There’s one grocery store in Hancock County, in downtown Sparta. On a recent Wednesday, business was steady there. Among the shoppers was Cedric Harris.
Harris is a traveling Certified Nursing Assistant who cares for two clients in the county. Like most people shopping here, he wears a mask.
"Well, they say it’s a hotspot here," Harris said, paper mask over his face. "Yeah, but I guess everybody learning to keep their social distancing now."
While many in Georgia think coronavirus is in the rear view mirror, and are shopping in Atlanta malls and swimming at Georgia’s beaches, rural communities like Hancock County are still in the thick of it. And, as rural communities struggle, information about how to access one of the tools for slowing the spread of COVID-19, getting tested for the disease, may not be reaching people.
Hancock County has the fourth highest per capita infection rate of COVID-19 in the state. That puts it in the same league as the counties in southwest Georgia well known as the state's major "hotspot." But unlike in southwest Georgia, the infection curve here is still climbing.
While the outbreak is centered at two nursing homes and has touched Hancock State Prison (the county's major employers), about a quarter of the documented infections are of people in the community at large. As of May 22, 17 people have died here, which is a big deal in a county of less than 9,000 people.
Cedric Harris has been tested for coronavirus once. That test came back negative.
"I guess it’s been about two weeks," he said. "But like they say, you can be tested today and get it tomorrow."
So he’d like another test, but doesn’t want to use his insurance coverage again. He hasn’t seen a place to get tested for free.
“Oh, I have heard nothing about tests yet,” Harris said. “You know, I figure the health department or somebody, but, nobody, you know, put it out.”
The places we used to find that information are thin on the ground. Daily newspapers from both Macon and Augusta used to circulate here. They don’t anymore. And the local paper, the Sparta Ishmaelite, is a weekly with no online presence.
But it turns out Harris has three local, free options for testing, all of which are trying in their own ways to be accessible.
Unbeknownst to Harris, the first option was just a few miles away from the grocery store, at the Hancock County Health Department.
There, across from the old boarded up hospital where virginia creeper was overtaking the caduceus by the front door, staff were waiting for people to show up for tests on the one day a week testing was offered. Very few did.
“We had a little rush there!” joked a technician after one test.
It picked up a little as time went on, but clearly testing capacity was outstripping demand. What was less clear was whether capacity outstripped need.
So far, the health department has managed to test a little over a 100 people. Of those, just over 30% have tested positive. The World Health Organization suggests if you are looking for a signal that testing is catching most of the infected people in your community, only 5% of tests should come back as positive.
Michael Hokanson is the spokesperson for Georgia’s North Central Health District, which includes Hancock County. He’s trying to drum up more demand for testing. He says it’s a challenge.
The social media messaging that might work in urban areas is less effective where people often have spotty internet access. And because of the widespread COVID-19 scams, text messages might be ignored as a hoax. So Hokanson is going to people’s physical mailboxes.
“We are actually doing a direct mail campaign providing cards with the testing information, the hotline that an individual needs to call, as well as some of the preventative information,” Hokanson said.
Hokanson said he wishes he could do more.
"I'd love to be able to cast out a net hit every single person with the information that we want to give them, but that net’s probably going to cost way more than we’re ever going to have,” he said.
Especially when, because of the COVID-19 economic meltdown, Georgia’s health departments are being asked to make 14% budget cuts like other state agencies.
The second option for testing is the federally supported clinic run by Community Health Care Systems where they treat anyone regardless of their ability to pay. In this majority black community, they see a lot of undertreated chronic diseases that put people more at risk of death from COVID-19. Health system CEO Carla Belcher said they, too, have more tests than people asking for them.
“We just didn't see that many because people didn't know they could come in for a test and if they didn't have symptoms,” Belcher said.
Community Health Care is telling all their patients about testing, putting fliers on cars and trying to collaborate with the health department, too, in efforts to raise awareness. And unlike the health department, they are conducting pop up testing days. For example, the pop up in the town of Wrens a little further east from Hancock County saw over 100 people tested.
The third testing option is a group of sites run by the National Guard and Augusta University, where Phillip Coule is chief medical officer. In Hancock County, as in the other 20 counties in which they are intensively working, they are mostly focused on the nursing home outbreaks and at risk communities. Coule said collaborations with church leaders are key to getting the word out about their community testing.
The biggest players in testing, in Hancock County or anywhere in the state, are the health department and Augusta University. And they are not talking to each other about their testing schedules. There is no single, statewide list of where coronavirus testing is available.
So, if someone like Cedric Harris, at the grocery store, wondering about where to get a second test to keep his clients safe, gets into the stream of information about one testing program he will not automatically have access to the others.
Phillip Coule of Augusta University said all these information gaps add up to a massive Catch 22 for people in rural, majority black communities like Hancock County.
“Whites are more likely to be tested. But African Americans and blacks are more likely to be tested positive,” Coule said. “And so you got a tricky disease with this maddening phenomenon of, you know, the people most at risk not getting tested.”
Michael Hokanson of the North Central Health District said he’s holding off on some of his ambitions for messaging until the Georgia Department of Public Health rolls out a statewide awareness campaign, something he expects in coming weeks.