A Michigan physician reflects on the lessons learned during the beginning of the COVID-19 crisis.

By Katie Friel

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For five weeks this spring, Dr. Asha Shajahan made the drive from her home in suburban Detroit to Beaumont Hospital, Grosse Pointe, where she is a family medicine physician and medical director of community health. Her commute, normally a 35-minute slog through traffic, was cut in half due to the stay-at-home order Michigan put in place on March 23 to combat the rise of COVID-19.

Since the pandemic began, Wayne County, which includes Detroit, has reported 21,000 positive cases of COVID-19 — more than one-third of the positive cases in the entire state of Michigan.

During the height of the health crisis, which spanned mid-March through early May, physicians like Dr. Shajahan pivoted from working in offices and clinics to hospitals overwhelmed by the sudden surge in patients. Dr. Shajahan left her clinical practice to join thousands of hospital healthcare workers on the front lines of the fight against the novel coronavirus. 

For Dr. Shajahan, her new 12-hour shifts kicked off at 7 pm and began at a checkpoint outside the hospital doors where she was screened for coronavirus symptoms. 

“Have you been around any COVID-19 patients without personal protective equipment?” 

“No.” 

“Do you have any symptoms of cough, fever, or cold?” 

“No.”

Deemed safe to enter the building, Dr. Shajahan was then sanitized, handed a mask, and allowed to enter the building.

“So, that’s how my days would start,” she says.

The hospital, says Dr. Shajahan, was “a ghost town,” with doors sealed off and the few people roaming the hallways looking otherworldly in their head-to-toe protective gear. With visitors banned, the waiting rooms were empty, and even the nurses’ station, usually a place buzzing with activity, was silent. 

Dr. Asha Shajahan volunteers every Friday at the Pope Francis Center in Detroit, where she provides basic health care services for clients who are experiencing homelessness. She used to bring her students there, but when classes moved online after the pandemic hit, she called the shelter to see how they were doing. "They were like, we need help," Dr. Shajahan says, "So I just started going down there."  [Photos by Jeremy Brockman]
Dr. Asha Shajahan volunteers every Friday at the Pope Francis Center in Detroit, where she provides basic health care services for clients who are experiencing homelessness. She used to bring her students there, but when classes moved online after the pandemic hit, she called the shelter to see how they were doing. "They were like, we need help," Dr. Shajahan says, "So I just started going down there."  [Photos by Jeremy Brockman]
Dr. Asha Shajahan volunteers every Friday at the Pope Francis Center in Detroit, where she provides basic health care services for clients who are experiencing homelessness. She used to bring her students there, but when classes moved online after the pandemic hit, she called the shelter to see how they were doing. "They were like, we need help," Dr. Shajahan says, "So I just started going down there."  [Photos by Jeremy Brockman]

Dr. Shajahan’s personal protective equipment, better known as PPE, was cumbersome and uncomfortable, with multiple masks, a face shield, gloves, scrubs, and hospital gowns. Her chestnut hair was tied up into a tight bun and her head capped with a surgical hat. 

The gear made it difficult for her to pick up on her patients’ physical cues, let alone touch them, so the doctor’s work took on an entirely new challenge.

“When you’ve got all this gear around, you look so silly and probably scary to the patient,” she says, later adding: “It is difficult because in the past you probably would put your hands on a patient and say, it’s going to be okay… and now there’s a lot of physical distance there.”

She quickly learned to pick up on new cues, paying particular attention to her patients’ eyes. “I think the eye contact has really changed in terms of connecting with a patient in real life,” says Dr. Shajahan. “You can see tears in eyes. You can tell when someone’s smiling through their eyes. And I think we just never really picked up on those cues because we have so many other cues.”

At the height of the pandemic, the doctor was working 70-80 hours per week, double her normal work week, due in large part to the sheer number of coronavirus patients the hospital was seeing. But, says Dr. Shajahan, it wasn’t just the numbers that were shocking (at its height in mid-April, Wayne County had more than 200 new hospitalizations a day), but how sick the patients were coming in the door. 

“I used to work as a hospitalist before and you pronounce death a lot. You see very sick patients, with acute heart attacks and strokes and things,” she says. “I think the difference in this situation… was the volume. There were so many acute patients.”

And that wasn’t the only pattern beginning to emerge. “When COVID started, we saw that the majority of the patients coming in were African-American from the city of Detroit,” says Dr. Shajahan, who is also assistant professor at Oakland University School of Medicine where she teaches courses in health disparities and social inequity. 

“In the city of Detroit, 33 percent live in poverty. So I think our city got hit pretty hard because we have a lot of people who are struggling with the social determinants — income inequality, like housing that’s unaffordable. Transportation issues. So all of those things in general kind of shape your healthcare outcome.”

Detroit echoes a pattern across the U.S., in which Black Americans have died at a shockingly higher rate than their white and Latinx counterparts. According to the Centers for Disease Control, Black Americans account for 25 percent of the country’s COVID-19 deaths despite only making up 13 percent of the U.S. population.

“[COVID-19] just magnified the fact that we have a lot of work to do in terms of the social determinants of health.”

The pandemic is also magnifying the need for healthcare workers to receive their own crisis care. Providers are not only tasked with treating this largely unknown virus, they’re doing so while navigating the same uncertainties and fears as everyone else. 

During the height of the COVID-19 crisis, Dr. Asha Shajahan pivoted from working as a family physician in a clinic to working in a hospital overwhelmed by the sudden surge in patients. [Photo by Jeremy Brockman]

In the early mornings, when her shift was over, the doctor would drive home in silence. The 12-hour grind left little time to process what she was seeing, so the silence, coupled with Dr. Shajahan’s daily “mindful walks,” were a few of the coping tools she deployed. 

There were days when it would hit her all at once. On a Zoom call with her family, she broke down in tears. “Out of nowhere… I was bawling and you could see everyone was like, what’s going on here?”

As the U.S. hits 125,000 deaths from COVID-19, she worries about the long-term effects of this level of loss. 

“I feel like we’re gonna have a lot of trouble with grief over the next year or two, because I think it’s going to be prolonged a lot more than it normally is,” she says. “People don’t get a chance to celebrate loved ones’ lives the same way as they used to.”

And then, of course, there is the current coronavirus spike to worry about, which has hit Florida, Arizona, Texas, and other states that began reopening in May. Though Michigan’s numbers have gone down since their mid-April peak, the reopening process is currently underway, and will likely cause case numbers to rise as more people leave their homes and venture out to shop or dine in restaurants.  

If, or when, the numbers do rise, Dr. Shajahan says she’s confident that the healthcare system — at least her healthcare system — can handle it. The protocols developed over those five weeks in the spring are still in place, and the PPE shortage that forced some providers to reuse equipment seems to be sorted out. 

Still, she says, like all things surrounding COVID-19, there is fear.

“I think there’s always just that fear of if it ends up getting as bad as it was, where it was pretty much the entire hospital was COVID patients. Nobody wants to see that again,” says Dr. Shajahan. “And I think we know the virus is still out there. It doesn’t just magically disappear.”

Now Dr. Shajahan is back to her regular family practice, though she answers a lot more questions about coronavirus than she used to. She volunteers once a week at a local shelter for people experiencing homelessness, a place she used to bring her students until her classes moved online. And though Dr. Shajahan says she sees the initial public enthusiasm for health care providers, like parades and yard signs, dying down a little, she thinks that’s okay, as long as the community remains supportive in other ways.

“It’s not about having the title of hero. It’s more like having that support. I think more than holding up a hero sign is voting for something that helps health care providers do a better job — those things are a lot more important,” Dr. Shajahan says. 

“So, maybe the first step is holding a hero sign. And the second step is, you know, putting a ballot in.”

Top photo: Dr. Asha Shajahan treats Deacon Leon, 71, at the Pope Francis Center in Detroit, where she volunteers every Friday. [Photo by Jeremy Brockman]