Q&A with Dr. Paul Thomas on COVID-19

Editor’s note: This guest column by Dr. Paul Thomas, a family medicine doctor and founder of Plum Health Direct Primary Care, has been adapted from this blog post on the health center's website. Click here for the full post published on April 4.

The COVID-19 pandemic has brought an overload of information — and there's a lot of misinformation out there. Do you have a question for Dr. Thomas about coronavirus? Join us on our Facebook page for a Facebook Live Q&A at 10 a.m. Wednesday, April 8, with Dr. Thomas.

Q: Which counties nationwide have been impacted the most by coronavirus?

A: From the perspective of the number of cases and the number of deaths, the following counties/areas have been impacted the most by the coronavirus:

  • New York City (Queens, Bronx, Manhattan, Brooklyn, Staten Island)
  • Wayne County, Michigan
  • King County, Washington
  • Orleans County, Louisiana
  • Cook County, Illinois
  • Oakland County, Michigan
  • Bergen County, New Jersey

This comes from the Johns Hopkins Coronavirus Resource Center and it's notable that Michigan has two neighboring counties in the top six hardest-hit counties: Wayne County and Oakland County.

Q: Why has Michigan and Southeast Michigan been hit so hard by the coronavirus?

A: Bridge Magazine wrote an excellent article on this and I agree with their assessment with one addition that we haven't been talking about.

In the article, Bridge Magazine talks about the following factors causing Michigan to be more susceptible to the virus:

  • Automotive trade with suppliers in Wuhan China
  • Detroit Metro Airport with Direct Flights to Wuhan, China
  • Michigan’s March 10th Presidential Primary
  • Ties between Detroit and Italy via Fiat Chrysler (FCA)

In addition to these factors, I would want to add a few others, including higher rates of overweight and obesity in Detroit and Michigan - rate of overweight is 47.5% in Detroit (34% in NYC) and rate of obesity is 34.6% in Detroit (22% in NYC).

All of these factors have led to a higher case fatality rate here in Detroit and Michigan than the national case fatality rate:

  • National case fatality rate is 2.47%
  • Michigan case fatality rate is 3.75%
  • Detroit case fatality rate is 3.29%

Q: What are the comorbid conditions increasing the risk of mortality in COVID-19 positive patients?

A: [Last] week, I spoke with a physician colleague at one of the nearby regional hospital systems and we discussed the conditions that lead to a higher mortality rate. These comorbid conditions are as follows:

  • Cardiovascular disease (High blood pressure)
  • Diabetes
  • Pulmonary Disease
  • Obesity
  • Cancer

These factors that we discussed were similar to those studied in Wuhan, China.

While it’s still too early to state exactly why this is the case, I have a few theories. First, African American folks have higher rates of diabetes, hypertension, and obesity than their white counterparts here in Detroit and in Michigan. As we stated above, these are risk factors for higher mortality from the coronavirus. Next, African American people may be more likely to depend on low and minimum wage jobs that put them at a higher risk of contracting the coronavirus.

Q: Should I wear a mask to prevent the spread of the coronavirus?

A: Yes, the CDC now recommends that all Americans wear a mask when in a place where they have a higher chance of contracting the Coronavirus, like grocery stores. This can be a cloth or fabric mask. Please wash these each day if you wear them. Please do not hoard surgical or N95 masks as these are needed at hospitals at this time.

Q: What can you do to slow down the coronavirus?


  • Stay at home
  • Donate extra supplies to hospitals or your primary care doctor’s office
    • Unused N95 masks
    • Unused nitrile gloves
  • Donate blood
  • DO NOT congregate in large groups
  • DO NOT visit elderly or vulnerable relatives, even if you feel fine
  • Act as though you have the virus
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