'It's gone haywire': When COVID-19 arrived in rural America

DAWSON, Ga. (AP) - The reverend approached the makeshift pulpit and asked the Lord to help him make some sense of the scene before him: two caskets, side by side, in a small-town cemetery busier now than ever before.

Rev. Willard O. Weston had already eulogized other neighbors lost to COVID-19, and he would do more. But this one stood as a symbol to him of all they had lost. The pair of caskets, one powder blue, one white and gold, contained a couple married 30 years who died two days apart, at separate hospitals hours from each other, unaware of the other's fate.

The day was dark. There was no wind, not even a breeze. It felt to some like the earth had paused for this.

As the world's attention was fixated on the horrors in Italy and New York City, the per capita death rates in counties in the impoverished southwest corner of Georgia climbed to among the worst in the country. The devastation here is a cautionary tale of what happens when the virus seeps into communities that have for generations remained on the losing end of the nation's most intractable inequalities: these counties are rural, mostly African American and poor.

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This story was produced with the support of the Pulitzer Center on Crisis Reporting.

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More than a quarter of people in Terrell County live in poverty, the local hospital shuttered decades ago, and businesses have been closing for years, sending many young and able fleeing for cities. Those left behind are sicker and more vulnerable; even before the virus arrived, the life expectancy for men here was six years shorter than the American average.

Rural people, African Americans and the poor are more likely to work in jobs not conducive to social distancing, like the food processing plant in nearby Mitchell County where four employees died of COVID-19. They have less access to health care and so more often delay treatment for chronic conditions; in southwest Georgia, the diabetes rate of 16 percent is twice as high as in Atlanta. Transportation alone can be a challenge, so that by the time they make it to the hospital, they're harder to save.

At least 21 people have died from COVID-19 in this county, and dozens more in the neighboring rural communities. For weeks, Weston's phone would not stop ringing: another person in the hospital, another person dead. An hour before this funeral, Weston's phone rang again, and this time it was news that another had succumbed to the virus-his own first cousin, as close to him as a brother.

Some here had thought that their isolation might spare them, but instead it made the pandemic particularly cruel. In Terrell County, population 8,500, everyone knows everyone and every death is personal. As the mourners arrived at the cemetery, just the handful allowed, each knew others suffering and dying.

The couple's son, Desmond Tolbert, sat stunned. After caring for his parents, he'd also rushed his aunt, his mother's sister, to a hospital an hour away, and there she remained on a ventilator. Her daughter, Latasha Taylor, wept thinking that if her mother survived, she would have to find a way to tell her that her sister was dead and buried.

'œIt's just gone haywire, I mean haywire,'ť thought Eddie Keith, a 65-year-old funeral home attendant standing in the back who was familiar with all the faces on the funeral programs piling up. 'œPeople dying left and right.'ť

Usually, on hard days like this, he would call his friend of 30 years, who was a pastor at a country church and could always convince him that God would not give more than he could endure.

But a couple weeks earlier, that pastor had started coughing, too.

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As Georgia and other states rush to reopen, some out-of-the way places might believe that the virus won't find them. Many here thought that, too. But it arrived, quietly at first then with breathtaking savagery.

The cemetery on the edge of town staggered graveside services, one an hour, all day. The county coroner typically works between 38 and 50 deaths a year; they reached No. 41 by mid-April. They ordered an emergency morgue.

Of the 10 counties with the highest death rate per capita in America, half are in rural southwest Georgia, where there are no packed skyscraper apartment buildings or subways. Ambulances rush along country roads, just fields and farms in either direction, carrying COVID-19 patients to the nearest hospital, for some an hour away. The small county seats are mostly quiet, the storefronts shuttered, some long ago because of the struggling economy, and some only now because owners are too afraid to reopen.

These counties circle the city of Albany, which is where authorities believe the outbreak began at a pair of funerals in February. Albany is also home to the main hospital in the region, Phoebe Putney Memorial, which serves an area of 800,000 people spanning more than 50 miles in every direction, many of them with little other access to care.

The hospital saw its first known coronavirus patient on March 10; within a few days, it had 60 and the ICU was full. Two weeks later, patients began flooding in from farther-flung rural communities. Helicopters buzzed from the top of the parking garage, flying patients to other hospitals that still had room to take them. They burned through six months of masks and gowns in six days, said Phoebe Putney president Scott Steiner. Then they were competing for supplies against wealthier, more politically powerful places; they paid $1 each for surgical masks that typically cost a nickel and were losing about $1 million each day.

The patients were very sick. Some died within hours. Some died on the way, in the back of ambulances. The region is predominantly black, but still African Americans died disproportionately, Steiner said. African Americans accounted for about 80% of the hospital's deaths.

Black people have been dying at alarming rates across the country: the latest Associated Press analysis of available data shows that African Americans represent about 14% of the population in the areas covered but nearly one-third of those who have died.

By nearly every measure, coronavirus patients are faring worse in rural Georgia than almost anywhere else in America, according to researchers at Emory University in Atlanta. Although New York City had thousands more deaths, the per capita death rate in these Georgia counties is just as high.

'œThey are vulnerable people living in vulnerable places, people who are marginalized on a variety of measures, whether we're talking about race, whether we're talking about education or employment, in places that have fewer resources,'ť said Shivani Patel, an epidemiologist at Emory. Then COVID-19 arrived: 'œIt's like our worst nightmare coming true.'ť

Dr. James Black, the medical director of emergency services at Phoebe Putney, was born in this hospital, grew up in this region and is proud of how they've managed with the odds stacked against them. He hasn't had a day off in two months. The question now, he believes, is whether society decides, in the wake of the virus, to continue neglecting its most vulnerable people and places.

'œI think that history is going to judge us not only on how well we prepared, it's not going to just judge us on how well we responded,'ť he said, 'œbut what we learned from it, and what we change.'ť

Georgia has lost seven rural hospitals in the last decade. Nine counties in rural Georgia don't even have a doctor, according to the Georgia Alliance of Community Hospitals; 18 have no family practitioner, 60 have no pediatrician, 77 without a psychiatrist.

Ezekiel Holley, the longtime leader of Terrell County's NAACP, said health care is what has left him 'œbanging his head against a wall.'ť

At first Holley thought a virus would be one thing that did not discriminate. He opened the newspaper, scanned the faces in the obituaries and knew every one of them.

'œThen I thought, why are low income people and people of color dying more than anyone else? This is the richest nation in the world, why doesn't it have a level playing field?'ť he said. 'œTell me that.'ť

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At first, Benjamin Tolbert just felt a malaise; he had no appetite. Within a couple days, he could barely stand.

His son, Desmond, took him to the hospital in Albany. By then it was full, and he was sent to another hospital an hour south. Benjamin's wife, Nellie Mae, who everyone called Pollye Ann, got sick the next day. She was routed from the Albany hospital to another an hour north.

Everyone in town knew Benjamin, 58, as a hard worker. He had worked for 28 years at a Tyson Foods plant, and yet he always found more work to do, washing his car, tending the lawn. He and his wife had been together 30 years. He was mild-mannered, but she found a joke in everything. She was a minister, she played the organ, sang gospel and danced, wildly, joyfully.

'œOh my goodness, she was a dancer, and the dances were so hilarious, you would just fall out laughing watching her dance and laugh at herself,'ť said their niece, Latasha Taylor, whom they loved like a daughter. Benjamin would hang back, but Pollye Ann would pull him up and he'd dance along with her.

Both were diabetic, Pollye Ann had had heart valve surgery, Benjamin had been on dialysis. Pollye Ann's sister, Katherine Taylor Peters, often got dialysis treatments with him. They were a close-knit family: Peters lived just blocks away.

Shortly after the Tolberts got sick, Peters called her daughter and said she too had an incessant cough and was struggling to breathe. Latasha was working hours away, so she called her cousin, Desmond, and asked him to check on her.

He put her in his car and drove her to another hospital an hour from home. They soon sedated her and put her on a ventilator.

Much of the rest is a blur for Desmond and Latasha: calls from doctors and nurses, driving hours among three hospitals, begging to see their parents but being told it was far too dangerous.

'œI couldn't see them, I couldn't talk to them,'ť said Desmond, 29, who had lived with his parents all this life. Suddenly he was alone.

And all around them, neighbors were getting sick.

'œSo many people, it's a feeling you can't even explain. It's like a churning in your stomach,'ť said Taylor. 'œPeople you're normally waving at, speaking to in passing, at the pharmacy, you're never going to see them again.'ť

Desmond was on the phone with a nurse as his mother took her last breath. Two days later, the call came from his father's caregivers. Benjamin never knew that his wife got sick. She didn't know her husband was on his death bed. They were apart, far from home, without their son at their sides.

The only solace he can find is imagining them meeting again on the other side, and that neither had to live without the other one.

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Eddie Keith had known this couple all his life, he knew their phone number by heart, where they lived, where they worked, their mothers and fathers.

'œThey knew me real well,'ť he said, 'œas well as I knew them.'ť

He has worked for the funeral home for 35 years, and part of his job is to pick up the bodies. He got a call about Pollye Ann's passing, and when a hometown person dies someplace else, he considers it his duty to bring them home to Dawson.

Sometimes he talks to them as he drives, sometimes he sings.

When the second call came about her husband, two days later, he wondered if what was happening in his city might be too much to bear. He's used to death. But now people were dying one right after the next, too quickly to reckon with each in real time.

Keith is a deacon at a country church down a dirt road just outside of town. His pastor, Rev. Alfred Starling, always told him that God doesn't make mistakes, and Keith wanted to be reminded of that now, because Dawson's people kept dying, and Keith kept retrieving them. But the next morning he was picking up a body in Tallahassee when the pastor's wife called. He'd gone to the hospital with a bad cough, and he hadn't made it.

They'd known each other 30 years. Once, years ago, he'd complimented his pastor's necktie. After that, every time the pastor bought himself a tie, he bought Keith one too. It became a symbol of their love for each other. 'œHe would always look out for me,'ť he said.

Keith pulled off the road and sat there a half an hour.

'œWhy God? Why God? Why God?'ť he thought, and he caught himself. He was always taught not to question God, so he asked for forgiveness.

There were three funerals the next day, and he left just after to pick up his pastor's body.

He talked to him: 'œI didn't think you'd leave me so early; I thought we were going to grow old together.'ť

He thought of his pastor's favorite spiritual. 'œGood news, good news,'ť the pastor would sing and walk from behind the pulpit, a little strut in his step. 'œI'm going to lay down my burden, store up my cross. And I'm going home to live with Jesus, ain't that good news.'ť

He sang it to his pastor as he drove him home.

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By time the Tolberts' funeral arrived, so many had been lost to COVID-19 that Rev. Willard Weston had gotten used to delivering his eulogies through a mask. Gloves. Hand sanitizer. Don't touch, don't embrace, no matter how much you want to.

'œAt this pace, you don't get a chance to really take a deep breath from the previous death, and then you're getting a call about another,'ť he said. He'd found himself on his knees in his bathroom, trying to scream out the sadness so he could keep going.

He put on his suit and tie.

He walked outside, looked up to the sky and pleaded with God to find the strength to deliver a double funeral.

'œLord, how can I go and do this?'ť

In normal times, the Tolbert family's funeral would have drawn a packed house. Pollye Ann was a minister at Weston's church. She could deliver testimony like no one he'd ever seen: she was like a freight train, he recalled, slow at first then faster, faster, faster. People were drawn to her.

Instead it was just him and a handful of mourners in the cemetery, staring at the two caskets. He read from scripture and told their son, Desmond, that he'd never walk alone.

He worried his instinct to comfort with an embrace would overtake his knowledge that he couldn't, so he walked away and got in his car. He felt guilty. He prayed for God to take that guilt away. Because there was more to do. The next Saturday, he would have three funerals, back to back.

A couple weeks later, on a Friday afternoon, he was preparing to leave his empty church and head home for the weekend without a single funeral planned for the first time in weeks. It felt hopeful. Then his phone rang again.

'œMan, no. Oh, wow,'ť he said, and his shoulders slumped.

'œSome more bad news. Somebody else has passed.'ť

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There was some good news too.

Pollye Ann Tolbert's sister survived weeks on a ventilator. She still tested positive for coronavirus and remained in isolation, so her daughter Latasha could only talk to her by phone.

The first thing she asked when she woke was how her sister and brother-in-law were doing. Latasha paused. Her mother repeated the question. It felt unreal. Mail still arrived in the mailbox for them. Their house was just as it was the day they left for the hospital. She and her cousin had washed the linens and wiped the surfaces to rid it of virus, but were otherwise too paralyzed to move a thing.

'œI had to tell her that while she was sleeping, her sister and brother-in-law left us forever,'ť Latasha said. 'œThey're already buried, they're in the ground.'ť

Peters told her daughter that the last thing she remembered was a doctor on the phone, telling her that her sister wasn't going to make it. She thought she would die too, if not from COVID-19, then from grief.

She had hoped it was all a bad dream.

Then she woke up.

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AP writer Katrease Stafford and data editor Meghan Hoyer contributed.