According to Denson, problems particular to Louisiana might make an outbreak there worse than what other parts of the U.S. have seen. The state has one of the highest poverty rates in the country, and with that burden comes health disparities—including the kinds of conditions that appear to put people at risk for serious complications from the coronavirus. Louisiana is one of the youngest states in the country, which would seem to suggest that its residents would have better outcomes, given that older people have so far been the most vulnerable to the outbreak. But about 43 percent of its adult population falls into “at risk” categories, according to the Kaiser Family Foundation. A sizable number of young adults in the state have preexisting conditions.

According to Denson, that means New Orleans and the rest of Louisiana might be looking at a different kind of outbreak than most countries—or even New York and Washington—have seen, including widespread hospitalizations or even deaths of young people. Yesterday, Louisiana reported its first death of a person under 35, a 17-year-old in Orleans Parish.

“We’re seeing different processes of this disease than they have seen in China, at least anecdotally,” Denson said. “We’re seeing more comorbid conditions that are common to Americans, such as high blood pressure, stroke, and diabetes.”

Read: What do the healthy owe to the vulnerable?

Many common assumptions about the coronavirus pandemic are about to be tested in the U.S., in ways they haven’t been so far. The effects of the virus on populations like those in the American South—poorer, characterized by marked racial and social disparities in health status and health access, and often saddled with multiple preexisting conditions—aren’t yet well known. And many other southern states, unlike Louisiana, New York, Washington—all of which expanded Medicaid under the Affordable Care Act—have little in the way of public health-insurance options for those younger at-risk populations. If Louisiana (likely through Mardi Gras) was COVID-19’s foothold in the South, then America is about to learn a whole lot about how the disease interacts with some of the most stubborn and intractable health-care issues in the country.

For now, the next point of focus should be on New Orleans. It’s not Italy, not yet. But the warnings are urgent, and perhaps even more portentous in their sobriety and certainty. The state will run out of crucial resources for taking care of coronavirus patients, likely before their number peaks. Hospitals will be under extreme strain. Health-care professionals will contract the virus themselves. Underlying health conditions will make their jobs more difficult.

That means now is the time for desperate measures, Denson thinks. He’s calling for the kind of mobilization people reserve for the worst disasters—including donations of supplies and more doctors and nurses. “I hope that two months down the road, people are saying, ‘I overreacted,’” he said.