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‘Death by structural poverty’: US south struggles against Covid-19

Oliver Laughland in Alabama and Mississippi

Lowndes county, Alabama

It was only two years ago that Pamela Rush travelled from Lowndes county, Alabama, to Washington DC to testify in front of a panel of US lawmakers, describing the conditions of crippling poverty and predatory lending in an area still blighted by generations of racial inequality.

“They charged me over $114,000 on a mobile home that’s falling apart,” she said. “I got raw sewage. I don’t have no money, I’m poor.”

And it was only last month that she died of Covid-19.

Her death from the virus, wrote the civil rights and moral movement campaigner the Rev William Barber, was “a death caused by structural poverty”.

The same could be said of many deaths in black belt counties in the deep south, where a combination of poor access to healthcare, failed political leadership and the endurance of segregation and generational racism has contributed to a surge in Covid-19 deaths in recent months.

As the rain pounded her raised front porch, Sandy Oliver, one of Rush’s best friends from high school, took a moment to reflect on those she had lost to Covid-19. Sitting in her rocking chair, she counted them in her head, gazing to the roof where an old ceiling fan whirred gently. “At least 10,” she said. “All within the last month and a half.”

<span class="element-image__caption">The Tuskegee confederate memorial monument stands across from the Lowndes county courthouse in Hayneville, Alabama.</span> <span class="element-image__credit">Photograph: Wes Frazer/Bloomberg/Getty Images</span>
The Tuskegee confederate memorial monument stands across from the Lowndes county courthouse in Hayneville, Alabama. Photograph: Wes Frazer/Bloomberg/Getty Images


Lowndes county, in south central Alabama, is a sparsely populated rural expanse with less than 10,000 residents. Coronavirus has spread like wildfire in the county, making it an epicenter in the state and a national hotspot. One in every 18 residents has been confirmed infected, by far the worst rate in Alabama and one of the highest rates in the US. The county is 72% African American.

Oliver knew many of the 24 people who have died from the virus here. A few days earlier Rush had been commemorated at a nearby socially-distanced funeral.

“I felt terrible because I know it could have been me too,” said Oliver, who recovered from the virus a few weeks earlier. “My heart just goes out for her, and for her two kids.”

For many communities in the deep south, the story of death, loss and suffering at the hands of the virus has been borne of the same entrenched issues.

‘I don’t feel like this is the richest country in the world because we’re struggling’

Decades ago, during the civil rights movement, the county was referred to as “Bloody Lowndes” due to its long history of lynchings, white supremacy and KKK activity. In 1965, voting rights marchers led by Martin Luther King Jr and the late John Lewis crossed the county on the way to Montgomery from Selma.

But 55 years later, and with the final mission of the civil rights movement to tackle economic inequality never resolved, 30% of residents here live in poverty making it one of the poorest counties in the state. There is no hospital in Lowndes, so those like Sandy Oliver and Pamela Rush, sought treatment many miles from home. Census records indicate at least 12% of residents have no form of health insurance.

Sandy Oliver (Left) Ricky Lewis and his wife, Quanita Oliver (Right)

Although the Trump administration has pledged federal aid to hospitals treating uninsured patients for Covid-19, the stigma and fear associated with no formal coverage left some here struggling to seek help.

When Rickey Lewis, Sandy Oliver’s son-in-law, got the virus, causing pneumonia in both his lungs, delirium and fever, he didn’t call an ambulance but drove himself to the hospital. He has no insurance and worried about ambulance bills. He also knew it could take hours for paramedics to arrive. By the time he made it, he said, he couldn’t walk and had to be carried inside.

Lewis spent four days at Vaughan Regional hospital in Selma before being discharged. Although he still had symptoms, he said, he drove himself home to avoid the risk of financial penalty.

“I had the faith I would survive,” Lewis said, now recovered. “I had to.”

But his wife, Quanita Oliver, felt less confident.

“It’s really bad when you have to drag yourself to the hospital if you’re sick,” she said, describing how she cried down the phone to her mother as Lewis’s symptoms got worse. “I don’t feel like this is the richest country [in the world] because we’re actually struggling.”

Montgomery county, Alabama

At Montgomery city hall, Mayor Steven Reed looked out of his boardroom window and considered the news of the day. His office is a few hundred feet from the state capitol building where governor George Wallace, on 6 March 1965, sanctioned the use of force against peaceful marchers in Selma, and where 19 days later Dr King delivered his How Long, Not Long speech after the march was finally completed.

Hours earlier Alabama’s Republican governor, Kay Ivey, had ordered a statewide mask wearing mandate in order to curb the spread of the virus. July marked the deadliest month for Covid-19 in the state as cases skyrocketed, disproportionately killing African American residents who constitute 41% of the 1,580 deaths in the state, but only 26% of the state population; 143 people have been killed by coronavirus in Montgomery county.

“Maybe it will help to de-escalate some of the political rhetoric around wearing a mask and doing other things that are necessary to win the battle in this pandemic,” said Reed, the city’s first Black mayor.

Montgomery found itself at the centre of the mask wearing culture wars in June, after the city council voted down a mask ordinance despite soaring deaths and testimony from hospital doctors urging them to pass legislation. The council, which consists of five white members and four Black members, voted largely on racial lines. Doctors who attended the vote walked out in disgust as the result was announced.

Following a national backlash, at the beginning of July the council eventually took another vote and passed the mandate.

But the council president, Charles Jinright, a conservative who changed his ballot the second time around, was frank about his motivation for doing so, and spoke openly about his own skepticism that mask wearing had an effect on transmission, despite overwhelming scientific evidence to the contrary.

“It was public opinion at that point,” he said of what changed his vote. “You get different stories from the White House, different stories from doctors, and then you see stuff that’s online – there’s so much information out there.”

Jinright, who is white and has sat on the council for over two decades, conceded that the June city council meeting was the first time he had heard of the racially disproportionate death toll in his city. His district is majority white.

Mayor Reed remained diplomatic when he heard of Jinright’s recent realization. “I think people often live in a cocoon of who and what they’re familiar with,” he said. “If you don’t venture out in terms of trying to get more information, it’s very easy to become trapped in the narrative that you find easiest.”

Last week governor Ivey extended the statewide mask wearing ordinance.

Left: Pulmonologist Dr Rachael Faught outside the Greenwood Leflore hospital in Greenwood, Mississippi, on 15 July. Faught is one of the two doctors rotating shifts at the hospital’s Covid-19 unit. Right: A sign dedicated to medical staff remains at the Greenwood Leflore hospital in Greenwood, Mississippi. Photographs by Rory Doyle for the Guardian.

Leflore county, Mississippi

Dr Rachael Faught found it difficult to hide her exhaustion. One of only two ICU doctors at the Greenwood Leflore hospital, which serves many counties in the rural Mississippi delta region, over the past month she has seen a surge of critical cases that have often left the hospital overwhelmed.

She has watched three members of the same family die from the virus. In recent weeks, as the county experienced a second surge in cases following a fresh wave of community spread, the 12 bed Covid-19 unit reached capacity and some patients were transferred out of state.

Patients coming in with severe symptoms are disproportionately black.

She walked up to a wing, converted from a ward into sleeping quarters for doctors and nurses working overtime, and showed her makeshift bedroom, where she naps and sometimes sleeps the night on a hospital bed.

“It’s a rollercoaster of emotion,” Faught said. “There are times when I feel very prepared and motivated to take care of people because I’m the one who’s trained to do this. But at times you can get a little desperate. Especially when we were having a lot of death.”

Leflore county is 75% black and has the third highest Covid-19 death rate in the state with 59 deaths. Despite this, it was only last week that the Mississippi governor, Tate Reeves, ordered residents in the county to wear masks. Cases have been surging in the state in many counties with majority Black populations, and following sustained pressure Reeves eventually issued a statewide mask mandate on Tuesday.

Dr Faught was frustrated with the fact that Mississippi was one of the first states to reopen after going into lockdown too late. The hospital has become more adept at treating Covid patients by establishing routine, and has seen some success with the use of the antiviral drug remdesivir. But, like many rural hospitals in America, it faces financial uncertainty and still goes through waves of PPE shortages, meaning staff are often forced to reuse masks, gowns and face shields.

“This is my hometown,” she said. “And in a lot of ways the care here is personal. I have less than six degrees of separation from everybody that I treat.”

Greenwood, on the banks of the Yazoo River and the largest city in the county, has its own rich history from the civil rights era. In 1962 numerous organizations descended on the town to start voter registration drives. In 1966, in front of a crowd of 3,000 people, Stokely Carmichael coined the phrase “Black Power” during a speech here following his arrest during “The March against Fear” from Memphis to Jackson.

At the city hall, where his grandparents were once denied the right to vote, Tavaris Cross reflected on that history in the context of the pandemic.

“Things have changed but so much has stayed the same.” Cross, an organizer with the Poor People’s Campaign, said. “We still have low salaries, low wages, the worst housing conditions, poor schooling and a healthcare system that needs a lot of work.”

A few feet from the city hall stands a confederate monument erected in 1913. Following Mississippi’s recent decision to remove the confederate battle flag from its state flag, the county voted to take the monument down as well. Cross was heartened by the move, but remained cautious of the long term effects on race relations in the city.

“It’s a double edged sword, because the reality is our white counterparts are the employers in this community. This statue represents their history and their heritage. And it’s not coming down by choice. It’s coming down by force.”

He has worked with Covid survivors in the community, some of whom, like Patrick Ivory, lost their jobs when taking sick leave.

Ivory sat out on his neatly mowed lawn and listed his symptoms from last month. A temperature of 104F and pneumonia on his right lung. “It felt like fire,” he said, describing how his wife Davuchi would place ice on his body only for it to melt instantly.

He spent one night in the ICU after his blood oxygen levels plummeted and then returned home with oxygen support. It took two weeks for his symptoms to subside, but by that time his employers at a local hardware store, Home Front, had terminated his job. He was unable to claim unemployment.

A manager for the store, Richie Fulgham, declined to comment on Ivory’s sacking.

“He did everything right,” said Davuchi. “But after he got sick they didn’t want anything to do with us.”