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Covid-19 making Sherman-like march to the sea

Having laid waste to southwest Georgia, the Covid-19 virus now appears to be making its way east across a swath of rural counties that largely escaped the virus for the first few months of the pandemic.

Like the Union General William Tecumseh Sherman, the Covid-19 forces are marching to the sea.

The bug long ago breached I-75 and began blazing a trail across a cluster of roughly 40 largely rural counties in southeast and east-central Georgia on its way to the coast.

It has, in fact, already reached Brunswick and Glynn County, where the infection rate is up more than 1,300 percent since Memorial Day, according to the latest data from the Georgia Department of Public Health (DPH).  On Memorial Day – May 25th – Glynn County reported 87 confirmed cases of Covid-19; on Tuesday, July 7th, that number was up to 1,231.

As usual, with this kind of data, it’s helpful to map it.  For the purposes of this map, I’ve excluded all counties that didn’t have an infection growth rate of at least 100 percent during the May 25-July 7 period.Ga Counties with 100% Increases

Hence the blank area over virtually all of southwest Georgia on this map.  (The shading on this map is intended to illustrate the extent of the increase in a county’s Covid-19 infections; the darker the shade, the bigger the increase from May 25th to July 7th.)

All the missing counties had May 25-July 7 growth rates of less than 100 percent, most of them dramatically under that level.  While those counties – once arguably the worst Covid-19 hotspot in the world – are still adding cases, the pace of that growth has slowed dramatically.

As one example, Albany and Dougherty County, ground zero for the Southwest Georgia outbreak, reported a total of 1,727 confirmed cases on Memorial Day; since then, it’s added 303 new cases, an increase of 17.5 percent that pushed its total to 2,030.

An hour or so to the southeast, Lowndes County reported 249 confirmed cases on Memorial Day; as of Tuesday, it had added 1,410 new cases, for a total of 1,659 and a growth rate for the May 25-July 7 period of 566.3 percent.  Lowndes County may not depose Dougherty as the Covid-19 king of South Georgia, but it has a fair chance of catching it if the current trends continue.

While the 40 or so east-central and southeast Georgia counties highlighted in the map constitute the biggest area of Covid-19 growth, other important sub-regions are being hit as well.  A number border counties showed significant growth during the May 25-July 7 period, including a cluster of counties anchored by Muscogee County on the Alabama line and another group in Georgia’s northwest corner.  Whitfield County, center of the state’s vital carpet industry, posted a 417 percent increase during the six-week period, and four mountain counties that border North Carolina — Fannin, Towns, Union and Rabun — are reporting significant increases.

 

 

A first dive into Georgia’s June 9 primary results: a Blue tide rises across the state

I’ve been waiting for all the votes from Georgia’s June 9 party primaries to be counted before jumping into the data and trying to figure out what it all means from a TIGC perspective.  As of Monday morning, the Georgia Secretary of State’s website tells me that all 2,627 precincts in all 159 counties have now been reported, even though the results are still listed as “unofficial” and it’s not clear that all the counties’ results have been certified.  I figure that’s close enough to get started.  If something major changes, I’ll update this report later.

Two years ago, the main political story out of the governor’s race was that rural Georgia and the Atlanta exurbs barely hung on and dragged Republican Brian Kemp across the finish line and into the governor’s office.  The 130 largely rural and sparsely populated counties Kemp carried turned out at a slightly higher rate than the 29 largely urban counties won by Democrat Stacey Abrams.

The story out of the 2020 party primaries appears to be that demography is finally having its way with the state.  This year has long been forecast as the year when the state’s politics would finally tip back in the Democrats favor, and it’s looking like those forecasts might well be correct.  A strong blue tide washed over most of the state in the June 9 primaries, basically flipping the fast-growing ‘burbs in the northern metro area and cutting into Republican margins in most rural counties.

For this analysis, I’ve focused primarily on a comparison between this year’s U.S. Senate primaries and the 2014 primaries for the same seat.  That year, longtime incumbent Republican Saxby Chambliss was retiring, and both parties had competitive primaries, especially the Republicans.  Michelle Nunn, daughter of former Senator Sam Nunn, won the Democratic nomination without much difficulty.  The GOP chose David Perdue, a cousin of former Governor Sonny Perdue, after a seven-candidate free-for-all and a run-off with then-U.S. Representative Jack Kingston.  Perdue went on to defeat Nunn and is now running for re-election to a second term.

(I spent some time rummaging around in the presidential primary numbers as well.  The results, not surprisingly, are pretty much the same as I found in the Senate data.  I may do a presidential primary breakout later.)

In that 2014 Senate primary, Republicans cast nearly twice as many votes as Democrats: 605,355 to 328,710.  Two weeks ago, the Senate primary turnout more than doubled its 2014 total – to more than 2.1 million votes – and the Democratic field outpolled Perdue, who was unopposed for nomination to another term, by nearly 200,000 votes: 1,179,198 for the Democrats to 984,274 for Perdue.  Overall the state flipped from about 65%-to-35% Republican in 2014 to nearly 55%-to-45% Democrat this year.

If the topline numbers are eye-catching, some of the subplots are downright jaw-dropping.  Perhaps most startling, the GOP stronghold across the north Atlanta suburbs and exurbs seems to be collapsing.  Cobb and Gwinnett counties were long regarded as critical fortresses in the Republican Party’s grip on power in the state.  Both flipped narrowly for Democrat Hillary Clinton over Republican Donald Trump in the 2016 presidential race, then stuck with Abrams over Kemp in the 2018 governor’s race.

But if those 2016 and 2018 suburban numbers hit hard at GOP HQ, the 2020 results probably felt like a lethal dose of Covid-19 – and it wasn’t just Cobb and Gwinnett.  Cherokee and Forsyth counties, which sit between Cobb and Gwinnett and are fast-growing, affluent exurbs, came in a lot less red this time around.  In the 2014 Senate primaries, both Cherokee and Forsyth delivered more than 10 Republican votes for every Democratic ballot; this year, the margin was just a little over two-to-one.

Overall, those four counties went from being an 80-20 Republican stronghold in 2014 to 56-44 Democratic territory this year, as this table details.

County 2014 Republican Senate Percentage 2014 Democratic Senate Percentage 2020 Republican Senate Percentage 2020 Democratic Senate Percentage Party Shift (R-to-D)
Cherokee 92.2% 7.8% 69.0% 31.0% 23.2%
Cobb 74.7% 25.3% 38.6% 61.4% 36.1%
Forsyth 92.4% 7.6% 66.8% 33.2% 25.6%
Gwinnett 76.8% 23.2% 35.7% 64.3% 41.2%
Totals 80.3% 19.7% 44.1% 55.9% 36.2%

As a whole, the state has shifted 19.3 percentage points in the Democratic Party’s direction since the 2014 Senate primaries.  Not surprisingly, Metro Atlanta has led that shift.  In 2014, TIGC’s 12-county Metro Atlanta region cast 43.7 percent of the state’s votes in the Senate primary and gave the GOP a 58%-to-42% advantage.  This year those same 12 counties accounted for 49.8 percent of the total vote and gave the Democrats a 70%-to-30% advantage.

Forty-two of the state’s 159 counties did tilt toward the GOP in 2020, and those counties delivered 55,669 more Republican ballots than in 2014.  But 116 counties leaned more blue in 2020, and they delivered the Democrats a combined total of 835,332 more votes than in 2014.  Four counties – – Fulton, DeKalb, Gwinnett and Cobb – each provided more additional votes to the Democrats than the other 42 counties combined did for Republicans.

Indeed, mapping the party shift data suggests that Republicans are being driven largely south and east across the state, perhaps into the Okefenokee Swamp (if not the Atlantic Ocean) and possibly across the state line into Florida, as these maps suggest.

The map on the left shows the counties where Democrats grew their share of the Senate primary vote versus the 2014 Senate primary.  The darker the blue, the bigger the shift from Republican to Democrat.  The map on the right shows the same thing for counties that shifted Republican between 2014 and 2020.

The two counties that posted the biggest Democrat-to-Republican shifts over the past six years are Atkinson and Clinch, adjoining counties in deep southeast Georgia.  Both cast more Democratic ballots in the 2014 Senate primaries but have flipped hard Republican since then; Atkinson has shifted 67.4 percentage points to the GOP over the past six years, Clinch, 43.1 points.  Together, however, they contributed fewer than 2,700 votes to the Republican cause.

If Georgia as a whole is now more competitive than it has been in a couple of decades, that’s no longer true of the vast majority of its individual counties.  In 97 counties, at least 70 percent of voters cast their ballots for one party or the other.

Only eight counties were decided within the truly competitive range of 55%-to-45%.  Thomas, Mitchell, Meriwether, Houston, Lowndes, Telfair and Early counties tilted narrowly to the GOP (Early by a single vote, 1,417-to-1,416), while Fayette, long considered safe GOP territory, turned a pale shade of blue.  The largest of these may well become battleground counties in the fall campaigns.

At the extremes, Democrats need not bother venturing into such rural climes as Glascock, Echols, Berrien and Pierce, which, among others, gave more than 90 percent of their ballots to the Republican Party.

As one measure of just how red rural Georgia has become, Dodge and Haralson counties, the homes of the last two Democratic speakers of the Georgia House of Representatives, Terry Coleman and Tom Murphy, both champions of rural causes, gave 86 and 90.2 percent, respectively, of their votes to Republicans this time around.

By the same token, Perdue and other Republicans probably have little to gain by spending time or money in Clayton County (91 percent Democrat) or DeKalb (89.8 percent).  For the uninitiated, Clayton and DeKalb are a good bit bigger than all the high-percentage GOP counties combined.

Bottom line, if there is little obvious good news in these numbers for Georgia Republicans or rural Georgia, they should not be read as the basis for a sure bet that the state will flip this year.

GOP turnout was arguably depressed by the fact that both their Senate and presidential primaries were uncontested, and their voters had less reason to turn out, especially in the midst of a pandemic.  What’s more, Democratic Senate nominee Jon Ossoff will have his work cut out for him.  Prodigious fundraiser that he is, he barely avoided a runoff and will have to consolidate the support of his six Democratic primary opponents.

The one good bet for the fall is that it will be a turnout election.  With a few exceptions, neither Perdue nor Ossoff will have much incentive to spend time or money trying to convert voters in their opponent’s territory.  Instead, they’re likely to put their effort into activating their geographic bases, which is virtually certain to deepen Georgia’s political divide even further.  That, in turn, will only complicate efforts to create a policy construct needed to address the challenges facing rural Georgia.

 

Even a nonpartisan plague gets politicized in 21st century America

It was, of course, inevitable that the Covid-19 pandemic would quickly be viewed through a political lens.  I’m as guilty as anybody.  Pretty early on, I was complaining on Facebook about President Trump’s bungling of the nation’s response to the plague, and here on Trouble in God’s Country I took note of the different strategies pursued by Republican governors here in the bright red old south versus their liberal Democratic counterparts the far west.

On Monday, The New York Times published a report that took the first big look (at least that I’ve seen) at whether the ugly little virus was wreaking more havoc on Democrats or Republicans.  Under the headline “The Coronavirus is Deadliest Where Democrats Live,” the Times reported:

“Democrats are far more likely to live in counties where the virus has ravaged the community, while Republicans are more likely to live in counties that have been relatively unscathed by the illness, though they are paying an economic price. Counties won by President Trump in 2016 have reported just 27 percent of the virus infections and 21 percent of the deaths — even though 45 percent of Americans live in these communities, a New York Times analysis has found.”

I’d been thinking about doing the same sort of piece about Georgia, but was concerned that any such analysis would be flawed by a variety of factors, including limited data and questions about the extent of testing in certain parts of the state, especially rural areas.  I still have those concerns, but if the great gray lady can hold forth on this topic, so can Trouble in God’s Country.

The Times sorted national Covid-19 data by counties that voted for Trump in 2016 versus those that went for Democrat Hillary Clinton.  I used county-level data from Georgia’s 2018 governor’s race and mashed it up with Covid-19 cases and deaths reported by the Georgia Department of Public Health as of early Tuesday morning, May 26.

Georgia’s Democratic counties — the 29 that voted for Stacey Abrams in 2018 — have so far borne the brunt of the virus’s attack, but the picture here isn’t as lopsided as the national breakdown reported by the Times.

The Abrams/Democratic counties are home to 53.2 percent of the state’s population and have so far suffered 55.8 percent of the infections and 57.4 percent of the Covid-19 deaths.  The Abrams counties were for the most part heavily and densely populated urban counties, including the largest counties in Metro Atlanta, along with major out-state counties and a handful of smaller rural counties.

The 129 counties carried by the ultimate winner in that 2018 race, Republican Brian Kemp, claim 46.8 percent of the state’s population and so far have posted 44.2 percent of the Covid-19 cases and 42.6 percent of the deaths.  Governor Kemp’s counties were largely rural counties (as the map here shows). 2018 Unshaded Map

The Times also reports that: “In the country as a whole, outbreaks in conservative rural counties are rising, but not on a scale that would close the gap in the virus’s impact on red and blue counties.”

I’m skeptical that holds here in Georgia.  While Abrams’s Democratic counties have logged more cases and deaths than Kemp’s Republican counties, their overall case rates and Covid-19 death rates aren’t that different.  In Abrams’s counties, 387.8 people per 100,000 have contracted the virus and 18.3 per 100,000 have died; in Kemp’s counties, 346.3 people per 100,000 have tested positive while 15.5 per 100,000 have died.

In addition to having relatively comparable case and death rates, my analysis of an admittedly limited body of DPH data suggests that case rates in rural Georgia are ticking up at least a little faster than in urban areas.  From May 16 through May 26, case rates in the Kemp counties rose 17.6 percent versus 14.5 percent in the Abrams counties.

Two other factors contribute to my suspicion that the gap between the Kemp and Abrams counties might continue to close.  One is that it’s still not clear that sufficient testing is being done in rural counties.  The other is that there’s a growing body of polling and other data to suggest that Republicans, perhaps especially those in rural areas, are taking the virus less seriously than their Democratic counterparts and not doing as good a job of following masking and social-distancing recommendations (here’s one good story on this phenomenon).

Bottom line, while more densely-populated Democratic counties may have represented low-hanging fruit for Covid-19, it’s far from clear that it hasn’t been able to find its way to Georgia’s sparsely-populated rural counties.  If testing becomes more pervasive in rural Georgia and its residents are indeed taking a casual attitude toward the virus, the gap between the Democratic and Republican counties will almost certainly close up.

My hunch is that we’ll eventually realize that the virus itself is the only truly nonpartisan actor in this ongoing tragedy.

___________

Following are lists of the counties carried by Republican Brian Kemp and Democrat Stacey Abrams in the 2018 Georgia governor’s race, along with data on the number of positive Covid-19 cases and deaths as of the morning of May 26, 2020.  To conduct this analysis and show the totals and case rates by the two groups of counties, I had to recalculate the county-specific case rates and then calculate the totals and rates for each group.  For some reason, the case rate results I got were a little different from those published by DPH.  As the denominator, I used the U.S. Census Bureau’s 2019 population estimates.  The equation for calculating the case rates is straightforward: (Positive Cases/2019 Population Estimates) X 100,000.  In the interest of transparency, I’m showing both the DPH Case Rates (as published on its website) and the TIGC Case Rate Calculation.

Kemp Counties:

County Positive Cases Deaths DPH Case Rate 2019 Population Estimates TIGC Case Rate Calculation
Appling 134 13 721.9 18,386 728.8
Atkinson 31 2 372.2 8,165 379.7
Bacon 77 2 675.2 11,164 689.7
Baker 33 2 1059.1 3,038 1086.2
Banks 73 0 365.3 19,234 379.5
Barrow 292 11 338.0 83,240 350.8
Bartow 443 36 399.9 107,738 411.2
Ben Hill 61 1 366.5 16,700 365.3
Berrien 37 0 192.0 19,397 190.8
Bleckley 38 0 296.0 12,873 295.2
Brantley 51 2 265.6 19,109 266.9
Brooks 67 9 426.0 15,457 433.5
Bryan 70 5 178.9 39,627 176.6
Bulloch 52 2 65.4 79,608 65.3
Burke 123 4 550.5 22,383 549.5
Butts 211 21 838.2 24,936 846.2
Camden 55 1 102.0 54,666 100.6
Candler 13 0 120.0 10,803 120.3
Carroll 472 24 392.9 119,992 393.4
Catoosa 105 0 152.7 67,580 155.4
Charlton 29 1 218.9 13,392 216.5
Chattahoochee 25 0 232.6 10,907 229.2
Chattooga 24 2 96.9 24,789 96.8
Cherokee 831 29 311.7 258,773 321.1
Clinch 56 1 841.4 6,618 846.2
Coffee 250 13 580.8 43,273 577.7
Colquitt 349 14 768.8 45,600 765.4
Columbia 224 6 141.2 156,714 142.9
Cook 46 2 263.8 17,270 266.4
Coweta 376 8 247.4 148,509 253.2
Crawford 26 0 212.6 12,404 209.6
Crisp 223 7 1000.5 22,372 996.8
Dade 27 1 167.1 16,116 167.5
Dawson 103 1 381.2 26,108 394.5
Decatur 153 4 581.3 26,404 579.5
Dodge 48 2 235.5 20,605 233.0
Dooly 172 12 1283.6 13,390 1284.5
Early 235 29 2316.2 10,190 2306.2
Echols 62 0 1562.1 4,006 1547.7
Effingham 63 1 98.4 64,296 98.0
Elbert 71 0 374.8 19,194 369.9
Emanuel 27 2 119.1 22,646 119.2
Evans 5 0 46.8 10,654 46.9
Fannin 40 1 152.0 26,188 152.7
Fayette 221 13 188.0 114,421 193.1
Floyd 228 14 228.2 98,498 231.5
Forsyth 480 12 190.1 244,252 196.5
Franklin 39 1 167.2 23,349 167.0
Gilmer 137 0 436.1 31,369 436.7
Glascock 1 0 33.1 2,971 33.7
Glynn 87 1 101.1 85,292 102.0
Gordon 138 15 237.7 57,963 238.1
Grady 93 4 379.0 24,633 377.5
Greene 64 7 341.9 18,324 349.3
Habersham 502 19 1096.1 45,328 1107.5
Hall 2327 41 1127.7 204,441 1138.2
Haralson 36 2 117.2 29,792 120.8
Harris 83 4 239.1 35,236 235.6
Hart 26 0 99.6 26,205 99.2
Heard 28 2 226.4 11,923 234.8
Houston 349 16 222.2 157,863 221.1
Irwin 24 1 254.4 9,416 254.9
Jackson 148 4 198.1 72,977 202.8
Jasper 31 1 218.3 14,219 218.0
Jeff Davis 34 1 224.5 15,115 224.9
Jenkins 18 1 209.9 8,676 207.5
Johnson 81 2 838.4 9,643 840.0
Jones 34 0 118.9 28,735 118.3
Lamar 53 1 273.9 19,077 277.8
Lanier 14 2 135.3 10,423 134.3
Laurens 104 1 219.9 47,546 218.7
Lee 354 22 1181.1 29,992 1180.3
Lincoln 15 0 184.6 7,921 189.4
Long 12 1 60.3 19,559 61.4
Lowndes 250 4 212.1 117,406 212.9
Lumpkin 91 1 269.2 33,610 270.8
Madison 39 1 129.2 29,880 130.5
Marion 49 2 590.9 8,359 586.2
McDuffie 63 5 291.7 21,312 295.6
McIntosh 12 0 82.4 14,378 83.5
Meriwether 78 2 371.1 21,167 368.5
Miller 38 0 659.3 5,718 664.6
Mitchell 399 32 1809.0 21,863 1825.0
Monroe 118 8 425.6 27,578 427.9
Montgomery 10 0 108.4 9,172 109.0
Morgan 37 0 193.3 19,276 191.9
Murray 78 1 193.7 40,096 194.5
Oconee 105 5 251.6 40,280 260.7
Oglethorpe 58 5 380.6 15,259 380.1
Paulding 291 11 168.7 168,667 172.5
Peach 70 3 255.7 27,546 254.1
Pickens 43 3 128.2 32,591 131.9
Pierce 90 3 460.5 19,465 462.4
Pike 50 2 265.1 18,962 263.7
Polk 97 0 223.1 42,613 227.6
Pulaski 39 2 358.0 11,137 350.2
Putnam 88 8 402.1 22,119 397.8
Quitman 11 1 479.5 2,299 478.5
Rabun 15 1 88.3 17,137 87.5
Schley 16 1 303.3 5,257 304.4
Screven 28 2 201.4 13,966 200.5
Seminole 43 2 528.3 8,090 531.5
Spalding 259 17 374.8 66,703 388.3
Stephens 123 2 467.2 25,925 474.4
Tattnall 15 0 59.0 25,286 59.3
Taylor 21 2 263.9 8,020 261.8
Telfair 33 1 210.9 15,860 208.1
Thomas 313 31 704.5 44,451 704.1
Tift 228 15 558.4 40,644 561.0
Toombs 50 4 185.3 26,830 186.4
Towns 22 1 182.8 12,037 182.8
Treutlen 8 0 117.2 6,901 115.9
Troup 260 9 369.2 69,922 371.8
Turner 105 12 1300.2 7,985 1315.0
Twiggs 14 0 173.1 8,120 172.4
Union 39 1 153.9 24,511 159.1
Upson 275 33 1046.5 26,320 1044.8
Walker 96 0 137.9 69,761 137.6
Walton 196 10 204.6 94,593 207.2
Ware 218 14 608.0 35,734 610.1
Washington 73 1 359.6 20,374 358.3
Wayne 17 0 56.7 29,927 56.8
Webster 11 1 431.4 2,607 421.9
Wheeler 9 0 113.8 7,855 114.6
White 94 3 296.0 30,798 305.2
Whitfield 283 7 270.4 104,628 270.5
Wilcox 98 13 1114.9 8,635 1134.9
Wilkes 32 1 319.6 9,777 327.3
Wilkinson 65 4 728.8 8,954 725.9
Worth 210 19 1042.6 20,247 1037.2
         17,137 765     4,948,281 346.3

Abrams Counties:

County Positive Cases Deaths DPH Case Rate 2019 Population Estimates TIGC Case Rate Calculation
Baldwin 330 25 742.8 44,890 735.1
Bibb 435 24 285.9 153,159 284.0
Calhoun 128 5 2026.3 6,189 2068.2
Chatham 448 21 153.3 289,430 154.8
Clarke 232 13 178.8 128,331 180.8
Clay 35 2 1225.9 2,834 1235.0
Clayton 1132 43 371.3 292,256 387.3
Cobb 2795 146 353.5 760,141 367.7
DeKalb 3305 104 416.7 759,297 435.3
Dougherty 1730 140 1924.3 87,956 1966.9
Douglas 504 22 331.8 146,343 344.4
Fulton 4080 199 371.2 1,063,937 383.5
Gwinnett 3198 121 329.3 936,250 341.6
Hancock 191 22 2331.3 8,457 2258.5
Henry 641 19 267.2 234,561 273.3
Jefferson 29 1 189.4 15,362 188.8
Liberty 67 0 108.2 61,435 109.1
Macon 95 6 731.4 12,947 733.8
Muscogee 564 17 294.3 195,769 288.1
Newton 311 10 276.8 111,744 278.3
Randolph 174 19 2576.3 6,778 2567.1
Richmond 534 19 264.0 202,518 263.7
Rockdale 267 9 281.2 90,896 293.7
Stewart 44 0 717.9 6,621 664.6
Sumter 449 41 1527.3 29,524 1520.8
Talbot 35 1 568.4 6,195 565.0
Taliaferro 1 0 61.3 1,537 65.1
Terrell 211 26 2492.0 8,531 2473.3
Warren 18 0 345.5 5,254 342.6
       21,983           1,055     5,669,142 387.8

 

 

 

 

Rural Georgia never recovered from the Great Recession. Now comes COVID-19

There’s a persistent pattern I’ve noticed in various buckets of economic, population, and education data, but I’ve never fully connected the dots or taken a stab at suggesting what it all might mean.  Now seems like a good time to do that.

Rural Georgia — and especially Middle and South Georgia — got the crap kicked out of it by the Great Recession and never has recovered.  Maybe that’s been obvious to everybody else, but it might be useful to look at several data points to get a sense of just how bad the damage has been — especially now that COVID-19 has rolled in and begun raining its own special brand of hell down on the state, and especially southwest Georgia.

I think the first part of the Great Recession picture I noticed was the result of an almost whimsical notion on my part.  I’d made numerous references to “the death of rural Georgia,” but I was thinking metaphorically about local economies and the collapse of various critical parts of community infrastructures, like school systems and hospitals.

Then one day I wondered if some of them might really be, literally, dying.

Turns out that’s an easy enough thing to check.  Thanks to the Georgia Department of Public Health’s excellent, publicly-accessible OASIS database, you can easily download county-level birth and death data for the past 24 years (since 1994) and use it to easily see whether many counties were reporting more deaths than births.

For about the first dozen or so years — from 1994 until 2009 — there wasn’t much news in those numbers.  The number of counties reporting more deaths than births floated up and down between a high of 19 (2002) and a low of eight (2006).

But then, coinciding with the onset of Great Recession, that number began a steady climb.  The year 2007 saw 13 counties report more deaths than births, an average year; in 2008, the number rose to 18,  a significant jump but still within the range seen up until that point.  In 2010, the number of counties reporting more deaths than births ticked up to 20 — not much of an increase, but a new high.  Since then, as this graph shows, the number has climbed steadily and dramatically.

More Deaths than Births Column Graph

As of 2018, 79 of Georgia’s 159 counties reported more deaths than births.  Of those, 78 are outside Metro Atlanta and the vast majority are small rural counties, as the map to the right illustrates.2018 More Deaths Than Births

The only Metro Atlanta county to make this group was Fayette County, long recognized as a redoubt for retirees well beyond child-bearing age.

Of course, suffering more deaths than births is not the only way to lose population, but it can hardly be regarded as a positive trend.  More than 60 counties lost population in the 10-year period from 2009 through 2018.

The second data point I noticed had to do with education — specifically, the number of high school graduates each county was sending to a University System of Georgia (USG) college or university. I’ve written about this before, but I’ve never really spotlighted how the pattern changed with the onset of the Great Recession.

Up until 2011, the 147 counties outside Metro Atlanta sent more freshmen to University System of Georgia institutions than the 12 Metro Atlanta counties, which is probably what you’d expect. But (as this graph shows) the number of freshmen being sent from those counties to USG institutions started to flatten out and decline in 2008 and ’09, and then basically fell off a cliff for the next several years before beginning what looks like a relatively weak recovery.

Metro Atlanta enrollment also took a significant hit, but it recovered faster and finally got back to its high-water mark in 2017 and ’18.  The other 147 counties saw their combined numbers drop through 2014 before showing any improvement, and they are still well below the numbers they posted prior to the Great Recession.

Finally, economics.  Based on various pots of Internal Revenue Service (IRS) and Bureau of Economic Analysis (BEA) data, I’ve reported that Metro Atlanta suffered a bigger initial economic hit but recovered faster and has since widened the gap between itself and the rest of the state.  But perhaps the clearest picture emerged late last year when the BEA, a unit of the Commerce Department, published county-level Gross Domestic Product (GDP) data for the first 18 years of this century.

The pattern is the same, as this graph illustrates.  GD{ Growth Metro Atlanta vs. 147 Counties

The 12 Metro Atlanta counties suffered significant drops in GDP in 2008 and ’09, and it took the region until 2013 to get back to pre-Great Recession levels.  The rest of the state took a softer hit but needed an extra year — until 2014 — to get back to pre-recession highs, and the growth since then has been fairly tepid.

This table shows GDP by region for each of the Trouble in God’s Country regions for selected years ($s in 000s).  Regional GDP ChartThe key takeaways from this are that — since the state began emerging from the recession in about 2013 — my TIGC Middle Georgia and South Georgia regions have lagged badly behind the rest of the state (and Metro Atlanta in particular), struggling to average a growth rate of one percent a year.

I can probably get an argument from actual economists or statisticians about cause-and-effect, but I’ll go out on a limb here and conjecture that the Great Recession set in motion forces that have contributed dramatically to the continued decimation of Georgia’s (and no doubt America’s) rural regions.

Significant areas of rural Georgia were suffering population loss and economic contraction even before COVID-19 hit (and now they’re sending fewer young people to college, let alone getting them back home if and when they graduate).

As perhaps the most dramatic example, Dougherty County lost more than three percent of its population and five percent of its GDP between 2009 and 2018 — and that, obviously, was before the novel coronavirus turned it into the public health equivalent of Chernobyl.

The same, indeed, is true for the entire southwest Georgia region.  Nearly every county in the Albany region has suffered both population losses and GDP contractions in the past decade, and now they have among the worst COVID-19 case rates in the nation and probably on the planet.

That, I think, is the new definition of trouble in God’s country, and it’s difficult to even envision what a recovery strategy and process might look like.  Whatever that strategy and process turns out to be, it will probably take generations to accomplish.

 

 

 

 

 

 

 

Old South-West Coast update

A quick update on the analysis I posted last Saturday comparing the COVID-19 performance of six Republican-led Old South states with the three West Coast states led by Democratic governors:

A week ago, the regional comparison looked like this:

Old South West Coast Summary

Today, based on the latest data available from all nine states’ public health websites, the regional comparison looks like this:

4.10 Old South West Coast Consolidation Update

A week ago, the Old South states already had nearly 6,000 more confirmed cases than the West Coast, but still had fewer deaths.  In the six days since I pulled that first batch of data, the numbers of confirmed cases and deaths have increased at a much more rapid pace in the Old South than on the West Coast, which bore the initial brunt of the COVID-19 onslaught.

Confirmed cases are up 74.4 percent across the Old South states versus 54.4 percent on the West Coast.  But the change in the death counts is even more dramatic.  A week ago, the Old South still trailed the West Coast in that category, but since then COVID-19 deaths across the south have shot up by 121.4 percent versus 80.8 percent in the west; as a result, the Old South now has significantly more deaths than the West Coast.

As I acknowledged in last week’s report, there are several obvious differences between the two regions and their various states.  The Old South is both less healthy and more religious than the West Coast; it is plagued by comorbidities that constitute the kind of underlying medical conditions that make people more vulnerable to the virus, and its residents have been slower to give up the kind of large religious gatherings that are now recognized as breeding grounds for COVID-19.

Another obvious difference, though, has been in the public policy approach to tackling the virus.  The Democratic governors on the West Coast acted earlier and more decisively than their Republican Old South counterparts to shut down their states, as I detailed in last week’s post.

The current state-by-state results look like this:

4.10 All states Update

Georgia now has the highest COVID-19 infection and mortality rate of any of the Old South states, and is second only to Washington, whose Seattle outbreak was one of the nation’s first epicenters, among the nine states.  Georgia’s poor numbers are driven in significant measure by the degree to which the virus has ravaged nearly a dozen counties in deep southwest Georgia.

I hope to flesh out the Georgia situation in another post over the weekend.

 

 

A tale of two regions: the Old South and the West Coast tackle COVID-19

It’s probably a little early for this kind of analysis, but our nation’s every-state-for-itself approach to dealing with the COVID-19 pandemic is already generating some interesting contrasts between different states and even regions of the country.

I’ve been following the differences between Georgia and North Carolina, neighboring southeastern states with nearly identical populations but very different COVID-19 results.  North Carolina continues to have substantially fewer confirmed cases, hospitalizations and deaths — despite performing a great many more tests than Georgia. The principal difference between the two states appears to be political: North Carolina’s Democratic governor, Roy Cooper, acted earlier and more decisively to begin closing down his state than his Republican counterpart, Brian Kemp, here in Georgia.

Today I decided to expand that analysis and look at two regions of the country: the West Coast (made up of California, Oregon and Washington) and the Old South (comprised in this analysis of Alabama, Florida, Georgia, Mississippi, South Carolina and Tennessee).  As it happens, these two regions also have very comparable populations: 52.0 million in the Old South versus 51.4 million on the West Coast.

This comparison also gives us the same political split.  The West Coast is famously deep blue; all three states have liberal Democratic governors.  The Old South is bright red and governed by proudly right-wing politicians.

So how are they doing?  Let’s look first at the regional numbers.

Old South West Coast Summary

The state-by-state numbers look like this:

Old South West Coast State by State Detail

The West Coast, which suffered the country’s first COVID-19 blows as the virus moved in from China, has actually (as of the numbers available this morning on state websites today) recorded 43 more deaths than the Old South — but significantly fewer confirmed cases.  The Old South may have recorded 8.6 percent fewer deaths than the West Coast, but it’s posted 22.6 percent more infections.

Perhaps more telling are the COVID-19 infection and mortality rates, which I’ve calculated using a standard formula: [(Confirmed Cases or Deaths/Population)*100,000].

This is, of course, a complex situation, with a great many variables at work.  The Old South starts at a disadvantage to its West Coast counterparts because it is both less healthy and more religious.  The higher percentages of comorbidities such as obesity, diabetes and heart disease constitute the kinds of “underlying medical conditions” that make people more vulnerable to COVID-19, and places of worship are among the mass gatherings that are now recognized as natural breeding grounds for the bug.  (I’ll try to flesh out these points in a later post, but you can find good rankings on health and religiosity here and here.)

That said, it seems increasingly difficult to argue that politics and public policy choices aren’t playing a significant role in how different parts of the country fare in the face of the COVID-19 pandemic.

The West Coast governors acted well ahead of their Old South counterparts to begin shutting down their states.  Indeed, probably the first major American politician to take such action was San Francisco Mayor London Breed; she imposed a shelter-in-place order on March 13 and was joined by other Northern California officials three days later.  California Governor Gavin Newsom followed suit on March 19.  Washington Governor Jay Inslee, who was confronted with the nation’s first major outbreak in Seattle, banned major gatherings in heavily-populated counties on March 11, and then imposed a full shelter-in-place order on March 23.  Governor Kate Brown of Oregon came on board the next day.

Meanwhile, the Old South governors lagged well behind their West Coast counterparts and to a great extent deferred to local officials (only, once they did act, to upend many of the local actions).  Mississippi Governor Tate Reeves initially said he had no plans to issue a statewide order but did take to Facebook Live to conduct a prayer session on March 22.  Today, his state has among the nation’s highest COVID-19 infection, hospitalization and mortality rates.

Ditto Alabama.  There, as the West Coast governors were shutting down their states, Governor Kaye Ivey announced on March 24 she had no plans to issue a statewide order.  “We’re not California, we’re not New York, we aren’t even Louisiana,” she said.

Today, her state’s COVID-19 infection and mortality rates are worse than California’s.  Both she and Reeves threw in the towel late last week and issued statewide shelter-in-place orders.  As did the governors of Florida, Georgia and Tennessee.  At this point, South Carolina is the only Old South hold-out.

Notably, the reluctant and belated actions by the southern governors have sowed widespread confusion.  Here in Georgia, Governor Brian Kemp justified his turnaround decision to issue a shelter-in-place order with the dubious claim that he had only learned the day before that asymptomatic COVID-19 victims could spread the virus — even though public health officials had been saying as much since February.

That explanation earned him national media scorn (“Georgia Gov. Shows Just How Far Behind The World He Is On Coronavirus,” blared a HuffPost headline), but his shelter-in-place order may have done him at least as much local political damage.  One presumably unintended consequence of his order was that — by superseding local ordinances — it reopened Georgia’s Atlantic beaches, including Tybee Island, Jekyll Island and St. Simons.

According to a story in today’s Atlanta Journal-Constitution, a Republican member of the Glynn County Commission, Peter Murphy, reacted thusly: “We had carefully considered ways to keep people safe here and the governor’s order has undermined everything we were doing.”  Murphy, a retired physician, had led the push to close down the local beaches.

Up the road at Tybee Island, an obviously peeved Mayor Shirley Sessions issued a statement that opened on a decidedly undiplomatic note: “As the Pentagon ordered 100,000 body bags to store the corpses of Americans killed by the Coronavirus, Governor Brian Kemp dictated that Georgia beaches must reopen, and declared any decision-makers who refused to follow these orders would face prison and/or fines.”

Mayor Sessions went on to say bluntly that she and the Tybee Island City Council “do not support” Kemp’s decision and to make clear that — while the beaches themselves might be open — the town-controlled access points and parking lots would remain closed.  “At no time,” she said, “has the state designated a single point of contact to orchestrate the implementation of the Governor’s plan.”

In Florida, Governor Ron DeSantis fared little better when he finally issued a stay-at-home order on Wednesday.  Hours after signing that first order, The Tampa Bay Times reported that he “quietly signed another one that appeared to override restrictions put in place by local governments to halt the spread of coronavirus.  However, DeSantis on Thursday said the amendment he signed does the reverse, instigating another round of confusion over the intent of his directives.”

Is all this definitive?  Probably not.  Again, it’s arguably a little early for this kind of analysis.  But the data that’s already in is a little hard to ignore.

Watch this space.

Georgia to ramp up Covid-19 testing, release non-violent inmates in response to pandemic

Tuesday produced a couple of major developments in Georgia’s battle with Covid-19.

First was an announcement from Governor Brian Kemp that the state is about to ramp its Covid-19 testing capability up to about 3,000 per day.  This is obviously good news.  Georgia has lagged nearly all its neighboring states in Covid-19 testing, and it hasn’t been clear where in Georgia the testing has — and has not — been taking place.

As of today’s mid-day report from the Georgia Department of Public Health, Covid-19 has been found in 139 of the state’s 159 counties, and the remaining 20 are all rural counties scattered across the state.  Within a few days, maybe a week, the expanded testing should tell us a great deal more about how deeply the virus has penetrated the state’s sparsely populated rural counties.

Governor Kemp and others have pointed hopefully to the lack of positive tests in rural counties and used that data as a rationale for not taking more aggressive action to limit large group gatherings or order business closings across the state.  But public health experts fear that posture may only have given the virus time to get a quiet foothold in the state’s rural regions.

The Georgia Recorder is up today with an excellent story about this danger, including an interview with Dr. Isaac Chun-Hai Fung, associate professor of epidemiology at the Jiann-Ping Hsu College of Public Health at Georgia Southern University in Statesboro.  From the story:

“If we have an outbreak, our risk is actually higher than Atlanta,” he said. “The risk of us not having adequate health care and, therefore, the old people dying, is higher than Atlanta. We have a lower risk of getting infected because we don’t have as many cases in our neighborhood, but unfortunately, having an outbreak … our rural hospital very soon would be overwhelmed, and people who do not have intensive care units or do not have ventilators to keep them breathing, they will die. And Atlanta is too far away for us. Even Savannah is an hour away.”

__________

The second major announcement, also reported by the AJC, came from the State Board of Pardons and Paroles.  As part of its response to the Coronavirus epidemic, it’s decided to release up to 200 inmates who are serving time for non-violent offenses.

The state’s 30-plus prisons, as well as jails in virtually every county, were identified early on as potential breeding grounds for the virus, and, as the AJC reported, one inmate at the Lee State Prison, in Lee County just north of Albany, has already died of Covid-19.

Last week, Bartow County Sheriff Clark Millsap announced he was releasing 90 inmates from his county jail because of the virus, according to The Daily Tribune News, the local newspaper.

Left unanswered in the AJC story and the Daily Tribune story was the question of whether the inmates would be tested for the virus before they were freed from jail and sent back into the community.

__________

Finally, a quick update of Georgia’s Covid-19 performance compared to its neighboring states:

March 31 REgional Summary

As was the case yesterday, the key takeaways are that Georgia leads the region in Covid-19 deaths and hospitalizations even as it lags in testing.  With just under 18 percent of the six-state region’s population, Georgia has recorded 43 percent of the Covid-19 deaths even though it’s conducted only 11.9 percent of the total tests.  Even with the smallest set of test numbers, its Covid-19 infection and mortality rates are the highest in the region.

The original version of this table, published late yesterday afternoon, proved to be fairly popular.  Typically, even a major Trouble in God’s Country post won’t draw more than a few hundred visitors, if that.  Yesterday’s post attracted more than 500 visitors last night and another then 1,200-plus from more than 30 countries today.  I’ll try to keep updating it at least periodically. 

 

 

 

 

Covid-19 seems to be hitting Georgia harder than its neighboring states

Over the weekend I published a post comparing Georgia’s Covid-19 performance with North Carolina’s and wondering out loud why the differences are so dramatic.  Today I’ve cast a wider net and put together this table comparing Georgia with its neighboring states.

March 30 SE Covid Table

Clearly, Georgia — at least so far — is being harder hit than its five contiguous neighbors.  Only Tennessee has a slightly higher Covid-19 infection rate, and Georgia leads the region in both Covid-19 deaths and hospitalizations; even Florida, with twice Georgia’s population, trails Georgia in both those categories.

The question is why?  There are obviously a great many variables at work in this situation, but at this point there’s enough data in the pot to warrant a little head-scratching.  Even if these southern states are using different protocols to determine who gets tested, we’re left with the fact that Georgia is outpacing its neighbors so dramatically in deaths and hospitalizations.

I’ve got lines out to several contacts in the public health world and hope to gather some informed answers to these questions over the next day or so.

[A note about the data above: The population numbers are 2019 Census Bureau estimates.  The raw Covid-19 data came from each state’s respective public health website as of about mid-day today.  The infection and mortality rates were calculated by dividing the number of positives or the number of deaths by the population and multiplying the result by 100,000.]

____________

Another interesting chunk of Covid-19 data comes from the Institute of Health Metrics and Evaluation (IHME) at the University of Washington.  It’s now out with state-by-state projections of how the now infamous Coronavirus curve — or wave — is likely to move across each state and its healthcare system.  IHME has developed a computer model that stirs together data on available healthcare resources with testing and mortality rates to date.

The projections for Georgia are grim.  IHME’s model predicts that Georgia will hit its “peak resource use” on April 22, when it calculates that the state will be short 755 ICU beds and 1,075 ventilators.  It also projects our “deaths per day” will peak the following day, April 23, at 84, and that the state will suffer a total of 2,777 deaths by August 4, 2020.

These projections are generally in line with the performance numbers posted above.  North Carolina is projected to hit its peak resource demand on the same day, April 22, but will only be short 278 beds and 676 ventilators; its “deaths per day” are projected to peak at 56, and total deaths by August 4 are forecast at 1,721.

__________

Meanwhile, the Economic Innovation Group, whose work I’ve cited on a number of occasions, is out with a new report focusing on the challenges Covid-19 poses for the country’s most “distressed communities,” many of which are rural.  Indeed, the new EIG report echoes and puts meat on the bones of an argument I started making nearly two weeks ago — namely, that Covid-19 represented a “perfect storm” for rural Georgia.

EIG annually assigns “Distressed Community Index” scores to all 3,000-plus counties in the nation, as well as all cities with populations of 50,000 or more.  It does this using a formula based on seven socioeconomic factors; a few years back, it named Albany one of the 10 most distressed mid-sized cities in the country.

This new EIG report offers four key takeaways:

  1. The uninsured rate for residents of distressed counties is much higher than those living elsewhere.
  2. Residents of distressed counties are more likely to be elderly and susceptible to complications resulting from coronavirus infection.
  3. Life-threatening health disorders are more prevalent and more dangerous in distressed areas.
  4. Life expectancy is already significantly shorter in economically distressed places.

After fleshing out each of those points, EIG then turns its attention to the state of healthcare systems in distressed communities.  It reports that it had analyzed more than a decade’s worth of American Hospital Association (AHA) data and found that distressed communities had seen a 16 percent reduction in the number of hospital beds between 2006 and 2017.  This report doesn’t offer a state- or county-level breakdown, but rural Georgia has almost certainly suffered that level of loss of beds over the past decade or so.

 

 

 

TIGC Covid-19 March 28 Round-Up

Random Questions and Observations on Covid-19:

  • Why are the results from Georgia and North Carolina so different?  The two states have nearly identical populations — 10.6 million for Georgia versus 10.5 million for North Carolina, according to 2019 Census Bureau estimates — but have very different Covid-19 results so far.  I’ve been watching this for a while, thinking the numbers might even out.  They haven’t.  As of today’s morning report from both states’ public health agencies, North Carolina has tested more than 50 percent more people than Georgia but found less than half as many “positives” as Georgia, and with only a fraction of the hospitalizations and deaths, as this table shows. Ga NC ComparisonThe question is why.  There are obviously a lot of variables at play, but the two states probably have a lot more in common than not.  Based on news reports I’ve read, North Carolina Governor Roy Cooper, a Democrat, seems to have acted earlier than his Georgia counterpart, Republican Brian Kemp — but not that much earlier.  We’re probably going to have to wait for the smoke to clear to develop a truly useful analysis of this, but these differences are worth keeping an eye on.  It’d be interesting to see the AJC and the Charlotte Observer collaborate on a tick-tock plotting state and maybe major local actions across a timeline.
  • Like Sherman, Covid-19 continues its march through Georgia.  As of today’s late-morning report from the Georgia Department of Public Health, Covid-19 has now been found in 108 of Georgia’s 159 counties.  March 28 Counties with Confirmed CasesAs this map shows, the areas that have so far avoided reporting positive tests are almost entirely rural, including a swath of sparsely populated counties through east-central and southeast Georgia and another group of counties in west Georgia that somehow haven’t yet been pulled into the orbit of the Albany hot spot.  While the bulk of the positive tests and deaths are in Metro Atlanta, the rate of infection and Covid-19 deaths is much higher in South Georgia, as the table below shows.  Indeed, if you focus on Dougherty County and its six contiguous counties, the Covid-19 infection rate and death rate are, respectively, 6.7 times and 20 times that of TIGC’s Metro Atlanta region.MARCH 28 Regional Summary
  • Using smartphones to gauge mobility in the face of Covid-19.  One of the more interesting chunks of data to surface in the Covid-19 pandemic has come from a company called Unacast.  Unacast uses location tracking data from smartphones to track how far users travel each day and aggregates that data to see what that can tell us about whether people are following the guidance of their state and local leaders and limiting their local travel.  The data seems to lag by a few days and it’s still early, but it’s still interesting.  As of today’s report, four of the five best-behaving counties in Georgia are in Metro Atlanta — Forsyth, Dawson, Cherokee and Fulton counties.  The other top-five county was Clay County, which ranked second and had slashed its “average distance traveled” by 39 percent.  Clay County sits hard on the Alabama line in southwest Georgia, on the edge of the Albany blast zone, but has yet to report a single positive Covid-19 test.  You have to wonder if everybody in that county hasn’t gone inside and shut all their doors and windows.  You can find the Unacast data here.  Scroll down until you find the U.S. map, then click on Georgia and, when that map comes up, click on your county and wait for the data to come up.  It’s a little slow and clunky, but still useful.
  • Covid-19’s economic toll may be tougher on rural Georgia than Metro Atlanta.  The great recession hit Metro Atlantans harder than their rural Georgians.  That reality showed up first in IRS data and in total personal income data from the Bureau of Economic Analysis (BEA) and later in a BEA report on county-level gross domestic product.  As Covid-19 began to spread, I found myself thinking it might be tougher on rural Georgia.  If the Great Recession hit Metro Atlanta harder, it recovered faster and has since widened its economic, education and health gap with rural Georgia; rural Georgia has generally lost population and seen its local economies contract, which, I figured, left it in a weakened position to deal with a global pandemic.  Now comes Politico with a really good piece fleshing out my general concerns.  It’s worth reading.
  • While the Covid-19 data is still developing day-by-day, there are already some interesting oddities and riddles that are worth noting and wondering about:
    • College towns.  One early theory was that college towns would be hard hit, given their population of young people who still think they’re invincible.  Well, yes and no.  Clarke County, home of the University of Georgia, had 35 cases as of mid-day Saturday, just over half of the 67 reported by Carroll County, home of West Georgia College.  Those weren’t all that surprising.  The bigger riddles were Baldwin County (home of Georgia College and State University) with only two cases and Bulloch County (Georgia Southern) with a big goose-egg so far.  I haven’t found data on the number of tests given in each county, but both Baldwin and Bulloch are large enough that you’d have to think they’d conducted a fair number of tests.
    • Bartow County.  Other than Albany, Bartow County, just of I-75 north of Metro Atlanta, has emerged as the state’s second-hottest hot spot.  As of Saturday, Bartow County, with a population of about 106,000, had reported 116 cases, the sixth-most in the state, and its infection rate was second only to Dougherty County.  I am, I believe, reliably informed that the outbreak traced back to a large community gathering in Cartersville, but I haven’t found any published reporting on it and am going to hold off on the details for the time being.
    • Taliaferro County.  This tiny, impoverished county of about 1,700 people might be considered a prime target for Covid-19.  It’s located about a hundred miles east of Atlanta on I-20 and a far piece from any major healthcare facilities.  As it’s worked out so far, it’s one of only two counties on that route between Atlanta and Augusta that still hasn’t reported a positive Covid-19 test (neighboring Warren County is the other).  One likely reason is a paucity of testing in the county, but another could be an early decision by the local school superintendent, Allen Fort.  As Jim Galloway reported nearly two weeks ago, Fort didn’t wait for guidance from Governor Kemp or anybody else; he acted on his own and sent all his students home.  In doing so, he may have flattened the curve in his little county.

Stay tuned.  I’ll follow up with more early next week.

New Kaiser Health News data adds political dimension to Covid-19 crisis

[Note: The third data column in the table about a half-dozen paragraphs down was mislabeled when this was initially posted.  It has now been corrected thanks to a good catch by alert reader Denese Whitney.  Trouble in God’s Country appreciates the help.]

Last Thursday I posted a piece suggesting that Covid-19 might constitute a perfect storm for rural Georgia — that old age and poor health status could combine with a frail healthcare delivery system to put rural areas in particular jeopardy.  Since then a couple of reports have come out that support that view and bring certain healthcare and political realities into sharp focus.

First was a report Saturday from Kaiser Health News (KHN) that documented the number of ICU beds available in virtually every U.S. county and compared those numbers with the population of people 60 and older in each of those counties.  That’s not a perfect measure of an older person’s access to critical care, of course; just because there’s not an ICU bed in your home county doesn’t mean there’s not one in the next county or a nearby city.  But it’s not a bad measure of the magnitude of the healthcare challenge taking shape.

The second was a report in today’s Washington Post.  Philip Bump, one of the nation’s top data journalists, took the KHN data and laid it over county-level data from the 2016 presidential election between Donald Trump and Hillary Clinton.

“Comparing the county-level data from Kaiser Health News to 2016 presidential election data,” Bump wrote,  “we discovered a remarkable bit of data: About 8.3 million people who voted for Trump in 2016 live in counties where there are no ICU beds or no hospitals. That amounts to about 13 percent of the total votes Trump earned in that election, or one out of every eight votes.

“Those counties are also home to about 3.8 million people who voted for Hillary Clinton, a figure which makes up only about 5 percent of her total. Most of the counties voted for Trump by wide margins; he won them by an average of 41 points. He won 10 times as many counties with no ICU beds as did Clinton.”

This afternoon I’ve pulled Kaiser’s Georgia data and combined it with data from Georgia’s 2018 gubernatorial election and today’s Georgia Department of Public Health report on the number of people in the state who have tested positive for Covid-19.  (As of mid-day today, that number was up to 600 people from 59 counties; 38 of the “positives” were from “unknown” counties.)

Overall, the situation here in Georgia is a microcosm of the national picture Bump found — and if the primary goal in this situation is to try to meet the healthcare needs of the entire state, state politics, as always, hovers not very far in the background and imposes a set of difficult strictures on the process.

In the 2018 gubernatorial election, Brian Kemp, the Republican nominee who ultimately won and is now governor, largely swept rural Georgia, carrying 130 counties.  Of those, 83 don’t have a single ICU bed (indeed, most don’t even have hospitals).  Combined, those counties have a population of 1.7 million, more than 380,000 of whom (22 percent) are over 60.  So far, only 47 of the state’s 600 confirmed Covid-19 cases hail from those counties, but it seems likely those numbers will rise as testing becomes more available in rural areas.

In contrast, the Democratic nominee, Stacey Abrams, dominated the state’s urban areas, which has a much younger population and much more robust healthcare delivery systems.  Twelve of the 29 counties she carried were indeed rural (including a half-dozen southwest Georgia counties that are now in the orbit of the Covid-19 hotspot erupting in and around Albany) and also boast no ICU beds of their own.  But the overwhelming majority of her support came from urban and suburban areas that are home to large healthcare systems with a good number of ICU beds.

This table illustrates the contrast.

Kemp Abrams ICU Bed Table

The 130 counties Kemp carried are home to right at 52 percent of the state’s 60-plus population but have fewer than a third of the state’s ICU beds.

To use Philip Bump’s Washington Post framework, more than a half-million Georgians who voted for Kemp — about 25 percent of his total — reside in counties without a single ICU bed.  That’s true of only about 10 percent of Abrams’s voters.

Again, rural Georgians who fall victim to Covid-19 may well be able to get access to an ICU bed in Metro Atlanta or another major city if they need it, but the current pandemic does seem to put a sharp new focus on a problem that has bedeviled the state’s Republicans since they took power at the turn of the century — how to provide healthcare to rural areas that constitute their political base.

For a decade now, the state’s GOP leaders have steadfastly refused to take advantage of billions of dollars in Medicaid Expansion funds and presided over a steady stream of rural hospital failures.

I’ll try to do more with this over the next couple of days.  For now, here’s a complete list of Georgia counties with all the data discussed in this post.

County # !CU Beds # Covid-19 Cases Confirmed by DPH 3/22/20 Brian Kemp’s % of 2018 General Election Vote Stacey Abrams’s % of the 2018 General Election Vote Population Aged 60+ Percent Population Aged 60+
Appling 3 0 79.7% 19.9% 4208 22.8%
Atkinson 0 0 74.4% 25.2% 1451 17.5%
Bacon 4 0 86.7% 12.7% 2329 20.6%
Baker 0 0 58.2% 41.4% 919 28.3%
Baldwin 12 2 49.5% 49.8% 9287 20.4%
Banks 0 0 89.8% 9.4% 4207 22.9%
Barrow 6 1 73.6% 25.2% 12454 16.6%
Bartow 21 57 76.1% 22.8% 18389 17.9%
Ben Hill 5 0 63.9% 35.6% 3982 23.1%
Berrien 0 0 85.0% 14.4% 4266 22.4%
Bibb 117 1 38.4% 61.0% 31993 20.8%
Bleckley 0 0 78.6% 20.5% 2860 22.4%
Brantley 0 0 91.3% 8.1% 3792 20.6%
Brooks 0 0 61.5% 38.1% 4099 26.2%
Bryan 0 0 70.1% 28.8% 4985 14.3%
Bulloch 24 0 62.8% 36.3% 11463 15.5%
Burke 0 0 50.6% 48.9% 4540 20.0%
Butts 0 1 71.7% 27.7% 4813 20.4%
Calhoun 0 0 42.7% 57.1% 1362 20.9%
Camden 5 0 65.3% 33.6% 8503 16.3%
Candler 6 0 72.4% 27.2% 2476 22.7%
Carroll 18 14 69.8% 29.1% 20423 17.8%
Catoosa 0 0 79.5% 19.3% 14752 22.4%
Charlton 0 1 75.1% 24.4% 2473 19.1%
Chatham 78 4 40.0% 58.9% 56014 19.6%
Chattahoochee 0 0 54.5% 44.7% 645 5.8%
Chattooga 0 1 79.9% 19.4% 5705 22.9%
Cherokee 15 18 72.1% 26.3% 42210 17.9%
Clarke 104 9 28.6% 70.3% 17345 14.0%
Clay 0 0 45.3% 54.0% 937 31.0%
Clayton 34 13 11.8% 87.8% 36959 13.5%
Clinch 0 0 76.1% 23.6% 1466 21.6%
Cobb 119 61 44.6% 54.0% 120689 16.3%
Coffee 10 0 70.7% 28.8% 7860 18.3%
Colquitt 10 0 75.9% 23.5% 8918 19.4%
Columbia 0 3 66.5% 32.5% 26092 18.2%
Cook 0 0 70.9% 28.7% 3527 20.5%
Coweta 19 8 69.7% 29.1% 25269 18.3%
Crawford 0 0 72.9% 26.4% 2798 22.6%
Crisp 16 0 63.0% 36.6% 5331 23.2%
Dade 0 0 82.5% 16.2% 4079 25.1%
Dawson 0 1 85.9% 13.1% 6208 26.5%
Decatur 10 0 60.2% 39.4% 5831 21.6%
DeKalb 168 45 15.7% 83.4% 121505 16.5%
Dodge 6 0 73.9% 25.7% 4726 22.4%
Dooly 0 0 52.7% 47.0% 3522 25.1%
Dougherty 50 48 29.8% 69.8% 18997 20.8%
Douglas 8 4 39.4% 59.8% 22028 15.7%
Early 0 2 55.2% 44.5% 2739 26.3%
Echols 0 0 88.2% 11.0% 681 17.0%
Effingham 0 2 76.9% 22.0% 9061 15.9%
Elbert 4 0 70.0% 29.5% 5092 26.4%
Emanuel 8 0 70.0% 29.5% 4782 21.3%
Evans 0 0 69.4% 30.2% 2260 21.0%
Fannin 5 0 83.0% 16.1% 8800 35.9%
Fayette 37 9 56.0% 42.7% 25277 22.9%
Floyd 65 9 71.1% 27.8% 20941 21.7%
Forsyth 24 4 70.6% 28.0% 33215 15.7%
Franklin 8 0 86.5% 12.7% 5691 25.5%
Fulton 538 108 26.8% 72.2% 159840 15.8%
Gilmer 0 0 83.7% 15.3% 9166 31.0%
Glascock 0 0 91.4% 8.2% 713 23.6%
Glynn 24 3 63.6% 35.6% 20679 24.8%
Gordon 8 4 81.9% 17.1% 10941 19.4%
Grady 4 0 67.3% 32.3% 5593 22.3%
Greene 0 0 65.1% 34.4% 6034 36.1%
Gwinnett 82 27 42.3% 56.5% 122430 13.8%
Habersham 4 0 83.5% 15.6% 10665 24.3%
Hall 85 9 73.4% 25.5% 36793 19.1%
Hancock 0 0 24.7% 75.0% 2435 28.1%
Haralson 0 0 87.7% 11.5% 6357 22.1%
Harris 0 0 74.0% 25.2% 7948 23.9%
Hart 0 0 76.6% 22.6% 7015 27.5%
Heard 0 1 83.2% 16.1% 2692 23.2%
Henry 40 7 42.0% 57.3% 34127 15.7%
Houston 36 1 57.9% 41.1% 25522 17.0%
Irwin 0 0 75.8% 23.9% 2170 23.4%
Jackson 0 0 81.6% 17.4% 12724 19.9%
Jasper 0 0 74.5% 24.9% 3116 22.7%
Jeff Davis 4 0 82.6% 16.9% 3219 21.5%
Jefferson 0 0 47.0% 52.6% 3828 24.0%
Jenkins 0 0 64.7% 35.0% 2049 22.9%
Johnson 0 0 72.5% 27.2% 2334 23.8%
Jones 0 0 67.8% 31.6% 6333 22.2%
Lamar 0 3 69.4% 29.9% 3955 21.6%
Lanier 0 0 71.3% 28.4% 1972 19.0%
Laurens 16 2 65.9% 33.6% 10610 22.4%
Lee 0 16 74.7% 24.8% 4964 17.0%
Liberty 0 0 36.2% 63.1% 7447 12.0%
Lincoln 0 1 69.4% 29.9% 2318 29.8%
Long 0 0 64.7% 34.4% 2398 13.4%
Lowndes 48 8 57.7% 41.6% 17921 15.7%
Lumpkin 0 1 79.2% 19.3% 7478 23.7%
Macon 0 0 36.9% 62.9% 2925 21.4%
Madison 0 0 78.5% 20.7% 6721 23.5%
Marion 0 0 63.9% 35.3% 2190 25.6%
McDuffie 0 0 60.5% 39.0% 4855 22.6%
McIntosh 0 0 59.5% 40.0% 4475 31.8%
Meriwether 0 0 58.9% 40.4% 5261 24.9%
Miller 0 1 77.9% 21.6% 1561 26.5%
Mitchell 0 0 56.2% 43.5% 4919 21.8%
Monroe 0 1 71.9% 27.2% 6594 24.6%
Montgomery 0 0 76.1% 23.3% 1891 21.1%
Morgan 0 0 71.2% 28.0% 4678 26.0%
Murray 0 0 85.8% 13.4% 7520 19.1%
Muscogee 61 2 38.6% 60.7% 34483 17.4%
Newton 10 4 45.1% 54.3% 18455 17.6%
Oconee 0 1 69.8% 29.0% 7602 21.1%
Oglethorpe 0 0 70.5% 28.4% 3441 23.5%
Paulding 8 4 66.6% 32.5% 21365 14.0%
Peach 0 3 52.2% 47.3% 5201 19.2%
Pickens 6 2 84.8% 14.2% 8464 27.9%
Pierce 0 0 88.9% 10.7% 4228 22.1%
Pike 0 0 85.7% 13.6% 3658 20.4%
Polk 0 4 79.1% 20.1% 8705 21.0%
Pulaski 6 0 69.8% 29.8% 2806 24.6%
Putnam 0 0 71.9% 27.5% 6275 29.3%
Quitman 0 0 55.5% 43.6% 913 42.7%
Rabun 0 0 80.0% 18.8% 5564 34.0%
Randolph 0 1 45.1% 54.4% 2258 31.3%
Richmond 264 10 31.5% 67.7% 38152 18.9%
Rockdale 16 2 32.0% 67.4% 17124 19.4%
Schley 0 0 81.0% 18.3% 1100 21.3%
Screven 0 0 60.4% 39.4% 3450 24.6%
Seminole 0 0 66.7% 32.8% 2541 29.7%
Spalding 22 2 61.2% 37.9% 14777 23.0%
Stephens 6 0 80.7% 18.6% 6327 24.7%
Stewart 0 0 41.8% 58.0% 1209 20.7%
Sumter 10 2 48.8% 50.7% 6539 21.3%
Talbot 0 0 39.5% 59.8% 2045 31.8%
Taliaferro 0 0 38.1% 61.6% 511 27.7%
Tattnall 0 0 76.3% 23.1% 4769 18.8%
Taylor 0 0 62.9% 36.5% 2020 24.4%
Telfair 0 0 66.8% 32.8% 3802 23.3%
Terrell 0 2 45.7% 53.9% 2148 23.9%
Thomas 35 0 61.2% 38.3% 10319 23.0%
Tift 20 2 69.7% 29.7% 8091 20.0%
Toombs 8 0 74.8% 24.8% 5815 21.4%
Towns 0 0 81.7% 17.4% 4566 40.9%
Treutlen 0 0 68.9% 30.8% 1666 24.7%
Troup 20 4 60.9% 38.4% 13380 19.3%
Turner 0 1 63.0% 36.6% 2004 24.9%
Twiggs 0 1 52.7% 46.8% 2395 28.8%
Union 5 0 83.4% 15.6% 8856 39.8%
Upson 28 0 66.8% 32.6% 6294 24.0%
Walker 0 0 81.0% 17.9% 16583 24.2%
Walton 7 0 76.9% 22.4% 17821 20.1%
Ware 22 0 71.7% 27.8% 7974 22.3%
Warren 0 0 46.6% 53.1% 1586 29.3%
Washington 0 0 50.6% 49.1% 4483 21.9%
Wayne 12 0 80.2% 19.1% 6149 20.6%
Webster 0 0 59.9% 40.0% 671 25.5%
Wheeler 0 0 71.1% 28.7% 1550 19.5%
White 0 0 84.5% 14.4% 7553 26.5%
Whitfield 34 2 72.3% 26.8% 18625 17.9%
Wilcox 0 0 73.3% 26.5% 1960 22.0%
Wilkes 0 0 59.0% 40.4% 2863 28.9%
Wilkinson 0 0 55.6% 44.0% 2285 25.0%
Worth 0 2 75.4% 24.1% 5131 24.7%
Totals 2508 562     1,863,154 18.3%