'Across the South, ‘Walking a Tightrope’ While Awaiting the Worst' diff viewer (15/16)

This article is from the source 'nytimes' and was first published or seen on April 10, 2020 12:12 (UTC). It last changed over 40 days ago and won't be checked again for changes.

You can find the current article at its original source at https://www.nytimes.com/2020/04/09/us/coronavirus-american-south.html

The article has changed 23 times. There is an RSS feed of changes available.

Previous version 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Next version

Previous version 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 Next version

Version 15	Version 16
Across the South, ‘Walking a Tightrope’ While Awaiting the Worst	Across the South, ‘Walking a Tightrope’ While Awaiting the Worst
2020-08-03 15:24:24 UTC	2020-08-05 03:44:48 UTC (1 day later)
ATLANTA — Months before the coronavirus arrived in the South, before it raced across rural communities and larger cities alike, sickening scores of vulnerable residents, Johnny Presley bought a shuttered 33-bed hospital.	ATLANTA — Months before the coronavirus arrived in the South, before it raced across rural communities and larger cities alike, sickening scores of vulnerable residents, Johnny Presley bought a shuttered 33-bed hospital.
Mr. Presley, 53, a businessman who also owns three health clinics in rural Tennessee, purchased the Cumberland River Hospital in Clay County, where 21 percent of the 7,600 residents live in poverty and 15 percent are without health insurance. When it closed last year, the hospital left residents at least 20 miles from the nearest emergency room.	Mr. Presley, 53, a businessman who also owns three health clinics in rural Tennessee, purchased the Cumberland River Hospital in Clay County, where 21 percent of the 7,600 residents live in poverty and 15 percent are without health insurance. When it closed last year, the hospital left residents at least 20 miles from the nearest emergency room.
If anyone understood the pressing need to quickly reopen the hospital, Mr. Presley said, it was him. He has spent his adult life in the medical care industry, serving some of the state’s poorest, most at-risk residents. But as the months passed, his efforts to secure loans from banks and the federal government were denied, and the hospital, which he plans to operate as a for-profit, has remained bolted shut.	If anyone understood the pressing need to quickly reopen the hospital, Mr. Presley said, it was him. He has spent his adult life in the medical care industry, serving some of the state’s poorest, most at-risk residents. But as the months passed, his efforts to secure loans from banks and the federal government were denied, and the hospital, which he plans to operate as a for-profit, has remained bolted shut.
So Mr. Presley, also a physician assistant, has watched from the sidelines as the death count from the novel coronavirus has ticked up across the South, including in Tennessee, which ranks second in the nation for rural hospital closures since 2010. Already, 72 residents in the state have died.	So Mr. Presley, also a physician assistant, has watched from the sidelines as the death count from the novel coronavirus has ticked up across the South, including in Tennessee, which ranks second in the nation for rural hospital closures since 2010. Already, 72 residents in the state have died.
He is worried, too, that the choices made by state leaders have left the South unprepared for a projected peak — and hundreds of virus-related deaths — that could come later this month.	He is worried, too, that the choices made by state leaders have left the South unprepared for a projected peak — and hundreds of virus-related deaths — that could come later this month.
“The governors of the Southern states did not take this seriously enough,” said Mr. Presley, a Republican who recently launched a campaign for an open U.S. Senate seat. He blamed hospital closures across the South on the refusal by members of his party in states like Tennessee to expand Medicaid insurance coverage, an option under the Affordable Care Act. “I think we’re really going to suffer through this pandemic.”	“The governors of the Southern states did not take this seriously enough,” said Mr. Presley, a Republican who recently launched a campaign for an open U.S. Senate seat. He blamed hospital closures across the South on the refusal by members of his party in states like Tennessee to expand Medicaid insurance coverage, an option under the Affordable Care Act. “I think we’re really going to suffer through this pandemic.”
At his health clinics, two of which are in a county with no hospital, employees are asking patients who think they have the virus to wait in their cars. Staffers in protective gear come out to treat them.	At his health clinics, two of which are in a county with no hospital, employees are asking patients who think they have the virus to wait in their cars. Staffers in protective gear come out to treat them.
As the coronavirus continues to ravage pockets of communities across the country, public health officials fear the potentially devastating effects in the South, a particularly vulnerable region because of a mix of bad health, poverty, and flimsy insurance options for the working poor. Some critics argue that late or tepid responses to the pandemic from some of its Republican governors made those problems worse.	As the coronavirus continues to ravage pockets of communities across the country, public health officials fear the potentially devastating effects in the South, a particularly vulnerable region because of a mix of bad health, poverty, and flimsy insurance options for the working poor. Some critics argue that late or tepid responses to the pandemic from some of its Republican governors made those problems worse.
“I really don’t think we can say strongly enough that we are a uniquely vulnerable population here,” Dr. Jeanne Marrazzo, the director of the Division of Infectious Diseases at the University of Alabama in Birmingham, said in a recent briefing. Dr. Marrazzo referred to the “abundance” of underlying health problems in Alabama and across the Deep South that could exacerbate effects of the virus.	“I really don’t think we can say strongly enough that we are a uniquely vulnerable population here,” Dr. Jeanne Marrazzo, the director of the Division of Infectious Diseases at the University of Alabama in Birmingham, said in a recent briefing. Dr. Marrazzo referred to the “abundance” of underlying health problems in Alabama and across the Deep South that could exacerbate effects of the virus.
The South, according to the Centers for Disease Control and Prevention, has the nation’s highest prevalence of obesity and one of the highest rates of adult diabetes. Of the 10 states with the highest rates of adult cigarette use, five are in the South, and the region also has some of the highest levels of hypertension and heart disease. All can contribute to higher chances of patients experiencing serious complications from Covid-19, which attacks the respiratory system.	The South, according to the Centers for Disease Control and Prevention, has the nation’s highest prevalence of obesity and one of the highest rates of adult diabetes. Of the 10 states with the highest rates of adult cigarette use, five are in the South, and the region also has some of the highest levels of hypertension and heart disease. All can contribute to higher chances of patients experiencing serious complications from Covid-19, which attacks the respiratory system.
Six of the nation’s poorest states are in the South, and many of these vulnerabilities are linked to Southern poverty.	Six of the nation’s poorest states are in the South, and many of these vulnerabilities are linked to Southern poverty.
“Poor people don’t have access to good food,”, said Dr. Susan Hassig, an associate professor at the Tulane University School of Public Health and Tropical Medicine in Louisiana. “They don’t have access consistently to preventive health care. And when they have a health problem, it is very difficult for them to maintain connections with a provider. They’re often attending clinics, so they’re not seeing the same health care provider on a regular basis.”	“Poor people don’t have access to good food,”, said Dr. Susan Hassig, an associate professor at the Tulane University School of Public Health and Tropical Medicine in Louisiana. “They don’t have access consistently to preventive health care. And when they have a health problem, it is very difficult for them to maintain connections with a provider. They’re often attending clinics, so they’re not seeing the same health care provider on a regular basis.”
In Louisiana, more than 17,000 cases of the coronavirus have been reported, and more than 650 people have died.	In Louisiana, more than 17,000 cases of the coronavirus have been reported, and more than 650 people have died.
Experts said the soaring death rate in New Orleans may be linked to the rampant obesity and other pre-existing health problems in that city. Nearby, St. John the Baptist Parish, a heavily industrialized area along the Mississippi River with a long history of air quality problems, has one of the highest per capita death rates in the country. And while it may not be possible to conclude what role industrial air pollution has played in that statistic, Dr. Hassig said that, more generally, “what we know is that bad air quality is associated with a lot of respiratory conditions.”	Experts said the soaring death rate in New Orleans may be linked to the rampant obesity and other pre-existing health problems in that city. Nearby, St. John the Baptist Parish, a heavily industrialized area along the Mississippi River with a long history of air quality problems, has one of the highest per capita death rates in the country. And while it may not be possible to conclude what role industrial air pollution has played in that statistic, Dr. Hassig said that, more generally, “what we know is that bad air quality is associated with a lot of respiratory conditions.”
Recent coronavirus projections watched closely by state officials and public health experts have shown the possibility of a less severe impact on the South than earlier forecasts, in terms of deaths and the demand on hospitals. But, Dr. Marrazzo said, the fluctuations underscore the level of uncertainty facing doctors.	Recent coronavirus projections watched closely by state officials and public health experts have shown the possibility of a less severe impact on the South than earlier forecasts, in terms of deaths and the demand on hospitals. But, Dr. Marrazzo said, the fluctuations underscore the level of uncertainty facing doctors.
“It’s just like walking a tightrope every day,” Dr. Marrazzo said in an interview, “because you don’t know what the wind is going to do and if it’s going to knock you over.”	“It’s just like walking a tightrope every day,” Dr. Marrazzo said in an interview, “because you don’t know what the wind is going to do and if it’s going to knock you over.”
The majority of Southeastern states under conservative control have declined to expand Medicaid insurance for the working poor under the Affordable Care Act, on the argument that the state’s contribution to such expansions, which would insure millions of working-class people, might eventually wreck state budgets.	The majority of Southeastern states under conservative control have declined to expand Medicaid insurance for the working poor under the Affordable Care Act, on the argument that the state’s contribution to such expansions, which would insure millions of working-class people, might eventually wreck state budgets.
That has left a number of Southern hospitals in shaky financial health, and has led to widespread closures in states like Tennessee.	That has left a number of Southern hospitals in shaky financial health, and has led to widespread closures in states like Tennessee.
Although Louisiana expanded Medicaid in 2016, the impact of the virus there nonetheless appears to be falling disproportionately on people of color, who for decades have been systematically denied access to economic opportunities and thus access to better health care. On Monday, Gov. John Bel Edwards of Louisiana, a Democrat, said that African-Americans accounted for 70 percent of all coronavirus deaths in the state, even though they make up about a third of total residents.	Although Louisiana expanded Medicaid in 2016, the impact of the virus there nonetheless appears to be falling disproportionately on people of color, who for decades have been systematically denied access to economic opportunities and thus access to better health care. On Monday, Gov. John Bel Edwards of Louisiana, a Democrat, said that African-Americans accounted for 70 percent of all coronavirus deaths in the state, even though they make up about a third of total residents.
Such grim statistics, and the potential for even grimmer days to come, are likely to reanimate longstanding debates in the South about the proper role and size of government, particularly in the realm of health care and insurance, and the extent to which institutional racism is a driver of Southern Republicans’ small-government philosophy.	Such grim statistics, and the potential for even grimmer days to come, are likely to reanimate longstanding debates in the South about the proper role and size of government, particularly in the realm of health care and insurance, and the extent to which institutional racism is a driver of Southern Republicans’ small-government philosophy.
As states across the country quickly implemented orders requiring residents to stay at home, many governors across the South hesitated, describing the competing pressures they faced to take serious action while also being worried about upending local economies. In Tennessee, Gov. Bill Lee, who eventually issued a statewide shelter-in-place order on March 31, also cited protecting personal liberties.	As states across the country quickly implemented orders requiring residents to stay at home, many governors across the South hesitated, describing the competing pressures they faced to take serious action while also being worried about upending local economies. In Tennessee, Gov. Bill Lee, who eventually issued a statewide shelter-in-place order on March 31, also cited protecting personal liberties.
“The danger isn’t visceral, it’s not tangible at that point,” said David Howard, a professor of health policy and management at the Emory University School of Public Health. “I think for a governor it’s a tough call to tell people statewide to not engage in business, not to go to work when we’re still unsure of the scope of the epidemic.”	“The danger isn’t visceral, it’s not tangible at that point,” said David Howard, a professor of health policy and management at the Emory University School of Public Health. “I think for a governor it’s a tough call to tell people statewide to not engage in business, not to go to work when we’re still unsure of the scope of the epidemic.”
As dire projections emerged, forecasting a sharp increase in deaths just weeks away, messages from governors in Alabama and Georgia, among other holdout states, radically changed.	As dire projections emerged, forecasting a sharp increase in deaths just weeks away, messages from governors in Alabama and Georgia, among other holdout states, radically changed.
Some governors said they did not want to act rashly.	Some governors said they did not want to act rashly.
“As we have said before — when the science, data, facts and experts determine it’s time to take action, it would be taken. It’s time,” Gov. Henry McMaster of South Carolina said in a statement announcing the “home or work” order he issued on Monday. “Taking this measure now will hopefully slow the future rise in infections and the virus’s toll on our state’s economy.”	“As we have said before — when the science, data, facts and experts determine it’s time to take action, it would be taken. It’s time,” Gov. Henry McMaster of South Carolina said in a statement announcing the “home or work” order he issued on Monday. “Taking this measure now will hopefully slow the future rise in infections and the virus’s toll on our state’s economy.”
~~Updated August 3, 2020~~	Updated August 4, 2020
Arkansas, which has one of the lowest rates of hospitalization for the virus, remains one of a few states left in the country — and the only one in the South — without a statewide order. Gov. Asa Hutchinson, a Republican, said the state had opted for a “targeted approach” in which state officials have responded aggressively, limiting commerce and encouraging people to act responsibly, while also allowing some 600,000 people to report to work.	Arkansas, which has one of the lowest rates of hospitalization for the virus, remains one of a few states left in the country — and the only one in the South — without a statewide order. Gov. Asa Hutchinson, a Republican, said the state had opted for a “targeted approach” in which state officials have responded aggressively, limiting commerce and encouraging people to act responsibly, while also allowing some 600,000 people to report to work.
Critics said the slow arrival of statewide action has made for a disorienting patchwork, where measures have varied by city and county. Researchers said the efforts of communities that acted early and intensely could have been undermined as people from surrounding areas with fewer safeguards passed through.	Critics said the slow arrival of statewide action has made for a disorienting patchwork, where measures have varied by city and county. Researchers said the efforts of communities that acted early and intensely could have been undermined as people from surrounding areas with fewer safeguards passed through.
“That’s why a more coordinated approach at the local, state and federal level is so critical,” said Benjamin Lopman, a professor of epidemiology at Emory University in Atlanta.	“That’s why a more coordinated approach at the local, state and federal level is so critical,” said Benjamin Lopman, a professor of epidemiology at Emory University in Atlanta.
Carter Wrenn, a veteran Republican strategist in North Carolina, said that Southern Republicans should not be faulted for taking into account the devastating effects of the strictest shutdown measures. “I think the economic concerns are legitimate, and you’ve got a case here where you’ve got two problems, and you’ve sort of got to thread the needle,” he said.	Carter Wrenn, a veteran Republican strategist in North Carolina, said that Southern Republicans should not be faulted for taking into account the devastating effects of the strictest shutdown measures. “I think the economic concerns are legitimate, and you’ve got a case here where you’ve got two problems, and you’ve sort of got to thread the needle,” he said.
Still, Democratic politicians are hoping voters see it differently. On Tuesday, Mike Espy, a former Secretary of Agriculture and current candidate for a Mississippi Senate seat, sent an email to supporters decrying the closure of five rural hospitals in the state since 2010, stating that “almost half of all current rural hospitals were on verge of financial collapse before the coronavirus pandemic.”	Still, Democratic politicians are hoping voters see it differently. On Tuesday, Mike Espy, a former Secretary of Agriculture and current candidate for a Mississippi Senate seat, sent an email to supporters decrying the closure of five rural hospitals in the state since 2010, stating that “almost half of all current rural hospitals were on verge of financial collapse before the coronavirus pandemic.”
Mississippi already has the highest flu death rate in the nation and is among the states with the highest hospitalization rates during the pandemic. It has recorded more than 2,200 cases, with about 76 deaths.	Mississippi already has the highest flu death rate in the nation and is among the states with the highest hospitalization rates during the pandemic. It has recorded more than 2,200 cases, with about 76 deaths.
The email urged Mississippians to sign a petition expanding Medicaid through the Affordable Care Act.	The email urged Mississippians to sign a petition expanding Medicaid through the Affordable Care Act.
Across the state line in Alabama, the lack of Medicaid expansion has been cited as a major reason for the closures of several hospitals. Over the last eight years, 13 hospitals have closed in Alabama, according to the state’s hospital association, including seven in rural areas. The most recent was a 56-bed hospital that closed last month, leaving rural Pickens County without a single hospital.	Across the state line in Alabama, the lack of Medicaid expansion has been cited as a major reason for the closures of several hospitals. Over the last eight years, 13 hospitals have closed in Alabama, according to the state’s hospital association, including seven in rural areas. The most recent was a 56-bed hospital that closed last month, leaving rural Pickens County without a single hospital.
Rural Chambers County has recorded eight coronavirus deaths so far, giving it the highest per capita death rate in the state. Many of the roughly 140 confirmed cases in the county appeared to be linked to church gatherings, including a service in early March at Mt. Hermon Baptist Church, where pastor Lamar Johnson has said that 10 members have been infected.	Rural Chambers County has recorded eight coronavirus deaths so far, giving it the highest per capita death rate in the state. Many of the roughly 140 confirmed cases in the county appeared to be linked to church gatherings, including a service in early March at Mt. Hermon Baptist Church, where pastor Lamar Johnson has said that 10 members have been infected.
State Representative Debbie Wood, a Republican who represents part of Chambers County, said this week that she remains opposed to the expansion of Medicaid in Alabama. She said she fears that the formula determining the state’s contribution could change in the future and leave the state with an unpayable bill. “The motherly side of me says let’s do it. My brain says how are we going to pay for it,” she said.	State Representative Debbie Wood, a Republican who represents part of Chambers County, said this week that she remains opposed to the expansion of Medicaid in Alabama. She said she fears that the formula determining the state’s contribution could change in the future and leave the state with an unpayable bill. “The motherly side of me says let’s do it. My brain says how are we going to pay for it,” she said.
Mr. Lee, the Tennessee governor, is also an opponent of expanding Medicaid, but this week he announced a $10 million grant program to support hospitals “facing financial strain due to the ongoing response to Covid-19.”	Mr. Lee, the Tennessee governor, is also an opponent of expanding Medicaid, but this week he announced a $10 million grant program to support hospitals “facing financial strain due to the ongoing response to Covid-19.”
Mr. Presley, the clinic owner, said he applied on Monday, hoping for the maximum disbursement of $500,000. But state officials denied the application because the money is meant only for hospitals that are currently operating. He had hoped to have the old hospital he purchased open by Friday, but that was looking increasingly unlikely. A handful of volunteers had been in the building, he said, “sweeping floors, mopping, getting crash carts fully supplied.”	Mr. Presley, the clinic owner, said he applied on Monday, hoping for the maximum disbursement of $500,000. But state officials denied the application because the money is meant only for hospitals that are currently operating. He had hoped to have the old hospital he purchased open by Friday, but that was looking increasingly unlikely. A handful of volunteers had been in the building, he said, “sweeping floors, mopping, getting crash carts fully supplied.”