Denise Fair Razo, Detroit’s chief public health officer, said she remembers the thousands of residents who died from COVID-19—and the pain that followed.
“We weren’t able to save them, and that’s what hurts,” Fair Razo said.
This is what happened to the survivors: In 2020, the pandemic stunned Detroit, a majority-Black city grappling with poverty, chronic illnesses and crowded housing. Stay-at-home orders disrupted learning for thousands of students, and earnings for thousands of businesses. Food pantries were overwhelmed by hungry families; hospitals were shocked by the colossal scale of sick patients, storing dead bodies in empty rooms. The virus imperiled bus drivers, teachers, nurses, grocery store clerks, and child care workers, who kept the engine of city living humming despite the danger of infection. Drivers cruised along the winding roads of Belle Isle to see portraits of Detroiters who lost their lives to COVID, gone but remembered forever.
Fair Razo led the city’s public health response to a historic crisis, after just six months on the job. The city organized mass COVID testing and distributed vaccines. Fair Razo became a regular presence at COVID press briefings, delivering updates on the virus’s horrific death toll and encouraging Detroiters to wear masks and social distance to guard against infection.
At times, she battled uncertainty, misinformation and grief over mass death—since 2020, more than 4,000 Detroiters have died from the fatal virus, per state health department data—but credits a village of city leaders and community messengers for slowing the virus’s spread.
“Every decision mattered. We focused on saving lives and, of course, protecting our community.”
Denise Fair Razo
The pandemic also reshaped the city’s approach to public health: frontline workers traveled to the places where Detroiters ate, worked, and lived.
Equity remains a bedrock of the health department’s mandate. Fair Razo said the department has embraced harm reduction, providing Narcan and other free healthcare supplies available at newsstands and vending machines as the city continues to battle the opioid epidemic. Last November, the city launched its Rides to Care program, which offers Detroit’s pregnant mothers free rides to prenatal appointments as some residents continue to struggle without cars and with unreliable mass transit.
“We can’t just remain locked into the four walls of the health department,” Fair Razo said. “People aren’t here.”
For the fifth year anniversary of the COVID-19 outbreak, Fair Razo spoke to BridgeDetroit at the Detroit Health Department administrative headquarters on Mack Ave. The wide-ranging conversation touched on the challenges of protecting local public health in times of crisis, lingering COVID trauma, the resources available to fight diseases and the city’s preparedness for future health emergencies.
This interview has been edited for length and clarity.
BridgeDetroit: At the onset of the pandemic in 2020, Detroit quickly became one of the epicenters of the virus in the United States. By mid-April, the city had reached a death toll of 538.
What was it like to lead the public health response to COVID? What were the toughest challenges?
Fair Razo: Everything happened so fast, and the pandemic really hit us hard. One of the great things is we did not panic. We prepared because we were seeing what was happening in Seattle, and our goal was to make sure we were ahead of what was happening.
But often, the information was coming to us so fast, and it was challenging. For me personally, it was traumatic. I was a new leader to the city. I was still going through my orientation, and we were learning about COVID-19.
I had to learn really quickly. The resilience of my team was phenomenal. The way that we all came together, the health department, the mayor’s office, the police department, the communications team. We all worked together with our community partners to make sure that Detroit thrived, and we did. In fact, we became a national example.
We stood up the mass testing site, and our mayor, he really led the way. He was in the room with us for those early-morning meetings and those late-night meetings. Every decision mattered. We focused on saving lives and, of course, protecting our community. Although this was traumatic, it showed us that we have a lot of work to do, and it created an opportunity for us to rethink how we deliver care, how we show up for our residents, how we advocate for them, and how we work together through a challenging time.
And this also shaped the direction of our city, and I’m really proud of that. I think there are still certainly some gaps, but we are continuing to prepare, because if there ever is another pandemic, we will learn from what we experienced.
BridgeDetroit: The pandemic exposed deep health and economic inequities which made Black residents especially vulnerable to the virus. And a lot of health misinformation spread across the country. How did that also affect the public health response?
Fair Razo: Despite the overwhelming uncertainty, the community’s response was inspiring too. I want to make sure that I don’t leave out our community because they suffered with us.
We remained focused on saving lives, but we did everything we could do to protect the public’s health, and that really is the role of the health department.
We are in a majority Black community, and we’re more vulnerable due to essential jobs, crowded housing, limited access to health care. We knew that going into the pandemic, so it was already challenging, and misinformation spread quickly. So we were competing against social media influencers that were just spreading misinformation, and one of the things that we learned quickly was that not only do we have to get ahead of that misinformation, but we needed to meet people right where they were.
Oftentimes, we were on social media with the influencers, and we were busting myths on the spot. I remember I was on an Instagram Live with one of the local rappers, and I was just answering questions because people needed to hear the truth. And there [were] so [many] mixed messages out there.
Not only do we have [the] health department leading the way, but we worked with our trusted messengers. That’s our pastors, that’s our block club leaders, and we shared information with them, and they passed it to the residents. And that was pretty powerful. So despite the challenges, the community stepped up, and together we reduced the virus’s spread.
BridgeDetroit: Once the first COVID vaccines became available (Michigan expanded vaccine eligibility in March and April 2021), we saw mobile clinics bring the vaccines directly to communities.
Can you talk about the impact of that model of healthcare delivery? Do you feel like that directly influenced the creation of the community-based health hubs we’ve seen in recent years?
Fair Razo: Yes, this is the traditional public health approach, which is meeting people right where they are. We know that transportation is a social determinant of health, so if you don’t have transportation, if you don’t have access, then you’re stuck.
We wanted to make sure that when we had our vaccines. We brought the vaccine directly to the residents. We brought testing directly to the residents. And we had a mobile unit so we were in neighborhoods, going door to door. Residents who were homebound were able to get vaccinated. [For] residents who didn’t feel comfortable leaving their home, we were able to get them access, and that certainly has shaped the direction of public health as well.
At one point, we were in grocery store parking lots vaccinating our residents. We were in churches, we were in school parking lots, we were in bars late at night, we were on Belle Isle. That just speaks to my team and their [willingness] to go the extra mile, because we know that if the community is vaccinated, then we’re more likely to stop the spread of the virus, and we did.
BridgeDetroit: Since COVID, we’ve seen more of a public conversation and actions taken to address the social determinants of health. Did COVID help spark that?
Fair Razo: Social determinants of health [are] nothing new, right? So there’s been a long-standing conversation, but now we’re finally doing something about it. The mayor just made an announcement in November of the new Rides to Care Program, which is launched as part of the Detroit Health Department. It is a program that gives rides to moms who are pregnant, caregivers who are taking care of an infant. They’ll get free rides to their doctor’s appointments, and also moms who are suffering from postpartum also get rides to the doctor’s appointment. That’s important, because if you don’t have access to care, then your health or your baby’s health could be impacted.
We learned from COVID that transportation is key. Since November, we’ve offered over 5,000 free rides to about 600 Detroiters, and that’s powerful. And after a year, we’ll go through our evaluation, and I’m sure it’ll have a direct impact on infant mortality, which is certainly a challenge in our community.
BridgeDetroit: COVID was very traumatic for many Detroiters. Do you still see that impact being felt today?
Fair Razo: Absolutely, we’re still traumatized. Five years really isn’t a long time. We’re still suffering from loss. We’re still suffering from just the challenges that we all went through, whether you were a student who didn’t get the chance to graduate and walk across the stage. Whether you were a mom who lost her child during COVID.
We didn’t have funerals during COVID. If we did, they were outside, and they were limited to 10 people. We all experience loss and challenges, and we’re still coping with grief and stress. But at the health department, we are providing resources. We’re providing training, outreach and education to help mitigate the impact of COVID and to provide an outlet for Detroiters who are still suffering.
BridgeDetroit: Looking back, are there any other lessons learned about protecting local public health in times of crisis?
Fair Razo: We need to do a better job of advocating for public health. It is a resource that we need to elevate, and that is part of the health department’s agenda, is to continue advocating for our residents, to advocate for additional funding for the health department so that we can continue to provide resources for our residents.
We have learned the importance of being flexible, keeping health equity central to every decision that we make. We’ve learned that we need to continue partnering with the CDC (Centers for Disease Control and Prevention), with the state of Michigan, with community-based organizations and also churches, if we need to come together, share resources, disseminate resources, because ultimately, we’re on the same team. We want Detroiters’ lives to be positively impacted, and that’s the agenda that we currently support.
BridgeDetroit: What’s the status of COVID in the city today? Are Detroiters still taking the vaccine? Or have the vaccination rates declined? If so, what’s your guidance?
Fair Razo: COVID is seasonal. We typically see a lull during the summer months, the spring, and then cases pick back up in the fall and winter months. So right now, cases have decreased, but vaccination rates have declined significantly.
(In the last 12 months, roughly 43,000 COVID vaccine doses were administered in Detroit, according to the state’s COVID-19 vaccine dashboard. By comparison, about 144,600 Detroit residents ages 16 and older received at least one COVID vaccine shot as of late April 2021, when skepticism and medical distrust among the city’s Black residents caused some vaccine hesitation. The city’s medical responders and frontline health workers were among the first recipients of the vaccine in Dec. 2020.)
The health department continues to recommend vaccinations. We have regular campaigns to remind people about the importance of getting the COVID vaccine, and we continue to offer testing as needed, but certainly it’s still important. It’s still affecting our community, and we really want Detroiters to take advantage of this lifesaving vaccine.
BridgeDetroit: Some public health experts warned about the spread of avian flu, noting health departments should prepare to respond to another future health emergency. What is the city health department doing to prepare for that potential reality?
Fair Razo: So we are preparing right now. There are no cases of H5N1,which is avian flu or bird flu, but we are monitoring the situation very closely. We do know that there are some cases in surrounding cities.
We are equipped with investigation plans, monitoring protocols and resources, and staff trained to act quickly if there is an outbreak.
BridgeDetroit: What city health department resources are available for Detroiters, whether it’s related to COVID or other diseases?
Fair Razo: We are getting ready to launch a harm reduction campaign. We are providing free resources to residents all across the city. We have about 50 purple newsstands that we are installing at gas stations, motels, community-based organizations, and we’re offering free harm reduction supplies. That’s free Narcan, HIV testing so you can test in the comfort of your own home. Condoms, pregnancy kits, medication deactivation bags. These are free, and they’ll be available to residents. So far, we’ve installed 15, and have a few more to go. We’re also installing these large vending machines at the Rosa Parks DDOT station and also the Jason Hargrove (Transit Center) location. This is just part of our effort to provide free public health resources to residents. Harm reduction is exactly like it sounds. It’s reducing the harm associated with using drugs.
So far it’s been successful. We’ve partnered with our community partners. We know there’s an opioid crisis in the city of Detroit, and our residents need access, and we’re providing it for them.
BridgeDetroit: Is there anything else you wanted to add?
Fair Razo: There is a gap in the city of Detroit, and I’m hoping the health department can help to fill that gap. There needs to be greater partnerships between community-based organizations, universities, hospitals, because, again, we’re on the same team. We need to uplift population health. We need to uplift resources so that our Detroiters can have greater access to healthcare. And it’s not one person leading this. It really is a collective.
The Detroit Health Department and the Samaritan Center located at 5555 Conner St. in Detroit offer COVID-19 vaccinations. For more information, visit the health department’s website.