Some Southern states, including Georgia and South Carolina, are among the first in the country to ease restrictions to try get back to business despite factors that make the South particularly vulnerable to the coronavirus pandemic.
And pressure is mounting on other Southern governors to get their economies back up and running. Outside the Alabama Capitol this week, a few dozen protesters drove by honking their horns, chanting "freedom" and demanding to get back to work
Republican Gov. Kay Ivey has issued a stay-at-home order through April 30. Paralegal Melissa Kirby from Athens, Ala., says she has had enough.
"If she was worried about safety, she could let the people who are actually in danger self-quarantine, wash their hands more," Kirby says. "But to force businesses to shut down, that's not her call."
From inside the Capitol, Ivey says that no one wants to open the economy more than she does, but that the state must first increase its testing capacity.
"Remember all of our decisions that I'm going to make are based on data, not desired date," Ivey says.
She is taking a more cautious approach than are neighboring states Georgia, Tennessee, Florida and Mississippi, where Republican governors have all moved to reopen at least parts of their economies.
"I think that we could be heading for a macabre game of whack-a-mole," says Thomas LaVeist, dean of the School of Public Health and Tropical Medicine at Tulane University in New Orleans. He worries that Louisiana — an early hot spot for COVID-19 — could see a resurgence in cases as surrounding states ease restrictions.
"Unless the states in the South can coordinate the way the states in the North, East, the West, and the upper Midwest are striving to do, we're going to have problems," he says.
LaVeist says longstanding policy decisions, and population characteristics in the South already put the region at risk in a health pandemic. He points to high poverty rates, large numbers of uninsured residents, lower minimum wages, and general health and well-being measures.
"The South is the epicenter for health inequities in this country," LaVeist says. "We call the South the stroke belt — higher rates of all kind of chronic conditions."
Conditions such as high blood pressure, diabetes, obesity and kidney disease have all been identified as factors in COVID-19 deaths.
LaVeist says rural communities in the South are not really resourced to manage an outbreak given the number of rural hospitals that have closed or downsized in recent years.
"You add all of that together and you've got sort of this toxic mix of political decisions, policy decisions, resource limitations that just create an opportunity for a pandemic to really just rage in the South," LaVeist says.
Another disturbing trend is the high proportion of coronavirus cases and deaths among African-Americans.
The early evidence of that is from Louisiana, where the death toll has now surpassed that of Hurricane Katrina. African-Americans make up 56% of reported COVID deaths, but just about one-third of the state's population. Other Southern states show similar disproportionate impacts on African-American residents.
In New Orleans, there are clusters of cases in predominantly black neighborhoods where people mostly work in the tourism industry.
"This virus has exposed the social and economic fragility of working families," says New Orleans Mayor LaToya Cantrell.
She points to a "tyranny of policies" that leaves families without a living wage or access to health care.
"All of this is embedded in really what we're seeing across the board in the city of New Orleans," Cantrell says. "And really the state of Louisiana is on the front line as it relates to these matters"
Southern states are also subject to natural disasters. This month, there have been deadly tornadoes and flash floods; hurricane season starts June 1; and there's spring flooding on the Mississippi River.
In the river town of Greenville, Miss., Mayor Errick Simmons says they're still reeling from record floods last year with some residents still displaced.
"In a city that has a 38.6% poverty rate, this COVID-19 is exacerbating all of the issues that we're having," Simmons says. "The acute nature of the pandemic's economic downturn is felt more here than many other places."
Simmons says demand at food pantries and soup kitchens has nearly tripled in the Mississippi Delta.
Regionwide, eight of the 10 states with the biggest jumps in unemployment claims are in the South.
The pandemic is also renewing calls for expanding Medicaid coverage. Nine of the 14 states that did not expand Medicaid under the Affordable Care Act are in the South. Of them, Texas has the highest number of uninsured residents.
Rep. Colin Allred, D-Texas, fears those numbers are on the rise based on calls to his office from constituents who have lost their jobs and their health insurance.
"So now, more than ever, we need to push to expand Medicaid," he says. "To provide a backstop to our health care coverage for many working people who desperately need it."
Allred, whose congressional district includes the Dallas area, is pushing legislation that would offer more federal money to states that expand Medicaid, in an effort to sway mostly Republican legislatures and governors to reconsider their repeated rejection of a key part of Obamacare.
Sen. Doug Jones, D-Ala., is behind the bill. He says expanding Medicaid would help protect everyone in these uncertain times.
"The thing that this pandemic has really brought home to people is that our health is dependent on our neighbors health more than we like to have thought about in the past," Jones says.
A test of that dependency is coming with some Southern states now on the brink of reopening.
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