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Posts from the ‘Covid-19’ Category

New medical study confirms what TIGC has been saying for a year now. You’re welcome.

The American Journal of Preventive Medicine (AJPM) earlier this week published a new statistical study which basically found that American states led by Democratic governors have fared better through the worst of the pandemic than those governed by Republicans.

Opined the authors: “Gubernatorial party affiliation may drive policy decisions that impact COVID-19 infections and deaths across the U.S. Future policy decisions should be guided by public health considerations rather than political ideology.”

Gee, you think?

Actually, I’m glad to see this kind of big academic study. As eye-glazing as it can be in places, it reinforces a lot of the observations I’ve made here at Trouble in God’s Country since Covid-19 rolled in a year ago. Early on, I started noticing differences between between Georgia, where Republican Governor Brian Kemp was famously loathe to impose restrictions because of the pandemic, and North Carolina, where Democratic Governor Roy Cooper acted pretty quickly and decisively to begin closing down his state.

The two states have a lot in common, including demographics, economics, educational levels, and population size. Pretty much from the get-go, North Carolina was performing more Covid-19 tests and reporting more confirmed cases but fewer deaths.

Based on the latest data available from the CDC’s COVID Data Tracker, North Carolina has since significantly out-performed Georgia. As of Thursday, March 11, Georgia, with a population of 10.6 million, had more than a million confirmed and probable cases and 18,117 Covid-19 deaths; North Carolina, whose population is only slightly smaller at 10.4 million, has recorded 879,825 such cases and 11,622 deaths.

A week or so after that first Georgia-North Carolina comparison last March, I posted a new piece that broadened the focus and compared a half-dozen Old South states led by proudly conservative Republicans (Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee) to three deep blue West Coast states led by liberal Democratic governors (California, Oregon and Washington).

The two regions had very comparable populations — 51.4 million for the three West Coast states versus 51.9 million for the six Old South states. But the regions’ governors were taking very different approaches in fighting the virus. The governors on the West Coast, which bore the brunt of the virus’s initial attack, took early, dramatic actions to shut down their states and limit the virus’s spread, while the Old South’s GOP governors were openly resisting most public health-driven actions.

At the time of that initial report — not even a month into the pandemic — the West Coast had suffered 543 deaths versus 500 for the Old South, but the Old South was already piling up more cases: more than 24,000 versus just over 18,500 for the West Coast.

I pulled fresh numbers from the CDC’s Covid-19 Data Tracking website on Friday, and the Old South’s performance now looks much worse in comparison to the West Coast (where, again, the virus initially turned Seattle into the public health equivalent of Chernobyl and has continued to savage the California coast) than it did last April. The Old South states have racked up 25,000 more deaths than the West Coast and a million more confirmed and probable cases, as this table details:

The AJPM study found that the Republican-led states had lower case and death rates for the first several months of the pandemic, but that those trend lines crossed — on June 3, 2020, for case rates and a month later, on July 4, for death rates.

That’s generally in line with another TIGC observation. I tracked county-level case and death rates on an almost daily basis for the first several months of the pandemic by the political party each county sided with in the 2018 Georgia gubernatorial election. Early on, the virus did most of its damage in urban areas that were heavily populated and largely Democratic, such as Metro Atlanta; the virus was indeed slow to show up in sparsely-populated rural areas of Georgia that largely sided with Governor Kemp and other Republicans.

But it did get there — and, just as the authors of the AJPM study found, the trend lines eventually crossed. By my calculations, the death rate in counties that went for Democratic gubernatorial nominee Stacey Abrams had been higher — that is, worse — from the opening days of the pandemic through most of August; they crossed on August 25, 2020. The case rate trend lines were a little slower to intersect, but finally crossed on September 9.

11-3-covid-data-table.jpg (328×125)

I took another look at this phenomenon following last year’s presidential election and found the same pattern, as this table to the right shows. By election day, President Donald J. Trump’s Georgia counties had significantly worse case rates, death rates and 14-day case rates than his then-Democratic challenger, Joe Biden.

The authors of the AJPM study were careful to avoid asserting causality in the statistical relationship between the governors’ party affiliation and their states’ Covid-19 results. And, indeed, there are a variety of factors other than politics that probably contribute to different outcomes. In an early piece speculating that rural Georgia might eventually be harder hit than the state’s urban areas, I cited the facts that rural Georgians were generally in poorer health than their city cousins and had access to much frailer health care delivery systems. At that point, the political differences were just beginning to come into focus.

But, statistical limitations aside, it now seems silly to ignore the obvious political relationships and implications. It’s often said that the 50 states function as laboratories for American democracy. For a year now, that’s clearly been the case where America’s response to Covid-19 is concerned. But it’s a shame we all wound up being used as human guinea pigs.

(c) Copyright Trouble in God’s Country 2021

Long-time friend and long-ago colleague Terry L. Wells contributed to this article. He first spotted and posted to Facebook an article about the AJPM study, without which I probably would have missed the whole thing.

Your TIGC weekend Covid-19 update: Things are bad and getting worse

Last weekend TIGC reported that 70 Georgia counties qualified as Covid-19 “red zones” and that the bug appeared to be mounting a new assault on Metro Atlanta from its fortifications in the North Georgia mountains.

Today we can report that the number of counties whose seven-day rates exceed 100 cases per 100,000 people — the “red zone” threshold set by the White House Coronovirus Task Force — is up to 96, and all 12 Metro Atlanta counties are now included in that group.

This is, obviously, part of a national trend. The AJC reported this morning that Georgia is one of 48 states that qualify as red zones. But, as usual, virus’s attacks are far from uniform, and it seems to move from one region to another in an almost deliberate manner. These two maps show its progression out of the North Georgia hills over the past week.

At the same time, the virus seems to be giving much of rural Middle and South Georgia a bit of a breather. This doesn’t mean that the virus has gone away, just that — for the moment — the seven-day case rate has fallen below the 100 cases per 100,000 people level.

But that could change, and quickly. As the bug has re-invaded Metro Atlanta, it also seems to be knifing its way back down I-75 and could easily branch off into the rural counties to the east or west.

At the moment, Whitfield and Murray counties, side-by-side neighbors on the Tennessee line, jointly constitute the hottest spot in the state. Combined, their seven-day case rate is 511.27 per 100,000 people — more than five times what it takes to qualify as a Covid-19 “red zone” — and their combined seven-day death rate is 7.59 per 100,000. The state average for the past seven days was 1.56 deaths per 100,000. The state’s three largest counties — Fulton, Gwinnett and DeKalb — had seven-day death rates of .45 per 100,000 people, .72, and .76, respectively.

The cause of the Whitfield-Murray outbreak isn’t clear. The Daily Citizen-News, the newspaper in the Whitfield county seat of Dalton, has covered the outbreak — including stories on the reluctance of local officials to impose a mask mandate — and editorialized about it. But a limited scan of its online stories (before the paywall came up) failed to find anything about what might be driving the outbreak.

In an editorial published today (November 21), the Daily Citizen-News noted Whitfield’s unhappy standing at the top of the new case-rate list and lamented the lack of citizen observance of recommended public health practices.

” … (M)any of us ignore the advice of the U.S. Centers for Disease Control and Prevention as we refuse to wear masks and/or practice social distancing. The lack of masks and social distancing is evident all over town. We have to do better,” the newspaper added.

(c) Trouble in God’s Country 2020

Trump counties taking the hardest Covid-19 hit; 14-day case rates nearly 30% higher

I noted back in September (here and here) that Covid-19 case and death rates in Georgia’s Republican-voting rural counties had squeaked past those in the state’s more heavily-populated Democratic counties.

I’ve been keeping an eye on that trend, but haven’t bothered to write much about it since then. Last week’s presidential election results, however, seem to invite a fresh look.

As a little more preface, it seems worth noting that the virus did the vast majority of its early damage in major urban areas, including Metro Atlanta, while rural areas seemed skeptical it would ever find its way to them. It did, of course, and has been exacting its heaviest toll on most of those rural areas for a couple of months now.

For this update, I’ve pulled the Georgia Department of Public Health’s (DPH) Covid-19 status report for election day, November 3rd, and sorted it by counties that went (according to the latest election results published by the Secretary of State’s office) for President Trump versus those that went for the Democratic nominee and apparent president-elect, Joe Biden.

This table summarizes that data sort.

As of November 3, the 30 Biden counties had better overall case rates, death rates and 14-day case rates than the 129 Trump counties. Even with a significantly smaller population, the Trump counties have now suffered more total deaths than the Biden counties — 4,017 to 3,814. Perhaps even more worrying are the 14-day case rates, which are a leading indicator of things to come. In the combined Trump counties, that rate was, as of November 3rd, 27.6 percent worse than the Biden counties.

Because the virus is oblivious to county lines, it’s difficult to demonstrate county-to-county correlations between Covid-19 rates and Trump-Biden voting splits.

And, indeed, there are any number of examples of counties whose Covid-19 performance doesn’t match its politics. Glascock County, for instance, gave Trump 89.6 percent of its total vote (second only to Brantley County) but has the fourth-best case rate in the state. (At the same time, and consistent with the 14-day case rate pattern referenced above, Glascock’s 14-day case rate is just under 300 cases per 100,000 people, easily enough to put it in the White House Coronovirus Task Force’s red zone.)

Just to the west of Glascock, though, Hancock County delivered nearly 72 percent of its vote to Biden but, as of November 3rd, had far and away the state’s worst death rate (549.25 per every 100,000 people) and one of the worst case rates.

If, however, clear county-level correlations are difficult to find, mapping the data does bring regional pictures into some focus. First, this map (at right) shows Trump-Biden split as of the general election results available Sunday, November 8th, on the Georgia Secretary of State’s website. (These results appear to be nearly complete, but haven’t been officially certified yet.)

Now compare that general election map with maps below of election-day Covid-19 data from DPH. In these maps, I’ve used the same red/blue color scheme I used in the political map, but here they tell different stories. In each case, counties shown in blue had Covid-19 case rates, death rates, or 14-day case rates that were better (lower) than the state average reflected in the November 3rd DPH data; counties in red had worse (higher) rates. The darker the shade of blue or red, the better or worse they were compared to the state average.

None of the Covid-19 maps is a perfect match for the political map above, obviously, but a comparison does tell several stories. Probably the most obvious is that heavily-Democratic Metro Atlanta is now beating the state average on all three Covid-19 metrics mapped above. Early on, it bore the brunt of the virus’s attack, and still isn’t out of the woods, but now has easily the best overall case rate, death rate and 14-day case rate numbers in the state.

A second is that the swath of heavily-Republican counties in east-central and interior southeast Georgia is now suffering higher than average Covid-19 case and death rates, with more of a mixed picture on 14-day case rates. The virus took its time getting to this part of Georgia, but has now been raging there for several weeks.

Southwest Georgia, though, seems to be cooling off. This politically-mixed region of the state still carries high case and death rates, the results of an early Covid-19 attack that at one time gave this part of the state some of the worst virus numbers on the planet. But it’s 14-day case rates — reflecting current trends — are now among the lowest in the state.

The northwestern corner of the state, meanwhile, seems to be on fire, as the map to the left illustrates. Perhaps the most conservative and Republican region of the state, Northwest Georgia had for the most part avoided the worst of the virus, until recently. As of election day, 18 contiguous counties in that part of the state had 14-day case rates of 200 per 100,000 people or more.

Does any of this demonstrate a cause-and-effect relationship between local political inclinations and the impact of Covid-19? It’s probably a little early to draw that conclusion, although the question certainly seems a fair one to raise.

Early on, it was possible to foresee (even without considering politics) that rural areas might well suffer more from the virus than their city cousins, primarily because they were home to older, less healthy populations that had less access to healthcare and whose healthcare systems were often frail and sometimes non-existent. (TIGC said as much in this post back in March.)

But the virus has clearly become one of the most heavily politicized issues in America in the months since the pandemic rolled in. President Trump has openly feuded with his public health experts and for the most part refused to wear a mask or encourage Americans to do so, while former Vice President Biden and state and local Democratic leaders have taken the opposite tack. (Trump, of course, contracted the virus, but recovered after several days at Walter Reed National Military Medical Center, and a significant number of his close aides have also come down with the bug.)

It’s also worth noting that Georgia is part of a national trend. The Daily Yonder, which covers rural issues, has documented Covid-19’s spread across rural America (see maps below) as well as the political overlap.

“Counties that voted by a landslide (more than a 20-point margin) for Trump in 2016 have a recent infection rate 75% higher than counties that voted by a landslide for Democrat Hillary Clinton in 2016,” The Yonder reported in this piece last week.

It remains to be seen whether a President Biden can prevail upon rural citizens and their leaders to follow conventional public health counsel on practices like wearing masks and social distancing, let alone how long that might take to have an effect. But it’s clear now that changes will be required to bring the virus to heel in the state’s — and nation’s — rural areas.

(c) Trouble in God’s Country 2020

Tiny Taliaferro County leads the state in fighting the virus

Taliaferro County hardly ever ranks anywhere close to the top of any list of Georgia’s 159 counties. A small, poverty-stricken patch of dirt that straddles I-20 a couple of counties east of Augusta, it’s home to about 1,600 people and not much else.

The Georgia Department of Community Affairs (DCA) puts its economy in 144th place in its latest Job Tax Credit Rankings. In its health rankings for Georgia counties, the Robert Wood Johnson Foundation lists Taliaferro 123rd for health outcomes and 137th for health factors.

For the moment, though, Taliaferro County is arguably outperforming all 158 other Georgia counties in one important category: holding Covid-19 at bay.

As of today’s Covid-19 report from the Georgia Department of Public Health (DPH), it’s the only county in the state that still hasn’t suffered a death at the hands of the virus, which has claimed more than 6,000 lives statewide. Taliaferro also has the third-best confirmed case rate in the state.

This is, frankly, something of a very pleasant surprise. The AJC’s Jim Galloway meandered out to Taliaferro County six months ago and did a nice piece on a nervy, bleeding-edge decision by the local school superintendent, Allen Fort, to shut down all the county’s schools and send his students home for what he said would be a long haul.

At the time, the bug was just getting started. As Galloway noted in his column, fewer than 75 cases had been reported in Fulton, DeKalb and Cobb counties — combined. Neither Georgia state government nor the White House had offered any clear guidance, let alone told folks to hunker down and shelter in place.

Fort told Galloway he took his cue from a couple of major economic decisions. The NCAA had announced the day before that it was cancelling its 2020 Final Four, which was to have been held about 100 miles west in Atlanta, and that morning, Augusta National, 50 or so miles to the east, postponed the 2020 Master’s Tournament.

If the virus was dangerous enough to prompt the NCAA and the Master’s to step back from hundreds of millions of dollars in revenue, Fort thought, maybe his little school system ought to take it seriously too.

Still, it was far from clear that Fort’s strategy would work. The county is one of the poorest in the state and almost bereft of healthcare services. Its first, last and only line of defense against the virus was a small community health clinic that operated only a few days a week.

Further, while Taliaferro is located pretty much dead center in the middle of nowhere, it nonetheless straddles I-20 and therefore might have been a sitting duck for the virus. In his column, Galloway wrote that he had wished the clinic staff well, but he seemed worried. ” … it’s not likely to be a fair fight,” he wrote.

Maybe not, but so far Taliaferro is holding its own.

In addition to the fact that it hasn’t given up any deaths, the county has so far had only 22 of the nearly 300,000 in-state Covid-19 cases recorded so far.

With a population of a little over 1,600, its case rate today was 1,348 per 100,000 people. That was the third lowest case rate in the state, behind only Long County (1,260 cases per 100,000) and Glascock (1,289). The state case rate today was 2,749 cases per 100,000 people, more than double Taliaferro’s.

It’s also worth noting that Taliaferro is doing better than all five of its contiguous neighbors — Wilkes, Oglethorpe, Greene, Hancock and Warren counties. Combined, those five counties had reported 1,651 confirmed cases and had a combined case rate of 2,878 per 100,000 as of today’s report. They had also suffered a collective total of 87 deaths.

The Covid-19 pandemic is, of course, far from over, and Taliaferro County’s fortunes could easily change. If the infection does find its way into the little county, it could wreak havoc before anybody realized it was there.

Hopefully that won’t happen, and, for the moment at least, it seems worth taking a minute to recognize a gutsy decision that almost certainly saved some lives.

With Covid-19, size matters: Death rate in 99 smallest counties is double that of four largest

In my last couple of TIGC posts, I’ve reported that Covid-19 case and death rates are now higher in counties that sided with Governor Brian Kemp, a Republican, over his Democratic opponent, Stacey Abrams in Georgia’s 2018 gubernatorial election.

That resulted in a handful of unkind comments from readers who apparently felt it was impolite to apply such a political lens to Covid-19 data, so I decided to take an entirely apolitical swing at the numbers.

If anything, the results are even more striking. Where coping with Covid-19 is concerned, size does seem to matter: the bigger the better.

For this analysis, I’ve divided the state’s 159 counties into six population groupings — more than a half-million people (four counties); between 200,000 and 500,000 (seven counties); between 100,000 and 200,000 (14); between 60,000 and 100,000 (14); between 30,000 and 60,000 (21), and less than 30,000 (99). Then I pulled today’s county-specific Covid-19 data from the Georgia Department of Public Health (DPH) website and sorted it into the appropriate buckets.

The truth is, I’ve probably put an unnecessarily fine point on the population groupings. There’s not a great deal of difference in the results for the three largest groups of counties — in other words, counties with populations of 100,000 or more.

As the popuation groupings get smaller, though, significant differences do emerge. Taking the worst beating, collectively, are the 99 counties with populations of fewer than 30,000 people. That group of counties had the highest Covid-19 case rates and far and away the highest Covid-19 death rates, as this table shows.

The big takeaway from this is that the 99 smallest counties have a combined Covid-19 death rate that is more than double that of the four largest counties — 102 deaths per 100,000 people in the under-30,000 counties versus 47.6 deaths per 100,000 in the four largest counties.

Indeed, as the population grouping gets smaller, the death rate gets higher — and the same generally holds true for case rates as well.

I should probably emphasize that this analysis is based on a single day’s data — today’s — and that there can be some day-to-day fluctuations. I haven’t had time to string together a long-term day-over-day analysis, but I’ve done enough spot-checking of recent data to say that today’s data isn’t a fluke or an anomaly, it’s part of a trend.

More later.

A quick dive into local Covid-19 data underlying AJC report on Georgia’s worst-in-nation performance

This morning’s AJC led with a blockbuster story based on an apparently confidential White House report that gave Georgia the dubious honor of generating the biggest increase in new Covid-19 cases in the nation last week.

According to the AJC, the White House report said Georgia produced about 216 new cases for every 100,000 people for the week that ended this past Friday, August 14th. The paper quoted the report as saying that figure was “about double” the national average.

What the story didn’t include (probably because it wasn’t detailed in the White House report) was any kind of breakdown on how the bug is affecting different parts of the state.

Not to worry. Trouble in God’s Country is here to help.

First, a quick caveat. As I’ve noted before, my arithmetic produces slightly different results than those found in the Georgia Department of Public Health’s daily Covid-19 updates. There are a couple of reasons for this. One is that I usually work only with in-state numbers, those attributable to specific counties, and omit cases DPH classifies as out-of-state or unknown.

The bigger reason, though, is that we’re using slightly different population numbers to calculate the case rates, which is a little weird. I pull my county population numbers from DPH’s public OASIS database, and I know those numbers are taken directly from the Census Bureau. I don’t know exactly where DPH’s Covid-related population data comes from, but it’s slightly different from the ones I’ve got.

Still, the numbers are, as the old saying goes, close enough for both government work and semi-retired, part-time bloggers.

In this case, my arithmetic puts the state’s case rate for the week of August 7 through August 14 at 205.2 per 100,000 people (versus the 216 figure cited in the AJC article). The total number of new in-state cases added during that period was 21,791.

Working with those numbers, we can begin to offer some observations about how different types and areas of the state are behaving now that we’re nearly six months into the pandemic.

Indeed, the factoid included in the AJC story that Georgia’s state-level increase of a little over 200 cases per 100,000 people is about double the national average is helpful: it gives us a point of reference for judging county-level and regional Covid-19 behavior not just within the state, but against the nation. It’s not a pretty picture.

Some 146 of Georgia’s 159 counties posted case rates of more than 100 — roughly the national average, based on the AJC’s reporting — for the August 7-August 14 period. But there’s a wide span within that group.

For that week, Appling County, located in deep southeast Georgia and home to fewer than 20,000 people, posted the most horrific numbers: a one-week case rate of 728.8. But it was hardly alone in that region. Indeed, one of the things the Covid-19 data suggests is that the bug acts and moves on what appears to be a regional basis.

This map below highlights 37 Georgia counties that posted case rates of at least 300 per 100,000 people from August 7 through August 14. As usual, the darker the color, the higher the increase in case rates.

Twenty-four of those counties make up an inter-connected chain of counties that now runs well over 200 miles from Lincoln County on the north end south to Clinch County on the Florida line.

Most of the rest of the counties posting exceptionally high case-rate increases — three times the national average — are scattered loosely around the state, although there do appear to be multi-county clusters in the southwest corner of the state and in northwest Georgia.

Clearly, rural areas of the state that were spared major infection rates in the early stages of the pandemic are now under siege.

Also apparent from this map (and the data) is that Metro Atlanta and the southwest Georgia cluster surrounding Albany and Dougherty County, both of which were savaged early in the pandemic, are so far avoiding the worst levels of increases now afflicting rural areas across east-central and southeast Georgia.

The table below lists all the counties that suffered case rate increases of at least 300 per 100,000 people from August 7 through August 14. The sort is by the case-rate increase, from highest to lowest.

Fifteen of these counties posted one-week case rate increases of 400 or more — in other words, roughly four times the national average, based on the AJC reporting.

I’ll try to loop back and flesh out a more complete regional analysis in the next couple of days.

Covid-19 now hitting rural Georgia harder than urban areas; east-central counties seeing biggest case-rate increases

Over the weekend, Dr. Deborah Birx, the White House Coronavirus Task Force coordinator, told CNN the Covid-19 plague’s assault on rural areas is now on a par with its toll on more densely-populated urban areas.

That’s certainly true here in Georgia. In fact, case rates are currently growing faster in rural counties than in major metropolitan centers, and rural areas by and large now have higher case rates.

To put this in perspective, Georgia is now one of 21 states accorded the dubious honor of being a Covid-19 “red zone” by Dr. Birx’s White House task force. That group recently began assigning that designation to states that meet one of two criteria — first, that the number of cases per 100,000 people rises by 100 or more over a seven-day period, or, second, that the “positivity rate” is higher than 10 percent.

Georgia makes the cut on both counts. Its cases and case rates have been rising relentlessly pretty much since the pandemic started, and its positivity rate has been floating above 10 percent for several weeks. Tuesday’s report (August 4th) from the Georgia Department of Public Health (DPH) puts the cumulative positivity rate at 11 percent and the rate for the batch of tests reported yesterday at 12.7 percent.

As of Tuesday’s report, 141 of the state’s 159 counties qualified as red zones in their own right, as the map to the left is intended to show. Each of the shaded counties posted increases of at least 100 cases per 100,000 people over the past seven days; the darker the shade, the bigger the increase. (The blank spots on the map represent the 18 counties that held their case rate increases under the 100-per-100,000-people threshold over the past seven days.)

One key story for Trouble in God’s Country is that Covid-19 is continuing to move tsunami-like across rural east-central Georgia. TIGC first reported in early July that the bug seemed to have finished savaging southwest Georgia and appeared to be moving, Sherman-like, eastward to the sea. The latest results make it clear that march is still underway.

While 141 of Georgia’s 159 counties posted increases of at least 100 per 100,000 people between July 28 and August 4, only 29 of those counties hit what might be considered stratospheric increases of 300 new cases per 100,000 in that same period.

As map below shows, 15 of those 29 counties are part of a connected chain covering much of east-central Georgia, an area that largely seeemed to escape the bug in its earlier phases. It runs more than 150 miles from Richmond County at its northern end to Atkinson County at the southernmost point.

And the case rates in most of the counties in that chain now dwarf those in Metro Atlanta. Such counties as Jeff Davis, Jefferson, Wayne, Toombs and Johnson, among others, have case rates of well over 2,000 per 100,000 people. The county with the highest case rate in Metro Atlanta, Gwinnett, has a current case rate of 1,874.18. (On the map, the number shown beneath each county’s name is the number of cases per 100,000 people that each county’s case rate increased between July 28 and August 4.)

Indeed, generally speaking, the smaller a county’s population, the bigger its recent increase in Covid-19 cases. As the table below shows, the 118 counties with populations of less than 50,000 people posted bigger increases in case rates than any of the other groups of counties with larger populations.

Interestingly, it was the groups of mid-sized groups of counties — 16 counties with populations between 50,000 and 100,000 — that posted the smallest increases (although those increases still qualified them for “red zone” status). There is no doubt a variety of reasons for this, but a couple of possibilities suggest themselves. One is that the group includes counties — like Dougherty and Floyd, among others — that suffered most of their damage in the early days of the pandemic, and their recent increases are relatively smaller. A second may be that many of these counties — Barrow, Walton, Jackson, Coweta and others — are in various stages of evolving from rural to exurban or suburban counties and have reached a stage where they can attract and sustain stronger healthcare delivery systems.