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Late to shut down, first to reopen, Georgia reports its highest daily death toll - USA TODAY

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It wasn’t easy for Jenny Hunter to send her kids back to school this fall, but she knew it was the better of two impossible choices for her family.

"I’m well aware of the clinical risks for children," Hunter, a nurse and mother of two in Cherokee County, just outside Atlanta, told USA TODAY on Wednesday afternoon. "I'm not a teacher, and neither is my husband. I felt the benefit versus the risk was better to get them in person for their education."

Minutes after hanging up, Hunter received a text from her son: His high school would be temporarily closing for two weeks after 14 students tested positive for the coronavirus.

"I was not surprised at all," Hunter said. "My son was saying how low in volume some of his classes were throughout the day because of kids getting quarantined. It was becoming a question of when, not if."

More than 1,600 students and staff are in quarantine this week as cases rise in Georgia – a state that has received criticism for its inaction and mixed signaling on the coronavirus pandemic.

Among the last states to institute a shelter-in-place order and the first to reopen businesses, Georgia is now seeing a rising number of COVID-19-related deaths. The state reported 136 deaths Tuesday – its most in a single day since the beginning of the pandemic – and another 109 deaths Wednesday, according to the state's department of health.

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Dr. Harry Heiman, a professor at Georgia State University's School of Public Health, said that with high numbers of hospitalizations and full ICUs in regions across the state, the death rate is likely to continue rising.

"Georgia is very much the poster child for what happens when leadership take a hands-off approach to managing a pandemic," Heiman said. "There are clear policies and practices that we know work to control this pandemic. Candidly, we’re not doing any of those things in our state."

Georgia is faring better than some other states, but it isn't trending in the right direction. Georgia has the fifth-most COVID-19 cases (seventh-most per capita) and the fourth-most hospitalizations, behind New York, Florida and New Jersey, according to data from the Centers for Disease Control and Prevention.

The state is the middle of the pack when it comes to coronavirus testing per capita and has conducted nearly 1.9 million tests. About 10% of those tests are coming back positive, meaning that Georgia is among the 36 states that don’t meet the World Health Organization's recommended 5% average positivity rate to reopen businesses.

Ben Lopman, a professor of epidemiology at the Emory University Rollins School of Public Health, said the state's approach has been "cavalier."

"We’ve had mixed messages about masks, with the governor trying to stop local leaders like Atlanta’s mayor from putting in a mandate," Lopman said. "The effort to control transmission in the community has been weak, so it’s not safe to open schools. Students, along with teachers and parents, have been put in a terrible position because of the state’s inaction."

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After declaring a statewide public health emergency in March, Georgia Gov. Brian Kemp signed a shelter-in-place order at the beginning of April. The order loosened some restrictions that cities and counties had put in place to fight the spread of the coronavirus, angering some local officials.

The mayor of Tybee Island, a small coastal city near Savannah, called the decision a "reckless mandate" that put the town's residents and visitors at risk. "As the Pentagon ordered 100,000 body bags to store the corpses of Americans killed by the coronavirus, Gov. Brian Kemp dictated that Georgia beaches must reopen, and declared any decision-makers who refused to follow these orders would face prison and/or fines," Mayor Shirley Sessions said at the time.

Local officials said they were blindsided again weeks later when Kemp announced plans to reopen some Georgia businesses, including gyms, bowling alleys, and hair and nail salons, despite no evidence of a 14-day downward trend in cases – a metric that was recommended by the White House Coronavirus Task Force. Atlanta Mayor Keisha Lance Bottoms and others criticized the move.

"We really are at a loss and I am concerned as a mother and the mayor of our capital city," Bottoms said at the time. "I am perplexed that we have opened up in this way. ... As I look at the data and as I talk with our public health officials, I don’t see that it’s based on anything that’s logical."

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But some Georgia business owners said they were eager to reopen their doors. At the time, more than 16% of Georgia's workforce had filed for unemployment in the preceding month, and protests against stay-at-home orders were cropping up across the nation.

Cases in Georgia rose steadily from March to mid-June as the nation's epicenter became New York. 

In April, the state set up a temporary hospital at one of the nation's largest convention centers, the Georgia World Congress Center, but wound down operations in May. That month, Kemp announced that summer camps would be allowed to reopen in Georgia, and about 260 people at one overnight summer camp would later test positive for the coronavirus.

New cases in Georgia began to accelerate in mid-June, according to data from the Georgia Department of Public Health. That's when the governor signed two executive orders that extended the state's public health emergency and existing COVID-19 safety measures. 

A month later, as several states were implementing face mask requirements to slow the spread of COVID-19, Kemp signed an executive order prohibiting cities and counties from mandating masks and sued Bottoms and the Atlanta City Council, saying they overstepped their authority by requiring masks. 

Days later, Kemp urged residents to wear masks in public, saying that "it's the community that defeats this virus, not the government."

Dr. Saad Omer, director of the Yale Institute for Global Health and a former 11-year Georgia resident, said he was initially shocked that Georgia would "go out of its way" to prevent local jurisdictions from implementing their own mandates, especially in light of the preponderance of public health experts in the state, which is home to the Centers for Disease Control and Prevention.

"There’s no shortage of expertise here, so that really concerns me," Omer said. "It sends the signal more broadly that these kinds of measures are not just not important, but that you should oppose them."

Some residents may have gotten that message. Since mid-July, the state has been averaging more than 3,000 new cases a day, and Kemp has reopened the temporary hospital in Atlanta. As of Thursday, Georgia was trailing just Florida and Mississippi in the rate of new cases per capita, according to Johns Hopkins University data.

"We have not controlled transmission in the community," Lopman, the Emory epidemiology professor, said. "Without doing that first, in-person schools are going to be the site of outbreaks and will amplify transmission in the wider community." 

Meanwhile, several school districts in Georgia gained national attention last week when photos of maskless students and crowded hallways went viral on social media. Many of those districts are now seeing COVID-19 infections.

As of Thursday, more than 80 students and staff in Cherokee County School District had tested positive for the virus since schools reopened Aug. 3, and nearly 1,400 students and dozens of staff were in quarantine. Nearby Paulding and Gwinnett counties have also seen outbreaks.

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Despite the outbreaks, Kemp said Monday that school reopening was going "well."

"There’s definitely going to be issues when you open anything. We saw that when we opened businesses. We're seeing that when we opened schools," Kemp said at a news conference with U.S. Surgeon General Jerome Adams. "Quite honestly, this week went real well other than a couple of virtual photos."

Health experts say there are clear steps Georgia can take to rein in the outbreak. More than 3,000 health care workers wrote two letters to the governor last month, pleading with him to "revisit" the state's COVID-19 strategy and implement policies recommended by the White House Coronavirus Task Force, such as requiring residents to wear face masks in public, limiting social gatherings to 10 people or fewer, and closing bars and gyms.

"We don’t need a total lockdown, but we need to take some evidence-based steps ... that are aligned with what we know works," Heiman, the Georgia state professor, said. "This is a very manageable pandemic if we would have the kind of leadership we would need at both the national and state level."

Georgia needs to take action now, before colder weather sets in, Omer said.

"Believe it or not, this is the low season for the virus in the sense that the virus is transmitting under suboptimal conditions. The humidity is high. The temperature is high," he said. "When the fall comes ... it will get colder. There will be additional disadvantages and better conditions for transfer."

Moving forward, Jenny Hunter said she'd like to see her kids' schools implement face mask policies. Hunter said she encourages her kids to wear their masks but isn't there to control it at school.

"They manage dress codes every day in schools. Girls can't wear a shirt that's not 3 inches wide. Why this couldn’t be mandated, particularly with the older kids, I don’t get," she said. "If you don’t think masks do anything, please let your surgeon know next time you roll into an OR, and they won’t have to wear theirs."

Contributing: Wyatte Grantham-Philips

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