In the next few months COVID-19 will transform rural America
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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.
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