The South is deeply conservative and widely impoverished — especially the Deep South. That combination could portend awful consequences for us as the spread of the new coronavirus, now officially a pandemic, accelerates.

The confluence of reactionary politics and an impoverished population will exacerbate the already frightening consequences of COVID-19. For one thing, many of the white voters of this region are not only diehard supporters of President Donald J. Trump, but they are also a dedicated audience for right-wing news outlets such as Fox News, whose hosts have repeatedly downplayed the seriousness of the virus.

Following Trump’s lead, conservative talk show hosts have told their listeners that the coronavirus is a “hoax” concocted by the “liberal media” to bring down his presidency. Even after Anthony Fauci, the highly respected head of the National Institute of Allergy and Infectious Diseases, testified before Congress about the lethality of the virus, Rush Limbaugh told his radio audience, “This coronavirus … all of this panic is just not warranted. This … virus is the common cold.” That means local leaders in this region will be ill-equipped to order shutdowns of mass gatherings or to urge the social distancing measures that are necessary.

But it also means we have a population dependent on hourly wages who are reluctant to stay home even if they have a fever. Further, it means that many of the sick will not have access to the medical care they will need. The ultraconservative governors and state legislatures that control this region have refused — just refused — to expand Medicaid, even though the federal government picks up most of the tab as one of the provisions of the Affordable Care Act.

(Perhaps political scientists even now are writing books about this utterly catastrophic and inexplicable rejection. I do hope so because I can think of no rational reason for this behavior except that Republicans are determined to portray Obamacare as a failure. Among Southern states, only Louisiana, Arkansas and Kentucky have expanded Medicaid, and two of those have Democratic governors.)

Traditional Medicaid covers poor children, impoverished pregnant women, poor senior citizens and the poor disabled. The Medicaid expansion, significantly, covers low-income able-bodied adults, including many men and women who work every day but can’t afford health insurance. Think of short-order cooks, restaurant wait staff, housecleaners, painters and even owners of small businesses such as pool-cleaning or plumbing. Sure, they can go to an emergency room, but those will become increasingly overwhelmed when the virus spreads through the region, as it surely will.

Oh, wait! What if the town they live in doesn’t have a hospital? Hospitals across the rural South — in rural areas across the nation, actually — have been shutting down because they cannot afford to stay open. They have been losing money for decades because so many of their patients are uninsured or underinsured.

The Medicaid expansion threw many of those hospitals a lifeline. But not here in my home state. Not in Georgia or Mississippi or Tennessee or South Carolina. Rural hospitals in those states continue to shut down. Last year, GQ reported that 106 rural hospitals had shut down across the country since 2010. Seventy-seven of those “were in deep red states where local politicians refused the Obama administration’s Medicaid expansion,” GQ said. More hospitals have likely closed since then.

Public health officials have already stated that the nation’s health care system could easily be overwhelmed by the virus as hospital beds are filled, all ventilators are in use and, of course, some nurses, doctors and other medical staff get sick. Patients in towns where hospitals have been shuttered will swamp already-overburdened facilities in larger cities.

House Democrats have put together an emergency aid package that includes funding to pay for coronavirus tests for those without insurance and paid sick leave for workers whose employers don’t provide it. Guess what? Republicans have already criticized it. (So, they want sick food service employees to show up for work?)

Republican Senators Lindsey Graham of South Carolina, Richard Shelby of Alabama and Cindy Hyde-Smith of Mississippi could tell their leader, Mitch McConnell (whose Kentucky constituents have access to Medicaid, thanks to a Democratic governor), to get on board with the aid package because their constituents need the assistance. But I’m not gonna hold my breath.