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Keren Landman

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Why is coronavirus data so damn difficult to communicate?

Coronavirus data Georgia why is it so difficult
A drive-thru COVID-19 testing site in Los Angeles. Virus test results, collected in Georgia at sites like this one, have recently been mixed with antibody test results on the state’s data dashboard, leading to more confusion among Georgians looking for information about COVID-19.

Photograph by Kevin Winter/Getty Images

TJ Muehleman is from Texas, but he has family in Louisiana, lived in Georgia for years, and now resides in Seattle. In the early days of the COVID-19 pandemic, he began to notice big differences in the ways data was presented by each of the states he’s called home. And he noticed something else about Georgia’s data in particular: it was a mess.

As co-founder of Standard Co, a company that builds public health data visualization platforms, it’s Muehleman’s job to find areas for improvement in charts and graphs. But the problems with the Georgia Department of Health’s data dashboard seemed particularly dangerous, he says, because of the life-and-death decisions business owners and others were making based on the data presented.

As a side project, Muehleman created the Covid Mapping Project, a website that displays simple charts describing the same key metrics from each state. And as he’s watched each of Georgia’s widely reported data fiascos play out, he has had increasing opportunity to reflect on the cause. “I don’t think anything nefarious is happening,” he says. “I just don’t think they know what they’re doing.”

That was his reaction last week, when a bewildering chart displaying county-level data in nonchronological order elicited widespread jeering. The chart in question showed case totals arranged from highest to lowest; Muehleman speculates that “somebody, somewhere, said, I want to know what have been the worst days in the past month” and that graphic was the result. The chart was quickly revised to reflect chronological order, and a spokesperson for Governor Brian Kemp acknowledged the visual was problematic and apologized. But the state’s website was again pilloried on Wednesday after the Columbus Ledger-Enquirer reported the total testing numbers it displayed mixed tests for the virus and antibody tests, artificially lowering Georgia’s positive test rate. Combining these two tests in figures has been an issue in several states—even the CDC has followed the practice, although the agency also recently announced it would stop doing so.

Communicating clear, easy to read data to the public is perhaps one of the most pervasive problems during the COVID-19 pandemic. “You have a lot of very smart people producing really neat visualizations that other professionals might understand,” Muehleman says, “but the general public is like, What the hell am I looking at? I just want to know if it’s getting better or worse.”

But it’s not that easy to tell—at least, not in real time. As governments worldwide wrangle data in an effort to thoughtfully re-open economies, they all must reckon with an intrinsic quality of the COVID-19 outbreak: because it takes so long for a single person to go from getting infected to being counted by the state where they live, there’s no great way to know the pandemic’s immediate trajectory. But data scientists say there are good and bad ways to forecast the pandemic’s path, share the data they use—and, as that much-maligned chart demonstrated—clearly communicate how they use information to make critical decisions.

Not all of Georgia’s data problems are man-made; no matter who is making public health policy, a number of days will inevitably elapse between the time a person becomes infected with the coronavirus and the time their infection turns up on a health department’s website. To start, there’s the period between the moment a viral particle enters someone’s body and the moment they first start feeling sick, which usually takes around five days but can take as long as two weeks. Once a person starts feeling sick, it could take days before they are tested for COVID-19, then additional days for the test to actually be processed at a laboratory. The laboratory must then communicate the result to the state (more days) before the state can include that person’s infection in its counts.

When the state is finally notified about a COVID-19-infection, it adds the case to the numbers it displays on the dashboard using the date the infected person first felt sick. That means “new” cases usually show up as occurring several weeks in the past, before the state was notified. (There are exceptions: if the state receives a case report that’s missing the date of symptom onset, it instead substitutes the test date or the date they received the result.) So today’s case counts are the lowest point of a rolling wave that won’t crest until it’s well out of reach, which could give the public a false sense of security.

Georgia denotes this time lag is an unreliable basis for decisions by displaying newer data as dots rather than a line on its chart of daily case counts. But that’s probably not enough to prevent observers from becoming confused, says Muehleman: “until we shorten that time lag, onset is a problematic indicator to the general public,” even if it is a useful one for health officials, he says.

While the data will never be perfect and the data lag cannot be completely eliminated, there are better ways to communicate uncertainty, convey what we do know, and do most other things the cluttered and confusing Georgia dashboard attempts to do, Muehleman says. He points to Louisiana’s data dashboard, where a chart tracking new cases only displays data more than 12 days old. He also likes Alabama’s, which lists positive cases by the day their test result was confirmed, shortening its data lag.

J.C. Bradbury, an economist and data analyst at Kennesaw State University, sees additional problems with Georgia’s dashboard. Among his frustrations is that the most useful data isn’t all reported in the same place. “The governor keeps mentioning the number of people currently hospitalized” with COVID-19, he says, a metric that to him seems like a promising indicator of current disease prevalence. (That number recently went below 1,000 for the first time since the first surge of cases.) But that figure is published by the Georgia Emergency Management Agency (GEMA) in a PDF document under the “Situation Report” section of the agency’s coronavirus site—not on the health department’s dashboard. That metric should be front and center among the data the health department shares, says Bradbury.

Another key change both Bradbury and Muehleman would like to see on the state’s dashboard is more information on each case included in the downloadable raw data set that they and other scientists use to understand pandemic dynamics in Georgia, including the date each person who tested positive was suspected to have been exposed, the date each case sample was obtained, and the date each test was run. They also wish the state would prominently display the number of newly confirmed cases each day, much the way the Atlanta Journal-Constitution’s data dashboard does—they both calculate this figure independently using the state’s raw data because it is subject to less data lag than the existing metrics displayed.

In addition to running his own calculations, Muehleman also makes daily visits to the Covid Tracking Project, a volunteer-run website created by The Atlantic magazine.

There are other data sources that may emerge as useful indicators of real-time COVID-19 prevalence in the future—such as where fevers are reported (measured by smart thermometers) or flu-like symptoms (reported by doctors)—but none of these have yet been established as reliable indicators of whether the pandemic is getting better or worse at any given moment.

For now, Bradbury says, people making daily decisions about what they can safely do should look at their county’s daily growth in newly confirmed cases and new deaths—metrics he calculates himself and tweets out each day. (Data reported by each county’s respective health department can also be found here: Fulton; DeKalb; Cobb/Douglas; Gwinnett/Newton/Rockdale; Clayton.) Changes in these numbers give him some sense of whether transmission is getting worse or better in his general area. On Thursday, he tweeted an ominous caption alongside his usual graphics: “Fulton had so many deaths, I had to add another category.”

Re-opening Georgia for business is a life or death decision—and the data doesn’t help

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Should we re-open businesses this early in Georgia?
An LA Fitness location in Austell just before it closed on March 15. Gyms will be allowed to open Friday, April 24 under Governor Brian Kemp’s executive order.

Photograph by Kevin C. Cox/Getty Images

In the month since Carrollton was shut down to prevent the spread of COVID-19, the volume at Jerry’s Country Kitchen has shrunk to less than a quarter of its usual business. Brock Eady took over the breakfast-and-lunch place from his dad about 30 years ago. He’s still paying his five employees, but is just about broke. “I’m just trying to make payroll Friday,” he says. “But we may not be able to buy food to sell.”

A few days ago, he watched at home as Governor Brian Kemp announced his plan to reopen Georgia businesses. When the governor said, “I don’t give a damn about politics right now,” Eady rewound the video so he could post a recording to Facebook.

“I’m thankful that he wants us to go back to work,” he says. “I don’t have the answer if it’s safe or not.”

Others felt considerably more certain. The mayors of several Georgia cities, including Atlanta’s, expressed concern about the order’s wisdom and encouraged their citizens to stay home. Throngs of Atlanta restaurateurs announced their intentions to stay closed. Public health cognoscenti and national media broadly condemned the decision.

Kemp said “favorable data, enhanced testing, and approval of our health care professionals” drove his decision to authorize the reopening of fitness centers, bowling alleys, body art studios, hairdressers, nail salons, massage therapists, and other personal service providers as early as Friday, April 24. (Dine-in restaurants and theaters will be allowed to reopen on Monday, April 27 under specific social distancing and sanitation conditions.)

But the existing data isn’t enough to ground such a critical decision, says Joshua Weitz, a quantitative biologist at Georgia Tech who specializes in disease dynamics. “It’s not just about looking at a number in a reported case count and saying, ‘Well, that looks flat enough that we can open up,’” he says; a better way is to consider whether current conditions allow a sustained downward curve—and if they don’t, to create better conditions.

There’s no playbook to guide leaders making the wrenching decisions they now must make: their choice is between subjecting their electorates to generational economic pain or to a plague of near-biblical proportions. Kemp’s decision suggests his priority is to salve financial wounds first—and with the kind of haste public health experts say will cost unnecessary lives.

To Kemp’s critics, the shape of Georgia’s epidemic curve is one of the greatest sources of concern. Each day, the state’s health department publishes a chart detailing the confirmed cases of COVID-19 by the date of illness onset. At first glance, the chart seems to show a downward trend in cases over the most recent week or so—but that trend doesn’t reflect reality.

It often takes days for new infections to be included in that chart, in part because people often have a fever or cough for days before getting tested for the virus causing COVID-19. Additionally, the way tests get reported to the health department can delay their inclusion in official case counts.

As a consequence of these reporting lags, what looks like a small number of cases today will grow substantially over the next week as new reports trickle in from around the state. These delays apply to COVID-19 death trends, too—a recent analysis suggested that on April 20, deaths attributed to COVID-19 were still being added to daily totals as far back as April 3.

So while Kemp said the virus is “on the downward trend,” daily case counts and fatalities have actually remained steady for the last few weeks, says Weitz. Even if there were clear evidence that Georgia had passed one peak, he says, “there’s no epidemiological rule that says there can only be one peak in an epidemic.” In diseases like COVID-19, cases can resurge or plateau after a peak—and human choices play an enormous role in the direction the curve takes.

“To those who see a trend, keep in mind that the trend is us,” says Weitz. “It’s our behavior that has led to the decrease, and if we change the behavior, there is a very high risk that there will be an increase.”

The way to avoid that increase is to build testing, tracing, and treatment infrastructure before changing our behavior. “In Georgia,” says Weitz, “almost all of us are susceptible to infection”—but survivors of COVID-19 may be less likely to become sick and contagious if they are re-exposed, potentially making them better candidates to re-enter the workforce sooner. Although scientists still have many unanswered questions about COVID-19 immunity, Weitz feels widespread testing for immunity should be a cornerstone of a successful reopening strategy.

Also important would be a strategy to identify, quarantine, and test contacts of known COVID-19 cases, known to public health authorities as “contact tracing.” This tool is critical for identifying the remaining disease hotspots once transmission rates trend downward, says Jeff Engel, executive director of the Council of State and Territorial Epidemiologists. But before attempting a contact tracing effort, states need to have “manageable” numbers of cases, says Engel—“maybe a hundred infected people for each person available to do the work. With Georgia lately averaging about 6,500 actively infected individuals on any given day, the workforce it would need to effectively trace contacts would be in the hundreds. It is unclear what progress the state has made toward this goal.

Weitz acknowledges the severe economic pressure created by the pandemic, and says the solution to those pressures is not to prematurely reopen businesses, but to provide financial aid directly to the people who are hardest hit—a process that has been delayed at the federal level. Furthermore, he said, businesses that do reopen need resources and information to help them keep employees and patrons safe. “Have they given that small business owner masks?” he asks. “Have they given the option to have at-will testing, especially for customer-facing staff? Have they given them advice on airflow?”

On Wednesday, Eady prepared to read a ten-page Georgia Chamber of Commerce document on the minimum basic operations needed to safely reopen a business; seven of its pages comprised the text of Kemp’s executive order. He’d bought his 83-year-old mother face masks at the Home Depot—she’s the “Jerry” in the restaurant’s name, and still works there almost every day. She hasn’t been wearing them.

He says he doesn’t know anyone who’s had severe health effects due to the virus, and isn’t sure what it would change if he did. “It would probably make me leery,” he says, “but the fact is, my doors have to be open.”

“My decision would still be, open this place up. Because it’s all I got.”

Too little, too late? Why testing has taken so long to come online in Georgia

COVID-19 testing
Healthcare workers handle samples from patients at a drive-in center in Jericho, New York.

Photograph by Bruce Bennett/Getty Images

When area medical practices started to close down in early March due to COVID-19 concerns, Adrienne Clark, a registered nurse, got on the phone with her friends in the healthcare business. She asked if any of them had extra throat swabs and viral culture media, the nutrient-rich liquid needed to keep a virus alive during transport to a testing lab.

“They were like, ‘Oh yeah, we do—why?,’” she says. She explained those relatively common materials were all that was needed to test for COVID-19. But many providers were either unaware of the simplicity of sample collection or unwilling to do the testing in their office, and the supplies were languishing in supply closets unused. Now, many of them have been donated to Clark’s concierge medical practice, Qualified Quacks LLC. Clark sees between 10 and 15 people a day in the course of the house calls she makes on a fee-for-service basis; beginning this week, she has swabbed four to five symptomatic people a day for COVID-19, sending their samples to a Quest lab for testing. “Evaluating doesn’t mean you’re necessarily going to get swabbed, but we will evaluate anyone—and that’s one of the things that doing house calls allows us to do,” she says.

To avoid overwhelming labs, Clark and other Georgia providers are deploying the test carefully, using it only when it can guide treatment and quarantine precautions. That’s a different approach to testing than most Americans are used to—and a different approach than other states are taking—but really, everything in the last two weeks has been different than what most Americans are used to. As a result of our collective crash course in public health, most of us now know what “social distancing” means, and the conversational use of “contact tracing” may be at an all-time high. And a large number of people now understand that widespread testing for COVID-19 is something we don’t have—but should have had for a while.

Testing for the microbe at the heart of an infectious epidemic is a critical part of reducing that microbe’s damage. When public health officials know who’s infected and who isn’t, they don’t have to guess at who needs quarantining. Sure, they can just tell the entire population of a city or state to quarantine themselves—and in many cases, they have—but if you’ve seen the videos of spring breakers crowding Florida beaches, you know that’s often ineffective. Testing gives quarantine instructions weight and authority.

Testing also gives doctors and scientists a lot of information about how a germ behaves within a certain group of people. Imagine that a certain microbe makes 50 of a city’s residents pretty sick, but we know 100,000 residents have been infected—we’d worry a little bit, but we probably wouldn’t cancel life as we know it. However, if we knew that only 100 residents had been infected, we’d react with much greater concern. Without widespread testing, it’s hard to know how to react.

Based on data from countries where testing has been more robust, we know we need to worry about COVID-19. However, because differences between countries’ populations and health care systems might be related to how lethal the disease is, it would be extremely useful to know how lethal the disease has been in this country specifically.

Still, testing for COVID-19 remains unevenly distributed throughout the U.S. and relatively scarce in Georgia. The reasons are complicated: early on, there were problems with a test developed by the Centers for Disease Control and Prevention (CDC). Over the weeks it took to solve those problems, bureaucratic bottlenecks at the Food and Drug Administration caused delays in developing other versions of the test. And while many private companies are now developing several versions of a COVID-19 test and even deploying them broadly within certain localities, the materials they need to scale up production and use of those tests have been in low supply due to high demand worldwide.

Emory University’s laboratory is among many nationwide that have a working COVID-19 test of their own. And while the state health department is reportedly working on a partnership with the university that could expand testing, there may be practical obstacles to overcome: on March 14th, an Emory scientist tweeted a list of supplies his lab would need to conduct COVID-19 testing. Message directly if you can help, he wrote, “and I’ll set you up with contact point.”

It is unclear why state and local public health officials are not scaling up distribution of these tests on a large scale, although the general lack of government resources to handle the scale of the current response probably has something to do with it. Lauren Bricks, COO of the Sandy Springs-based Ipsum Diagnostics, says her lab has developed the capacity to do 1,000 to 1,200 COVID-19 tests per day and on Friday applied for emergency use authorization from the FDA. However, calls to the state public health department, the mayor’s office, and the governor’s office to offer her lab’s capacity have gone unanswered. “I do want to believe that it’s because they’re so overwhelmed,” says Bricks.

In the case of COVID-19, testing does not actually guide treatment—and implementing widespread testing efforts consumes money and manpower while also increasing the risk of transmission to the healthcare workers performing the test and other people sharing the same space. The suspected density of cases in any area helps determine the testing strategy local public health officials design. Friday, for example, in New York City, where there are more than 5,000 confirmed COVID-19 cases, public health officials released guidance discouraging testing people unless they are sick and hospitalized, suggesting that in situations of wide local spread of the virus, public health authorities are pivoting away from testing. The same day, however, the Georgia Department of Health dispatched a team of epidemiologists to investigate a cluster of COVID-19 deaths in Albany, suggesting state and local public health officials think there is still potential to curtail local spread.

At press time for this article, about 170,000 COVID-19 tests had been conducted in the U.S. Other countries scaled up at a much higher clip: South Korea, for example, has tested more than 270,000 people since February, despite having a population one-seventh our size. More than 120 other countries have been testing thousands of people each day using a test developed for the World Health Organization, and while the U.S. could have saved weeks of dithering and delay by adopting this test up front—or even by switching to this test when the delays became evident—it did not. (Although the reasons for that are unclear, they may be largely political.)

Currently, between the CDC and state public health labs nationwide, about 3-5,000 tests are being done every day. Private, commercial labs are scaling up testing, too: LabCorp has announced it now has the capacity to perform 20,000 tests daily across three labs nationwide, and Quest expects to achieve this capacity, also spread across three labs, by next week. More than 3,000 tests have been done so far in Georgia, about 2,300 of them in a commercial lab.

In the meantime, Georgia’s public health officials have asked clinicians to reserve the test for those most vulnerable to severe illness in the event of an infection (such as elderly people and people with chronic underlying health conditions), those at risk of spreading the infection to vulnerable people (like healthcare workers and first responders), and hospitalized people.

Unlike many other tests healthcare providers order, the nasal swab needed to test for COVID-19 isn’t collected at an outpatient lab—it’s collected either in a clinic or, as of this week, at one of 18 drive-through specimen collection sites around the state, where people prioritized for testing could get swabbed for testing using one of hundreds of LabCorp and Quest kits reportedly purchased by the state. People will only be tested at these drive-through sites if they’ve been prescreened by a healthcare provider and have a referral.

The Georgia Department of Health has encouraged people with mild cold symptoms to isolate themselves at home until their symptoms go away. However, people with more severe symptoms should call their doctors or an urgent care center, where staff can determine whether the next steps should involve testing for COVID-19, the flu, or other common infections.

Coronavirus cancels Atlanta

cancelled events Atlanta coronavirus covid-19
The Atlanta Motor Speedway was set to hold NASCAR’s 2020 Folds of Honor QuikTrip 500 race this weekend, but after first announcing the on Thursday the event would be held without fans present, it was postponed on Friday.

Photograph by Chris Graythen/Getty Images

“The world is upside down right now,” said Keiran Neely, operator of the 175-person Music Room, speaking while on his way to a meeting with his landlord on Friday afternoon. “I’m not going to be able to pay the rent,” he said. “We’re in the business of creating large gatherings, and the messaging we’re receiving is that people should not be attending large gatherings.”

Over the next few days, Neely will be experimenting with live-streaming DJ sets. He’s not closing the venue yet, but he feels the pressure to shut its doors: this weekend is an experiment, he said, “to see whether people are brave enough to go out and dance.”

On Thursday and Friday, after a few days of what felt like an extended exercise in breath-holding, much of Atlanta got canceled.

It started with a trickle—Tuesday’s Fulton County public school closures following an employee’s positive test for infection with the COVID-19 virus; the NCAA’s Wednesday announcement it would play its much-anticipated men’s Final Four games, scheduled for early April at Mercedes-Benz Stadium, without fans (it later canceled the event altogether).

Then, on Thursday, the same day Governor Kemp announced the state’s first death from a COVID-19 infection, a torrent: Atlanta Public Schools, Decatur City Schools, and most other area school districts closed for at least two weeks. The Mayor’s annual State of the City address and the Atlanta Symphony Orchestra’s weekend programming were postponed; Atlanta United—along with the rest of Major League Soccer—canceled its games; NASCAR suspended an upcoming race event at the Atlanta Motor Speedway. The Atlanta Opera and the Alliance Theatre have also canceled shows.

“It’s not an overreaction,” says Benjamin Lopman, an epidemiology professor at Emory’s Rollins School of Public Health. “As there’s more and more people who are infected in the community, the risk becomes higher,” he says, “so as things move along, it makes sense to be more aggressive.”

Canceling crowds is not a new public health trick, but it’s an effective one. During the 1918 Spanish Flu pandemic, cities that closed gathering places like schools, churches, and theaters had about half the peak death rates of cities that didn’t. “Proactive approaches are going to be more effective at slowing transmission,” says Lopman.

Upon reaching the point where there are thousands of infections circulating in the community, the chance that someone at a 10,000-person event will be infected increases sharply. Josh Weitz, a Georgia Tech biology professor who models viral dynamics in populations, recently tweeted a chart demonstrating the risk of encountering a COVID-19-infected person at an event as crowd size and the virus’ prevalence increase. “Take-away point: serious questions should be asked soon about policies for holding large-scale events,” he wrote.

Georgia’s numbers of confirmed COVID-19 infections might seem so low as to be negligible: 45 people out of the state’s 10.5 million doesn’t sound like many. But because access to testing is so profoundly limited in the U.S., the number of cases we know about is probably just the tip of a very large iceberg. In Washington state, where 457 cases have been reported, viral dynamic modeling has suggested the actual number of cases is at least twice as high and will double every 6 days.

To date, neither the Centers for Disease Control and Prevention nor the Georgia Department of Public Health have recommended canceling mass gatherings. Georgia’s elected officials have not made formal statements on the subject, although the Atlanta Journal-Constitution reports city mayor Keisha Lance Bottoms is in discussions with Governor Kemp about issuing a ban on large events. [Editor’s Note: On March 15, the CDC recommended postponing and canceling gatherings of more than 50 people for the next 8 weeks. Bottoms signed an order to prohibit gatherings of more than 250 people, but noted on Twitter that in light of the CDC’s recommendation, her administration would “continue to evaluate and adjust our policies accordingly.)

Georgia currently has 45 confirmed cases of COVID-19 infection. States with fewer cases have been more proactive about crowd control: In a press conference Thursday, Florida Governor Ron DeSantis recommended postponing large-scale events, according to local reports; 31 cases have been reported in that state. Governor Mike DeWine of Ohio, where five cases of COVID-19 infection have been confirmed, announced Thursday that gatherings of more than 100 people would be prohibited.

The goal of canceling large events isn’t to stop transmission entirely—most public health officials agree that’s impossible—but to slow it down to reduce the chance a surge in infections will overwhelm an already-strained healthcare system.

“We’re at a turning point in the response to this epidemic,” said Lopman. He’s been following the accounts of healthcare workers in Northern Italy, where more than 100 deaths each day are being reported from COVID-19 infection, and where hospital intensive care units and healthcare workers have been overwhelmed.

The infection is highly transmissible, likely to be severe in many adults, and likely to be new to almost everyone’s immune system, he said. “Public health is not overplaying its hand.”

Don’t panic: Your guide to navigating coronavirus in Atlanta

Coronavirus FAQ Atlanta how do I prepare for coronavirus COVID-19
A coronavirus illustration from the CDC

Courtesy of the CDC

Right now, Dr. Carlos del Rio is more worried about driving in this city than he is about getting COVID-19. “Accidents on the Connector are more common than any coronavirus I know at this point in time in Atlanta,” said the Emory University infectious disease doctor during a recent morning rush hour. Currently, a handful of COVID-19 cases have been identified in the metro area, most linked to recent travel—but it’s likely Georgia will see more cases. Below, we’ve gathered some information, including top tips from Dr. del Rio, on how to prepare yourself and your family. [Editor’s note: This story was initially published on March 6; the amount of cases in Georgia has since grown to more than 100.]

Should I wear a mask?
Seeing healthcare personnel suit up in personal protective equipment to transport patients with COVID-19 makes people wonder if they, too, need full-body Tyvek to avoid infection. They do not. People providing direct care to infected and seriously ill patients get exposed to large amounts of virus-loaded respiratory droplets and then have close contact with other uninfected but vulnerable patients, so they need a much higher level of protection than people who might pick up the virus through casual contact.

“We need to do a lot of handwashing,” says del Rio, to protect from this and most other respiratory illnesses. Wash your hands when you think they’re dirty or when you’ve been in public places, around children, in bathrooms, or anywhere else your hands may have touched surfaces others have touched. Twenty seconds with warm water, soap, and a catchy tune does the job, and you can use any soap—it doesn’t have to be branded as “antibacterial.”

Alcohol-based hand sanitizers are great for convenience, but are not otherwise superior to handwashing. If you haven’t stocked up and shelves near you are empty, you can make your own at home using other widely available ingredients and the World Health Organization’s recipe. And remember that if your hands are visibly soiled or very greasy, sanitizer won’t work—you’ll need to wash with soap and water.

As for face masks, healthcare personnel use two types: surgical masks to prevent their own germs from reaching patients, and N95 masks to prevent themselves from catching patients’ germs. If you are sick but need to go to the store for milk, says del Rio, a surgical mask is a public kindness; but N95 masks are a different story. To work at all, they need to be individually fit-tested to the user’s face to ensure no air flows around the sides of the mask. Because of that fit, they’re stifling to have on and cannot be worn for long periods of time.

Additionally, N95 masks are critically important for people providing direct care to patients. If healthcare providers get infected with a COVID-19 patient’s germs, not only could they infect other patients, but they would have to stay out of work for at least two weeks, further straining an already-overburdened healthcare system. So don’t hoard masks, especially N95s.

Do I need to stay home even if I’m not sick?
Because older adults and people with chronic medical conditions are at higher risk for more serious illness with COVID-19 infection, the CDC has now recommended people in these risk groups stay home as much as possible and avoid crowds. [Editor’s Note: Since the publication of this story, many large gatherings including the NCAA tournament, MLS, MLB, and NBA games have been canceled or postponed, schools and universities closed, and some offices have implemented work-from-home polities. Social distancing is strongly encouraged and Mayor Keisha Lance Bottoms has prohibited gatherings of more than 50 people. Follow local guidelines and stay home if you feel ill—see below for more on what to do if you feel sick.]

How is COVID-19 transmitted?
The virus that causes COVID-19 is part of the family of coronaviruses, which cause 10 to 30 percent of common colds. Like other coronaviruses, it’s spread by breathing in droplets from an infected person’s cough or sneeze. But it’s also transmitted when those droplets land on surfaces; if an infected person sneezes into their hand then touches a doorknob, the person who touches that doorknob next could easily get viral particles on their hands, making it easy to introduce into their respiratory tract by rubbing their eyes or touching their nose or mouth.

One of the best ways to protect yourself is to avoid touching your face. “It’s not going to go in through your skin,” says del Rio. “After you touch that doorknob, if you don’t touch your face, you’re not going to get contaminated.”

Can the coronavirus live on surfaces?
We don’t yet know exactly how long this particular virus hangs around on surfaces, so it’s also a good idea to clean that doorknob on a regular basis. Research on other coronaviruses suggests that while they can stay on metal, glass, or plastic for over a week, they usually persist for closer to half a day. The good news is that the COVID-19 virus is a relatively delicate organism, making it easy to remove from surfaces with common household cleaners such as diluted household bleach solutions, alcohol solutions with at least 70 percent alcohol, and most common EPA-registered household disinfectants. If you’re cleaning after sharing space with someone who might be sick, focus on high-touch surfaces, including tables, hard-backed chairs, doorknobs, light switches, remotes, handles, desks, toilets, and sinks.

What should I do if I might be infected?
If you develop fever and a dry cough after recent travel or contact with a sick person who traveled recently to a place where COVID-19 is spreading, call your doctor. If you don’t have a doctor, reach out to an urgent care center. Either way, call in advance rather than appearing unannounced at the clinic, where you might infect other patients and staff. You might not need testing; but if you do, the samples will need to be gathered at a healthcare provider’s office and sent to CDC.

Will testing be expensive?
In Georgia, COVID-19 tests are currently being done at CDC and the Georgia Public Health Laboratory, and they do not cost anything to the people who are tested. However, testing should soon be more widely available, as several commercial laboratories have also developed COVID-19 tests.

America’s Health Insurance Plans, a lobbying organization that represents some of the nation’s biggest insurers—including Georgia’s largest, Anthem Blue Cross Blue Shield—today released a statement indicating it would provide coverage for coronavirus tests ordered by physicians, and that insurers may waive out-of-pocket costs for testing. Check with your insurance plan to determine what your individual policy will cover.

What are state officials doing to prepare now that the virus is here?
The Georgia Department of Public Health is adapting its pandemic flu plan to prepare in case of COVID-19 spread and has epidemiologists on call to help health care providers evaluate people with symptoms. Passenger screening is underway at Hartsfield-Jackson Atlanta International Airport. If needed, the health department may recommend measures to reduce community spread, like school and child care closures and postponement or cancellation of mass gatherings. But in Atlanta, we’re not there yet. Keep an eye on the state’s COVID-19 website for updates. [Editor’s note: Many metro Atlanta schools have since announced closures, including Cobb, Fulton, DeKalb, Decatur, and APS. Please check with your local school system for updates.]

If the health department does recommend reduced social contact, it will be much less painful if you’ve done some prep work. That means having three days’ worth of shelf-stable food and water in the house: “You don’t need to go to Costco and buy the entire store,” says del Rio. “This is not nuclear catastrophe.” It is also worth having a month’s supply of medications you or your pets take regularly at home. The CDC maintains a robust disaster preparedness checklist that works well for epidemic preparation. [Editor’s note: Since publication of this story, the CDC is strongly encouraging social distancing. Based on CDC recommendations, the mayor has prohibited gatherings of more than 50 people.]

And an important note:
One more thing, says del Rio: Take care not to hold entire ethnicities and nationalities responsible for infections like COVID-19. He loves something CDC director Robert Redfield recently said: “Stigma is the enemy of public health.” Although COVID-19 might have originated in China, Chinese food and products cannot transmit the virus, says del Rio. Unfortunately, the AJC reported recently that business at local Chinese restaurants has been depressed, likely due to coronavirus anxiety.

Hell yeah, he’d go eat on Buford Highway, del Rio says. “My biggest concern,” he noted, “would be trying to get there and driving and having an accident.”

At Atlanta’s first food forest, you can forage for mushrooms and pick medicinal herbs

The Urban Food Forest at Browns Mill
A squash grows at the new Urban Food Forest at Browns Mill

Photograph by The Sintoses

In southeast Atlanta, a newly designated city park is set to become the nation’s largest food forest—a place where volunteers tend crops of fruits, vegetables, nuts, and herbs, much of which is available to the public for free. The Urban Food Forest at Browns Mill occupies a seven-acre plot where husband and wife Willie and Ruby Morgan once kept a farm; the couple often left surplus produce in bags on neighbors’ fence posts.

In the mid-2000s, developers bought the Morgan property—but the planned townhouses never materialized. Instead, the Conservation Fund purchased the plot in 2016 to preserve the greenspace and pass it on to the city’s parks department, which will help with the group effort to transform the land into a space to feed, educate, and engage the community.

The Urban Food Forest at Browns Mill

The surrounding Browns Mill Park and Lakewood neighborhoods are U.S. Department of Agriculture–designated food deserts (places with limited access to affordable and nutritious food), and southeast Atlanta as a whole has seen little of the recent investment in the city’s urban core, says Soisette Lumpkin, who leads the Friends of the Forest community group. “The Food Forest not only brings food but brings life to the area,” Lumpkin says.

Below is a glimpse of the crops, plants, and people who form the crux of the forest and its mission.

The Urban Food Forest at Browns Mill
Mullein and cardoon

Photograph by The Sintoses

Mullein and cardoon

. . . or how to heal with herbs

Celeste Lomax, the park’s community organizer, oversees the forest’s medicinal herb garden. “There’s healing in herbs,” she says; her favorite is mullein, thought by herbalists to ease respiratory conditions like asthma, which disproportionately affects south Atlanta residents. Lumpkin says that offering access to the plants used in ancestral healing practices sends a message to the community about the park’s purpose: “The Food Forest is not just a garden,” she says. “It’s a holistic approach to health.”

The Urban Food Forest at Browns Mill
Figs, nectarines, plums, and pawpaws

Photograph by The Sintoses

Figs, nectarines, plums, and pawpaws

. . . or how to teach others to grow

Some of the Food Forest’s hundreds of fruit trees were planted in the past year by students from nearby elementary schools. It will be several years before the trees bear fruit, but eventually, they will yield thousands of pounds of figs, nectarines, plums, apples, pears, pomegranates, cherries, and native pawpaws, which taste like banana custard with hints of mango and cantaloupe. The forest also houses beehives and newly sown mushroom beds, which provide additional educational opportunities. “For many of these kids, it’s their first time interacting with a fruit or vegetable in the ground,” says Michael McCord, the food forest’s ranger and a staff member at Trees Atlanta.

The Urban Food Forest at Browns Mill
Corn and collards

Photograph by The Sintoses

Corn and collards

. . . or how to feed the neighbors

Corn, collard greens, and other vegetables are already growing in the community garden, where Doug Hardeman and Rosemary Griffin, who live nearby, volunteer nearly every day. For now, the harvest is distributed among volunteers and neighbors. Later, produce may be distributed to neighborhood food pantries.

The Urban Food Forest at Browns Mill
Pecans and black walnuts

Photograph by The Sintoses

Pecans and black walnuts

. . . or how to honor the original farmers

“The piece of the Morgans we’re trying to replicate is that willingness to share with your neighbor,” says Shannon Lee, the Conservation Fund’s urban conservation manager. The family’s legacy lives on in more than one way; there are dozens of mature pecan, black walnut, and mulberry trees across the property that date back at least to the Morgans’ ownership, including four giant pecan trees near what’s now the picnic table area.

The Urban Food Forest at Browns Mill
Butterfly milkweed and echinacea

Photograph by The Sintoses

Butterfly milkweed and echinacea

. . . or how to engage the community

Designing the greenspace was a group effort driven largely by the Browns Mill Community Association. Lead designer Lindsey Mann’s job, she says, was to “distill what it was the community wanted and then draw it up into a plan.” Among the community’s desires was a garden to memorialize ancestors, to be planted near the park’s East Rhinehill Road border. It will bloom with wildflowers and pollinators, including milkweed, echinacea, and other flowers, that attract insects such as bees and butterflies, which help propagate future generations of plants. “Flowers are good medicine for the emotional heart,” Mann says.

This article appears in our August 2019 issue.

The Patch Works museum aims to keep Cabbagetown’s mill town history alive

The Patch Works Cabbagetown
Various pieces of memorabilia from the Fulton Bag and Cotton Mill on display at the Patch Works

Photograph courtesy of the Patch Works

Worn by anyone else, white cotton flour sacks printed with the “Fulton Seamless” logo might not have been particularly clever costumes. But when Jake Elsas’s parents wore them to a party sometime in the early 1970s, they were a hit: his great-great-grandfather, the original Jacob Elsas, was the founder of the Fulton Bag and Cotton Mill—which produced the sacks—and built the neat shotgun houses of Cabbagetown to accommodate his workers nearby. Although the Elsas family sold the mill in the late 1950s, both it and the neighborhood remained a strong part of the family’s identity—and, at least as late as Jake’s childhood, an occasional source of self-referential fashion.

Flour sacks weren’t the only mill relics the family held on to. Now, photos and artifacts from the Elsas family’s collective archives, along with art made by and about Cabbagetown, are on display at the Patch Works, a neighborhood art and history center opened by Jake and his wife, Nina, who has a degree in art history.

The Patch Works Cabbagetown
Photos on display at the Patch Works

Photograph courtesy of the Patch Works

The Patch Works Cabbagetown

Growing up in a variety of well-heeled Atlanta neighborhoods, Jake knew Cabbagetown as a tightly knit community where people took care of each other with a irrepressible and noisy pride. He says he drank lemonade at annual reunions while displaced old-timers made music on porches of their former neighbors, who themselves tried to negotiate neighborhood revitalization projects with the City of Atlanta. The mill’s gradual closure between 1974 and 1981 greatly depressed the neighborhood and the mostly white, Appalachian mill workers who had lived there, and Cabbagetown began to gentrify in the 1980s. Jake’s father chaired the board of the Patch, a socioeconomic assistance organization founded by Esther Lefever that provided arts programs and other education for laid-off mill workers and functioned as a drop-in center for neighborhood kids.

After spending most of his adulthood outside of Atlanta, Jake returned in 2012 to care for his ailing father. When he visited Cabbagetown, he hardly recognized the neighborhood: “It suddenly dawned on me that a lot of what I understood Cabbagetown to be was in danger of being lost forever with these waves of outsiders and gentrification,” he says. What worried him most was how little new residents knew about the neighborhood’s history.

He bought one of the lofts in the Stacks, the residential development built on the mill’s ruins at the turn of the 21st century. When his home was featured on a 2013 loft tour, he used the space to showcase mill-related ephemera from his father’s archives. Family members caught wind of the exhibit and offered to empty their attics into his collection. For a while his loft was “basically an art museum,” he says.

The Patch Works Cabbagetown
Inside the Patch Works

Photograph courtesy of the Patch Works

The Patch Works Cabbagetown
Artwork from Panorama Ray

Photograph courtesy of the Patch Works

The Patch Works Cabbagetown
The Patch Works logo

Photograph courtesy of the Patch Works

The mushrooming assemblage needed more space. In 2015, he and Nina moved it to a space on Carroll Street previously occupied by a tattoo parlor and named it the Patch Works in homage to the organization his father had helped lead. It was a trial run, Jake says, for a more permanent location, which opened in December 2017 in a blue house on the corner of Gaskill and Carroll Streets. Next door is the lot where the Patch once stood, now the Agave restaurant. Jake and Nina have been self-funding the museum and launched a GoFundMe in January that has since raised a little over $3,000. They hope to eventually secure 501(c)(3) nonprofit status, which would make them more eligible for grants.

The museum has three distinct spaces: the entry room contains mill-related displays, including a table of cogs, bobbins, and scale models of mill buildings. Two other rooms showcase Cabbagetown art, including works by street artist Donna Howells (aka 70dot) and the late photographer and artist Panorama Ray, along with rotating exhibits, such as one featuring the music of Cabbagetown folk singer and activist Joyce Brookshire, who died in 2017. The space also hosts monthly acoustic concerts and bagel pop-ups several Sundays a month with Emerald City Bagels.

The Patch Works Cabbagetown
Artwork from Panorama Ray

Photograph courtesy of the Patch Works

The Patch Works CabbagetownWhen people leave the museum, Jake hopes they will have a better understanding of the neighborhood’s contribution to Atlanta’s economic development after the Civil War, and the ferocious pride its residents once took in their unwavering support for each other. 593 Gaskill Street; Open Tuesday and Thursday 12-6 p.m., Friday and Saturday 1-7 p.m., Sunday 9 a.m.-3 p.m.

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