turn into months, many people are experiencing a greater and greater sense of isolation. They’re also dealing with the uncertainty of when and how the pandemic will end, the fear of getting infected, the economic crisis that has cost millions of Americans their jobs, and the inconsistent messaging about the virus from authority figures. “All aspects of life are affected” by the pandemic, said Arash Javanbakht, a trauma specialist and assistant professor of psychiatry at Wayne State University. “It was like one day, everything changed.” And while the current crisis is stressful for everyone, people who already have conditions like anxiety or depression may be especially at risk, psychologists say. For people with anxiety disorders, for example, “any new stressor can make it worse,” Javanbakht said. It’s safe to say that billions of people around the world are in a stressful situation right now. For many, life changed nearly overnight, with little time to prepare, Javanbakht noted. Some are now trying to work from home while caring for children. Others have been laid off or furloughed and may be worried about how they will pay their bills. Meanwhile, people are getting a lot of contradictory information about the virus and the measures needed to combat it, Javanbakht said. While President Trump may say one thing, public health officials may say another. “It’s confusing and stressing,” Javanbakht said.

The coronavirus is pushing people to make a lot of tough choices. Dr. Teena Chopra, an infectious disease expert at Wayne State University, weighs in with a doctor's perspective on those choices and responds to listeners’ questions.

As the COVID-19 pandemic moves into high gear in Michigan, thousands of frontline hospital workers are facing increasing stress, fatigue and frustration going into the second month of the public health crisis that is projected to kill more than 2,000 in the state over the next several weeks. The COVID-19 pandemic has exposed flaws and vulnerabilities in how government responds to pandemics and how hospitals staff, supply and deliver health care to populations they serve. Some medical experts fear once the current emergency is over, political leaders and hospital executives will go back to bickering over holding down budget deficits and rising health care costs instead of focusing on real solutions. They say permanent changes in health care delivery and financing should be made because future killer outbreaks should be expected. "Inertia is a powerful force. (After a crisis is over), people tend to step back to their baseline position," said Mark Schweitzer, M.D., incoming dean of the Wayne State University School of Medicine. "I hope we learn from this and change." Teena Chopra, M.D., DMC's corporate director of epidemiology, said COVID-19 has exposed Detroit's broken public health system and fragile health care infrastructure. She said high incidence of chronic disease, poverty, low literacy rates and lack of trust in the medical system of many inner-city residents contributes to the high numbers of cases and hospitalizations in Detroit. "We will see even worse than what we are seeing today (last Thursday). We haven't peaked yet. We are going to see a lot of cases; we are going to see a lot more deaths. We are on the exponential phase of the epidemic curve," said Chopra, who also is a professor at Wayne State University School of Medicine.