ATHENS, Ga.—At Piedmont Athens Regional Medical Center, the staff has spent the past few days MacGyvering gear: Can anesthesia machines be repurposed as ventilators? Looks like it. Do hand-sewn masks help stanch the shortage of medical-grade gear? Absolutely. On a Monday Zoom conference call, Piedmont Athens Regional chief executive officer Michael Burnett told civic leaders in this college town better known for R.E.M. and Georgia Bulldogs football: “I have a UGA mask a nurse’s mom made for me. I’m stylin’.”
Joining the call from across town at St. Mary’s Hospital, CEO Montrez Carter said his staff is also planning for a wave of Covid-19 patients. “It’s not just adding beds,” he said. “It’s the staff, equipment, physicians, the infrastructure needed to handle that surge.”
The hospitals are located in Athens-Clarke County, population 126,000. They’re prepared to handle Covid-19 cases in Athens. But the real question is: Can they handle their neighbors?
St. Mary’s and Piedmont Athens Regional jointly serve an area that encompasses 16 additional counties, and more than 650,000 residents. Like hospitals in small and mid-sized cities across the South, they have seen their patient network expand as rural hospitals elsewhere in the state close down. And now, Athens is facing a big test. “If you add a pandemic, health systems serving these communities are exponentially more strained,” said Grace Bagwell Adams, a public health professor at the University of Georgia and director of the Athens Wellbeing Project, which assesses community health needs.
That healthcare strain is adding to other long-boiling political tensions. Some Athenians resent the added burden from their more laissez-faire neighbors who, in the absence of orders from the Republican governor, allowed most businesses to operate and continued gathering in large crowds well into the later weeks of the outbreak. “We can do everything right, and suffer because of lack of responsibility of others,” Athens-Clarke County Commissioner Russell Edwards told me.
The coronavirus storm already is rapidly gathering in Athens and surrounding areas. At noon on April 11, the Georgia Department of Public Health recorded 82 cases of Covid-19 in Athens-Clarke County and 36 cases in next door Oconee County. Across the 17 counties served by the two Athens hospitals, the DPH reported 334 cases, up from 200 at the middle of the week. A model from the University of Texas based on data from earlier in the month gave Athens-Clarke County a 100 percent chance of epidemic infection, and its 16 neighboring counties probabilities ranging from 55 percent to 99 percent.
Those numbers mean the two hospitals here aren’t just getting ready for local patients. “As we look at an Athens surge, we have to look at 15, 16, 17 counties that are being served by our facilities,” Carter said. Beyond that, though, Carter doesn’t know what to expect, comparing the surge in infections to tracking the landfall of a gathering hurricane while it’s still early. “There is no consensus where it will turn.”
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Since 2005, 170 rural hospitals have closed in the United States, eight of them in Georgia. As these hospitals leave, the facilities in nearby cities and towns pick up the slack, said Brock Slabach, vice president of the National Rural Health Association. The closure of Hart County Hospital in 2012 a few counties away, for instance, sent those patients to the Athens hospital region—what people in the industry call a “catchment” area, like a stream bed.
When you exclude hospitals in metro Atlanta, just a handful of regional hospitals serve 95 of Georgia’s 159 counties. Adams points to six Georgia cities in addition to Athens where a smaller health system caters to a huge rural and exurban ecosystem. In Gainesville, 55 miles north of Atlanta, Northeast Georgia Medical Center serves 16 counties. In Columbus, West Georgia-Piedmont Columbus Regional serves 21 counties.
Even before coronavirus, an influx of new patients to city hospitals added strain, both because of their sheer numbers and the unique health problems of rural populations. Rural patients tend to be older, poorer, and in worse general health than urban residents, said Slabach and Adams, all of which can make a coronavirus infection much worse. “Places like rural Georgia will see greater complications and death rates because of these conditions,” Slabach said. Rural and urban Georgia alike also have larger African-American populations—27 percent of Athens-Clarke County’s residents are black—and new data from the CDC reveals that African Americans have had disproportionately higher rates of Covid-19 infection and death.
Elected officials, experts and hospital administrators in Athens are particularly worried about these strains because of one worst-case scenario that recently played out in Albany, less than 200 miles away in the same state. Coronavirus surged there in March after an outbreak spread through attendees of two funerals. Dougherty County, Georgia, where Albany is located, logged 1,076 COVID-19 cases and 69 deaths as of April 11. Coronavirus infection was spreading into nearby counties, such as Sumter, which logged 222 cases and 9 deaths—in a population of just under 30,000.
Infected residents of Albany and environs were sent to Phoebe Putney Memorial Hospital in Albany, which serves a catchment area of 15 counties and had only 38 ICU beds at the onset of the epidemic. Thirty-five of those beds were filled at the beginning of April, and the hospital later rushed to expand its overall fleet to 49. The staff ran out of masks so quickly that one team was assigned to sew new ones out of bedsheets. The hospital has been forced to transfer more than 100 patients to nearby hospitals in Georgia and Alabama.
With similar capacities and similarities in the number of patients served and their demographic makeup, Athens could easily become the next Albany if communities do not adhere to social distancing.
Since late March, Governor Brian Kemp has deployed the National Guard to hospitals and nursing homes across Georgia to assist with hotspots like Albany and to prepare for a projected surge in cases statewide. National Guard medic, Dr. Brett Atchley, M.D., was assigned to Piedmont Athens Regional, where, in civilian life he is an ER doctor. He goes to work in scrubs one day, and the next puts on his Air National Guard uniform, shifting from hands-on treatment of patients to coordinating big-picture planning with the hospital administration, National Guard troops assigned to the area, and GEMA, the Georgia Emergency Management Agency.
In past deployments, Dr. Atchley and his counterparts have been assigned to provide medical care following natural disasters like hurricanes. Now, he’s bracing for another kind of catastrophe.
“When you think about all the counties depending on our hospital, and how wide the catchment area is, you realize we share what happens in every community we serve,” Dr. Atchley said. “If something happens there, we will share in that catastrophe with them, even if Athens itself stays somehow protected.”
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It’s not just their scarce medical resources that make Athenians worried about an influx of their rural neighbors. People in Athens are also worried the more rural areas around them were too slow to respond to the spread of the outbreak, with potentially catastrophic results.
Kemp was notoriously slow in issuing a statewide shelter-in-place policy, which he eventually announced would go into effect on April 3. Until then, though, Georgia was a patchwork of Covid response policies, with noticeable differences between rural, suburban and urban areas. Athens’ mayor and commissioners were quick to act, for instance, issuing a stay-at-home order for residents on March 20. Nearby counties issued such orders much later, as did many other areas of Georgia.
“Looking at the coming few weeks, there are two essential scenarios” for what will unfold across Georgia, Adams told me. “In scenario A, people widely shelter in place and cases peak in late April. In scenario B, there is little to no adherence to shelter in place and cases increase until a much wider segment of the population is infected.”
For the Athens hospital chiefs Burnett and Carter, whether scenario A or B will play out in the coming weeks depends on their neighbors. “Locally I feel that we are stabilized,” Burnett told the city leaders on Monday. “What we are watching before the surge are the communities around us. They might have been lagging a bit.”
Others were harsher. “We had businesses advertise ‘Come to [nearby county] Oconee, we’re still open for business,’” Edwards said. “They depend on Athens for customers, but they seemed to be profiteering. It was opportunistic.”
“There will be a two- to three-week lag time in the shelter-in-place policies paying off,” Adams said of policies passed by Athens-Clarke County commissioners and mayor Kelly Girtz. “Counties that Athens-Clarke County hospitals serve did not have shelter-in-place policies, yet their residents will come here to be cared for when they get very sick.”
The lack of a timely response in outlying areas, coupled with the expected surge in rural patients, has amplified tension between early adopters of stay-at-home ordinances and the rest of the state. “I have never felt like less of a Georgian than I do right now,” said Edwards of the pushback Athens felt from surrounding counties and from Kemp, who happens to be an Athens native himself. “I have never felt like more of an Athenian.”
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April is traditionally a glorious month in Athens. The city is a riot of azaleas and greenery, the restaurant and bar patios stay open late, students party on the lawns of the antebellum mansions that now house fraternities and sororities. There are concerts and festivals downtown. The last weekend of April is dedicated to the Twilight Criterium, Pro-Am bicycle races through city streets lined with beer tents and cheering crowds.
This year, Twilight was supposed to kick off on April 24, which current models project as Georgia’s Covid-19 pandemic peak, with deaths reaching at least 100 per day.
On Tuesday night, as the mayor and commissioners of Athens-Clarke County were starting their weekly meeting, news alerts went off: An Atlanta TV station reported 10 deaths at Pruitt Grandview, a long-term care facility in Athens, a toll that potentially doubles the death rate in Athens-Clarke. The station was tipped off by a whistleblower; no one in local government had been alerted. A Pruitt spokesperson confirmed the Covid diagnoses and client deaths in an email statement to me, but said whether they were logged in the state tally depended on CDC and health department policy. On Friday, the state issued an updated report on the rate of coronavirus infections and deaths in Georgia nursing homes and long-term care facilities, revealing that 80 locations had reported cases—up from 47 a week earlier. Only eight deaths were reported for the facility in Athens.
City Manager Blaine Williams is figuring out if capacity can be added to a newly completed morgue, preparing for the kind of disaster that has not been seen for a century. The National Guard has been sent to assist at the hospitals. A downtown Athens boutique that runs a fashion label for recycled fashions has been cranking out fabric face masks, and on the University of Georgia campus, engineering students are fabricating medical face shields and researchers have joined the quest for a vaccine.
At St. Mary’s and Piedmont Athens Regional, administrators have figured out how to squeeze in more ICU beds. They are pleading with the community for donations of basics such as Sani-Wipes. All elective surgeries have been put on hold and family visitation is restricted.
On Monday’s call, the two hospital managers cautioned care. “This is going to be a marathon, not a sprint,” Montrez Carter, CEO of St. Mary’s said. “Our colleagues continue to put themselves in harm’s way.”
Without testing and accurate forecasts, leaders in Athens are preparing for the unknown within a larger unknown, a condition that will be playing out across the South in the coming weeks.
“It’s so clear the feds and state governments have dropped the ball,” Adams said. “It’s up to cities and counties, and hospital systems, working together with community support to make it through this.”
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