This is the second story in a three-part series. Read the rest of the series here.
DALTON, Ga. — Stoney Ponders took notice when news broke in March that a funeral nearly 300 miles to the South in Albany, Georgia, sparked what would become one of the nation's first and most noteworthy COVID-19 clusters.
He said that's how he and his staff at Ponders Funeral Home, which he founded in Dalton 28 years ago, knew early on the dangers of congregating together as long as the coronavirus is circulating.
As the pandemic progressed and COVID-19 spread across the region, so did the demand for funeral services. Though funerals in 2020 look a bit different than years past — more outside services, fewer guests, people donning face masks – Ponders said it's important to find ways to safely conduct services so that families and friends can mourn the loss of their loved ones.
"Grief that's shared is grief that's lessened, and when you're grieving and dying alone, it's horrible," he said. "That's the tragedy of COVID. Our loved ones are dying alone."
Then in August, as the coronavirus reached its summer peak in Whitfield County, Ponders said he found out how real that tragedy was.
George Cross, one of Ponders' longest-standing and most-loyal employees, contracted COVID-19.
"We experienced it right here. George got tested on Wednesday, his results came back Friday and he died the next day," Ponders said. "That was very scary for us. I just think people should know it is very real people, and people are dying every day from it."
But getting that message to resonate with people hasn't been easy, especially in Whitfield County.
"For some reason, it's become a political issue. I've said it's almost as if they're denying that it's actually real," Ponders said. "I've heard countless numbers of people who would say, 'Oh, when the election's over the COVID will go away.' Since the election, it's quadrupled."
Jason Gibson, Ponders' nephew and funeral director, said that usually it's the people whose families haven't been affected by COVID-19 who don't think it's a big issue.
"We make it mandatory that people wear a mask to come into the building, and you would not believe the people griping about that. It's scary that people don't take it seriously," Gibson said.
Whitfield County is not unique in that many of its residents reject policies meant to control the spread of COVID-19, such as face mask mandates. Similar stories can be found across the Chattanooga region.
But what sets Whitfield County apart from other counties are the social, economic and environmental factors that make it especially vulnerable to COVID-19.
Shivani Patel, a social epidemiologist at Emory University's Rollins School of Public Health, said that although large, publicly available data sets are useful, they only provide a small piece of the COVID-19 puzzle. For example, counties with large high-risk populations — such as older adults, people with chronic disease, minorities, low-income individuals, essential workers and those living in close quarters — tend to be disproportionately impacted by COVID-19.
That's why Emory created a "COVID-19 Health Equity Interactive Dashboard" to add context and help policymakers determine which counties are high risk by assigning them a "vulnerability score" based on factors such as poverty level and population density.
Patel said Whitfield County "sticks out like a sore thumb" as a county that's both high risk and heavily impacted by COVID-19, according to Emory's analysis.
"When I looked at this, I said, 'Wow.' This is the portrait of a county in terms of the vulnerability score is high, cases are high and deaths are high," she said. "It's not just a county that's been hit by the second wave, if you will, but it is hard hit throughout."
Patel said the characteristics that stand out about Whitfield County are its large Hispanic community, densely populated living conditions, high percent of residents without health insurance, above-average poverty levels and lack of public transportation.
"It ranks as highly vulnerable," she said. "We should have seen this coming."
Known as the "Carpet Capital of the World," Whitfield County's large manufacturing industry has for decades been a hub for immigrant workers, hailing primarily from Mexico and other Latin American countries. The Hispanic community makes up about 34.5% of Whitfield County's population — significantly higher than the statewide rate of 9.4%.
Race and ethnicity place certain groups at higher risk for COVID-19 infection and death, according to the U.S. Centers for Disease Control and Prevention.
In the United States, Hispanic or Latino residents are 1.7 times more likely to contract COVID-19, 4.1 times more likely to be hospitalized and 2.8 times more likely to die due to the coronavirus than non-Hispanic white people, according to the CDC.
Health care providers, advocates and community leaders in Whitfield County knew these grim statistics and began working on a plan to provide outreach to the Latino community.
Heather Donahue — executive director at the DEO Clinic, a primary care clinic in Dalton that provides health care services to people without health insurance — said local officials in August approached the group about partnering to provide more outreach and COVID-19 testing. As the group began to aggressively promote safety measures throughout the Latino community, they realized how many people were unaware of the danger and how to protect themselves.
"There were a fair number of people that still just had very little understanding of COVID," Donahue said, adding that people were terrified of the disease. "I think people were avoiding testing because they were in denial and then they would wait so long to go to the hospital that the outcome was poorer."
Teresa Mendez, a well-known community health worker and DEO Clinic employee, said one of the key problems the group identified was the location of the health department, which at the time was the only place in town to offer free COVID-19 testing. The health department sits atop a hill and requires that people drive past the sheriff's office and be greeted by military personnel.
"That was the most discouraging part of this whole testing, especially for the Hispanic community. Nobody's going to make an appointment to get tested, then pass by the police," Mendez said.
Using funding from the city and tests from the North Georgia Health District, the DEO Clinic was able to offer free, drive-thru testing to anyone with or without health insurance at its location in the middle of the city. Unlike testing at the health department — which conducts the vast majority of free testing in the county — no appointment is needed and weekday hours are from 6 a.m. to 8 p.m. to better accommodate work schedules.
While the effort has greatly improved the rate of COVID-19 cases among the Hispanic community, for many help came too late.
Dr. Pablo Perez, an internal medicine physician in Dalton and an advocate, said that culture, work ethic and lack of information helped COVID-19 spread rapidly through the Hispanic community. For example, families are tight-knit and grandparents are rarely seen in nursing homes because in the Latino culture, it's morally wrong not to look after one's elders. Multigenerational homes create a prime environment for COVID-19 to spread, since younger household members may not show symptoms and unknowingly transmit the virus to older adults.
Many Latinos work in essential services such as construction, factories, meat processing plants or in the harvesting of crops — jobs that never shut down and don't have a work-from-home option.
Ash McEuen, head pastor at Trinity United Methodist Church in Dalton, said that a large portion of Whitfield County's Hispanic residents are "living in the shadows." Now, many of those same people are grappling with the pandemic alone.
"There is so much that is hidden. The virus we can't see, but we can't see so many of the effects of the virus, either," he said. "We know that people are struggling and trying to live and survive, but most of us don't take the time to talk to those people and know who they are."
McEuen's church operates a food pantry, which fed about 75 people in January. But since COVID-19 hit, there have been months in which more than 300 people came through needing assistance.
"Our food pantry every month is literally completely empty, and there's people coming from all walks of life," McEuen said. "Some of the criticisms we've gotten are, 'those people don't need food, look at the car they're driving.' We can't judge on that, because this pandemic hit everybody in different ways."
He knows a family now living in an extended-stay hotel — a common problem due to lack of affordable housing in Dalton — after losing their home. Although the father has a job, it doesn't pay well enough to support the whole family. The mother wants to work but is homeschooling the children instead.
"They're afraid of the virus because of family members that have underlying conditions," he said. "It's that kind of vicious cycle that's really, really hurting people, and they don't know the best way to move forward."
There are also many barriers that prevent people from accessing help or information about the pandemic. Aside from not always speaking English, McEuen said he quickly realized when the church moved to online services early in the pandemic that a number of people don't have internet in their homes or on their smartphones.
Dr. Perez said the group has worked hard to help people, but the effort hasn't had the impact that he hoped. He blames some community leaders and politicians for spreading misinformation and downplaying the pandemic.
"I'm incredibly sad and frustrated as a health care provider that in our community people didn't get the right message. Still they are in denial. They have the wrong message — that this is like the flu, that with this virus we don't have to use masks," Perez said. "It seems like there's a total disconnect for so many people."
At the funeral home, Ponders keeps a picture of Cross, his longtime employee, on display in the lobby to honor his friend and serve as a reminder to others that COVID-19 is not to be taken lightly. Ponders contracted COVID-19 after Cross and wasn't able to attend the funeral. Although he was fairly sick for about 10 days, Ponders said he's grateful to have made a full recovery. He remembers Cross, who was 73 years old when he died, as an instrumental member of his community and the person who was the first to show up and last to leave work every day.
Coronavirus deaths in Whitfield County have more than doubled since Cross died. Ponders said December has been the busiest month yet for funerals.
"Since it's gotten colder, it seems to be like pouring gas on fire," he said. "It's just now peaking. I mean, I don't even know if we've reached the peak. That's what's so scary."
Ponders thinks that until people can find a way to look past the politics and focus on protecting each other, more innocent people are going to die.
"That's my opinion," he said. "Trust me, the virus is apolitical, and if you are in a group of people, you need to be very, very careful, socially distanced and everything, and the least thing you could do is wear a mask."
Contact Elizabeth Fite at firstname.lastname@example.org or follow her on Twitter @ecfite.
Note: This story was updated on Dec. 28 to clarify sources of funding and support for the DEO Clinic's testing effort.