The coronavirus storm already is rapidly gathering in Athens and surrounding areas. At noon on April 11, the Georgia Department of Public Health recorded 82 cases of Covid-19 in Athens-Clarke County and 36 cases in next door Oconee County. Across the 17 counties served by the two Athens hospitals, the DPH reported 334 cases, up from 200 at the middle of the week. A model from the University of Texas based on data from earlier in the month gave Athens-Clarke County a 100 percent chance of epidemic infection, and its 16 neighboring counties probabilities ranging from 55 percent to 99 percent.

Those numbers mean the two hospitals here aren’t just getting ready for local patients. “As we look at an Athens surge, we have to look at 15, 16, 17 counties that are being served by our facilities,” Carter said. Beyond that, though, Carter doesn’t know what to expect, comparing the surge in infections to tracking the landfall of a gathering hurricane while it’s still early. “There is no consensus where it will turn.”

Since 2005, 170 rural hospitals have closed in the United States, eight of them in Georgia. As these hospitals leave, the facilities in nearby cities and towns pick up the slack, said Brock Slabach, vice president of the National Rural Health Association. The closure of Hart County Hospital in 2012 a few counties away, for instance, sent those patients to the Athens hospital region—what people in the industry call a “catchment” area, like a stream bed.

When you exclude hospitals in metro Atlanta, just a handful of regional hospitals serve 95 of Georgia’s 159 counties. Adams points to six Georgia cities in addition to Athens where a smaller health system caters to a huge rural and exurban ecosystem. In Gainesville, 55 miles north of Atlanta, Northeast Georgia Medical Center serves 16 counties. In Columbus, West Georgia-Piedmont Columbus Regional serves 21 counties.

Athens, Georgia, has been under a local stay-at-home order for weeks.

Even before coronavirus, an influx of new patients to city hospitals added strain, both because of sheer numbers and the unique health problems of rural populations. Patients from rural areas tend to be older, poorer and in worse general health than those from urban areas, said Slabach and Adams, all of which can make a coronavirus infection much worse. “Places like rural Georgia will see greater complications and death rates because of these conditions,” Slabach said. Rural and urban Georgia alike also have larger African American populations—27 percent of Athens-Clarke County’s residents are black—and new data from the CDC reveals that African Americans have had disproportionately higher rates of Covid-19 infection and death.

Elected officials, experts and hospital administrators in Athens are particularly worried about these strains because of one worst-case scenario that recently played out in Albany, less than 200 miles away in the same state. Coronavirus surged there in March after an outbreak spread through attendees of two funerals. Dougherty County, Georgia, where Albany is located, logged 1,076 Covid-19 cases and 69 deaths as of April 11. Coronavirus infection was spreading into nearby counties, such as Sumter, which logged 222 cases and nine deaths—in a population of a little less than 30,000.