--:-- Sean Rameswaram: It's Friday, April 24th, 2020. It's a great day to abstain from injecting disinfectant into your body. I'm Sean Rameswaram. This is your coronavirus update from Today Explained.
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--:-- Sean Rameswaram: The president of the United States suggested Thursday night that it would be interesting to look into injecting disinfectant into humans to combat COVID-19. This prompted the makers of Lysol to issue a statement reminding people that, quote, under no circumstance should our disinfectant products be administered into the human body through injection, ingestion, or any other route.
--:-- Sean Rameswaram: Not sure who needed to hear that, other than the person in charge of the country, but glad it's all been cleared up. The Food and Drug Administration is also issuing guidance that contradicts the president. Remember those anti-malarial drugs Trump was promoting? In a statement today, the FDA strongly cautioned against using hydroxychloroquine or chloroquine to treat COVID-19 outside of a hospital setting or a clinical trial due to risk of heart rhythm problems.
--:-- Sean Rameswaram: One thing everyone seems to agree on is aid for small businesses in the United States. The president signed a $484 billion relief bill that will also help hospitals and provide funding for testing. Missing from the package is aid for state governments, which Democrats were pushing for, Republicans less so.
--:-- Sean Rameswaram: And while we're on the state, some of them are opening back up today. Georgia's really going for it, and we'll talk about Georgia in today's show. But Georgia's not the only one. Beaches have already begun to open back up in Florida. Alaska is lifting restrictions. Oklahoma is reopening parks, and stores are opening up in South Carolina. More states are expected to lift their shelter-in-place orders in the coming weeks.
--:-- Sean Rameswaram: This as the death toll hit 50,000 in the United States today. Interestingly, the president urged caution, at least in the case of Georgia, saying he disagreed strongly with the governor's decision to reopen certain businesses, but the president's messaging on the matter has been inconsistent at best.
--:-- Sean Rameswaram: No matter what state you're in, you can call Today Explained and let us know how you're doing, what's on your mind, whatever. Call our listener voicemail line at 202-688-5944, For email, todayexplained at vox.com or tweet at us. We are at today underscore explained. I'm at Ramis Verum.
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--:-- Sean Rameswaram: Support for Today Explained comes from Saks Fifth Avenue. Fall is here. Might be time to find some nice new pieces you can wear again and again. With Saks Fifth Avenue, it can be a breeze to shop for your personal style. Like maybe a relaxed Prada blazer or Gucci loafers that are great for both work and the weekend.
--:-- Sean Rameswaram: This is very Sean. This is very Sean-coded, Gucci loafers. Saks says Saks makes shopping feel totally customized to you, whether that's from an in-store stylist or a visit to Saks.com, where they can show you just what you want to see. They say they'll even let you know when arrivals from your favorite designers are in or when something you've been eyeing is back in stock.
--:-- Sean Rameswaram: You can find inspiration for your personal style every day at Saks Fifth Avenue. Georgia is reopening today, even as its death toll continues to rise. According to a model from the University of Washington, the state shouldn't be allowing people to get mani-pedis until June 22nd at the earliest. But here we are. It's happening today. And people are scared with good reason.
--:-- Sean Rameswaram: Jillian Weinberger has been talking to someone in Georgia for Today Explained. I had been talking to this woman for a different story. About voting rights, but then coronavirus hit her town. Here in Albany, you're about three people removed from knowing someone. I mean, it becomes real close, really fast.
--:-- Sean Rameswaram: Her name is Lillian Rambo Sneed. And I live in Albany, Georgia. I grew up here. So Albany is pretty rural. It's mostly Black, and a lot of people live below the poverty line. We are a Title I county, meaning every child in the county eats free.
--:-- Sean Rameswaram: Back in mid-March, Lillian and her husband were out of town, and they got a call from a friend of theirs. It's actually a member of their church, where Lillian's husband is a bishop. She called and said her daughter's mother-in-law is in ICU. And another friend of the family, she told us, too, that he was in ICU.
--:-- Sean Rameswaram: Lillian and her husband decided to head home, and they got on the road. My husband's over there sleeping, and I'm driving to One Song for 15 hours. The Promise, awesome song by the late Andre Crouch. I never leave you neither forsake you And all of a sudden I like hold on
--:-- Sean Rameswaram: Okay, based on the people that I knew that were in the hospital, in ICU, I put together a picture of how it happened. There was this big funeral, and the people from the funeral left and went to another funeral. And then they went to a church anniversary and so it spread through three or four churches that way.
--:-- Sean Rameswaram: State officials don't know exactly who started the outbreak in Albany, but the state's first coronavirus casualty was a man who attended that first funeral, a guy who traveled to Albany from Atlanta. He ended up in Albany's hospital while he was in town. Well, he was here in the hospital for about a week. Not tested for the virus.
--:-- Sean Rameswaram: So that person initially might have come in contact with the nurses, the doctors, the janitors, the cafeteria people. When that person left and went back to Atlanta, Atlanta put him back in the hospital. They called back to the hospital here and said he has the virus.
--:-- Sean Rameswaram: Now Albany has one of the highest infection rates in the state and more people have died in Albany than in Atlanta, which is a much bigger city. The minister that did the first funeral has since passed. Three family members and one family have since passed.
--:-- Sean Rameswaram: That one sick guest at one funeral has led to a lot more funerals. Our social media has turned into an obituary column. And so at this point, you know, we've moved to gravesite services. What we traditionally, especially in the South, it's not a very common thing to have a gravesite service.
--:-- Sean Rameswaram: The first funeral we went to during this virus was a judge whose two brothers, his mother and his father are all ministers. That funeral should have been attended by at least three different churches. Along with all the legal judges. And, you know, we're talking about at least a thousand person funeral dwindled down to 10 people and about 30 people standing by their cars to watch it live on Facebook.
--:-- Sean Rameswaram: And we're standing there and I see his mother, tears running down her face, and she inhales grieving and says, my baby. And she's looking around, but there's no one that can come up to her and hug her, grab her hands. So she puts her hands on her husband's shoulder, and he breaks into tears. And they're just there trying to console one another.
--:-- Sean Rameswaram: And, you know, the next funeral I went to was my classmate. She was an activist here in Albany, Doherty County, what they call a real Renaissance woman. We all grew up together and we all went to school together. Our parents were civil rights leaders here in Albany together.
--:-- Sean Rameswaram: There again, at the car, about 20 feet away. And I'm standing there and I look over the graveyard and there's three tents within a 50-yard radius of each other. So you have three services going on at the same time. And you're like, oh, my Lord.
--:-- Sean Rameswaram: And there again, we're only three people removed here in Albany. So you recognize, oh, that's Pastor So-and-so. So that must be so-and-so that just died.
--:-- Sean Rameswaram: Places like Albany, Georgia are especially vulnerable. The uninsured rate in Albany's home county is about double the national average. And Georgia, unfortunately, did not take the expansion for Medicaid. So therefore, you have a disproportionate amount of people that do not have access to adequate health care.
--:-- Sean Rameswaram: That means they don't have a primary care doctor. They don't go to the doctor for any and everything. They've grown accustomed to using emergency rooms if there is a need. And our emergency room of course now is inundated with people that are suffering from the virus.
--:-- Sean Rameswaram: The other thing is people don't have access to medications because they haven't been to a doctor to get that chronic disease under control which could easily be managed. So that's another part that has played with making Albany a hotspot because you have so many people that have underlying conditions, asthma, diabetes, high blood pressure, that are being exposed without the proper insurance, without medical attention.
--:-- Sean Rameswaram: The ICU units are full and they're sending patients to surrounding areas. They had a stockpile of masks, gloves, that kind of thing, and they went through protective gear. Six months supply in one week. We've survived floods of 94, 98, tornadoes, hurricanes. We've never seen anything like it.
--:-- Sean Rameswaram: More in a minute on Today Explained. Support for today's show comes from Adio. What is Adio? Adio is an AI-native customer relationship management system built specifically for the next era of companies.
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--:-- Sean Rameswaram: You can go to attio.com slash todayexplained to get 15% off your first year. That's attio.com slash todayexplained.
--:-- Sean Rameswaram: Jillian, Lillian said the ICU in Albany, Georgia was so packed, patients are being flown to other cities for care. And that's because what, so many people got sick so quickly? That's part of it, but also the health care system in rural America was kind of a mess even before this pandemic began.
--:-- Sean Rameswaram: We have always faced health care disparities in rural America. Jacob Warren is a researcher at Mercer University in Macon, Georgia, not too far from where Lillian lives. And he outlined two major problems with rural health care.
--:-- Sean Rameswaram: One, there's a serious lack of doctors and hospitals. And two, patients either can't or won't use health care. We started with one, the shortage. Over the past 15 years or so, 10% of all rural hospitals have closed. And there are another 20 to 30% that are at risk of closing.
--:-- Sean Rameswaram: There are many, many rural counties that don't have a physician at all. So no providers whatsoever. Right. There are some that have not a single physician. But if counties do have a doctor or two, that's not enough during a pandemic.
--:-- Sean Rameswaram: If you have a county that has one medical provider and no hospital, and you have two cases of COVID, and if that one provider became exposed to that patient and wasn't wearing PPE, then they're going to have to self-quarantine until they can get their test results back, which are slower in rural communities.
--:-- Sean Rameswaram: And then you've effectively wiped out the whole medical system in that county by having one or two providers out. And if a county's lucky enough to have access to a clinic or a hospital?
--:-- Sean Rameswaram: Because rural providers, both physicians and hospitals, operate on such a tight margin, or quite often a negative margin, talking to a lot of my colleagues, they are facing really hard decisions about what they're going to have to do to be able to make payroll.
--:-- Sean Rameswaram: Because of the pandemic, clinics and hospitals have had to cancel non-surgeries like back or knee surgery. And that's a problem for clinics that are already operating at a loss because those are the procedures that bring in money.
--:-- Sean Rameswaram: There's one clinic that has had to send some nurses home, which is ironic, even quite the right word. We're in the middle of this crisis where we need all hands on deck, but they're having to send some competent health care providers home because they just don't have the volume of services to make payroll.
--:-- Sean Rameswaram: And they don't have the resources to stock up on things like PPE. So they're much less likely to have had a stockpile in the first place, and they're not able now to purchase all of this additional equipment that's needed in the context of a reduced income stream.
--:-- Sean Rameswaram: So that's issue number one. Issue number two is the patients. We see problems because we have higher rates of unassurance, higher rates of poverty, lack of reliable transportation.
--:-- Sean Rameswaram: And we know that states that did not expand Medicaid are disproportionately rural. And then even if patients do have access, there are some that just don't feel comfortable seeing a doctor. There's issues of mistrust of the medical community.
--:-- Sean Rameswaram: We have lower levels of healthcare literacy. We have lower levels of general literacy. All of that plays into medical care being a big black box for a lot of people that they don't understand and don't quite trust.
--:-- Sean Rameswaram: We do also, you know, we have to say things the way they are. We do still have issues of racism and discrimination within the healthcare setting. We know that early experiences of discrimination and racism within the healthcare setting make you much less likely to go back and seek care.
--:-- Sean Rameswaram: And in times of crisis, where we're asking individuals to take precautions that they might feel subject them to additional profiling, such as wearing a mask in public, we're really layering on complexity here that makes it hard for marginalized populations to do everything we're asking.
--:-- Sean Rameswaram: So rural patients are less likely to have insurance. Even if they do, they might not want to use it. And if they're not going to the doctor, they're more likely to have chronic diseases. So we have higher rates of diabetes. We have higher rates of hypertension. We have higher rates of general coronary disease.
--:-- Sean Rameswaram: And so they're more susceptible to the negative effects of COVID-19. And then at the same time, even if they don't become infected, they're not able to access the primary care they were able to previously to help them manage their diabetes and hypertension and heart disease.
--:-- Sean Rameswaram: And so a lot of us are very concerned about what this is going to look like in three, four months in terms of regular chronic disease outcomes. Because care has become a vacuum in this interim.
--:-- Sean Rameswaram: Still, Jacob sees potential for change coming out of the pandemic. He thinks it's an opportunity for states to look at expanding access to Medicaid. Whether that's temporary expansion of Medicaid during this crisis, that's one option.
--:-- Sean Rameswaram: And right now, insurance companies are covering virtual doctor's visits, telehealth. Jacob hopes that sticks around. Those are things we've been pushing for in rural health care for a long time, because that will give patients access to it.
--:-- Sean Rameswaram: But in the short term... We're seeing this pandemic play out in rural areas in ways that we're not seeing in other urban areas. It does reinforce this feeling that the health care system is failing them.
--:-- Sean Rameswaram: I'm worried it'll lead to some more disillusionment with the health care system. But at the same time, if we're able to support change out of all of this, it could be an opportunity where they could say, OK, this led to change. So there was something positive that came out of all this.
--:-- Sean Rameswaram: Jillian Weinberger reported this story for today's show. The rest of the team includes Noam Hassenfeld, Bridget McCarthy, Afim Shapiro, Amin Al-Sadi, and Halima Shah. Cecilia Lay is our fact checker. The mysterious Breakmaster Cylinder provides music. He didn't write this one.
--:-- Sean Rameswaram: Liz Nelson is Vox's editorial director of podcasts, and Today Explained is part of the Vox Media Podcast Network. Thank you.
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--:-- Sean Rameswaram: See how you can turn your team into a content machine with Adobe Express, a quick and easy app to create on-brand content. Learn more at adobe.com slash express slash business.
