Boarded-up windows in the French Quarter, mobilised federal relief and a deployed National Guard are grim reminders of Hurricane Katrina and the levee failures in 2005. Louisiana officials are preparing to open an emergency overflow hospital inside the Ernest N Morial Convention Center, emblematic of the disaster that followed after the federally built levees broke and flooded much of the city.

New Orleans is used to "hunkering down" ahead of bad weather. It's now living in the shadow of previous disasters, experiencing a kind of deja vu as coronavirus creates an invisible catastrophe that is devastating the region.

The national death toll from the Covid-19 disease has eclipsed the number of reported deaths following Katrina. Unemployment claims are comparable to the thousands filed in the wake of the hurricane.

With fewer than 400,000 people living in Orleans Parish, the rate of infection in New Orleans rivals counties across New York state despite having just a fraction of the population.

The city is bracing for the first few days of April, waiting for a stock of ventilators that could mean the difference between life and death for many patients, and hoping those Convention Center beds don't have to be filled at all.

By the end of March, the state had confirmed at least 239 deaths, among more than 5,200 cases, including a single-day spike of more than 1,200.

There were 1,355 patients hospitalised, including 438 on ventilators — figures that doubled within five days.

New Orleans has always been on the brink of its next emergency, from a broken Sewerage & Water Board system to the annual threat of tropical storms and hurricanes when the Atlantic storm season officially begins every June.

The region's trademark resiliency and ability to celebrate and laugh despite it all masks the repeated trauma that residents have endured.

"The storm," as those who lived through it will call it, was a generation-defining moment that exposed to the rest of the country the disasters and disasters-to-be that Louisiana had felt for decades, from the deep rifts in inequality to the idea that the federal government can turn its back on its own people.

In the months and years that followed, the city and its communities rebuilt at great expense, from failed government programmes to assist people returning to their homes, to a "shock doctrine" effect in a reinvigorated city that became ripe for gentrification alongside the elimination of public housing.

"This is such a strange thing," New Orleans author Maurice Carlos Ruffin tells The Independent. "There's virtually nowhere to go. You could run from Katrina. You can't run from this."

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The virus has dealt a massive blow to the region's restaurant workers and its cultural communities woven into the fabric of the city, from its musicians to parading groups and the bars, venues and families that depend on them.

It has been especially devastating for communities that are used to celebrating together in the streets — including in its funeral repasts that break into celebratory "going home" ceremonies in the form of second line parades — who now cannot bury their dead with more than 10 people present.

Mayor Cantrell joked that when the threat has been lifted, the city is "going to have the biggest and best second line ever."

"We're not going to be able to hold funerals as usual," she said during a virtual town hall on Monday. "We'll have to save our memorials for later, to give our family members the type of going away that they deserve."

Polo Silk, who has photographed the city's second lines and street culture for more than 30 years, is now posting to Instagram from his archives instead. He wrote: "We bounced back from Katrina, we can beat this. We are NOLA strong!"

The city now is faced with the tragic irony that its celebratory Carnival season — which began on Twelfth Night (6 January) and culminated with Mardi Gras on Fat Tuesday — likely accelerated the spread of the virus, which was mostly undetected throughout the US at the time.

As the state now faces an overwhelming number of cases, Louisiana officials have been criticised for failing to "cancel" Mardi Gras, which this year fell on 25 February, preceded by two weeks of nightly parades, parties, balls, concerts and other events.

"Unfortunately for us, Mardi Gras happened," says Tulane University epidemiologist Susan Hassig.

At the time, there was "no factual evidence-based reason to ban it or stop it" as thousands of people descended on the city to celebrate against the "unfortunate juxtaposition of a covert presence" of the virus, she says.

"Mardi Gras was an amplifying petri dish," she says. "It's just a lot of contact with people coming from all over."

Mayor Cantrell told CNN: "When the experts told me that social gatherings would be an issue, I moved forward with cancelling them. ... In hindsight, if we were given clear direction, we would not have had Mardi Gras, and I would have been the leader to cancel it."

Officials are not denying that the event luring thousands of visitors from around the world was a likely incubator for the virus.

But several other grim shadows were cast over this year's Carnival, while the threat of coronavirus loomed in the background after the first confirmed cases in the US were identified thousands of miles from New Orleans. Health officials did not warn against mass gatherings until weeks after the city had resumed its normal pace.

The city rerouted parades that were scheduled to pass near the partially collapsed Hard Rock Hotel, where the bodies of two construction workers killed in the crash remain inside what is left of the building on the edge of the French Quarter on Canal Street. The body of one man was visible from the street for several days after a tarp that was covering him had blown away.

Three men died in the collapse last fall. Residents have protested outside City Hall and have alleged cronyism among city officials putting the interests of the building's developers ahead of the safety of its workers and residents.

Two people were also struck and killed by floats in separate accidents within three days.

The deaths muted some of the celebrations, though the city's downtown was packed through Mardi Gras morning.

That week, officials had confirmed fewer than 100 cases in the US, most of which were onboard the Diamond Princess cruise ship. There were no reported cases in Louisiana, Texas, Mississippi or anywhere on the Gulf Coast.

On Mardi Gras day, the Centers for Disease Control and Prevention warned about the likely risk of "community spread" and suggested states prepare "social distancing" guidelines.

Two days after Ash Wednesday, the president called Democrats' growing concerns for a federal response their "latest hoax" following his impeachment in Congress.

The next day, Washington state reported the first US death from the virus.

Louisiana's first case was confirmed on 9 March. The next day, Mayor Cantrell cancelled several citywide events.

On 11 March, more than two weeks after Mardi Gras ended, the World Health Organization declared the virus a pandemic. The NBA postponed its entire season. Four days later, Disney closed its parks. Three states held Democratic primary elections, and Joe Biden's campaign assured voters that it was safe to head to the polls.

The region has not been immune to "outsider" criticism of a region that's fiercely defended by its locals, who reserve their claim to be the ones to criticise their leaders, and have routinely battled allegations of a kind of southern provincialism and stereotypes lobbed against majority-black cities.

Residents argue that finger-pointing and revisionism in the middle of the crisis has made them the scapegoats for a larger institutional crisis, after which they'll ultimately be forgotten once again until the next emergency, continuing a cycle of trauma under a national microscope.

Mr Ruffin wrote: "That whiplash of America ignoring New Orleans, then attacking New Orleans, then ignoring New Orleans again is a repeat of our Katrina experience."

While New Orleans celebrated Mardi Gras, "the whole world was acting like itself," he tells The Independent. "Unfortunately, people who were in the same position as us — other Americans — couldn't see themselves in that. ... They were living their lives like we were living our lives."

Asked about Mardi Gras criticism as the confirmed cases increase, Mayor Cantrell said: "I don't know if I'm surprised. We're in a society where everyone wants to point the finger and not take any responsibility at all. [I] was given no red flags from the federal government, the CDC, and all our other federal partners at the table as we planned and prepared for the Mardi Gras season."

The city began closing down long before New York officials closed Times Square, "which is like a Mardi Gras happening every day," New Orleans Health Department Director Jennifer Avegno said. "The second we had cases, we were done."

The New Orleans area is served by a network of private hospitals and a large state university-run hospital complex providing emergency care.

Charity Hospital, a 14-story Art Deco tower across from City Hall with 1m square feet of space, was a lifeline for low-income New Orleans residents for decades, with a history that begins with the city's French colonisation in the 1700s.

The state refused to reopen the hospital following Katrina, leaving the city without an emergency room for indigent and uninsured patients for months.

After inheriting a $850m state surplus, former Republican Governor Bobby Jindal refused to expand Medicaid for the state's so-called working poor through the Affordable Care Act. The state's public hospitals faced millions of dollars in deep cuts to account for significantly reduced Medicaid financing, forcing closures for many, including state-run mental hospitals.

In 2015, a massive $1.1bn University Medical Center complex replaced the city's former public hospital system, displacing a residential neighbourhood in the process after its residents fought to rebuild following Katrina.

Governor John Bel Edwards, a Democrat, ultimately moved to expand Medicaid after he became governor.

But Louisiana has some of the worst health outcomes among US states, making the risk of hospitalisation and death from coronavirus dangerously acute.

It's also a poor state. The statewide minimum wage is still set at the federal level of just $7.25 an hour. According to the New Orleans Data Center, the city's median household income is roughly $38,500, roughly a third of median household income in similarly hard-hit Westchester County, New York.

Lower-income workers are more likely to be working in service positions, from at-home health aides to grocery clerks and others deemed "essential" workers that put them at risk of exposure to the virus.

They also are more likely to experience high blood pressure, diabetes and other conditions that increase the likelihood of hospitalisation, according to the Data Center.

The region has some of the highest rates of underlying health conditions like high blood pressure, heart disease, diabetes and chronic obstructive pulmonary disease than other similarly impacted areas in the US.

The city's poverty rate is also at nearly 25 per cent — more than double that of Westchester County. More than a quarter of New Orleans households have an effective zero net worth.

Nineteen per cent of households also don't have a car, and can't access drive-through testing, which has proven successful in identifying cases throughout the region.

"Introducing infection into a population that is heavily weighted to serious complications has led to the kind of clinical crisis we're experiencing right now," Dr Hassig says.

Impact coronavirus is having on Louisiana and New Orleans Show all 25 1 /25 Impact coronavirus is having on Louisiana and New Orleans Impact coronavirus is having on Louisiana and New Orleans A view of empty Bourbon street in the French Quarter amid the coronavirus pandemic in New Orleans, Louisiana Getty Impact coronavirus is having on Louisiana and New Orleans Nyla Clark, 3, accompanied by her mother, Chavonne Clark, sits in a baby stroller at a corner in New Orleans, hoping to get a few dollars from an occasional passerby. Clark was a phlebotomist with a local company until she lost her job because of the coronavirus pandemic. She is waiting for unemployment The Advocate via AP Impact coronavirus is having on Louisiana and New Orleans A man boards a streetcar Reuters Impact coronavirus is having on Louisiana and New Orleans Jackson Square, normally bustling with tourists, is seen deserted AP Impact coronavirus is having on Louisiana and New Orleans Words from Gloria Gaynor's "I Will Survive" are painted onto plywood covering the window of a closed business AFP via Getty Impact coronavirus is having on Louisiana and New Orleans Street performer Eddie Webb looks around the nearly deserted French Quarter looking to make money AP Impact coronavirus is having on Louisiana and New Orleans Boarded up businesses Reuters Impact coronavirus is having on Louisiana and New Orleans The normally bustling tourist mecca of Bourbon Street lies deserted in the early afternoon Reuters Impact coronavirus is having on Louisiana and New Orleans A sign along I-10 informing persons who travel from Louisiana to quarantine AP Impact coronavirus is having on Louisiana and New Orleans A man cycles along Jackson Square AFP via Getty Impact coronavirus is having on Louisiana and New Orleans Elena Likaj, prevention department manager at Odyssey House Louisiana (OHL) which runs a drive-through testing site, takes the temperature of New Orleans resident Peyton Gill Reuters Impact coronavirus is having on Louisiana and New Orleans A man walks his dog past a boarded up business on Frenchmen Street Reuters Impact coronavirus is having on Louisiana and New Orleans An empty Bourbon street Getty Impact coronavirus is having on Louisiana and New Orleans A meal is distributed at the Lantern Light Ministry at the Rebuild Center Reuters Impact coronavirus is having on Louisiana and New Orleans A woman walks in the French Quarter Reuters Impact coronavirus is having on Louisiana and New Orleans People practice social distancing as they queue up for a meal at the Lantern Light Ministry at the Rebuild Center Reuters Impact coronavirus is having on Louisiana and New Orleans French Quarter Getty Impact coronavirus is having on Louisiana and New Orleans A sign is pictured in the French Quarter amid the outbreak Reuters Impact coronavirus is having on Louisiana and New Orleans A view of Bourbon Street Reuters Impact coronavirus is having on Louisiana and New Orleans National Guard members walk down Rampart Street AFP via Getty Impact coronavirus is having on Louisiana and New Orleans A man rides his bicycle in front of a boarded up French Quarter restaurant Reuters Impact coronavirus is having on Louisiana and New Orleans A shuttered business is pictured on Decatur Street AFP via Getty Impact coronavirus is having on Louisiana and New Orleans The normally bustling tourist mecca of Bourbon Street lies deserted Reuters Impact coronavirus is having on Louisiana and New Orleans A view of Canal Street Reuters Impact coronavirus is having on Louisiana and New Orleans A New Orleans firefighter works to contain an early morning fire Reuters

The network of private hospitals and public institutions are working in concert to treat coronavirus patients but ultimately are competing for the same resources.

Governor Edwards has requested hundreds of ventilators from the national stockpile but is set to receive only 150.

Competition is "clearly not working," Dr Hassig says. The city would be a "very different position" with a more robust state-run hospital system.

She says that the crisis underlines the "importance of evidence-based and rational distribution and allocation of health resources" and the need for assurance that agencies serving basic needs are "freed from political influence.

By the end of April, the New Orleans Convention Center will house up to 2,000 patients, if necessary, for "medical monitoring" only. The beds will be used for patients to leave intensive hospital care in an effort to free up bed space and ventilators to treat more severe cases.

The first 1,000 beds are scheduled to be available on 4 April.

Typical coronavirus-related hospital stays last up to 10 or 15 days. Doctors and nurses say patients are now beginning to show up to hospitals increasingly much sicker and needing ventilators much sooner.

Dr Avegno said: "We are preparing for that surge and don't want to be in a position where we run out of ventilators."

Together Louisiana, made up of more than 250 religious and civic organisations across the state, has been raising the alarm about the impending crisis.

"Our first priority was to have local officials understand how fast and how severe the outbreak was here, which was clear early, but only if you were looking really hard," organiser Broderick Bagert tells The Independent.

Two pastors that belong to the organisation were on ventilators for nearly two weeks. One recovered. The other died.

Without that equipment, "what happens some time in the first week of April is neither get on ventilators," Mr Bagert says. "You lose everyone who needs stabilisation at that time ... The fact that the kind of urgency is coming in now is incredibly disturbing."

Together Louisiana is helping organise teams of people across the state to relay information and support.