Tricia Neuman, a senior vice president at the Kaiser Family Foundation, says this analysis points to the underlying issues that might complicate or worsen the pandemic in the South. “Due to high rates of conditions like lung disease and heart disease and obesity, the people living in these states are at risk if they get the virus,” Neuman told me. These aren’t “people who are sick, but these are people who have underlying comorbidities that put them at higher risk of serious illness if they get infected.”

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The KFF analysis doesn’t include potential complications from hypertension—which is also suspected to be driving coronavirus-linked hospitalizations—but the data are predictable on that front. If you define Oklahoma as part of the South, southern states fill out the entirety of the top 10 states in percentage of population diagnosed with hypertension by a doctor. Southerners are more likely to suffer from chronic diseases than other Americans—even as Americans are more likely to suffer from chronic diseases than citizens of other countries with comparable wealth. According to Neuman, these estimates don’t include people with cancer or who are immunocompromised—groups that are also at high risk for serious illness from COVID-19. And cancer mortality rates are highest in southern states.

These differences are not innate to southerners; they are the result of policy. Health disparities tend to track both race and poverty, and the states in the old domain of Jim Crow have pursued policies that ensure those disparities endure. The South is the poorest region in the country. The poor, black, Latino, or rural residents who make up large shares of southern populations tend to lack access to high-quality doctors and care. According to the State Health Access Data Assistance Center, Mississippi, North Carolina, Texas, Florida, Georgia, and Louisiana all spend less than $25 per person on public health a year, compared with $84 per person in New York. Nine of the 14 states that have refused to expand Medicaid to poor residents under the Affordable Care Act are in the South. And many of those states are led by Republican leaders who have imitated President Donald Trump’s dallying and flip-flopping, and now find themselves flat-footed.

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The slow response from those governors will be even more ruinous in a region with so many challenges. Chronic disease and the apparent increased risk for younger people from COVID-19 are only part of the story in the South. Other factors could complicate its pandemic response. Advocates have drawn attention to the extreme vulnerability of people in prison to the coronavirus—and the South incarcerates a larger proportion of its population than anywhere else in the United States. A federal prison in Louisiana has already seen a spike in COVID-19 cases this week. Also, a global fear in this pandemic is that it will sicken health professionals and doctors, and leave them unable to contend with waves of hospitalizations. Southern states have some of the lowest ratios of active physicians to patients in the country.