ROCKY MOUNT — Her mom had been gone for more than a month, and Kendra Ward still hadn't been by the cemetery. For now the thought of that was too much. She wasn't ready to see the grave, or to confront the finality.
Annie Pearl Wiggins — everyone called her Ms. Pearl — died on Oct. 28. For almost 40 years she'd run a salon out of the back of her house and, though she was 68 and slowed by underlying health conditions, she'd worked almost right up until she became sick with COVID-19.
When Ward and her siblings were young they'd sit in the salon while their mom worked. She was theirs but also belonged to the neighborhood. Everyone knew Ms. Pearl. Sometimes Ward and her brother and sister gained wisdom and other times they tested their mother's patience.
"One thing she didn't like was for us to spin around in her chairs," Ward, 43, said on Wednesday, standing outside the salon and the house where she'd grown up in Rocky Mount. Now, those chairs had been donated, and the salon was mostly empty except for a few things.
There was still an old gumball machine near the corner, and her mom's Marcel curling iron set on the counter. She'd had that for as long as she'd been working, and though Ward thought about bringing it home with her she figured it belonged where her mom had left it.
"She used that every single day," Ward said. More than a month later, her grief hadn't abated.
She hadn't visited the cemetery and she hadn't attended the funeral, either, because Ward had also contracted the virus. She has "recovered" now, after testing negative, but still felt the effects. Bouts of difficulty breathing. Gastrointestinal problems. Ward figured she caught it from her mom, before she knew her mother had it. And yet where her mom had contracted it, no one could know.
"She took every precaution," Ward said. "When I came in to clean up her things, I saw gloves, I saw Lysol wipes. Hand sanitizer. She even had masks at the door, for a dollar, that she was selling for someone else."
Now all that was left were the memories and the reminders, like the mirrors and the curling irons and the price list on the wall: $40 for a shampoo and style; $15 for treatments. There was a table nearby, and on top of it a local newspaper from earlier this week was half-unrolled. If the salon still had customers, they could've read one of the headlines on the front page: "Virus cases keep rising across area."
A never-ending count
Before Ms. Pearl Wiggins tested positive for the virus, two of the most important numbers that defined her were 47, the number of years she'd been married, and three, the number of children she'd had. In late October she'd become a number herself, a data point in the grim, never-ending count of COVID-19 victims.
In Nash County, 68 people have died of the virus since Oct. 1. Among North Carolina's 100 counties, only Gaston County (103 deaths), Mecklenburg (99) and Guilford (71) have had more virus deaths since the start of October. Mecklenburg and Guilford are the second- and third-most populated counties in the state. Gaston is 10th. Nash, with a population of about 94,000, is 30th.
Numbers have long played a leading role in the story of the novel coronavirus — the number of positive cases and their percentage among those tested; the number of deaths; the demographic breakdowns distilled into statistics.
North Carolina surpassed 5,000 COVID-19 deaths on Nov. 21. By then, the data had revealed another concerning trend: The virus was taking hold in places where it hadn't been so prevalent.
For the first six months of the pandemic, Nash County, about a 45-minute drive east of Raleigh, was among those places where the threat might not have felt as urgent. Life changed, as it had everywhere, with the closing of schools and the restrictions on businesses. In Rocky Mount, Nash General Hospital, part of the UNC Health Care system, prepared for a surge that never really arrived.
All the while, for months, the numbers weren't as dire as they were in places with bigger cities and more people. Over the past two months, though, Nash has become representative of a lot of the state's more rural counties: The number of confirmed COVID-19 cases has almost doubled since Oct. 1, from about 2,500 to nearly 4,600, and deaths have increased by more than 150%.
It took almost seven months, from the state's first confirmed case of the virus in March, for 50 people to die of it in Nash County. It took six weeks for the virus to claim its next 50 victims there. Of the state's 15 counties where at least 100 people have died of the virus, Nash has experienced the greatest percentage increase in deaths since Oct. 1.
"That's the easy part, to do the numbers," Bill Hill, who has been the Nash County health director for 42 years, said during a recent phone interview. "It's really hard to accept these deaths and cases, and some are much worse than others.
"The difficult part is trying to analyze it, (and) figure out what's going on in rural areas."
'People don't listen'
Part of what's going on in rural areas is that cases are surging in places where a not-insignificant segment of the population, for whatever reason, has long dismissed the precautions public health officials have urged people to take: wearing a mask and keeping a distance from others, for starters. All anyone needs to do is spend a bit of time in Nash County to encounter the defiance.
The Nashville Diner, about a 15-minute drive from downtown Rocky Mount, is across the street from the Nash County Health Department. Back in March, when the pandemic first brought North Carolina to a halt, the diner quickly became a take-out only operation. A few of the regulars scoffed at the thought of an extended shutdown and predicted things would be back to normal in a matter of weeks.
Nine months later, Tammy and Bob Davis, the owners of the diner, are still serving take-out only for breakfast. For lunch, they allow a limited number inside the dining room, where tables are spaced out and signs on the wall instruct diners to limit their time inside to no more than 20 minutes. The Davises and their staff always wear masks, and they put a sign in the window, on bright neon paper, instructing customers to wear masks inside, too.
Inevitably, though, some people simply ignore the order, like the late-middle-aged man who sat at a table in the center of the dining room on Wednesday, reading the newspaper over his lunch. He didn't wear a mask, he said, because he didn't appreciate the government telling him what to do.
The sentiment was hardly uncommon around here.
"There's a little bit of, 'You're not going to make me wear a mask' kind of mentality, I think," Bob Davis, one of the restaurant owners, said.
Even after living in the area for decades, he still had a difficult time articulating why so many in rural areas refused to do something simple in an effort to slow the spread of the virus.
"Maybe it's a sense of independence. Maybe a sense that we're just not around as many people. I don't know," he said.
It brought to Davis' mind some thoughts about one of the diner's regulars, a woman who was among its most social customers. Even recently, she'd go around, table to table, and strike up conversations. She was older, and had some health problems, and Davis couldn't remember seeing her wear a mask.
Not long ago, she contracted the virus. Her funeral was just last week, Davis said.
"She kind of refused to wear a mask consistently, when it got to be important to wear one," he said. "And I think it kind of caught up with her, sad to say. ... People don't listen."
Down the road a little ways, at the Nashville Walmart, a lap inside the store revealed spotty mask adherence. Masks were required, technically, but 12 people were shopping without one. Among them was Frank Miller, 73.
Asked to share why he wasn't wearing a mask, Miller answered with profane enthusiasm.
"It's a lot of bull (expletive)," he said. "Putting the mask on and breathing, you're breathing your own carbon dioxide, and that's not any good for you. Now, the thing is the only reason why we're doing this is to kill the economy of the little small business. And that's the whole damn thing in a nutshell."
Miller, who was wearing a Trump hat, lived in Spring Hope, in western Nash County. He also cited his health — he'd had two heart attacks — as a reason for not wearing a mask. It made it more difficult for him to breathe, he said, and he'd shown the Walmart greeter, who'd offered him a mask, the small canister of nitroglycerin he kept on his keychain for his heart.
Did anyone in Nash County ever give Miller grief about going maskless?
"No," he said. "Because I'll tell them to go (expletive) themselves."
A few moments later, in something of a non-sequitur, he spoke of his concern for America: "If Biden gets this presidency, you're going to see worse than this. You're going to see a socialist-run country."
'We really need to step up our game'
Miller did not concern himself with contracting the virus, despite living in a county where cases are up 85% over the past two months. The spikes have been more dramatic in a lot of other rural counties. In Madison County, along the Tennessee border, cases have quadrupled in the past two months. In Mitchell and Alexander counties, they've more than tripled. In 29 counties, most all rural, cases have at least doubled from what they were in early October.
On Oct. 1, there were still three North Carolina counties that hadn't had anyone die of the virus. Now there have been victims in all 100. In Greene County, not far from Nash, five people had died of COVID-19 through Oct. 1. Since then, there have been 23 more virus deaths there.
Early last week, several organizations hosted a food giveaway and a free COVID-19 testing event in Greene County. By the time it began at 10 a.m. Thursday, dozens of cars were lined up, waiting. Joy Brock, the county health director, attributed some of the more concerning data points in the county to recent outbreaks at the three correctional institutions there.
Then there was also a sense of general malaise that she was attempting to fight.
"People are tired, I get that," she said. "People in the health care world, we're tired, as well.
"But now is the time that we really need to step up our game and wear our mask properly and hand wash and keep our 6 feet social distance, and only stay with the people that are within our household."
There, like everywhere throughout rural North Carolina, mask adherence proved challenging. Eight months after public health officials began recommending masks to slow the spread, Brock was still spending time attempting to educate people on how to wear one.
"We try to get that education out about it's not just a mask that's covering your mouth," she said. "You've got to wear it properly over your nose and your mouth for it to work."
Burnout, fatigue and the need to be 'on'
Back in Nash County, Nash General Hospital has been preparing since the spring for virus patients to test the hospital's limits. The staff there spent weeks earlier this year converting parts of the hospital into a safer space to treat COVID-19 patients, and then waited for the worst.
It never quite arrived, though the number of patients is rising, Lee Isley, the hospital CEO, said during a recent phone interview. Throughout most of the pandemic, Isley said, the number of COVID-positive patients requiring hospitalization there has remained steady, in the low 20s. In early October, the hospital reached its high point of virus patients, with more than 40 of them — about a third of whom required a bed in the intensive care unit.
"We are beginning to challenge that high point again," Isley said.
The ratios have remained the same, he said: about one-third of virus patients at Nash General require an ICU stay. The others are considered "medically stable." Among the 1,600 employees at Nash General, Isley said, about 85% are defined as "frontline" workers, and those who face the risk of directly interacting with COVID-19 patients. Among the staff, burnout and fatigue are concerns, after months of needing to be "on."
The dynamic is similar beyond the hospital. The most recent projections Isley received had the hospital, which prepared for a capacity of around 80 virus patients, to remain at its current level for the next four to six weeks.
But "we have to be careful with projections," Isley said, "because even the very best of them use retrospective data. And so (they) can't account for things like the holidays, Christmas, Thanksgiving, and individuals becoming fatigued in the community and forgetting and letting their guard down.
"So everyone needs to be mindful, to continue to press forward with CDC recommendations. (COVID) doesn't just impact them, but it impacts their neighbors and their family, their friends."
Searching for 'the magic bullet'
Nash General is in the 27804 ZIP code, which stretches from northwest Rocky Mount and across Interstate 95 and into the town of Red Oak. In the 27804, 62 people have died of COVID-19, according to the most recent data from the state. That's more than in any other ZIP code in North Carolina.
It is the ZIP code with the area's largest hospital, and one with congregate living facilities, like nursing homes, and the 27804 is also where Bill Hill, the county health director, lives. He has been studying the data recently, and trying to figure out what about that ZIP code's population has made it particularly vulnerable. The question has stumped him.
"What is unique about that ZIP code, and deaths," Hill asked, repeating the question to himself. "I can't tell you that more obese people live there, more people with cardiovascular disease live there, more people that are elderly, necessarily, live there. Because I know that area.
"I'm not sure I've got a reasonable explanation. I don't think our citizens are less responsible."
Years ago, Hill served on a state commission that studied North Carolina's troubling record of infant mortality. He said that commission never did identify "the magic bullet" that fully explained why the state's infant mortality rate was among the highest in the country. He has thought about the virus and Nash County in a similar way.
Were people dying at a greater rate there because they were less healthy, in general, relative to other counties? Had the virus hit the elderly population in a way it hadn't elsewhere? Was an overall lack of access to health care to blame?
"I'm not sure if we're going to figure out the magic bullet behind the deaths in Nash County with COVID-19," Hill said. "At least we haven't at this point."
The funeral director's plea
About three years ago, Crystal Matthews-Marrow opened the Matthews Family Mortuary. It is in the 27804 ZIP code, and she did not express much surprise recently to hear that area had the most COVID-19 deaths in the state.
"I have seen a lot of families lose loved ones in regards to this virus," Matthews-Morrow said.
The virus changed everything from the way she planned funerals with surviving family members to the way those services were carried out. Now Matthews-Morrow had to be cognizant of limiting the number of mourners who could attend a service. Now she had to make plans to stream funerals so that loved ones could watch virtually.
Out and about, she took precautions in her own life. She always wore a mask. She avoided restaurants. She hadn't been out shopping in a mall in a long time. Yet living in Nash County, she knew, too, that not everyone took the virus as seriously as she did.
"I just plead with everyone to please take this virus seriously," she said, "because I am in the business where I see families lose loved ones — not able to say their final goodbyes, that are dying alone."
She could tell stories about the consequences, the people who'd been lost, or were now lost without a loved one. A son still mourning his father. A woman who entered the hospital with COVID-19 along with her husband after they'd both tested positive; she'd awoken from a coma only to find out he was already gone.
Matthews-Marrow could talk about Ms. Pearl Wiggins, the beautician with the salon in her house. Ms. Pearl did the hair for about half of Rocky Mount. Her youngest daughter, Kendra Ward, had to watch her mother's funeral over a screen.
"Because of technology, I was able to say goodbye to my mom, through a live stream," Ward said Wednesday outside her mother's house. "Which, it was good, but it also hurts. Who wants to do that? I would have much rather been present."
Behind her, inside, they'd put up a Christmas tree to make the salon look a little more festive.
Outside, Ward considered the question of where her mom contracted the virus. She considered the behavior of people around town who didn't believe they should be bothered to wear a mask.
Ward called it "very irresponsible" and "frustrating" and "heartbreaking to know that people would be selfish enough not to wear a mask, and put others at risk of dying. Not just getting sick. You're talking about death."
It'd been a Saturday morning when her mom asked to go to the hospital. Just the night before she'd asked for a cheeseburger, and Ward thought that meant she was feeling better. Four days later she was gone.
Ward isn't sure when she'd find the strength to visit the grave.
"I wish my mom was here," she said.
News & Observer photographer Robert Willett contributed to this report.