Ronald Lewis’s home was among the first to be rebuilt after Hurricane Katrina swept away much of New Orleans’s Lower Ninth ward. In the 15 years after, as this city’s poorest neighbourhood struggled to recover, Lewis became its most impassioned advocate and cultural champion – founder of the House of Dance & Feathers, a community museum dedicated to African American city street culture.

But last week Lewis, the 68-year-old neighbourhood hero, became one of the first to die in New Orleans after contracting the novel coronavirus, which has swept through this city and throughout the state of Louisiana at a rate in keeping with the worst in the world.

“I need to rest my mind, and my body. They are both aching,” said Lewis’s grieving wife, Charlotte, in a brief phone interview.

“He was one of the best,” said his neighbour Jimmy Lewis. “After Katrina he spoke up for us all. He was full of love and concern.”

jimmy and ninth ward Left: Jimmy Lewis has mostly stayed inside or on his front porch in the Lower Ninth ward of New Orleans. Right: Homes in the Lower Ninth ward. Lower income people in New Orleans will be especially affected by the outbreak. Photographs by Bryan Tarnowski/The Guardian

As the afternoon sun began to dip over the Ninth ward’s silent streets, Lewis, another survivor of the hurricane that remains inked in people’s memory here, began thinking about the current crisis – its similarities and its many differences.

“We were flooded before, but this time it’s dry. They’re both flowing. One by water, the other by air,” he said. “It will test our hearts and our minds like last time, but we will overcome again.”

As the coronavirus pandemic takes hold across America, major outbreaks in the coastal cities of Seattle and New York City have dominated headlines. But New Orleans, the historic city on Louisiana’s southern tip, has more quietly become one of the worst-affected areas in America.

As of Wednesday there were 1,975 confirmed Covid-19 cases in Louisiana, with more than 800 in New Orleans alone. Sixty-five people have been killed by the virus in the state, with over half those in New Orleans. The death toll is only six less than in California, a state with 35 million more people.

Analysis by local news outlet the Advocate earlier in the week highlighted that New Orleans has a higher per-capita rate of infection than some boroughs of New York City. Research conducted by the University of Louisiana at Lafayette concluded that coronavirus cases here have spread at a faster rate in the first two weeks than any state in America or any country in the world.

“If you’re looking at what we’ve seen around the world, if you think that the situation in Spain and Italy is dire, well, we’re on that trajectory too,” said Dr Gary Wagner, who authored the research.

Facebook Twitter Pinterest Haji Ahkba played trumpet on the corner of Royal Street and St Peter Street in the French Quarter, a popular corner for musicians that usually draws dozens of spectators. There was no one listening on this night because of the pandemic. Photograph: Bryan Tarnowski/Bryan Tarnowski for The Guardian

On Tuesday, the Trump administration, reeling from criticism of its botched national response to the crisis, which critics have labelled Trump’s “viral Katrina” – a reference to George W Bush’s disastrous handling of the response to the 2005 hurricane – issued a major disaster declaration for Louisiana following similar orders in New York, Washington and California. Hours later, the Louisiana governor, John Bel Edwards, a Democrat, forecast that the state would reach hospital capacity by the first week of April as he pleaded for more ventilators.

The sobering acknowledgment came as little surprise to Dr David Mushatt, chief of infectious diseases at Tulane University and one of those on the frontlines treating intensive care Covid-19 patients at University medical center in New Orleans.

Doctors here, like other locations around the world, have begun discussing the ethics of rationing and prioritizing care as beds come close to filling up.

Facebook Twitter Pinterest Dr David Mushatt, an infectious disease doctor and professor at Tulane Medical, quarantined at his home in New Orleans. He is waiting on his test results after being exposed to Covid-19. Photograph: Bryan Tarnowski/The Guardian

“It breaks your heart, because you know that patients probably aren’t getting the same amount of attention that they would have if they didn’t have this infectious, deadly virus,” Mushatt said. “There’s no way that nurses and doctors can spend the amount of time that they would like to in the room because there’s not enough protective gear.”

Mushatt, who has been forced to self-isolate after being exposed to the virus by a patient, described the physical and emotional toll of fighting the disease head on.

“You’re fighting for the most challenging life of your career, but it’s every single patient,” he said. “And then there is the fear of the unknown. As bad as it is already, is it going to get worse? Will we have enough ventilators? Nurses? Enough room?”

Other experts pointed to a number of factors that could explain New Orleans’s status as an early coronavirus hotspot: at the end of February the city celebrated the annual Mardi Gras festival, drawing a million visitors to crammed street parades.

“We get a lot of people for those springtime events, and we’re already a very close-knit community,” said Richard Oberhelman, professor of community health at Tulane University. “Anytime you have large groups of people together, then you’re going to have more opportunities for transmission once it’s introduced.”

Now, New Orleans’s busiest areas are almost entirely empty. Bourbon Street, in the city’s historic French Quarter, just weeks ago packed with thousands of Mardi Gras revellers, is lined with boarded-up shopfronts and bars, the hum of fluorescent signage often the loudest noise on the block.

Edwards ordered a statewide stay-at-home order over the weekend in an attempt to flatten the curve, but Wednesday’s infection rate announcement and death toll marked the steepest increase in figures so far in Louisiana.

“The problem isn’t that cases are growing every day, it’s that they’re growing drastically every day,” Edwards said.

This deep south state is also one of the poorest in America, with 20% of residents living in poverty. New Orleans’s economy is dependent on tourism, and with restaurants and bars forced to offer takeout-only services, many have begun laying off staff. Earlier in the week the Advocate, the paper that has driven in-depth coverage of the crisis here, announced it had been forced to furlough staff and issue a 20% pay cut. Statewide unemployment claims soared from an average of 1,400 new claims a week to 71,000.

Burnell Cotlon Left: Burnell Cotlon in his small market in the Lower Ninth ward of New Orleans. Right: Miraculously, Cotlon, has supplies available unlike most stores such as masks, toilet paper, and hand sanitizer at the store Burnell’s Ninth Ward. Photographs by Bryan Tarnowski/The Guardian

In the Lower Ninth ward’s only fresh grocery store, owner Burnell Cotlon, another local community champion, has been forced to issue store credits for the first time. Many of his loyal customers have no money left to pay for basics, including toilet paper, soap and vegetables. The tally is already $722.13 – a major amount for his business.

“Musicians, hotel and restaurant workers, people who used to have 40 hours work a day, now have nothing,” Cotlon, who constructed the store on a plot destroyed by Katrina said. “Some people are coming in here, crying and begging for work.”

Cotlon’s mother, who just lost her job, is also in self-isolation after being exposed to the virus.

“It’s like a nightmare all over again,” he said. “I remember coming back after Katrina, losing my home, I cried like a baby. To go through this all again … words can’t describe.”