Galax has less than 10,000 residents. Why was it leading the state in new COVID-19 infections?

GALAX — Around 30,000 people crowded downtown Galax last year during the first week of August, gathering in Felts Park for the city’s annual, internationally known Old Fiddlers’ Convention. 

The same week this year, the streets of the small Southwestern Virginia city are quiet. Many of the local businesses, especially the antique shops and art galleries, are closed. The 2020 Old Fiddlers’ Convention — its 85th year — was canceled for the first time since World World II. This time, the cause was biological. Donald Trausneck, an officer for the local Moose Lodge, told the Mount Airy News in May that the “very difficult decision” was spurred by public safety concerns amid the COVID-19 pandemic.

Tom Barr, who’s run his eponymous fiddle shop on South Main Street for the last 40 years, said he’s lost at least half of his business in the last few months as the usual summer foot traffic has slowed to a slow trickle. It can feel like the virus is inescapable. He’s reminded by his wife, a home health worker who sometimes travels hundreds of miles through the mountains of neighboring North Carolina to help her clients. He’s reminded by the “Closed” signs on nearby businesses and the customers who come in wearing masks — reminding him to slip his own over his face.  

“We do it because we know better,” he said. “We know we have to. Anytime anybody comes in and they got a mask, I stick my mask on right quick because I don’t want to offend anybody and I don’t want them to give me something either.”

Not everyone feels the same way. Earlier in the pandemic, town manager Keith Barker said the local health department had to pay visits to some business owners who posted defiant signs informing customers they wouldn’t be enforcing Gov. Ralph Northam’s indoor mask mandate. There are still a few lingering signs of resistance. Less than a 10-minute drive from Barr’s Fiddle Shop, the County Line Cafe is displaying a flyer for Republican gubernatorial candidate and current state Sen. Amanda Chase, who made headlines this week for allegedly threatening to sue a local restaurant in Harrisonburg over its mask requirement. Another sign on the front door notes that the executive order exempts Virginians who can’t wear face coverings for medical reasons.

“Due to HIPPA [sic] and the 4th Amendment, we cannot legally ask you what your medical condition is,” the sign reads. “Therefore, if we see you without a mask, we will assume you have a medical condition and we will welcome you to support our local small business.”

Inside, regulars trade quips and family gossip over mugs of hot coffee. Almost no one is wearing a mask.

In mid-July, even residents of Galax were surprised to see their small city of 6,625 make national news when a White House report listed it as one of Virginia’s coronavirus “red zones.” The same week, the New York Times reported it had the highest rate of COVID-19 in the state (it’s since been supplanted by nearby Martinsville and Franklin, both set close to the North Carolina line).

At the start of the pandemic, the Mount Rogers Health District, which stretches across the far corner of Southwest Virginia, was recording less than five cases a day. Last week, that number spiked to 50. The majority have been in Galax, with a total of 350 cases and 24 deaths.

The numbers might seem small compared to the heavy case burden in Northern Virginia and the Eastern Shore. But Barker pointed out that it equates to roughly 5 percent of the population that’s now contracted the disease. Johns Hopkins University lists the case rate at a staggering 5,402 per 100,000 residents. Fairfax County, by contrast, has a rate of 1,429 per 100,000.

“In a small city like Galax, when you have cases, the rate will pop up very high,” said Dr. Karen Shelton, director of the Mount Rogers Health District. “Having said that, we have had a lot of cases. I’m not discounting that. It’s an undue burden on the population.”

Early on, there were hopes that Galax might be different. As suburban Northern Virginia’s case numbers spiked in April, with more than 100 new infections daily by the start of the month, southwestern cases emerged sluggishly and incrementally. Dickenson County didn’t see its first infection until June, according to the Virginia Department of Health — though frequent changes in the department’s data reporting makes it difficult to determine how widely available tests were in Southwest Virginia throughout the first half of the pandemic.

As Gov. Ralph Northam ordered statewide business closures and a weeks-long stay-at-home order to curb the spread, calls intensified for him to exempt low-hit regions of the state. “The Governor’s actions do not take into account the vast differences in Virginia’s regions, treating densely populated areas like Northern Virginia and sparsely populated ones like Southwest and Southside alike,” Virginia’s Senate Republican Caucus wrote in an April 15 statement after Northam extended the closures. “Virginia is a geographically vast and diverse state, and the Governor’s orders need to account for those differences.”

But when the virus hit Galax, those differences suddenly didn’t seem as stark. It ripped through nursing homes and densely populated communities, spreading among families and close colleagues. The city’s newly appointed mayor was hospitalized with a severe case of the disease. And as numbers in other regions have dropped precipitously, cases in Southwest Virginia are still growing. VDH lists the seven-day moving average as just over 205 daily new cases — only 27 less than Northern Virginia. The primary difference is resources. Fairfax County has 178 ICU beds, according to an analysis by Kaiser Health News. Galax has 10.

Watching the numbers

Barker was at home in late April when he got a call from the local health department that two of the city’s residents had tested positive for COVID-19. Capt. James Cox, the deputy chief of the Galax Police Department and the city’s emergency services coordinator, said the city’s only previous case came nearly a month earlier when another resident returned from a trip out of town with symptoms of the disease.

“They were aware that they potentially had it, so when they came back, they self-quarantined at home,” Cox said. “That case stayed isolated. The person recovered, and we had no further spread from that case.” But April was different. Shelton said community transmission started with an out-of-town visitor who came to Galax for a funeral. It spread among a large local household, and to more families after that. “These families continued with social gatherings, so we had a lot of disease come from there,” she added. 

With its gently rolling hillsides spotted with brown and white clusters of cattle, traditions in Galax remain a point of pride for its residents. Barr insists it’s Galax, not nearby Bristol, that’s truly the birthplace of country music. The town is peppered with references to its musical heritage, including a logo in the shape of a guitar pick. “Galax: The Best Pick in Virginia” remains the official motto on the city’s tourism site. The region was also once known for its vibrant furniture-making industry; the 2014 New York Times bestseller “Factory Man” details an industrial scion who waged a war to save his business from Chinese imports. His company, Vaughan-Bassett, remains one of the last remaining furniture factories in Galax.

Barker, a native of the city, said it’s the type of place where lots of people come to visit and decide to settle down. Since the 1990s, it’s also been home to one of the state’s fastest-growing Latino populations. Like the rest of Virginia, this has factored into the spread of COVID-19. Many of the earliest cases were centered among the Spanish-speaking community, who help sustain the region’s surviving factories and farms — including several large Christmas tree farms in neighboring Grayson County and across the border in nearby North Carolina. Christianne Queiroz, director of the Virginia Farm Workers Program at Central Virginia Legal Aid Society, said VDH is currently keeping tabs on an outbreak at one Christmas tree farm in Sparta, North Carolina that’s led to at least 102 cases.

Rev. Kevin Rosenfeld, the senior pastor at First Baptist Church in Galax (whose Hispanic ministry has its own active parish downtown), said many of the families live in nearby trailer parks. Most households are multigenerational, Shelton added, which can make it more difficult to contain the spread between family members. Then there’s the fact that many don’t have the option of taking off work. Father Herman Katongole, the pastor at St. Joseph’s Catholic Church, said some of his Latino congregants told him they couldn’t take sick leave even if they were actively displaying symptoms.

“Their employer promised to fire them if they stopped coming to work,” he added. “So, they continued. And in the process, more contracted the disease.”

The city tried to respond quickly. Barker said Galax devoted roughly $2,000 a month in federal CARES Act funding to food delivery services through God’s Storehouse, a soup kitchen on Main Street that transitioned to dropping off food and groceries with help from local pastors and police officers. The city’s police department, which now has two officers from the Latino community after a conscious recruitment effort, also played an active role in translating educational materials from the Virginia Department of Health before the agency began distributing its own multilingual communications.

“Everything was English, English, English,” said Police Chief DeWitt Cooper. “Well, I can’t send that out to my Hispanic community. So what I did was, they sent out the English posters and we just translated all the precautions to Spanish and delivered it ourselves.”

The health district began working long hours on contact tracing to help curb the spread, Shelton said, hiring an additional 10 case investigators and 12 contact tracers to supplement its regular staff. But compliance was another challenge. Galax, a city with an economy heavily influenced by manufacturing and tourism, was already weary of pandemic restrictions. The virus reached its peak just as the rest of the state was beginning to reopen.

A financial hit

The Galax Smokehouse sits at the corner of North Main Street downtown, steps from the city municipal building and historic Rex Theater. Normally, it’s bustling during the summer. Co-owner Bernadette Hodges estimates that at least 75 percent of her business comes from out-of-town visitors, driven by the Fiddlers’ Convention and other local events.

This August, though, the windows are dark. Hodges said she made the decision to close at the end of April after weeks of trying to keep the business afloat with curbside pickup. “The money we brought in was barely enough to cover payroll,” she added, pointing to a discarded pile of laminated parking spot numbers.

The restaurant’s knickknacks and posters are gathered in the center of the dining room, awaiting a deep cleaning as Hodges prepares to reopen — hopefully sometime in the next few weeks. She has plans for transitioning the restaurant into more of a quick-bites spot, repairing its ancient soda fountain and adding grilled sandwiches to the menu along with the usual barbecue. 

Hodges, who’s worked at the restaurant since 2006, describes herself as “forever the optimist” when it comes to the future. “But at the same time, reality is reality,” she added. “If I can get Galax to come out, we can make it. But if I can’t get this turned around, then I have to acknowledge that this isn’t going to work.”

The Smokehouse was just one casualty of the safety restrictions that came with the ongoing pandemic. In early April, before cases in Galax even began to crest, Vaughan-Bassett temporarily stopped operations in response to a dramatic decrease in demand for furniture and to comply with the state’s stay-at-home order. The result was layoffs. Terri Gillespie, the community impact director for the local nonprofit Rooftop of Virginia, said her agency saw an influx in requests for assistance with rent and utility payments.

“That really hit our community hard,” she added. Even Rooftop had to temporarily lay off its weatherization workers after it stopped sending them into private homes. Hillsville, a town in neighboring Carroll County, has already been forced to cancel a Labor Day flea market and gun show that typically brings hundreds of thousands of visitors to the community. 

Some worry that Galax’s smaller businesses will never recover. And many residents said the financial hit — delivered before the city recorded a single case of the virus — helped fuel lasting skepticism over the executive orders coming from Richmond.

“I think some people have just gotten to the point where they’re done,” Gillespie said. “They’ve gotten to the point where they’re like, ‘I’m just going to live my life.’”

“I wanted them to keep everything open,” she said, referencing early calls to remove the restrictions in Southwest Virginia before the rest of the state. “With education and proper practices. But our median income around here is like $39,000. When you’re closing businesses, that’s people’s livelihood.”

Among many officials, there’s also a longstanding perception that Southwest Virginia is overlooked by the rest of the state. It was felt even more acutely after Galax was initially left out of a pilot program that distributed protective equipment, hand sanitizer, and educational materials to low-income and high-risk communities across Virginia. Republican state Del. Israel O’Quinn, R-Washington, said he had to make a special request to the governor’s office to include Galax in the program, spearheaded by the governor’s Health Equity Working Group. Supplies did start flowing into the city, but they didn’t fully quash the sense that at a critical point for the community, Galax was left alone.

“When you put it on a per-capita basis, our cases were up there,” Cox said. “Top 10, top five. We’ve been number one per capita in cases and fatalities. So, we kind of felt like we needed that extra attention here.”

With limited community buy-in, though, health officials had to beseech businesses to enforce the governor’s mask order. “Galax has the highest rate of new COVID-19 infections in Virginia,” Shelton wrote in a June 26 statement to residents. “On July 1, the Governor plans to move Virginia into Phase 3 of Forward Virginia. The only way we can continue to make progress in this plan is to prevent disease transmission, and the ways we do this are to wear a mask in public, practice physical distancing, wash hands, and stay home when sick.”

On social media, Gillespie saw friends celebrating weddings, birthday parties, and even unofficial proms as the stay-at-home order remained in place. But as numbers rose, it became clear the area was far from an isolated rural corner. Shelton said cases throughout southwestern region have been driven by summer travel and recent spikes in neighboring Tennessee and North Carolina, where the official state borders blur almost indistinguishably with Virginia. More than half of the city’s deaths are linked to one of the local nursing homes, Galax Health and Rehab, where the virus entered through an infected contract worker.

Moving forward

Tammy Eichner, the facility’s director of nursing, said she hoped the coverage of the outbreak helped make the COVID-19 pandemic tangible to the community. She was forced to stay home for two weeks in June when she caught the virus caring for patients. When she got back, she wrote an editorial in the local Galax Gazette defending how she and her coworkers managed the surge in cases.

“We had tried so hard,” she said. “I know my staff had done everything in their power to keep it out. We were screening people, we were sanitizing. We had all our doctors doing telework. It was like Fort Knox.” A June survey conducted by VDH’s licensing division found no deficiencies in the facility’s response.

For the past few weeks, she and Gillespie said there’s been a noticeable increase in the number of residents wearing masks. Cases in Galax are also steadily improving. Since the city’s peak in mid-June, new cases have slowed to less than 10 a day since the beginning of August. On Monday, the police department reported there were currently only six active cases left in the community.

Still, there’s not a unified consensus on how to move forward. School reopening remains a particularly contentious debate, Shelton said. Parents have the option of virtual learning, but Galax City Public Schools still plan to reopen in-person for a full five-day week. Emory & Henry, a nearby college, will also resume classes on August 17. 

“It’s very controversial right now,” she added. “A month ago, there was pretty much no question. But with the month of July” — when many neighboring counties began to see their own spike in cases — “that has changed everything.”

The same is true in the community, Eichener said. “The people who do take it seriously, you can tell they do take it 100 percent seriously,” she added. “If you see them out, you see them with their masks on.”

“But just the other day, I had to run out to Food City” — the local grocery store — “and I saw a woman storm out with her two children because they told her she had to wear a mask,” Eichener continued. “It’s still very much 50/50.”