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Friday July 10, 2020
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(clockwise from top l) Franky Bennett, Allecia Wilsonx, Adam Lauring, Allecia Wilson

The Essentials

Ann Arborites working through the shutdown

by Ken Garber, Trilby MacDonald, Cynthia Furlong Reynolds, Jan Schlain

From the May, 2020 issue

The Covid-19 pandemic divided Ann Arbor between those with too little to do, and those with too much. While the economic shutdown triggered a record surge in unemployment, people in "essential occupations" are busier than ever.

They're healing the sick and studying the infection--but also feeding the hungry, fixing plugged sinks, and learning lessons that only the dead can teach.


Treating patients and tracking the virus

A specialist in infectious diseases at Michigan Medicine, Adam Lauring normally spends about four weeks a year seeing inpatients and the rest doing research. But in mid-April, he'd spent three of the previous five weeks with patients, almost all of them severely ill with Covid-19. "It's a time when I should be involved," he says. "I try to recharge when I'm not on, and to spend time with my family the best I can. But yeah, it's been busy. And it's stressful. And I probably don't sleep as much as I used to."

With as many as 150 Covid patients at a time in intensive care, Lauring is quick to point out that others are working even harder and at greater risk. The staff members who intubate patients to keep them alive on ventilators, the respiratory therapists who operate the machines, and the nurses all are "more on the front line," he says.

Lauring's life changed on March 9, when the hospital's head epidemiologist, who was preparing for the outbreak, asked him to cover her rounds. The U-M's first Covid-19 patient, one of the first in Michigan, had just arrived. Lauring spent the next two weeks seeing virtually every Covid patient in the U-M's hospitals.

"I'm used to seeing people who are very sick," Lauring says--but not "so many people very sick with the same thing." And Covid patients "can all of a sudden get much worse very quickly, in the course of hours."

A ban on visitors adds to the stress for caregivers and patients alike. "The interaction with family

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members is just not there," Lauring says, "and I think that can be tough. It's very hard for patients. It's very hard [for caregivers] to see."

When he's not seeing patients, Lauring runs a six-person lab, which studies how viruses evolve and spread. They'd been working on influenza, but after the outbreak hit, they abruptly shifted to the coronavirus. They're preserving virus samples from infected patients (inpatient, outpatient, and homebound) and preparing to sequence their RNA genomes.

Because the virus is constantly mutating, these genomes differ between patients and even within the same patient. The gene sequence "is almost like a signature, a fingerprint," Lauring says. It's entirely feasible, using such viral fingerprints, to pinpoint the person who infected a patient and to rule out others who didn't.

He says the data could help answer some key questions: "Does everyone transmit the same, or are there some people who transmit the virus more than others? Who's doing most of the transmission--is it kids, is it adults, is it people with certain conditions? Is it happening more from people who have symptoms, or people who don't?"

"We're still pretty early in understanding the evolution of this virus," he cautions. But he's confident that it will, in time, be contained: "There's no reason to think that we're not going to be able to get a vaccine."

--Ken Garber

---

Delivering food to those in need

"I feel it's very important to be of service, to give back to my community especially during this time," says Franky Bennett, fifty-two. "Hunger is very real now, and it affects everyone, one way or another."

Five days a week, Bennett drives a Food Gatherers' truck to groceries and big-box stores, where he collects produce, baked goods, canned foods, health care items, and prepared foods. He delivers his loads to Food Gatherers' northside warehouse, then goes out again to supply the food pantries that are struggling to sustain the newly jobless and their families.

A year ago, Bennett left a "nightmare" of a job "putting Xerox copiers in all of the [U-M] medical and campus buildings." Looking for more meaningful work, he found it as one of one of Food Gatherers' forty employees.

The staff normally works with an army of 5,000 volunteers, but during the pandemic, his job has evolved dramatically. To start with, the governor's stay-at-home order has replaced some volunteers with National Guardsmen and -women.

When U-M closed, Bennett worked overtime as sororities, fraternities, and cafeterias hurried to empty their pantries. When Governor Whitmer ordered restaurants to close their dining rooms, Bennett collected unused food so it wouldn't go to waste. "Common Grill alone gave us 500 pounds of fresh food. Casey's also emptied a lot of stock. And many more did the same."

When the governor's stay-at-home orders went into effect, Food Gatherers employees were exempted as essential workers, and they are: "The need is growing every day," Bennett says.

To reduce his own risk of infection, he routinely wears a mask and gloves. Riding shotgun in his truck are two huge containers of hand sanitizer. "Still, my job's a little stressful," he says. "Not everyone abides by the social distancing guidelines, but we try to.

"We no longer ask food pantries to sign for orders. I sign for them and slip the paperwork onto a table without any contact. I'm doing the best I can with the precautions, but it's challenging."

With so many restaurants closed or operating at reduced levels, grocery and big-box stores are Food Gatherers' primary food sources. Busch's, he says, "is very involved in fighting hunger; everyone there is on board. Trader Joe's is extremely generous--they donate a lot of really good food, a lot of produce. Kroger, too. The People's Food Co-op and Whole Foods give us healthy prepared foods--hummus, cheeses, prepared foods. We also pick up big loads from Costco and Sam's Club.

"They used to give us packages of meat, but no longer--the demand is too great; they can't keep them on their own shelves. For a while, there was no bread to donate, but supplies are better now."

Bennett delivers to Catholic Social Services, church food pantries, the Salvation Army, the Bryant and Hikone community centers, Faith in Action, Delonis Center, Aid in Milan, and other sites. Though he gets there well before they open, lately "I'm seeing people lined up outside the centers long before they open their doors.

"Some days I collect sandwiches from Whole Foods in the early afternoon, and by 3 o'clock I'm giving those sandwiches to people who otherwise wouldn't have a meal.

"Unlike many people, I get to see the good I'm doing firsthand. Every day I know I'm helping someone, someone who won't have to go to bed hungry that night.

"It's a calling now. I'm helping with a desperate need. There's great satisfaction in doing that. You look beyond yourself to the greater good."

--Cynthia Furlong Reynolds

---

Keeping the lights on

James Bentley III is lead emergency on-call tech for McKinley Properties. His team of four covers the night shift at the Aspen Chase, Villas, Roundtree, Golfside Lake, and Glencoe Hills apartment complexes. There are 720 units in Glencoe Hills alone.

Bentley has a broad smile and quick, springy step. He has been with McKinley since 2015 and knows many tenants by name. But to reduce the risk of spreading Covid-19, during Governor Whitmer's "Stay Home, Stay Safe" order, his team is responding only to emergencies such as major plumbing issues, lack of heat, or broken windows.

"You are thinking about so much when you go into someone's home," he says. "The first thing I ask is if anyone is quarantined."

What concerns him more are residents who don't know they're infected. Bentley has lost five close personal friends to Covid-19 in his hometown of Detroit, and several more people in his church congregation.

"My precautions are masks, gloves, and booties, and I always wipe down the areas where I work," he says. "In a discreet way, I ask residents to observe social distancing. I don't want to infect anyone and I don't want to be infected .... I honestly think they don't want us in their houses any more than us having to go there. It's so comical--they're like, 'Okay!' They open the door and step away."

Bentley says the pandemic has made residents more self-sufficient. "People are not allowing crazy things to happen, like bathtubs overflowing and leaking into the apartments below them," he says "Pre-shutdown, people would call maintenance for almost anything. Now, people are trying to rectify problems themselves because they don't want to bring anyone into their home."

He is grateful that residents have been limiting their calls to true emergencies. "I have been surprised by how nice people are," he says. "We try to get in, repair the problem, and get out as soon as possible. We are more organized now and always bring the exact tools we need."

When residents do start conversations, he tries to disengage gracefully, for his sake as well as theirs. But he understands the shutdown is hard for "people who are lonely, particularly the older residents--you can tell that it is more bothersome to them having to be in the home. It's subjective, because even though you might like to be home, your homebody control is taken from you."

Staying home by choice, he points out, is one thing. "Being told you can't go out is another story."

--Trilby MacDonald

---

The medical detective

Allecia Wilson became director of U-M's Autopsy and Forensic Services and chief medical examiner for Washtenaw County on January 1--and "walked right into a pandemic."

Her workday starts at 6:30 or 7 a.m. "looking at a list of who passed away the day and night before." On a typical day, she and another forensic pathologist will identify three or four to autopsy. "An autopsy is just a medical procedure that helps us understand the cause of death," she says.

Her docket comes from Washtenaw and Livingston counties. Michigan Medicine also contracts with Wayne County to provide medical examiner services, and five more forensic pathologists there have their own docket.

Despite the pandemic, "in terms of our actual numbers, I think right now they're about the same," Wilson says. While she hasn't studied the numbers, with fewer cars on the road, they're seeing fewer people who died in motor vehicle accidents.

While some might find her work gruesome, "I love medicine," says Wilson. "My passion has always been medicine, but I also loved law enforcement. I thought about being a detective, a homicide detective, growing up.

"In medical school I learned about forensic pathology and it just clicked for me ... I love the study of disease. And I also love investigating and putting pieces together. So I'm a detective at heart."

During the pandemic, Wilson and her colleagues are playing a lead role in understanding how and why Covid-19 kills. "People are dying from respiratory distress, so a lot of patients are developing pneumonia," she explains. Though seniors and people with pre-existing medical conditions are at greatest risk, they've performed autopsies on people in their thirties. An autopsy may also be called for, Wilson says, when "someone was expected to recover or on their way to recover and died suddenly." Then, both the treating physicians and the family may want answers.

"One of the things that was brought to our attention very early on was that some of these patients were developing clots or thrombi in the [blood] vessels," Wilson says. Autopsies confirmed that they were "developing these microclots in the vessels in their lungs." That knowledge, in turn, may lead clinicians to provide "anti-coagulation, or some type of blood thinners" if they think the patients are experiencing these clots.

"We're working hand in hand with the treating doctors," she says, "to really use the autopsy to help us understand what's going on in the living."

She says she "doesn't worry any more than usual" about being exposed to infection during autopsies. "In terms of what we know right now, with postmortem transmissions, the risk is very low. But we do have increased precautions."

They perform Covid-19 autopsies in a negative pressure room so virus-laden air can't escape, and wear full personal protection equipment. They're also not examining Covid patients' brains, because the saw used to open the skull can generate a virus-laden aerosol ("I don't know how you're going to write that nicely").

"My role has always been as a public health official, so my purpose is really to do things that keep the citizens of our county safe," Wilson says. "Personally, I go through the same thing that everyone else goes through in terms of the disinfecting, the isolation. I do have close family members that I live with, so it's been some great bonding time with loved ones. But I think I'm pretty much experiencing the same things that others are in the community."

She thinks "the recommendations that have been set forth in terms of wearing those masks is always a good idea," even if it only keeps people from touching their own noses and mouths. She thinks wearing masks also "gives people some sense of security, and that's really important, I think, as we go through this. It's a really challenging time for all of us.

"I'm all for people doing things that give people the comfort and safety they need to live their lives and go grocery shopping and just be able to do the everyday things we need to do to make it through this.

"Mass disaster training is part of what we do," she says. "We've read about it, we've studied case models and things of the past, but to actually go through it yourself, to actually activate the mass disaster plan or to employ the methods that some of us have had to do in order to deal with the deaths as we go through this, I think it's a sobering experience. I think it's one of the things that many people don't have the opportunity to do in their career -- and it really grounds you into remembering why you went into this profession.

"I really look at it as though I'm the person's last doctor. I'm the one that gets to answer a lot of questions for their families, for their doctors, for our community."

She also has some heartfelt advice about how not to be her next "patient."

"I would really encourage the community, that if you suspect someone is ill--if they have any of the Covid-like symptoms that have been reported--that they seek medical care," she says.

"There is a lot we can do at the autopsy to help us understand, but ... as much as we can do that, I would really encourage [everyone] to seek medical attention--for the living."

--Jan Schlain     (end of article)

[Originally published in May, 2020.]

 

 
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