DAWSON, Ga. (AP) — The reverend approached the makeshift pulpit and asked the Lord to help him make some sense of the scene before him: two caskets, side by side, in a small-town cemetery busier now than ever before.

Rev. Willard O. Weston had already eulogized other neighbors lost to COVID-19, and he would do more. But this one stood as a symbol to him of all they had lost. The pair of caskets, one powder blue, one white and gold, contained a couple married 30 years who died two days apart, at separate hospitals hours from each other, unaware of the other’s fate.

The day was dark. There was no wind, not even a breeze. It felt to some like the earth had paused for this.

As the world’s attention was fixated on the horrors in Italy and New York City, the per capita death rates in counties in the impoverished southwest corner of Georgia climbed to among the worst in the country. The devastation here is a cautionary tale of what happens when the virus seeps into communities that have for generations remained on the losing end of the nation’s most intractable inequalities: these counties are rural, mostly African American and poor.

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This story was produced with the support of the Pulitzer Center on Crisis Reporting.

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More than a quarter of people in Terrell County live in poverty, the local hospital shuttered decades ago, and businesses have been closing for years, sending many young and able fleeing for cities. Those left behind are sicker and more vulnerable; even before the virus arrived, the life expectancy for men here was six years shorter than the American average.

Rural people, African Americans and the poor are more likely to work in jobs not conducive to social distancing, like the food processing plant in nearby Mitchell County where four employees died of COVID-19. They have less access to health care and so more often delay treatment for chronic conditions; in southwest Georgia, the diabetes rate of 16 percent is twice as high as in Atlanta. Transportation alone can be a challenge, so that by the time they make it to the hospital, they’re harder to save.

At least 21 people have died from COVID-19 in this county, and dozens more in the neighboring rural communities. For weeks, Weston’s phone would not stop ringing: another person in the hospital, another person dead. An hour before this funeral, Weston’s phone rang again, and this time it was news that another had succumbed to the virus–his own first cousin, as close to him as a brother.

Some here had thought that their isolation might spare them, but instead it made the pandemic particularly cruel. In Terrell County, population 8,500, everyone knows everyone and every death is personal. As the mourners arrived at the cemetery, just the handful allowed, each knew others suffering and dying.

The couple’s son, Desmond Tolbert, sat stunned. After caring for his parents, he’d also rushed his aunt, his mother’s sister, to a hospital an hour away, and there she remained on a ventilator. Her daughter, Latasha Taylor, wept thinking that if her mother survived, she would have to find a way to tell her that her sister was dead and buried.

“It’s just gone haywire, I mean haywire,” thought Eddie Keith, a 65-year-old funeral home attendant standing in the back who was familiar with all the faces on the funeral programs piling up. “People dying left and right.”

Usually, on hard days like this, he would call his friend of 30 years, who was a pastor at a country church and could always convince him that God would not give more than he could endure.

But a couple weeks earlier, that pastor had started coughing, too.

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As Georgia and other states rush to reopen, some out-of-the way places might believe that the virus won’t find them. Many here thought that, too. But it arrived, quietly at first then with breathtaking savagery.

The cemetery on the edge of town staggered graveside services, one an hour, all day. The county coroner typically works between 38 and 50 deaths a year; they reached No. 41 by mid-April. They ordered an emergency morgue.

Of the 10 counties with the highest death rate per capita in America, half are in rural southwest Georgia, where there are no packed skyscraper apartment buildings or subways. Ambulances rush along country roads, just fields and farms in either direction, carrying COVID-19 patients to the nearest hospital, for some an hour away. The small county seats are mostly quiet, the storefronts shuttered, some long ago because of the struggling economy, and some only now because owners are too afraid to reopen.

These counties circle the city of Albany, which is where authorities believe the outbreak began at a pair of funerals in February. Albany is also home to the main hospital in the region, Phoebe Putney Memorial, which serves an area of 800,000 people spanning more than 50 miles in every direction, many of them with little other access to care.

The hospital saw its first known coronavirus patient on March 10; within a few days, it had 60 and the ICU was full. Two weeks later, patients began flooding in from farther-flung rural communities. Helicopters buzzed from the top of the parking garage, flying patients to other hospitals that still had room to take them. They burned through six months of masks and gowns in six days, said Phoebe Putney president Scott Steiner. Then they were competing for supplies against wealthier, more politically powerful places; they paid $1 each for surgical masks that typically cost a nickel and were losing about $1 million each day.

The patients were very sick. Some died within hours. Some died on the way, in the back of ambulances. The region is predominantly black, but still African Americans died disproportionately, Steiner said. African Americans accounted for about 80% of the hospital’s deaths.

Black people have been dying at alarming rates across the country: the latest Associated Press analysis of available data shows that African Americans represent about 14% of the population in the areas covered but nearly one-third of those who have died.

By nearly every measure, coronavirus patients are faring worse in rural Georgia than almost anywhere else in America, according to researchers at Emory University in Atlanta. Although New York City had thousands more deaths, the per capita death rate in these Georgia counties is just as high.

“They are vulnerable people living in vulnerable places, people who are marginalized on a variety of measures, whether we’re talking about race, whether we’re talking about education or employment, in places that have fewer resources,” said Shivani Patel, an epidemiologist at Emory. Then COVID-19 arrived: “It’s like our worst nightmare coming true.”

Dr. James Black, the medical director of emergency services at Phoebe Putney, was born in this hospital, grew up in this region and is proud of how they’ve managed with the odds stacked against them. He hasn’t had a day off in two months. The question now, he believes, is whether society decides, in the wake of the virus, to continue neglecting its most vulnerable people and places.

“I think that history is going to judge us not only on how well we prepared, it’s not going to just judge us on how well we responded,” he said, “but what we learned from it, and what we change.”

Georgia has lost seven rural hospitals in the last decade.

Nine counties in rural Georgia don’t even have a doctor, according to the Georgia Alliance of Community Hospitals; 18 have no family practitioner, 60 have no pediatrician, 77 without a psychiatrist.

Ezekiel Holley, the longtime leader of Terrell County’s NAACP, said health care is what has left him “banging his head against a wall.”

At first Holley thought a virus would be one thing that did not discriminate. He opened the newspaper, scanned the faces in the obituaries and knew every one of them.

“Then I thought, why are low income people and people of color dying more than anyone else? This is the richest nation in the world, why doesn’t it have a level playing field?” he said. “Tell me that.”