Story at a glance

  • Urban areas, especially in New York, have some of the highest rates of COVID-19 cases and deaths.
  • Some rural counties, however, have more coronavirus cases and deaths per capita.
  • Experts are concerned that rural areas are less prepared to handle the pandemic, leaving its residents vulnerable.

While the initial coronavirus outbreak struck major metropolitan areas in California, Washington and New York, the disease is making its way further out.  


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Randolph County, Ga., has the most COVID-19 deaths per capita — 278 — according to the Kaiser Family Foundation. The nonmetro county has a population of less than 10,000 people and is located in the Black Belt, historically known for its rich, fertile soil and plantations. 

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About 1 in 5 Americans live in rural America, which makes up 97 percent of the country’s land mass, according to the Census Bureau. On average, these areas are older, with higher rates of poverty and unemployment and lower median incomes and rates of insurance. Residents also have lower life expectancy and higher rates of underlying conditions, putting them at higher risk for COVID-19.


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Right now, both overall and per capita numbers of COVID-19 cases are lower in many rural areas compared to urban areas. But while the disease has taken longer to reach these areas, Carrie Henning-Smith, a researcher at the University of Minnesota School of Public Health, warns that rural cases are spiking in some states that are now reopening.   

“As we’re seeing some states decide to loosen their social distancing requirements and start to open up businesses, I worry that those case numbers and their case rates will start to go up in rural areas because they haven’t had the chance to insulate themselves from it,” she said. 

Residents of rural communities often lack reliable broadband internet or cellular connectivity, making telehealth and other Internet services difficult to access and forcing residents to leave their homes for daily necessities. Henning-Smith worries that the late arrival of COVID-19 to these communities might also make them less likely to practice preventative measures. 

“In some rural areas the message hasn’t been communicated clearly enough that everyone is potentially at risk,” she said.

At the same time, these areas also lack critical public health infrastructure. In the last decade, Henning-Smith said 128 rural hospitals have closed, including three since the pandemic began. Rural areas face persistent health care shortages in their workforces and resources, such as ICU beds or ventilators.  

“Structural inequities, be they geographic or racial or economic, they weren’t invented by COVID-19, they're simply being exposed by COVID-19,” Henning-Smith said. “Rural areas already had less access to health care...that’s not getting better, arguably, that’s getting worse.


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Published on May 05, 2020