The South is about to take a crushing blow from COVID-19, with Alabama set to have the nation's highest per-capita death rate, passing New York

A deserted street corner in New Orleans (Bloomberg)

The South, already the most unhealthy region of the country, is set to take a pummeling from the coronavirus, according to a report at Bloomberg and Yahoo! News. As if to help drive home the point, al.com followed with a report showing that Alabama is projected to have the nation's highest death rate from COVID-19, based on a new epidemiological model.

What makes the South particularly vulnerable to a deadly viral outbreak? Bloomberg reporters Margaret Newkirk and Michelle Cortez spell it out, in a piece titled "The South, Sickest Part of a Sick America, Falls Prey to Virus":

A virus that is particularly lethal for people with underlying health conditions is now spreading into the unhealthiest part of the U.S.: the South.

For decades,­ people in the 11 states that seceded during the Civil War -- America’s poorest region -- have suffered from a scourge of obesity and hypertension, which intensify the danger of the coronavirus and the Covid-19 respiratory disease that it causes. Four of the five states with the highest diabetes rates are in the South. And eight didn’t expand Medicaid under the Affordable Care Act, leaving thousands of families without access to routine care, even as financially troubled rural hospitals wither away.

Those factors give the South a special vulnerability, as did the haphazard response from some governors as the disease began to course through the country. Without clear direction from the Trump administration, they were loath to mandate stay-at-home orders. Beaches were open in Florida, churches held services in rural Tennessee and Mardi Gras went on in Louisiana.

Now Covid-19 has infected 47 long-term care centers in Georgia, overwhelmed hospitals in New Orleans, spread into at least six Alabama nursing homes, forced the evacuation of scores of elderly residents from a Tennessee rehabilitation center and killed a country music star in Nashville.

Public-health experts see grim weeks and months ahead throughout Dixie. Perhaps worst of all, the college football season, which drives the region's social scene throughout the late summer and fall, is likely to be curtailed or canceled altogether:

“Covid-19 is going to be a disaster in the Southeast,” said Aaron Milstone, a Tennessee pulmonologist. “We’ll see higher morbidity, which is getting sick from the virus, and higher mortality, which is dying from the virus.”

That prediction is already playing out in Louisiana, which saw Covid-19 infections and deaths soar in New Orleans after weeks of Carnival celebrations ended last month. Of the 239 Covid-19 fatalities there, 40% had diabetes, 25% were obese and 21% had heart problems, according to state figures.

“We, in general, have a sicker population, and we are concerned that our outcomes in the Covid-19 pandemic are going to be worse because of that,” said Joseph Kanter, an assistant state health officer.

The South is the sickest part of a sick country: The U.S. is unhealthier on average than other developed nations.

Underlying health conditions are a major concern with the coronavirus, and they tend to be more prevalent in the South than in any other region:

Among American Covid-19 patients, diabetes, lung or heart disease accounted for 78% of those who developed severe respiratory infections and needed critical care, according to a U.S. Centers for Disease Control and Prevention report issued Tuesday.

Diabetics were at greatest risk, said the report, which was based on data from 7,162 early U.S. patients. Diabetes mellitus, tied to excess weight and poor fitness, is at epidemic levels in the U.S., where nearly 40% of the population is obese and another 30% overweight.

Those conditions run rampant in the South, according to the nonprofit United Health Foundation. For example, Mississippians are 85% more likely to die of cardiovascular disease than Minnesotans, and 41.9% of Arkansans have high blood pressure, compared with 24.5% in Utah, according to the organization’s America’s Health Rankings report. The region also has a large African-American population, which is disproportionately prone to the underlying conditions.

“We have a higher than usual rate of underlying, chronic conditions like diabetes, obesity, asthma and hypertension,” said L. Faye Grimsley, head of the Public Health Sciences department at Xavier University in New Orleans. “We're at the bottom of the rankings when it comes to heart attacks, strokes, infant mortality and maternal mortality.”

It hasn't helped that the region's white majorities have tended to elect Republican leaders, many of whom take a suspicious view of science:

The South’s white majorities have supported Republican presidential candidates for most of the past 40 years, and state parties there recently have marched in lockstep with President Donald Trump. As the president slowly came to grasp the gravity of the crisis, the region’s nine Republican governors mirrored his response.

Only the Democratic governors of Louisiana and North Carolina had issued stay-at-home orders for their entire states until Tuesday, when Republican Greg Abbott of Texas told residents to remain behind closed doors except for essential errands. Ron DeSantis, the Republican governor of Florida, did so Wednesday after resisting such a move for weeks. So did the governor of Mississippi, Tate Reeves. Georgia’s Brian Kemp said he would issue rules Thursday. (Note: Alabama's Kay Ivey followed suit on Friday, weeks after she had been urged to take such action.)

Speaking of Kay Ivey, her virus-related problems likely will get worse before they get better. Reports al.com's Ramsey Archibald:

No one knows what will happen in the coming weeks and months of the coronavirus pandemic. Alabama has already seen more than 1,500 confirmed cases of the virus and 26 confirmed deaths.

But some estimates predict a more dire situation here, as a recent epidemiological model shows Alabama could have the highest per capita death rate in the country, and the fourth highest total death count.

If the worst were to happen - if Alabamians refuse to follow social distancing measures, the state’s intensive care units become overfull with the most ill coronavirus patients, or even if people here are unlucky - nearly 10,000 Alabamians could die from COVID-19 by the middle of next month.

That’s according to projections released earlier this week from the Institute for Health Metrics and Evaluation at the University of Washington. IHME released projections for every U.S. state on April 1, and will continue to update them.

The projections show Alabama could suffer anywhere from 849 deaths to 9,624 by as early as May 16. Those are the state’s low and high projections, according to the data. The mean, or average, projection, shows the state could see 5,516 deaths by May 16, when the projections say the death rate would flatten.

That number is the fourth highest in the country - ahead of much more populous states like California, Pennsylvania and Illinois.

Where does the news turn really grim for Alabama? Archibald explains:

Alabama’s estimated deaths per 10,000 people, based on the mean projection from IHME, is by far the highest in the country. The data suggests 11 in 10,000 Alabamians could die from coronavirus in the next few months. The next closest state, New York, has a projected death rate of eight in 10,000. . . .

The data shows Alabama could see anywhere from 15 to 500 deaths per day when the virus is projected to peak on April 19 - just a couple of weeks away. The mean projection predicts 300 Alabamians will die from the virus on that day.