When the New Covid Surge Struck, Mississippi Was Uniquely Unprepared

JACKSON, Miss. — On the ground floor of a parking garage at the University of Mississippi Medical Center, there are coronavirus patients where the cars should be — about 20 of them on any given day, laid up in air-conditioned tents and cared for by a team of medical personnel from a Christian charity group. Another garage nearby has been transformed into a staging area for a monoclonal antibody clinic for Covid-19 patients.

These scenes, unfolding in the heart of Mississippi’s capital city, are a clear indication that the health care system in the nation’s poorest state is close to buckling under the latest avalanche of cases triggered by the highly contagious Delta variant of the virus.

“We have reached a failure point,” LouAnn Woodward, the medical center’s top executive, said late last week. “The demand has exceeded our resources.”

The current coronavirus spike has hit the South hard, but a combination of poverty and politics made Mississippi uniquely unprepared to handle what is now the worst coronavirus outbreak in the nation. The state has fewer active physicians per capita than any other. Five rural hospitals have closed in the past decade, and 35 more are at imminent risk of closing, according to an assessment from a nonprofit health care quality agency. There are 2,000 fewer nurses in Mississippi today than there were at the beginning of the year, according to the state hospital association.

“If you look around, the state’s hospitals were in bad shape before there was such a thing as Covid,” said Marty Wiseman, an emeritus political science professor at Mississippi State University. “It was not a good time to layer a pandemic on top of that.”

Mississippi has waged decades of political battles over health care policy that can run almost as hot as the fights over the symbols of the old Confederacy. Most crucially, the state rejected a proposal to expand Medicaid, the federally subsidized health insurance program for low-income residents, a decision that critics say has deprived Mississippi of a much-needed infusion of federal money that might have strengthened small hospitals on the brink of failure and allowed them to recruit and retain doctors and nurses. That debate is being revisited by advocates who hope the pandemic will force a new reckoning.

What Mississippi has been left with, after years of infighting, is a system believed to be the weakest in the nation. According to a 2020 report from the Commonwealth Fund, a New York nonprofit group, Mississippi ranks at or near the bottom among states on key health care measurements, including infant mortality, childhood and adult obesity, and adults who have gone without care because they could not afford it.

The hospitals that have shut down in recent years cited the same factors plaguing many of those still operating in the state: not enough money from patients with private insurance, not enough government help to care for the poor. Money is also at the root of the health care personnel shortage: Doctors and nurses can often make significantly more money elsewhere.

The hospital closures have meant real challenges for local communities. Quitman County Hospital,…