Fear and mistrust in rural Georgia as Gov. Kemp urges the state to reopen.

Sheryl Means already has lost so much to the invisible virus burning through her hometown. Her mother and her aunt died within days of each other. Her sister has been on a ventilator for weeks in a hospital miles away, and there are no visitors allowed in the covid-19 isolation unit. She has this tightness in her chest, and she’s scared she might be next.

But Means can’t get a test. Even now, six weeks into a national emergency, with the death toll still climbing in southwest Georgia, and her kin sick from the novel coronavirus. Even though, as a home health-care worker, she’s at high risk for exposure. She isn’t displaying enough symptoms to get the required doctor’s referral. If she wanted, though, she could get her hair and nails done, since the state’s governor invited some businesses to reopen Friday, despite local leaders, public health experts and residents like Means insisting Georgia isn’t ready. They fear the restart will spike new infections, particularly in the southwest region, with some of the highest death rates in the nation. In these small, interconnected towns, where everyone seems to know everyone else, each death reverberates. “It’s crazy to open these businesses,” said Means, a 51-year-old Damascus resident. “Which do you want us to do: Be safe or be sorry? Live or die?”

Of the 20 counties in the nation with the most deaths per capita from covid-19, the disease caused by the coronavirus, five are in southwest Georgia, including Early, where Means lives. In the state’s hardest-hit places, African Americans make up most of the population, and about 30 percent of residents live in poverty. They’ve struggled for years with a severe lack of access to health care. Some counties have no doctors, no hospitals and a high percentage of uninsured residents. The facilities and physicians already were stretched thin A shuttered downtown Albany may soon exhibit signs of life as restrictions on some businesses are lifted. Then came the coronavirus, fast-moving and super-infectious, preying on the elderly and those with underlying health problems — perfectly primed to devastate a vulnerable population. When Gov. Brian Kemp (R) announced he was lifting restrictions on businesses, some residents in this region felt cast off, like the state was telling them to fend for themselves once again.

“To open up businesses where it’s impossible to practice social distancing — hair salons, nail salons, theaters — people are like, what? You want to put everybody in a closed room, and that’s supposed to be okay?” said Demetrius Young, a city commissioner in Albany, the center of the state’s epidemic. “For black folks, it’s like a setup: Are you trying to kill us?” Without a widespread testing infrastructure and local health departments able to do meticulous contact tracing, Young said, his region will continue to suffer. Georgia ranks 40th in tests per resident, well behind states that have pledged to maintain their shelter-in-place orders, according to an analysis of Covid Tracking Project data. Some models say the state has not yet reached its peak number of daily deaths, suggesting the worst is still to come. “We need to save lives,” Young said. “The way we feel is, this is another ‘Black Lives Matter’ moment.”

Glen Singfield, 67, owns two restaurants in Albany that have been shuttered for more than a month. He said he doesn’t plan to reopen them on Monday, when Kemp’s order for restarting the economy extends to restaurants. He is not convinced the virus has been brought under control, especially in Southwest Georgia. “We were hit hard, and our restraint needs to be harder. We have to make sure we’re way beyond the curve,” he said. He hasn’t had time to come up with a plan, such as how to screen customers, to make sure he can keep everyone, including his employees and family members who work in the restaurants, safe. “My wife, my sons, my granddaughters are in there. My employees. These are folks we love. I can’t play with their lives. We’re a small town. When somebody dies here, everybody knows them.”

Glen Singfield, who owns two restaurants in Albany, says he’s not prepared to reopen safely even if the government says he’s allowed to. Through Friday, African Americans accounted for more than 50 percent of Georgia’s deaths, despite making up about 30 percent of the state’s 10.6 million people. The toll is far greater in less populous counties where the largest share of residents is black. The number of cases per capita in plurality-black counties is 1.75 times that of plurality-white counties. The number of deaths per capita in plurality-black counties is twice that of white counties. There are signs the virus’s spread is picking up pace in white communities, too, though the mostly black neighborhoods are still seeing the highest number of cases per capita, according to an analysis of Census block-level data scraped from documents on Georgia’s Department of Public Health

These disparities illuminate a deep racial inequality: In Georgia, where Kemp has resisted Medicaid expansion, African Americans are less likely to be insured and more likely to have preexisting health conditions like diabetes, said Ben Lopman, a professor of epidemiology at Emory University. They’re also more likely to work in industries with a greater risk of exposure such as transportation, nursing homes and animal-slaughter plants — like the still-operating Tyson Foods plant in Mitchell County, where four infected workers have died.

“In the South, we’ve seen these kinds of inequalities in health for a long time,” Lopman said, comparing the pattern to the AIDS epidemic. “These inequalities are being repeated again for covid.” States from Wisconsin to Louisiana are seeing disproportionate numbers as well, but the disparity in Georgia is also geographic. Across the United States, urban counties have higher rates of coronavirus cases and deaths than rural counties. In Georgia, it’s the opposite. The state’s rural areas have a death rate 1.5 times that of its large cities. “Is this an indicator of what we’re going to see throughout the country? Absolutely,” Andrew T. Pavia, head of the pediatric infectious diseases division at the University of Utah School of Medicine, said of rural Georgia at an Infectious Diseases Society of America briefing this week. “It’s a perfect storm for risk of death when the virus lands in these poor, more rural communities.”

The resources to fight an epidemic like this — ventilators, intensive care facilities, infectious disease experts, doctors in general — are overwhelmingly concentrated in cities, Pavia said, making rural areas particularly vulnerable. Many of the southwest Georgia counties with the highest death rates have no hospitals. Unlike smaller cities and towns in northern Georgia, which are closer to Atlanta and have easy access to more than one regional medical center, residents in the southwest are forced to travel to Albany, the area’s hub, or to neighboring Alabama or Florida.

Monty Veazey, president and CEO of the Georgia Alliance of Community Hospitals, described the dire situation in the state’s rural communities, including the southwest: “Nine counties have no doctors — none, zero — 18 counties without family physicians, 32 have no internists, 60 without pediatricians, 76 counties have no OB/GYNs.” At least seven rural hospitals in Georgia have closed during the past decade.

Amid the outbreak, many doctors have shuttered their offices and are consulting with patients online. But vast swaths of rural Georgia do not have Internet access, further limiting residents’ ability to seek care. Aisha Bennett, a nurse at Emory Hospital, takes a nasal swab on April 16 at a drive-through testing site for covid-19 at the Georgia International Horse Park in Conyers. Federally funded community health centers fill in the gaps in some rural counties, but Veazey said of the nearly 30 counties that make up southwest Georgia, only a handful have those centers. Even those facilities are out of reach for some residents because they charge at least a nominal fee for care.

Veazey’s association represents not-for-profit hospitals, and he is concerned some might not survive the pandemic, having halted the elective procedures that typically generate revenue. Hospital closures would mean less access for residents and fewer jobs, contributing to the region’s economic distress. In Cuthbert, Mayor Steve Whatley is worried about the fate of the only hospital in Randolph County, Southwest Georgia Regional Medical Center. His county’s outbreak began in a nursing home, where 43 of its 60 residents have tested positive and are quarantined in the facility. The other 17 were transferred to the hospital, which is straining to take care of them. The crisis has “really impacted our hospital financially,” he said. “I cannot tell you what it’s done to us. We’re bleeding money.”

State Sen. Dean Burke, a Republican who supports Kemp’s decision to begin reopening businesses, said the coronavirus has shown the importance of a well-funded rural health-care system. Burke, who is also the chief medical officer at a hospital in Decatur, a southwest county that mostly has been spared, said facilities like his will need more financial support from the state and federal governments. “I think we will, after this is all over, come to understand the importance of a rural health network and the fact we can’t just let the big cities have big medical facilities and let rural facilities die on the vine,” Burke said. “I do think there will be a new appreciation that we have to use more resources to stabilize our rural health care network.” In the absence of robust testing and official contact tracing, residents have used an informal grapevine to form their own theories about how the virus spread: Some attendees of an early March birthday party in Blakely, the seat of Early County, were among the first to fall ill. But most believe the region’s outbreak began at a Dougherty County funeral in February that drew more than 100 mourners, including a man from Atlanta who died a few days after the services. The virus spread from there, quickly overwhelming Albany, the county seat, and radiating to neighboring locales. The county has nearly 1,500 cases and 108 deaths, a toll outnumbering everywhere else in Georgia — even Fulton County, home to Atlanta, where the population is 10 times that of Dougherty.

Most of those victims have died at Phoebe Putney Memorial, the county’s only hospital and the only hospital in southwest Georgia that is equipped to treat covid-19 patients. The facility’s administrators say they’ve seen significant progress in slowing the spread of the coronavirus, but they’re concerned a reopened Georgia will bring another tide of patients. “While we have successfully slowed the rate of covid-19 transmission in our area, we know there are still significant numbers of covid-positive individuals in our community,” Scott Steiner, the hospital CEO, said in a statement the day after Kemp’s announcement. “We worry that if people start returning to large gatherings too soon, we could see another ‘super-spreader event’ where a lot of people contract the virus. We certainly don’t want that to happen.” U.S. Rep. Sanford D. Bishop Jr., a Democrat who represents southwest Georgia, said he has worked with state and local officials to get additional resources for Phoebe Putney, including a drive-up testing site. He said the relief package passed this week by Congress will provide money for additional testing, in addition to economic relief for residents and businesses. Phoebe Putney Memorial Hospital in downtown Albany may receive funding for additional testing for the coronavirus from a relief package passed by Congress. (Kevin D. Liles for The Washington Post)

“We’ve had a really, really bad experience in southwest Georgia,” Bishop said. “Unfortunately, it’s a result of the fact that a lot of people — some 500,000 people in Georgia — are not covered by Medicaid, so they do not get regular preventive care and have a lot of preexisting conditions that lend themselves to attack by coronavirus.” Even as the state reported more cases and deaths in the days leading up to its reopening, Kemp defended his decision as one bolstered by data and public health recommendations. “Now, with favorable data and approval from state health officials, we are taking another measured step forward by opening shuttered businesses for limited operations,” he added. Kemp’s office did not respond to questions about his decision and its impact on the state’s southwest. In Blakely, a city of about 5,000 near Alabama, Mayor Travis Wimbush — who tested positive for covid-19 — has streamed regular addresses to his residents on Facebook, imploring them to stay home. “I will not put the power of a dollar over the value of a life in any decision that I will make,” he said on Wednesday. “There are currently still citizens of Blakely on life support.” In Damascus, Means is still mourning. Her aunt, 83-year-old Rosetta Salter, died April 3, two days before test results confirmed she had covid-19. Means’s mother, Bernice McCray, 80, was in a nursing home when she ran a fever. She was at a hospital in Dothan, Ala., where the family was allowed to visit only to say their goodbyes two days before she died April 9.

Means doesn’t know how her sister got infected but suspects it was in Albany. She was first diagnosed with pneumonia, then tested positive for covid-19 and was transferred to Dothan. Means hasn’t seen her since. Because Means hasn’t displayed symptoms other than chest tightness since her family members were diagnosed, her doctor, whom she sees regularly for her diabetes, said there was no need to be tested. She was probably just stressed. She told him she couldn’t rest until she knew. The doctor sent her to Thomasville, over an hour’s drive, where a county-run drive-up site tests patients free without a referral. Means arrived early Thursday morning. She didn’t have a fever, cough or shortness of breath, so the nurse there wouldn’t test her. She blamed stress, just like Means’ doctor had. The nurse’s message: “Don’t you go bothering yourself about the coronavirus now.”An uplifting message from reggae pioneer Bob Marley appears on a theater marquee in downtown Albany.

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