More than a year into the pandemic, it’s clear its impacts hit some communities much harder than others. People of color have died in greater numbers in many parts of the state, and COVID-19 death rates are often higher in rural areas with a shortage of medical facilities. On the latest Georgia Today podcast, host Steve Fennessy and Olivia Goldhill, an investigative reporter who covers the pandemic for Stat News, explore how hospital closures are hampering some counties’ efforts to combat the pandemic in southwest Georgia.

RELATED: Shuttered hospitals, soaring COVID-19 deaths: Rural Black communities lose a lifeline in the century’s worst health crisis

TRANSCRIPT

Steve Fennessy: In many ways, the story of the COVID-19 pandemic in America is a tale of two nations. Roughly 600,000 Americans have died from the virus, but numbers show poor communities and communities of color have been hit especially hard. And the public health emergency, where expert care often means the difference between life and death, has also revealed another disparity: High-level medical care is hard to come by in rural America. Many remote communities in states across the country struggled with a lack of access to medical care even before the pandemic and Georgia is no different. The state's far-flung counties saw a record number of hospital closures in 2020 and exponentially higher death rates.

News Tape NPR: Rural America is home to few doctors, few ICU beds and not enough replacement staff when health care workers get sick.

Steve Fennessy: This is Georgia Today. I'm Steve Fennessy. In this episode, we look at what happens when a community's last remaining hospital shuts down and residents are left with just one ambulance. I'm joined by Olivia Goldhill, an investigative reporter who covers the pandemic for online health news site STAT.

Olivia, since the beginning of the pandemic over a year ago, we have heard a lot about how the coronavirus has revealed vast inequities within the United States. We've heard about how the virus has disproportionately affected people of color, people struggling with poverty, people in rural areas. And last week in the online health news site STAT, you wrote in depth about two rural counties in southwest Georgia: Terrell and Randolph counties. What brought you there in the first place?

Olivia Goldhill, investigative reporter at STAT: The hospital in Randolph closed in the middle of the pandemic last year.

News Tape WTVM: After 73 years of service, Patterson Hospital at the Southwest Georgia Regional Medical Center is preparing to close its doors.

Resident: I was devastated. I was born here.

News Tape WTVM: For residents like Brenda Clarke, there are many concerns about the only hospital in rural Randolph County closing.

Resident: Closing the hospital, especially the ER, we're going to have more deaths.

Olivia Goldhill: And I started to look at the statistics across the United States and in the counties where hospitals shut, there was a far higher death rate than in the States overall, so you could see the impact of not having local health care.

News Tape NPR: When COVID-19 hits rural communities, there's little backup in their health care systems. Nursing staffs are strained and doctors are often few and far between.

Olivia Goldhill: And in Randolph and Terrell, it was 2.8 times higher than Georgia overall, which was the highest difference that we saw across the U.S. and there was a really high rate of coronavirus in this area. One in every 200 people living in those counties died of the virus.

Steve Fennessy: So if you were living in Randolph County, your chances of dying from coronavirus were almost three times as high as if you were living in, say, metro Atlanta?

Olivia Goldhill: I mean, you can't draw — say definitively for any one case that not having a hospital would make a difference, but there's only one ambulance in the county, which means that during COVID, when that ambulance had to travel an hour's drive away to take someone to hospital in Albany, that ambulance would be out of commission for three hours for every trip. And with COVID, you often need to hospitalize quite suddenly and quickly and it helps to have early diagnosis and it helps to have treatment early on when you need it. Roughly 25% of people living in those two counties are in poverty, so large numbers don't own cars, and it's always been an issue there when someone had to go to hospital, when you know an ambulance is going to take you an hour's drive away and you have no idea how to get back. That's going to be a deterrent.

News Tape WTVM: The plan is to close the doors here at Patterson Hospital for good, meaning patients will have three options: traveling 25 miles to Eufaula [Alabama], 45 miles to Albany or 55 miles to Columbus. It's also important to note that families should make a plan to know where they are going to go in emergency situations when these doors close, whether it be Eufaula, Albany or Columbus.

Steve Fennessy: The hospital that closed in Cuthbert, Ga., was called Southwest Georgia Regional Medical Center. But most people, it sounds like, refer to it not by that kind-of-clunky name but by its original name, Patterson Hospital. What was the significance of the history of that particular hospital there?

Olivia Goldhill: Yeah, so this small city — I think it's three-and-a-half thousand people — there's a really long medical tradition there, and if you go to the Chamber of Commerce, there's this amazing exhibition dedicated to the hospital and the various doctors who have worked there. Patterson Hospital is absolutely the center of the town. You kind of can't drive anywhere without running into it. Obviously, it's a huge employer so a lot of people work there, and historically as well, this was a hospital that was always open and warm to Black patients. You know, there are plenty of people who still remember health segregation.

News Tape WSB: Kennesaw State University has released the architectural drawings of hospitals built across Georgia in the 1940s through the early ‘60s; all of them were segregated hospitals.

News Tape PBS NewsHour: Dr. Vanessa Northington Gamble: African Americans could not get care in predominantly white hospitals.

Olivia Goldhill: And when there was such high rates of COVID and death rates in that area, it was so shocking on top of that to then lose your place of care. And the hospital stopped accepting COVID patients right from the beginning of the pandemic.

Steve Fennessy: Why wasn't it providing COVID support in the initial days of the pandemic?

Olivia Goldhill: The hospital, it was managed by a larger health care system, Phoebe Putney. And it was management's decision from Albany, which is 45 miles away. They didn't think the hospital was capable of accepting COVID patients, which — this I heard from, from various experts — wasn't that unusual a decision early in the pandemic. We didn't know that much about the virus and some places did decide, let's just put all the COVID patients together in one place in the hospitals that are the most advanced — this Cuthbert hospital, it didn't have a ventilator — but it took quite a while for people to realize that a large number of COVID patients can be managed, you know, without ventilators, just kind of through the standard care that you get at local hospitals.

Steve Fennessy: Albany, Ga., was very much in the news in the early days of the pandemic back in April.

News Tape 11 Alive: Gov. Brian Kemp said Albany, in Dougherty County, Ga., is a major hotspot for the virus and it's spreading rapidly. Yesterday at noon, there were 267 cases. By 4 p.m. today, there were 462. Kemp is sending in National Guard troops to help support health care workers there.

Steve Fennessy: And what did you see of the impact of the virus on that area of rural Georgia?

Olivia Goldhill: So, as you say, early on, it was terrible. Nobody has been untouched. I think everyone knows someone that has died.

News Tape GPB: Albany City Commission Ward 6, represented by Demetrius Young. Young says he lost a lot of people he knew to COVID.

Demetrius Young: We had the highest, in this zip code had the highest rate of diabetes, hypertension. We were all kind of living with this fear that the virus was, you know, going to get you and literally kill you.

Steve Fennessy: As you point out, the crisis in rural health care was not something that was just brought about by the pandemic, but was sort of exacerbated by it. Why is it so hard in America today to operate a financially sustainable hospital and in the rural areas?

Olivia Goldhill: What I heard from from experts who study this is there hasn't been a really sustained effort from the government to address this. There's been patchwork policies here and there.

News Tape WTVM: Steve Whatley wears several hats in this area, including the mayor of Cuthbert and the chairman of the Randolph County Hospital Authority. He says for the 26  years he's been on the board, finances have always been a concern.

Steve Whatley: I would say the COVID pushed us over the edge, but we were struggling before that also.

News Tape WTVM: Unfortunately, the situation is all too familiar across the country, even during a pandemic.

Olivia Goldhill: And we do know that when hospitals close, it's much more likely to happen if that hospital is in an African American community, that when a hospital closes, sometimes they're replaced with, you know, an urgent care center or something, and sometimes there's just nothing. It's an empty building. So, I think there is a sense that race plays a factor in terms of how policies are made and the attention paid to the community's needs.

Steve Fennessy: Whether it's a question of race, whether it's a question of poverty or both, there's not a lot of political influence there. And so it's not a topic that necessarily rises to the top of discussion in the state capitol.

Olivia Goldhill: The population has declined. So the population of those two counties, Randolph and Terrell, are just over 15,000 at the moment. And, you know, if there's a lower population then there’s kind of, I guess, fewer votes and less political clout. And so maybe that's part of why their voice isn't being heard.

Steve Fennessy: How did the place strike you when you first went there because you spent a bit of time down there. What were your impressions of the place?

Olivia Goldhill: It's obvious when we arrived that it's a place of inequality. You know, there's kind of the very traditional Georgian houses with the pillars and the beautiful gardens and then not that far away, there will be public housing. And it's very, very rural, so you know, wherever you go you're driving past the peanut fields and the cotton fields and the red clay, which is very distinctive of the area. But it's quite — it's so quiet that it didn't even feel sleepy to me. You know, it felt more than that. It felt desolate in places, you know, where I was almost surprised to see a kid riding his bike down the street just because I hadn't seen anyone. Factories and lumberyards have closed over the past few years and decades, which obviously means less employment, which means more and more people leaving. It's not hard to imagine if this continues for a few more decades that it will just become ghost towns, these areas.

Steve Fennessy: Stay with us for more Georgia Today. Up next, we'll hear more about one southwest Georgia family's struggle to find COVID-19 treatment and what their story tells us about the rural health care gap in Georgia. I'm Steve Fennessy.

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Steve Fennessy: This is Georgia Today; I'm Steve Fennessy. I'm joined by investigative reporter Olivia Goldhill from STAT, an online health news site. Olivia says the pandemic highlighted the state's critical shortage of rural hospitals.

Olivia Goldhill: On top of everything, just to know that you have to fight so hard to get care and travel so far is an added burden at a time when people really couldn't cope.

Steve Fennessy: When you were down there, who did you talk to who was especially affected by the COVID-19 pandemic?

Olivia Goldhill: I mean, I spoke to several people who had lost loved ones, and there was one woman I spoke with, Latasha Taylor, and her mother, aunt and uncle, had all died of COVID, and they were all very close. So this is the majority of her family, who had died one after the other. And so they lived in Dawson, which is in Terrell, kind of halfway between Randolph and Albany. It was brutal. And her mother was there [in the hospital] for months and she wasn't able to visit and she had to talk to the doctors on the phone while her mother was unconscious and deteriorating. And it was devastating. Her mother was 62 when she died.

Steve Fennessy: And were it not a pandemic, were it not the coronavirus, would they have normally taken them to the hospital in Cuthbert? Because the hospital in Cuthbert was open then, right?

Olivia Goldhill: Yes, it was open, though I think it wasn't accepting COVID patients and as it was, her mother got sick and her mom kind of was like, “Well, I'm just going to stay put and see if this fever goes away.” And it didn't. So, you know, a couple of days later was when Latasha's cousin drove her mum, Kat, all the way to Columbus.

Steve Fennessy: When you first met Latasha Taylor, tell us a little bit more about — about her and how she's coping with these unimaginable losses.

Olivia Goldhill: Her mother was such — you could just see in the photos, she's such a character and she would dress in these matching, you know, like really glamorous dresses with these wide-brimmed hats. And she would always be at church and always sociable and Latasha said she'd always be digging in the yard and trying to kind of call her to come over and she would be trying to avoid all the chores that she had to do. And yeah, and she was only 62, which is really young. And when she was in the hospital, she was there for months on a ventilator and because she wasn't moving it meant that her body started to deteriorate. And the doctors called her and said, you know, we're going to have to amputate both her legs from the knee down and both her hands, which, I mean, it's like —  it just feels so barbaric that this is something that was happening in this century. And she said, “Well, I have to be the one to tell her.” And even though her mother was on life support on a ventilator and wasn't conscious, she went and spoke to her in person and said that she could see that there was a tear. She was crying. And, you know, the doctor said, “If we can't do the amputation, the other option is just we make sure she isn't in pain and she dies.” And so that's what they did a few days later.

Steve Fennessy: It's just staggering to think about, you know, this poor woman lying unconscious in a hospital bed and withering away to the point where she would have to have her limbs amputated and you talked about — I mean, we're 21st century America, that seems staggering.

Olivia Goldhill: When the hospital systems were overwhelmed, I mean, the health care system couldn't cope and the care they got, I mean — was too often limited just because it was so overwhelmed. And to also see your hospital close, it does just make you feel like, you know, you can't get proper health care.

Steve Fennessy: One of the questions all of these stories bring up is, what's to be done? I mean, is there any sort of concerted effort on the state or the federal level to address all of these closures of rural hospitals, not just in Georgia, but across America?

Olivia Goldhill: One thing is Medicaid expansion. There are a lot of people who think that that will help significantly. And Georgia is kind of hopefully going to be one of the ones to finally enact that.

News Tape 11 Alive: Georgia House Minority Leader Bob Trammell, along with Democratic candidates for the state House, say Medicaid needs to expand in Georgia.

Bob Trammell: And our rural hospitals are more likely to close, because Georgia is a state that hasn't expanded Medicaid, when compared to hospitals, similarly situated hospitals in the 38 states that have expanded Medicaid.

Steve Fennessy: How would that help specifically? What would that do?

Olivia Goldhill: It just means that there are more people who can go and get care and have that covered and that the hospital will get the compensation from the government. Obviously, insurance is more lucrative than Medicaid, but still, it's better to have that than to have no patients. But I think there needs to be a look at kind of what are the hospitals that are absolutely required and need to remain open and then funding or maybe even incentives for whoever manages them to make sure that they do stay around and they're there to support the community.

Steve Fennessy: Olivia, you talked to a number of people while you were down in Randolph and Terrell counties. And one of the people was the mayor of Shellman, which is a small town in Randolph County. What story did he tell you about COVID-19?

Olivia Goldhill: He has lived there his whole life and has had family around him and is rightly really proud of the area and is the mayor there. And like so many, he also lost a loved one to COVID: His sister died in February of this year. Her daughters were with her when she was taken off life support. And as her daughters were driving home from the hospital, they got rear-ended and the car flipped and one was driven to a hospital in Albany and the other taken by helicopter to another hospital. And I think just their experience really highlights how desperate the situation is without a hospital there. And Paul said he knows people who've said they just don't feel safe being somewhere without a hospital. You know, maybe they have had a heart attack in the past or something and people are moving away. And, unless something is done, he expects that to continue to deteriorate. When you go now to the Patterson hospital in Cuthbert there's a sign and it says “Hospital closed, call 911.” But, you know, if you call 911 and the ambulance is out of commission, you've got a three-hour wait. There is a clinic, but it's a clinic that there's no doctor who works there. I mean, there are nurse practitioners. And, you know, there's certain things that they can definitely do. But, you know, there's a lot of health care that you need an M.D., a doctor for, and there's no M.D. that's based in the county working there.

Steve Fennessy: I'm thinking about the confluence of factors that have kind of emerged over the last year in rural Georgia and especially in Randolph and Terrell counties, you have the — this pandemic, which is taking so many people before their time, and you have hospitals that are, you know, closing — partly a function of the pandemic, but mostly a function of factors that predated that. During your reporting, what sense you got from the people who live there, the kind of effect it's having on their psyche, on, you know, on their not just their physical health, but their emotional health?

Olivia Goldhill: I mean, I heard a lot about people just being scared to go out. And because it's a fairly small population, just knowing potentially dozens of people have died is horrendous for anyone. And then you've got the closure of the hospital. And there are some people, kind of, I think, feeling, you know, left behind almost, that way. Should they move away, too? But they don't necessarily have the means to, but they're worried about the lack of employment in the area. Just watching your community fade away, I think, unless something is done, will continue.

Steve Fennessy: It's trauma on multiple levels.

Olivia Goldhill: Yeah. Very, very traumatic, yeah. 

Steve Fennessy: Is there anything to be said about how the vaccination campaign is going down there? Is there acceptance of the vaccine and — and the recognition of its importance in trying to curb this thing?

Olivia Goldhill: The people I spoke to have got their vaccine. Some of them said, “I'm scared of needles, but, of course, I still got my vaccine,” wanted it. Phoebe Putney were planning a mobile unit to come by and offer vaccines. That's a huge factor as well. You know, knowing where to go to get your vaccine, especially now that there is no hospital, it's that practical element that I think is a bigger factor. Everyone I spoke to was pretty happy and excited about it. But of course, that's anecdotal.

Steve Fennessy: My thanks to Olivia Goldhill, an investigative reporter at STAT. As COVID-19 death rates continue to fall, the Biden administration is touting its goal to vaccinate 70% of American adults. CDC Director Dr. Rochelle Walensky recently testified before a Senate hearing about the administration's vaccination program in rural communities.

Rochelle Walensky: Places now have pop-up sites. They have mobile vaccination units. And we're starting to see the effects of this work. We've been really successful in reaching racial and ethnic minorities in ways we hadn't up until this time.

Steve Fennessy: For more Georgia Today, go to GPB.org. I'm Steve Fennessy. Georgia Today is a production of Georgia Public Broadcasting. Subscribe to our show anywhere you get podcasts. Don't forget to leave us a rating and review on Apple. Jess Mador is our producer. Our engineer is Jesse Nighswonger. Thanks for listening. We'll see you next week.

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