RURAL TRANSCRIPT

APRIL 24, 2020/ GEORGIA

[NEWS]

SEAN RAMESWARAM (host): It’s Friday, April 24th, 2020 — a great day to abstain from injecting disinfectant into your body.

I’m Sean Rameswaram and this is your coronavirus update from Today, Explained.

The President of the United States suggested Thursday night that it would be interesting to look into injecting disinfectant into humans to combat Covid-19

This prompted the makers of Lysol to issue a statement reminding people that quote “under no circumstance should our disinfectant products be administered into the human body (through injection ingestion, or any other route.)”

Not sure who needed to hear that other than the person in charge of the country, but glad it’s all been cleared up!

The Food and Drug Administration is also issuing guidance that contradicts the president. Remember those antimalarial drugs Trump was promoting? In a statement today, the FDA strongly cautioned against using hydroxychloroquine or chloroquine to treat COVID-19, outside of a hospital setting or a clinical trial due to risk of heart rhythm problems.

One thing everyone seems to agree on is aid for small businesses in the United States. The president signed a 484 billion dollar relief bill that will also help hospitals and provide funding for testing. Missing from the package is aid for state governments, which Democrats were pushing for, Republicans less so.

And while we’re on the states, some of them are opening back up today. Georgia’s really going for it, and we’ll talk about Georgia in today’s show, but Georgia’s not the only one: beaches have already begun to open back up in Florida. Alaska is lifting restrictions. Oklahoma is reopening parks, and stores are reopening up in South Carolina. More states are expected to lift their shelter in place orders in the coming weeks.

This is as the death toll hit 50,000 in the United States today.

Interestingly the president urged caution, at least in the case of Georgia, saying he disagreed strongly with the governor’s decision to reopen certain businesses. But, the president’s messaging on the matter has been inconsistent at best.

No matter what state you’re in you can call Today, Explained and let us know how you’re doing, what’s on our mind, whatever. Call our listener voicemail line at 202 688 5944, email today explained at vox dot com or tweet at us: we’re at today underscore explained and I’m at rameswaram.

[THEME]

SEAN: Georgia is reopening today, even as its death toll continues to rise.

According to a model from the University of Washington, the state shouldn’t be allowing people to get mani/pedis until June 22nd at the earliest.

But here we are. It’s happening today.

And people are scared, with good reason. Jillian Weinberger has been talking to someone in Georgia for Today, Explained.

JILLIAN WEINBERGER (reporter): I had been talking to this woman for a different story about voting rights, but then then coronavirus hit her town.

LILLIAN RAMBEAU SNEED: Here in Albany, you're about three people removed from knowing someone. I mean, it becomes real close really fast.

JILLIAN: Her name is Lillian Rambeau Sneed.

LILLIAN: And I live in Albany, Georgia. I grew up here.

JILLIAN: So, Albany is pretty rural. It’s mostly black, and a lot of people live below the poverty line.

LILLIAN: We are a Title I County. So every child in the county eats free.

JILLIAN: Back in mid-March, Lillian and her husband were out of town. And they got a call from a friend back home -- it’s actually a member of their church, where Lillian’s husband is a bishop.

LILLIAN: She called and said her daughter's mother-in-law is in ICU. And another friend of the family, she told us, too, that he was in ICU.

JILLIAN: Lillian and her husband decided to head home. They get on the road --

LILLIAN: My husband's over there sleeping and I'm driving to one song for 15 hours.

LILLIAN: The Promise. Awesome song by the late Andrae Crouch.

<The Promise> I’ll never leave you. Neither forsake you...

LILLIAN: And all of a sudden I'm like, hold on.

<The Promise> No matter what you’re going through…

SCORING <Saturn’s Rings>

LILLIAN: Okay, based on the people that I knew that were in the hospital, in ICU, I put together a picture of how it happened. There was this big funeral and the people from the funeral left and went to another funeral and then they went to a church anniversary. And so it spread through three or four churches that way.

JILLIAN: State officials don’t know exactly who started the outbreak in Albany. But the state’s first coronavirus casualty was a man who attended that first funeral, a guy who traveled to Albany from Atlanta. He ended up in Albany’s hospital while he was in town.

LILLIAN: Well, he was here in the hospital for about a week, not tested for the virus. So that person initially might have come in contact with the nurses, the doctors, the janitors, the cafeteria people. When that person left and went back to Atlanta, Atlanta put him back in the hospital. They called back to the hospital here and said he has the virus.

SCORING OUT

JILLIAN: Now, Albany has one of the infection rates in the state. And more people have died in Albany than Atlanta -- which a much bigger city.

LILLIAN: The minister that did the first funeral has since passed. Three family members in one family have since passed.

JILLIAN: That one sick guest at one funeral… has led to a lot more funerals.

LILLIAN: Our social media has turned into an obituary column. And so at this point, you know, we've moved to graveside services. What we traditionally, especially in the South, it’s not a very common thing to have a graveside service. The first funeral we went to during this virus was a judge whose two brothers, his mother and his father are all ministers. That funeral should have been attended by at least three different churches, along with all the legal judges. And, you know, we're talking about at least a thousand-person-funeral, dwindled down to 10 people and about 30 people standing by their cars to watch it live on Facebook. And we're standing there and I see his mother, tears running down her face and she inhales grieving. And says, “My baby.” And she's looking around. But there's no one that can come up to her and hug her, grab her hands so she puts her hands on her husband's shoulder. And he breaks into tears. And they're just there, trying to console one another. And you know, the next funeral I went to was my classmate. She was an activist here in Albany, Dougherty County. What they call a real Renaissance Woman. We all grew up together and we all went to school together. Our parents were civil rights leaders here in Albany together. There again, at the car, about 20 feet away. And I'm standing there and I look over the graveyard and there's three tents within a 50 yard radius of each other. So you have three services going on at the same time. And you’re like, Oh, my lord. And there again, we’re only three people removed in Albany. So you recognize, oh, that’s Pastor So-and-So, so that must be So-and-So that just died.

JILLIAN: Places like Albany, Georgia are especially vulnerable. The uninsured rate in Albany’s home county is about double the national average. And --

LILLIAN: Georgia, unfortunately, did not take the expansion for Medicaid. So therefore, you have a disproportionate amount of people that do not have access to adequate health care. That means they don't have a primary care doctor. They don't go to the doctor for any and everything. They've grown accustomed to using emergency rooms, if there is a need. And our emergency room, of course, now is inundated with people that are suffering from the virus. The other thing is people don't have access to medications because they hadn't been to a doctor to get that chronic disease under control, which could easily be managed. So that's another part that has played with making Albany a hotspot.

SCORING <Saturn’s Rings>

LILLIAN: Because you have so many people that have underlying conditions -- asthma, diabetes, high blood pressure -- that are being exposed without the proper insurance, without medical attention. The ICU units are full and they're sending patients to surrounding areas. They had a stockpile of masks, gloves, that kind of thing. And they went through protective gear, six months supply, in one week. We survived floods in ‘94, ‘98. Tornadoes. Hurricanes. We’ve never seen anything like it.

SEAN: More in a minute, on Today, Explained.

SCORING OUT

[MIDROLL]

SEAN: OK, Jillian, Lillian said the ICU in Albany, Georgia was so packed, patients are being flown to other cities for care. And that’s, what, because so many people got sick so quickly?

JILLIAN: That’s part of it. But also -- the health care system in rural America was kind of a mess before the pandemic began.

JACOB WARREN: We have always faced health care disparities in rural America.

JILLIAN: Jacob Warren is a researcher at Mercer University in Macon, Georgia, not too far from where Lillian lives and he outlined two major problems with rural health care. One -- there’s a serious lack of doctors and hospitals. And two -- patients either can’t -- or won’t -- use health care. We started with one, the shortage.

JACOB: Over the past 15 years or so, 10 percent of rural hospitals have closed. And there are another 20-30 percent that are at risk of closing. There are many, many rural counties that don't have a physician at all.

JILLIAN: So no, no providers whatsoever.

JACOB: Right. There are some that have not a single physician.

JILLIAN: But if counties do have a doctor or two -- that’s not enough during a pandemic.

JACOB: If you have a county that has one medical provider and no hospital and you have two cases of Covid, and if that one provider became exposed to that patient and wasn't wearing PPE, then they're going to have to self-quarantine until they can get their test results back, which are slower in rural communities. And then you effectively wiped out the whole medical system in that county by having one or two providers out.

JILLIAN: And if a county’s lucky enough to have access to a clinic, or a hospital --

JACOB: Because rural providers, both physicians and hospitals, operate on such a tight margin or quite often a negative margin -- talking to a lot of my colleagues, they are facing really hard decisions about what they're going to have to do to be able to make payroll.

JILLIAN: Because of the pandemic, clinics and hospitals have had to cancel non-essential surgeries. Like back or knee surgery. That’s a problem for clinics that are already operating at a loss -- because those are the procedures that bring in money.

JACOB: There’s one clinic that has had to send some nurses home. Which is -- ironic isn’t even quite the right word, we’re in the middle of this crisis where we need all hands on deck, but they’re having to send some competent health care providers home because they just don’t have the volume of services to make payroll. And they don't have the resources to stock up on things like PPE, so they're much less likely to have had a stockpile in the first place. And they're not able now to purchase all of this additional equipment that's needed in the context of a reduced income stream.

JILLIAN: So that’s issue number one. Issue number two is the patients.

JACOB: We see problems because we have higher rates of uninsurance, higher rates of poverty, lack of reliable transportation. And we know that states that did not expand Medicaid are disproportionately rural.

JILLIAN: And then -- even if patients do have access, there are some who just don’t feel comfortable seeing a doctor.

JACOB There’s issues of mistrust of the medical community. We have lower levels of health care literacy. We have lower levels of general literacy. And all of those play into medical care being a big black box for a lot of people that they don’t understand and don’t quite trust. We do also, you know, we have to say things the way they are -- we do also still have issues of racism and discrimination within the health care setting. We know that early experiences of racism and discrimination within the health care setting make you much less likely to go back and seek care. And in times of crisis, where we're asking individuals to take precautions that they might feel subject them to additional profiling, such as wearing a mask in public, we're really layering on complexity here that makes it hard for marginalized populations to do everything we're asking.

JILLIAN: So rural patients are less likely to have insurance. Even if they do -- they might not want to use it. And if they’re not going to the doctor ... they’re MORE likely to have chronic diseases.

JACOB: So we have higher rates of diabetes, we have higher rates of hypertension. We have higher rates of general coronary disease. And so they're more susceptible to the negative effects of Covid-19. And then at the same time, you know, if they don't become infected, they're not able to access the primary care they were able to previously to help them manage their diabetes and hypertension and heart disease. And so a lot of us are very concerned about what this is going to look like in three, four months in terms of regular chronic disease outcomes, because care has become a vacuum in this interim.

JILLIAN: Still -- Jacob sees potential for change coming out of the pandemic. He’s thinks it’s an opportunity for states to look at expanding access to Medicaid --

JACOB: Whether that’s temporary expansion of Medicaid during this crisis, that’s one option.

JILLIAN: And right now, insurance companies are covering virtual doctor’s visits, telehealth. Jacob hopes that sticks around.

JACOB: Those are things we've been pushing for in rural healthcare for a long time, because that will give patients access to it.

JILLIAN: But in the short-term --

JACOB: We’re seeing this pandemic play out in rural areas in ways that we’re not seeing in other urban areas. It does reinforce this feeling that the health care system is failing them. I'm worried it'll lead to some more disillusionment with the health care system. But at the same time, if we're able to support change out of all of this, it could be an opportunity where they could say, OK there was something positive that came out of this.

SEAN: Jillian Weinberger reported this story for Today, Explained.

The rest of the team includes Noam Hassenfeld, Brigid McCarthy, Efim Shapiro, Amina Al-Sadi and Haleema Shah.

Cecilia Lei is our fact checker.

The Mysterious Breakmaster Cylinder provides music. He didn’t write this one.

Liz Nelson is Vox’s Editorial Director of Podcasts.

And Today, Explained is part of the Vox Media Podcast Network.