DETROIT — The man who raised Keith Gambrell, who loved him like a son and married his mother, died in a blue recliner of novel coronavirus in his Michigan home.
Gary Fowler, 56, went to the emergency rooms of three metro Detroit hospitals in the weeks leading up to his death, begging for a coronavirus test, begging for help because he was having difficulty breathing, but was repeatedly turned away, Gambrell said.
"My dad passed at home, and no one tried to help him," Gambrell, 33, of northwest Detroit said through tears. "He asked for help, and they sent him away. They turned him away."
In the hours before his death, breathing was so difficult, Fowler slept sitting up in the bedroom chair, while his wife, Cheryl Fowler, dozed in the bed by his side. When she woke, her husband of nearly 24 years was gone.
Before he took his last breaths, Gary Fowler had scrawled on a piece of paper: "Heart beat irregular ... oxygen level low."
"My little brother called me, screaming, 'Daddy won't wake up!' " Gambrell said.
By the time Gambrell got across town to their house on the morning of April 7, police and emergency medical workers had already arrived.
His dad was still in the recliner. A bluish tinge had settled on his lips and fingers.
"I went up and talked to him," Gambrell said, his voice breaking as he held back tears. "I told him I love him, and that I'll see him again one day, and that I'm sorry we couldn't even have a funeral for him.
"I just felt so bad because he was begging for his life, and medical professionals did nothing for him."
The virus, which has hit Detroit harder than any other city in Michigan — infecting at least 30,791 people and killing 2,308, of whom 7,497 are in the city of Detroit, where 589 have died — has brought renewed attention to health disparities for people of color.
"About 33% of the cases of COVID-19 in this entire state of Michigan are in African Americans, and about 40% ... of the deaths," Dr. Joneigh Khaldun, the chief medical executive for the Michigan Department of Health and Human Services, said during a Facebook Live interview Thursday with Detroit's Civil Rights, Inclusion and Equal Opportunity Department. "And that's incredibly concerning. We know that African Americans are only about 14% of the entire population."
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Gambrell lives in Detroit's 48235 ZIP code, a coronavirus hot zone with the highest infection rate per capita — with 162 cases per 10,000 residents — and the highest number of confirmed cases of the virus at 724, according to data released Friday by the city.
Gambrell's grandfather, David Fowler, lived in the Boston Edison District. His 48202 ZIP code is in the top 10 for coronavirus infections, too, with 114 cases per 10,000 residents.
David Fowler died of COVID-19 just hours before his son Gary was taken by the same disease.
Denise Fair, Detroit's chief public health officer, said Friday that the ZIP code data still are huge under-estimations. Coronavirus testing remains a barrier for many in the community, as does access to care.
"It's estimated that there are upwards of 10 people with undetected infections for every confirmed case, and in some communities, the estimates are even higher," she said.
Health disparities turn deadly
Dozens of factors feed the health disparities for people of color, said Khaldun, who formerly worked as the director and health officer for the Detroit Department of Health.
"It's a contagious disease," she said. "That's the bottom line. And people who have chronic conditions, asthma, diabetes are more likely to get the disease and then have more severe illness."
And in Detroit — the biggest majority black big city in America — rates of many of those chronic conditions are higher than the rest of the state, making Detroiters especially vulnerable. Add poverty to the mix, Khaldun said, and it's the perfect recipe for rapid-fire spread.
For many of the city's poor, it's impossible to practice social distancing and stay home because they are more likely to hold low-wage jobs in grocery stores, gas stations, and other work in services that are considered essential and still operating through this crisis.
Transportation plays into it, too, Khaldun said.
"People who are more likely to be underprivileged and people of color, living in poverty, are more likely to get sick from this disease," Khaldun said. "I think it's quite simple, actually. And I think we'll see that once we get more data and start doing the analysis."
Even when people in poverty get the disease, Khaldun explained, isolating from others in a household might not be possible, increasing the chances that the virus will spread through entire families.
But even beyond the economic drivers that make the black community more vulnerable in this pandemic, there's also bias within the medical community, Khaldun said.
That bias might play a role in who gets a COVID-19 test and who does not, who gets hospitalized and who does not, and whose symptoms are taken seriously and whose are not.
"I'm a doctor and my own doctor did not listen to my concerns about a headache after I had my first child," she said. "And I ended up in an ICU (intensive-care unit) with a head full of blood. ... My own doctors did not listen to me...
"We know there's often delays in diagnosis for all kinds of medical conditions in the black community and people of color. So are there delays in testing? Are there delays in treatment? Are we sending people home when they really should be admitted to the hospital because they're so at risk for deteriorating quickly? So those are the types of things that we're going to have to look at."
COVID-19 devastates the Fowlers
Hours before Gary Fowler died in his rocking chair, his father, David Fowler, also slipped away.
COVID-19 came for David — a grandfather of 11 and great-grandfather of two — while he lay alone in a hospital bed about a dozen miles from his son, who was "his best friend," Gambrell said.
He was 76.
David, a retired tool and dye maker who loved camping and the outdoors, took ill in mid-March.
On the morning of March 22, Gambrell went to visit his grandfather to check on him. Gambrell's mom and dad went, too.
"We just thought he had the flu," Gambrell said. But that afternoon, it was clear to them all that David's illness was serious — he'd passed out in the bathroom.
They called 911, and an ambulance took David to Henry Ford Hospital in Detroit, where he was admitted. He tested positive for the virus, and was put on a ventilator.
"The following week, my father started developing a cough," Gambrell said, "and the cough was getting worse and worse by the hour."
In the last week in March, Gary Fowler spiked a fever, too, and his breathing was becoming labored. He went to Beaumont Hospital in Grosse Pointe for help, Gambrell said.
"He tells them, 'My father has the coronavirus. I would like to get a test because I am showing symptoms. I am coughing,' " Gambrell said. "He had a fever of 101. He had shortness of breath. He was showing all the signs.
"They tell him, 'Sir, more than likely the fever is from bronchitis.' And they tell him to go home. But they also give my dad a piece of paper saying to act like you have the virus."
Gary Fowler was not tested for COVID-19. He followed the instructions and went back home.
The same scenario played out at several other hospitals in the days that followed as Fowler continued to seek medical care, knowing his body was starting to fail.
After going to Detroit Receiving Hospital, Fowler was told he'd get better care at Henry Ford.
When he arrived at Henry Ford, Gambrell said his father explained: " 'My chest hurts. I can't breathe. I have a fever that has not broke. I've been taking Tylenol, I've been drinking stuff and it is not breaking. I think I have the virus because my father tested positive for it and I saw him ... the day he went to the hospital.'
"But it was the same thing. They tell him: 'You're fine. You have bronchitis. Go home. Drink water. Act like you have the virus.' "
Gary Fowler was never tested. He was never admitted to any hospital or given any treatment, his son said, perplexed by the way each hospital turned away his father in his moment of need.
"If I have to act like I have a virus, does that mean I have a virus and you guys are sending me home until I'm on my deathbed?" Gambrell asked. "And then, when I come back to the hospital, it's too late?
"I honestly think that's why the death rate for blacks is so high. It's because we're being pushed to the back and told to go home, but come back if you can make it before you die.
"That shouldn't be the medical procedure for anything."
Beaumont issued the following statement after questions about how Gary Fowler was treated:
"COVID-19 is hitting southeastern Michigan particularly hard. As patients come to Beaumont for care during this extraordinary time, we are doing all we can to evaluate, triage and care for patients based on the information we know at the time. When making care decisions, we do not discriminate against anyone based upon their gender, race or any other factor. We grieve the loss of any patient to COVID-19 or any other illness."
Henry Ford Health System said Saturday that no one who comes to the hospital is denied care.
"All patients who come to our emergency departments receive care and assessment," said Brenda Craig, vice president of integrated communications at Henry Ford Health System. "Some patients will meet criteria for admission at the time, while others may not. In the case of COVID-19, we have a multi-step triage process. As patients arrive to our emergency department, all are screened for COVID-19 symptoms. Those with mild or moderate symptoms who do not meet admission criteria at the time they present may be sent home with strict instructions to return immediately if symptoms worsen.
"Our thoughts and prayers are with the Fowlers and all families devastated by the effects of COVID-19. We’re not able to share details due to patient privacy, but we don’t take lightly any concerns of biased care given our dedication to putting patients first. Throughout this pandemic, we have followed CDC (Centers for Disease Control nad Prevention) guidelines related to testing and clinical care protocols. Henry Ford has also been a leader in addressing health disparities and driving true health equity as part of our core mission and values and that work will continue."
Craig acknowledged that testing for coronavirus remains limited.
"Given the U.S. currently does not have the ability to widely expand testing to everyone, the CDC has issued guidelines to health systems to prioritize testing," she said. "We’ve followed these guidelines closely, whereby patients who are currently admitted and health care workers experiencing symptoms are among those receiving top priority for testing."
Even though his father never had a COVID-19 test, Gambrell said his dad's death certificate says he died of the virus.
"There's no question," he said.
A son fights to save his mother
Despite the fresh grief of losing both of the family patriarchs within hours of one another, the coronavirus still wasn't done with the Fowler family.
The day her husband died, Cheryl, 57, got sick, too.
"She started coughing and had a fever of 102" degrees, said Gambrell, who was terrified about waiting too long to get help for her.
Cheryl's cousin, state Rep. Karen Whitsett, who also had COVID-19, heard about the deaths of Gary and David Fowler, and called the family.
When she learned that no one else had been able to get tested, and that Gary had been unable to get hospital care, Whitsett gave them a number for the doctor who treated her for COVID-19.
But even Whitsett said she'd had trouble getting tested.
"The part that bothers me the most through this whole entire process is that ... if I hadn't used my name, if it wasn't for my name and my job title, I don't think I would have gotten anywhere, either," with testing and treatment, said Whitsett, a Detroit Democrat.
Whitsett made national headlines earlier this month for praising President Donald Trump and crediting him with saving her life because he'd touted the anti-malaria drug hydroxycholoroquine as a potential treatment for coronavirus. Last week, she went to the White House to meet him.
Obstacles to getting COVID-19 testing and care are not just happening in Detroit's black community.
The American Hospital Association sent a letter last week to U.S. Department of Health and Human Services Secretary Alex Azar about the racial disparities in the federal COVID-19 response, highlighting a lack of available tests for African Americans, unequal medical treatment for those who have the disease and lack of public health information about coronavirus for communities of color.
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And the CDC released on Friday its first national report on race and coronavirus. It suggests 30% of COVID-19 patients so far in the outbreak are black, though the U.S. population is only about 12% black. The federal agency acknowledged, however, that race data was missing from 75% of the cases it examined.
The doctor who prescribed hydroxychloroquine for Whitsett wrote prescriptions for Cheryl Fowler, Gambrell, his brothers, sister and niece to get coronavirus tests, Gambrell said.
But before any of them could get in for testing, Cheryl's condition worsened. Her fever was rising and she was having trouble breathing, too.
Gambrell drove her to Beaumont Hospital, Grosse Pointe, the night of April 7 — just hours after her husband's body was taken to the funeral home.
"Before they even looked at my mother, there was a young Caucasian lady complaining about sushi she got from GrubHub that upset her stomach, and they swooped her in the back like she had coronavirus," Keith said.
"But my mom, she had all the symptoms, and they tell her just go home. That makes no sense. ... They helped a girl who ate bad seafood over someone with all the signs of needing medical need help.
"I felt like they sent my mother home to die."
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Gambrell refused to give up. Next, he took Cheryl to Henry Ford Hospital in Detroit.
He said he kissed her forehead before she entered the doors of the emergency room alone — during the pandemic, most hospitals don't allow adults to have support people with them inside to avoid further risk of infection.
Gambrell wondered whether it would be the last time he'd see her alive. The grief was still raw from the death of his father. He prayed he wouldn't lose his mother, too.
"I was very concerned that my mother wouldn't walk out of that hospital, especially after what just happened to my dad," he said.
There was relief when he got a call about an hour after he dropped off Cheryl at Henry Ford. She was being admitted.
"She tested positive for the virus as well," he said. "It was a blessing they kept my mom. I think the only reason they kept my mom was because she had prescriptions to get tested for the virus."
Hearts broken, but on the mend
Cheryl Fowler soon also needed a ventilator to help her breathe. Gambrell got daily updates from the hospital, and his sister frequently checked on her by calling the nurse's station.
Gambrell said he began to feel a little off as well. He had a tickle in the back of his throat, felt hot and cold flashes and had lost his sense of taste and smell.
His youngest brother, Ross, was sick, too.
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On April 8, while their mother struggled for air at Henry Ford Hospital, the rest of the family went to get coronavirus tests.
Keith and Ross, 19, and their brother Troy, 21, sister, Paris, 28, and her daughter, Logan, 7, all got tested at an urgent care clinic. They were told it would be at least five days before they got results.
They all went home to wait, and to pray.
A day later, Ross was getting sicker.
Gambrell took him to Henry Ford in Detroit, too. Ross had been complaining of chest pain, and also had fever and a cough. It was the same hospital where their mother was starting to show signs of improvement.
"He said every time he inhales, it hurts. It hurts very bad," Gambrell said the evening of April 9. "They did a chest X-ray and were like, 'Oh, you have pneumonia. So here's a piece of paper. Go home, and act like you have the virus.'
"I am so tired of hearing that. If I have it, I have it. Please let me know that I have it so I can save my life.
"If my dad could have gotten tested the first time he went to the hospital, he would be here today."
Cheryl came off the ventilator April 10, Gambrell said. And two days after that, she had recovered enough to be discharged home.
She'll be on supplemental oxygen for at least two weeks, he said, but she's slowly healing through her grief.
Gambrell and his brother Ross both tested positive for COVID-19, but both are feeling much better now. Everyone else in the family who was tested got negative results.
He is shaken, he said, by all the family has endured in this crisis, and what it has revealed about inequities in this country.
"Why isn't there enough testing in the areas that are mostly impacted, which are black areas?" he asked.
"This coronavirus is gonna cause so much PTSD for people. It's sad. There's going to be a major fallout after this.
"It's not right at all. ... I don't try to put color on things and say, 'Oh this is black or this is white.' I don't do that with anything in my life, but when you see it, you have to call it how it is."
Contributing: Kristi Tanner, Detroit Free Press. Follow Kristen Jordan Shamus on Twitter: @KristenShamus