Vanessa Williams’s uncle Johnny Carter died in late February, at the age of seventy. On the first Saturday in March, the family held a funeral at the Gethsemane Worship Center, a large, modern building on the north side of Albany, Georgia, a city of about seventy-five thousand people in Dougherty County, in the southwestern part of the state. It was packed. “Maybe four hundred of us filling up three sections of nine rows,” Williams, who is thirty-three and works as an office administrator, said. “We were in there together, close contact, for at least an hour and a half, remembering my uncle.” She exchanged hugs with family and friends and watched everyone wipe the tears from their faces.
The previous Saturday, worshippers from the same congregations had hosted another large funeral, for Andrew Jerome Mitchell, a local custodian who had died from apparent heart failure on February 24th. Mitchell had ten siblings, and his extended family and friends came from Louisiana; Washington, D.C.; Hawaii; and elsewhere to remember him. “The minister, he was shaking pretty much everybody’s hand, just giving the family comfort and condolences,” Mitchell’s niece later told the Atlanta Journal-Constitution. “The funeral home officiants, they were kind of doing the same thing. That’s kind of their job, to give comfort.” Gatherings followed at the homes of family members.
“And that’s exactly where it started,” Winfred Dukes, Williams’s boss, told me. Dukes is a state legislator and also the owner of a construction company where Williams works. “We’re tracing it back to an individual from Cobb County,” north of Atlanta, Dukes said. “He came down to the Mitchell funeral.” (It remains unclear whether this man from Cobb County was Albany’s initial carrier.) That night, the traveller, who was sixty-seven, was admitted to Phoebe Putney Memorial—a six hundred and ninety-one bed hospital in southwest Georgia—with shortness of breath. He had chronic lung disease, which seemed to offer an explanation. But his condition deteriorated, and he was attended by dozens of hospital staff before being transferred to Atlanta, on March 7th, the day of Johnny Carter’s funeral. On March 10th, tests revealed that he had the coronavirus. He died two days later.
Back home in Albany, Williams had begun to feel unusually tired. Then: chest pain, fever, chills, and a visit to the doctor, who diagnosed her with strep throat, which didn’t improve with antibiotics. Williams was tested for COVID-19 on March 16th. Dukes sent the rest of his construction-company employees home. He was already under quarantine himself, because a fellow-legislator, the Republican state senator Brandon Beach, had continued to work at the state capitol despite having COVID-19 symptoms, in early March, and had subsequently tested positive. (“I’m not a bad person,” Beach told the Journal-Constitution, adding, “I thought it was my regular sinus bronchitis stuff I get every year.”) By this time, Dukes said, “it became abundantly clear that all of these people from this church were coming down sick with the same thing.” Dozens of Mitchell’s family members were ill; the pastor who delivered Mitchell’s eulogy later died from the coronavirus.
Williams didn’t get her test results for eight days, during which she felt the worst of the illness. Williams lives in a second-floor apartment with her husband, her six-year-old son, and her mother, who’s retired. It was hard to keep her family at a distance. “My husband, he’s hard-headed,” she said. “He’s, like, ‘We’ve been married five years and I ain’t never not slept in the bed with you. Let’s put up a wall of pillows.’ ” That’s what they did. “But when we watched TV, he sat on one end of our large sectional, I sat on the other.” Her son was not allowed outside, but he insisted on playing football and basketball indoors and ran around constantly. “I did everything I could to let him know ‘Mommy can’t play,’ ” Williams said. “He wants a hug and to do all these things. He doesn’t understand what’s going on.” She sighed. “I tried to make sure my closest family didn’t contract it. I can’t promise they didn’t, though.”
A half-dozen of Williams’s family members have become sick. She figured they’d all contracted the virus either at the funeral or during a regular Sunday dinner in the days that followed. “Thank God we all kind of pulled through together,” she said. Several people who were at the funeral didn’t make it. “Every morning I woke up, for a week, sick in bed, somebody I knew had died,” she said. Two weeks after Carter’s funeral, the virus was everywhere in Albany. “We call this ground zero,” Dukes said.
The Medical Director of Emergency Services at Phoebe Putney Health System is James Edward Black, a fifty-three-year-old who grew up in Albany. Black has been working seventeen- to twenty-hour shifts for most of the past month, overseeing the hospital’s coronavirus response and also performing emergency physician duties. “This is the challenge of a lifetime,” Black told me. Tornadoes and hurricanes have hit southwestern Georgia in the past few years, he said. “We’re used to high waters and major flooding—natural disasters that have had a quick impact and left. When you’re talking about things of a viral or biological nature, you don’t know when it’s gonna crest, and you don’t know if this is the first wave or one of many.”
Black tries to do a little exercising before the sun is up, if he can manage it, and then he heads to the hospital and does a survey of patients waiting to be admitted and patients who can be transferred out to make room. “By seven o’clock this morning, we had three patients that needed to be admitted, three awaiting transfer,” he told me earlier this week. Six hours later, he said, there were twenty patients who needed to be admitted or transferred. “It changes so quickly,” he said. Virtually all possible hospital wards at Phoebe Putney have been converted to COVID-19 wards with their own doctors, nurses, and medical personnel. About a month ago, he said, he and his colleagues were growing concerned about the coronavirus but felt that they probably had what they needed. “We had the conversation: ‘Is it like ebola, large in scope overseas but we didn’t really see it here? Or something closer to SARS, maybe?’ With that, almost a thousand people died worldwide. Nobody envisioned the Spanish flu.” A week later, patients from the Mitchell and Carter funerals started coming in, and his confidence began to waver. Now, Black said, “it’s like nothing we’ve ever seen before.” The hospital is near a breaking point. “We haven’t run out of anything yet, but we’re close to the cut line,” Black said. “Between the inpatient wards and the emergency department, you have two hundred patients who require P.P.E., and all your staff, too—you burn through P.P.E. at such an incredible clip.”
The hospital network’s C.E.O., Scott Steiner, is monitoring supplies in real time. “Surgical gowns, we are three days from running out,” he told me on Tuesday. “N95s, we’re seven days. Surgical masks, the thinner ones, we’re at about six days. Face shields, we’re in good shape. Hand gel—we’ve been going through an incredible amount, but we think we have about ten days on hand.” He went on, “We’re constantly sourcing new products. New sources. Our traditional sources no longer have anything available and haven’t for two weeks.” Hospital employees have begun sewing their own masks, “MacGyvering things up,” as Steiner put it. “We rolled that out yesterday morning,” he said. “That’s helped extend the life of our N95 masks. Had we not done that, we’d be out of N95 masks now.” (“I’ve almost likened it back to the war effort back in the day, when family members would help with munitions or whatever it took,” Black told me.) Since Tuesday, the hospital has produced twenty thousand fabric masks, allowing them to further stretch their supply of N95s and surgical masks, which Steiner expects will now last about two and three weeks, respectively. They’re down to six days of hand sanitizer and two days of face shields, he said in a follow-up call.“It’s impossible to predict what we’re going to get here and when,” Steiner explained. “Sometimes it comes on a skid from the state stockpile. We’re also sourcing items individually from certain vendors.”
Black said, “We don’t see a plateau or an end yet. And almost everyone is A-plus sick by the time they come to the emergency department. Patients have almost self-triaged to being very sick when they come in.” More than half of the patients coming to the hospital are directed to emergency care; normally, the admission rate is closer to fifteen per cent, Black said. “Our conversation is centered around ‘How do we expand our capability more?’ ” he continued. “Will we get the extra resources? Masks? Gloves, gowns? How do we prepare for the long haul?” Black coughed. “That was a choked-on-some-water cough,” he explained, “not a fever cough.” He told me he gets his temperature checked a couple of times a day.
In the first weeks, Steiner allowed hospital staff who’d tested positive but had no symptoms of the virus to continue working, a practice that he’s since curtailed, after thirty-six hours of back-and-forths with both the C.D.C. and the Georgia Department of Public Health. “We were trying to go by what we believed the C.D.C. guidelines and Department of Public Health were,” he told me. “There’s this sort of caveat in a staffing emergency: employees who test positive but show no symptoms, there might be consideration to have them work. We felt like that’s what they were saying.”
“If this were a three-day thing, we’d just get it done in the parking lot or whatever we need to do,” Black told me. “But to sustain the response, it’s different. How do you establish a rhythm and maintain it over a period of time, while dealing with staff becoming ill?” A few nurses, physician assistants, and physicians have tested positive. “The thing that keeps me up at night is what happens if six of them go down sick at one time?” Black said. “How do you keep the schedule covered?”
The day that I spoke with Steiner, a patient who had been removed from a ventilator a few days earlier had been discharged, which had offered a moment of hope for hospital staff. “He’d been on the ventilator for more than a week,” Steiner said. “The staff on the unit were lined up in the hallway applauding this young man, who was going home. He was crying, and so were we.” I asked him if he thought much about where this all began. “It’s less about where did it come from and people wanting to point a finger,” he said. “It’s Public Health and the C.D.C.’s responsibility to eventually tell that story, so we can learn from it and hopefully don’t repeat it again.”
Georgia’s Republican governor, Brian Kemp, did not issue a stay-at-home order until Wednesday, after days of criticism. When he announced the order, Kemp claimed that people had only learned in the previous twenty-four hours that the virus could be transmitted by carriers who were not exhibiting any symptoms. In fact, there have been reports suggesting asymptomatic transmission for weeks—Robert Redfield, the director of the Centers for Disease Control, which is located in Atlanta, recently said, in an interview on NPR, “We have asymptomatic transmitters and we have individuals who are transmitting forty-eight hours before they become symptomatic.”
As of Saturday morning, Georgia had almost six thousand confirmed cases of the virus, which had killed a hundred and ninety-eight people in the state. More people—thirty—had died in Dougherty County, the state’s twenty-seventh most populous county, than anywhere else in Georgia. While Dougherty is served by a well-regarded hospital, nine Georgia counties, most of them also in the southern part of the state, not only lack hospitals but have no practicing physicians at all, according to Monty Veazey, the president of the Georgia Alliance of Community Hospitals. Eighteen have no family-practice doctors. Thirty-two have no internal-medicine doctors. Seventy-six counties have no ob-gyn. A number of these counties have long sent their neediest patients to Phoebe Putney, and they will continue to do so.
Tripp Morgan, a forty-seven-year-old vascular surgeon who grew up outside of Albany and still lives there, worked at Phoebe Putney until moving to a private practice last year. In addition to his medical practice, he co-owns a brewery and a C.B.D. processing facility, where he proofed a formula for emergency hand sanitizer; he then used the brewery’s fermenters to produce some forty thousand gallons of it. “The thing people don’t understand about South Georgia is it’s so rural,” Morgan told me. “There’s a Third World country up underneath a First World country.” He compared what was happening to the area now, and what was about to happen, to the arrival of Hurricane Katrina in New Orleans. “We have an older population, and a lot of them live together in smaller areas,” he said. “We’re down here in the ‘bacon belt,’ with high levels of cardiovascular disease.” Georgia is one of fourteen states that has not expanded Medicaid to poor residents under the Affordable Care Act, and the state spends less than twenty-five dollars per person on public health annually. (By comparison, New York spends eighty-four dollars per person annually on public health.) Morgan added, “When it eventually burns out in Albany, you’ll see it bloom in the surrounding areas, some of which have far fewer resources.”
The Georgia Alliance of Community Hospitals is a network of nearly a hundred facilities meant to serve the state’s most vulnerable populations. Thirty-six of these hospitals are in rural areas, and twenty-seven of them were considered “at risk” before the spread of COVID-19, Monty Veazey told me. The Alliance’s hospitals do not have sufficient reserves of operating capital, he went on. “We have hospitals burning fifty million dollars a month out of their reserves right now. The only way we can get capital, as nonprofits, is a tax increase, a letter of credit from the county, or AAA-rated bonds backed by the county, which nobody wants to do.” He added, “If we don’t get them funded immediately, we’ll have a health-care crisis looming. It will be large and faster than people expect. It could cripple the core of the health-care system here.”
Before the coronavirus had reached this part of Georgia, I called up Karen Kinsell, the lone doctor in Clay County, which lies to the west of Dougherty County, on the Alabama line. Clay consistently ranks at the very bottom of county health-outcome rankings in the state; for more than two decades, Kinsell has operated a simple, life-sustaining clinic in Fort Gaines, built out of a former Tastee-Freez. When I called, Kinsell had no masks on hand. “A widow brought in some of her husband’s leftover surgical masks,” she told me, “and a woodworker brought a few N95s.” The Health Department eventually got her some masks, shortly thereafter, she told me more recently, but she had decided that it wasn’t safe to remain open. “There were a number of patients with what appeared to be coughing from allergies, but there’s really no way to know that,” she told me. One week before closing her office, she received five COVID-19 test kits. She used one on herself and one on a ninetysomething-year-old patient. (Both tests came back negative.) “It was very scary for all to have these individuals along with old sick people in the office.”
Kinsell reluctantly transitioned to a telehealth system, which, ideally, involves patient-doctor interaction through high-speed Internet and computer screens. But most of her patients don’t have high-speed Internet, or access to screens. Even when they did, Kinsell found this approach little better than a simple phone call. Unfortunately, phone calls can’t be billed as doctor visits by insurance companies the way that computer-mediated visits are, and these reimbursements are much of what keeps rural clinics afloat. (On April 2nd, Kinsell received a message from the Georgia Primary Care Association seeming to indicate that a new policy would allow for phone consultations to be billable as doctor visits, but she has not been able to confirm this change.) “Of course, there are some things that can’t wait or be done remotely,” Kinsell noted. Last week, she made daily house calls for an elderly patient who needed to have medicine administered through an I.V. “I also went into the office to give an antipsychotic monthly injection, and I’m taking out sutures today for someone else,” she added. Kinsell, who had a brief health scare a few weeks ago, is feeling O.K. herself. But she’s heard about other health-care professionals, in nearby counties, who are sick. If they can’t work, remotely or otherwise, even more counties will be without local medicine. “It’s very scary, and may have a long-term impact on the availability of health-care around here,” she said. It’s going to be tough for much needed specialists to stick around.
Clay is rural even by the standards of southwest Georgia, and the virus took a little while to arrive at its modest doorstep. Its first case was diagnosed late last week; by the end of March, it had five reported cases. On Thursday night, the county reported its first death; another county resident is in the I.C.U., and more tests are pending. Kinsell has been receiving an increasing number of phone calls on her personal line from or about people who seem to have symptoms of the virus. “It’s been obvious for several weeks that we were going to have many cases of COVID-19 in our county, especially since we are so close to Albany,” Kinsell told me. “Some people didn’t believe that,” she added, “but, you know, pandemics do spread.”
