It takes more than good intentions to transform the South. It takes money.
What the hell is a Scalawag?
On April 20, in a press conference peppered with words like "encouraged," "proud," and "confident," Georgia Gov. Brian Kemp announced that gyms, massage therapists, nail salons and other businesses could soon open their doors. Restaurants and bars would follow. With this, Georgia became the first state in the nation to open its economy after weeks of trying to keep the coronavirus at bay.
On April 25, Atlanta Mayor Keisha Lance Bottoms tweeted, "please share these noon numbers with your manicurist." There was a 28 percent increase in cases statewide in the previous week, and 34 percent increase in deaths.
The disconnect between state leadership and policies on the one hand, and the widening reach of the virus across Georgia, has proceeded apace. By July, the number of daily confirmed cases had surged beyond the records set in April, and hospitalization and death rates were trending alarmingly upward. An open letter to Kemp from 1,400 healthcare workers urged the governor to backtrack on allowing businesses to operate as usual. Instead, he sued Bottoms for implementing a mask requirement in Atlanta. And now students are packing the halls of public schools that have reopened.
Ashley Chupp "finds peace" amid her ongoing "post-virus" symptoms by taking care of her plant collection.
What follows are stories from people whose lives have been changed along the way. They complicate and often contradict the narratives Georgia officials have been feeding the public since reopening, like: young people have nothing to fear, "hotspots" are under control, protestors caused the virus to spread across the state, hospitals are equipped, and public institutions are following strict precautions. The Georgians I spoke to had different stories to tell, and they are hard to forget.
Months of illness with no end in sight
Ashley Chupp took her temperature shortly before we spoke on the phone. It was 100.6 F. The 35-year-old said she had never seen her temperature go above 100 degrees before this spring. But between March and the summer day of our call, she had been running a fever several times a week.
The highest was 103.2 F.
Chupp went to Emory University Hospital a week before we talked. Blood pooled under her skin from elbow to forearm, due to blood clotting issues.
Two weeks before, she had an outbreak of psoriasis on her neck for the first time in seven years.
On some days, Chupp gets winded walking out of her Decatur house to the trash can in the driveway. Doing her laundry and a few chores is enough to exhaust her she sleeps until the following day.
The photographer and waitress has also tested negative for COVID-19 four times.
When she first experienced symptoms in March—scratchy throat, a loss of taste and smell for several days—her doctor had run out of tests. He gave her a number for a nearby testing site; they had also run out. She doesn't have a car. By the time she found a place nearby to take the test, three or four weeks had gone by. When it came back negative, "they told me it was probably a false negative," she said.
At Emory several weeks ago, they told her she appears to be experiencing "post-virus syndrome"—regardless of test results. "They told me, 'A lot of people are not getting better.' They told me to follow up with my primary care doctor."
Meanwhile, the restaurant where Chupp worked laid her off in mid-March. She's been receiving $460 a week after taxes in additional federal unemployment benefits since the first week of April. But that was set to end soon after we spoke, on July 31. Along the way, a charity has paid one month's rent at her Decatur house, where she pays $900 and has a roommate.
Chupp also hasn't had health insurance for two years. She pays her doctor on a sliding scale when she has medical issues. "I've found it's cheaper to pay cash discounts than monthly premiums," she said. But her health is fragile, as she has a condition known as gastroparesis, which means her stomach doesn't absorb food properly.
"Dying is not the only thing to be afraid of with COVID-19. I have systems in my body not working any more. And there's no numbers for that."
Asked about the Emory bill, she said, "I have no idea what I'm gonna do with that. Put it in the trash with the other bills." Chupp was turned down for Medicaid. She's thinking of applying for disability benefits.
"I'm struggling to find hope," she said. "This has done a number on my mental status." For about an hour each day, she "finds peace" caring for her collection of exotic plants, which are gathered in a room and on her back porch.
She sometimes enters arguments online with people who have countered recently rising coronavirus case numbers in Georgia by pointing to relatively low numbers of fatalities. "I love when people argue numbers," she said. "All those numbers, I'm not included in those numbers. It's shocking to me that the doctor in the hospital was like, 'We're seeing this all the time.'"
Healthcare workers in Atlanta's Piedmont Healthcare system devised a plexiglass box to separate themselves from COVID-19 patients they intubate.
Given the apparent frequency of cases where people have experienced ongoing symptoms for months, Chupp doesn't understand why no one from the public health system has contacted her. "It's frustrating that I've not been more closely monitored," she said. "It could provide some knowledge." Between feeling ignored by health officials, denied by Medicaid, and losing her unemployment benefits, she said, "For the first time in my life, I've understood what it feels like to have government not care about me."
"Dying is not the only thing to be afraid of with COVID-19," she insisted. "I have systems in my body not working any more. And there's no numbers for that."
In hospitals, long hours, short supplies, and racial disparities
Jeremy Amayo became a physician assistant in 2015, two years after moving to Georgia. He specializes in pulmonary/ critical care medicine at Atlanta's Piedmont Healthcare system, where the Intensive Care Unit was at 130 percent capacity when we spoke in mid-July. Amayo remembers earlier this year, when news of the coronavirus became water cooler talk for him and his colleagues. "Some [of them] said, 'Wouldn't it be crazy if this turned into a global pandemic?'"
Within weeks, the first cluster of about 30 people sick with COVID-19 came into his hospital. It was late February, early March. They had all been to the same funeral. "Nobody knew what we were getting into," he recalls.
Months later, 50-hour weeks pile up. We were speaking on his first 24-hour break for days. The 29-year-old and everyone he works with have been on a crash course the whole time. "We tried Plaquenil (hydroxychloroquine), Valsartan. None of it worked," he said, ticking off the names of drugs they administered to COVID-19 patients.
At first, he added, staff used ventilators immediately to help patients with difficulty breathing. But then a new study made them think they were intubating too early. "Usually if oxygen levels decrease, the heart rate changes and you don't feel well. But with COVID-19, patients would come to us with 70 percent oxygen saturation and they would still be at their normal heart rate, texting on their phones! This added to uncertainty."
Innovation has been a daily necessity. Amayo and colleagues ran out of sterilizing wipes; they made their own. Then, "we made an intubation box—a big, plexiglass box. It protects us from particles splashing up."
In May, when case numbers briefly dropped, Amayo saw "a wave of people who were afraid to go to the hospital and stayed at home too long. People with heart attacks who would have recovered ended up with a hole in their hearts."
But over time, numbers have gone back up. The disease continues to confound. "People with 20 to 30 years of experience are befuddled," he said. For example: "[w]e have a lot of patients testing negative; they look, walk and talk like COVID-19 … At least 10 of my patients have been negative, but I have no doubt they had [the virus]—including some of my own colleagues."
Also, supplies and staff are running low. There has been an influx of patients in intensive care for weeks on end that he had previously only seen "for a shift or two."
Apart from being "stretched thin" and the stress that implies, Amayo, who is biracial—his father is Nigerian—has been keenly aware of the fact that Black people are most affected by COVID-19. "I think with racial disparities being highlighted, some of it is due to comorbidities—but I wonder how much is implicit bias in patient care," he said. "It's hard to see people who look like me dying."
"I don't dread taking care of patients—saving lives, or giving a dignified death. But with COVID-19, you ask, 'Where does it end?'"
The 100 or so healthcare professionals in Amayo's group have been discussing racism and healthcare in recent weeks, on Zoom calls, in texts, during shifts. That's a good thing, he said, but he also noted that Georgia isn't doing a good job of gathering race and ethnicity data for coronavirus cases—because it's not a priority. (The largest category to date in the state's database of coronavirus cases classified by "Race and Ethnicity" is "Unknown." There's another large category: "Other.") "If Governor Kemp mandated race and ethnicity data for 100 percent of cases, it would happen tomorrow," Amayo said.
He added, "I leave work after intubating three patients with COVID-19 and drive by a restaurant and see people eating with no masks. It feels like people are tired of isolating, less fearful. We've politicized COVID-19 and masks.
"Personally, I feel a sense of hopelessness. Looking at the political landscape, at the culture of individualism we have … I wouldn't be surprised if COVID-19 comes back with a vengeance in the fall.
"I don't dread taking care of patients—saving lives, or giving a dignified death. But with COVID-19, you ask, 'Where does it end?'"
No protections in prison
Nadine has worked as a nurse in prisons for a long time. Prisoners "are one of the forgotten populations as far as healthcare goes," she said. What's more, "most of them are very grateful. They say, 'Thank you for coming to work.'"
Scalawag is not using Nadine's real name because she doesn't want to jeopardize her current job at a Georgia prison. She spoke with us because she felt the pandemic "is not being managed well" since the prison's first positive test result in March. Several prisoners have died with the virus.
One of Nadine's concerns is that inmates who test positive are put in the same area as prisoners who aren't, and the two groups aren't restricted from interacting with each other. In fact, two transgender women were put in the same location as cisgender men who had tested positive, even though they had not, as a way of separating them from the general population. "When we ask the warden why, we're told, 'It's a security decision,'" she said.
"They're not taking it seriously. They're laid back like it's all over. And it's not all over!"
Then there's testing. "They don't have enough for the whole population," she said. About 40 prisoners are tested at a time, and most are not tested again. Less than a third of the prison's population had been tested by mid-July, she estimated. The current number of positive cases listed on the Georgia Department of Corrections website is the same as the number mentioned in news accounts from mid-June. One of those reports quoted an official saying positive cases had not increased since May. The department has also not issued a "COVID-19 update" on its website in 10 weeks, after issuing four in May. These facts call into question whether prisoners continue to be tested, or if the Georgia Department of Corrections is updating its data.
As for the healthcare staff, Nadine said she and her colleagues are not tested at the prison.
She's also concerned about the cultural flashpoint currently roiling outside prisons: masks. Prisoners were issued cloth masks in the second week of April, Nadine said. Some have since lost their masks; some have made their own. By July, "out of every 10 patients I see, four don't have masks anymore. Some will just pull their shirts over their mouth and nose." As for the staff, including officers: "For some reason, [they] refuse to wear masks. We're at risk! I always ask them about it. They say, 'I just forgot it,' or 'I don't feel like it.' They're not taking it seriously. They're laid back like it's all over. And it's not all over!"
A detailed query to Georgia Department of Corrections spokesperson Lori Benoit, including specific questions about testing, masks, and the policy of congregating prisoners who are positive with others who aren't, was met with a cut-and-paste reply about general policies and procedures. Benoit declined repeated requests to answer Scalawag's questions.
Meanwhile, Nadine keeps working 50 to 72 hours a week, even with chronic bronchitis, which places her at particular risk. "I'm worried about my health," she said. "But I chose nursing. I can't just stay home til the pandemic is over. Those are people; they need care."
A public health breakdown on par with Liberia
Josh Mugele arrived in Georgia from Indiana in October, only months before the pandemic arrived on U.S. shores, to start a new job training of emergency medicine doctors in five hospitals—including one in Gainesville, where he lives. Mugele also works emergency room shifts, mostly in the same northern Georgia town.
"I always thought we would do better. I thought we would have resources for enough testing, contact tracing. Now, I'm seeing so many parallels to Liberia—[one of the] most-impoverished countries in the world."
Mugele's hospitals have seen the same trend as elsewhere: people postponed care for conditions such as diabetes until several months into the pandemic. Now they're filling up hospitals, along with COVID-19 patients.
Customers enter a Walmart in Lawrenceville, Ga., on July 20, the first day the supermarket chain began requiring customers to wear masks.
That means they're "not quite at capacity yet, but we're talking about dialing back elective procedures and setting up tents outside the hospital, with several dozen beds," Mugele said. The experienced disaster and emergency medicine specialist—he worked three years in Liberia to help stem the Ebola outbreak—has gotten used to uncertainty. "Every time we come up with a rule, it changes one week later," he said.
Recently, he said, they're seeing more patients who have COVID-19 symptoms but test negative. This may be due to "tests not being done properly. If they're self-administered, unless they're done properly, it's easy to test negative and have symptoms." Mugele thought "there's not enough science out there yet" to know if people will feel long-term effects of the virus.
As for who he sees getting sick in Gainesville, "Unfortunately, this is disproportionately affecting people of color and immigrants," especially Latino men in their 30s and 40s who work in chicken plants. "That is the most frustrating thing to me. People who suffer the most are the people who are most vulnerable. People making decisions won't be as affected."
Mugele is critical of the state's response to the crisis and is active on Twitter, blasting takes such as "I think he's literally trying to kill people," in reference to Georgia Governor Brian Kemp's lawsuit against Atlanta Mayor Keshia Lance Bottoms' attempt to mandate wearing masks.
"I'm not a public health expert," he said. "But I rely on experts to inform decisions. What's frustrating in Georgia is that there's not only a resistance to listening to expertise… but there almost seems to be an active fight against some of these measures… it seems like [officials are] actively trying to make the pandemic worse. You can't draw other conclusions."
Meanwhile, when he goes out to shop, or take a walk, in Gainesville, "I see dozens of people, and nobody is wearing masks!"
Mugele knows how a virus can affect an entire population. From 2013 to 2016, he worked with Ebola patients in Liberia. "I saw the effects of an entire generation of students out of school for one and a half years. The healthcare system shut down. People being shot in the streets. Other diseases running rampant. I saw the most severe forms of public health failure.
I always thought we would do better. I thought we would have resources for enough testing, contact tracing. Now, I'm seeing so many parallels to Liberia—[one of the] most impoverished countries in the world."