Coronavirus cases expanding in states preparing to reopen

New coronavirus hot spots are emerging in rural and non-metropolitan counties across the country, including many states that are taking steps to slowly reopen their economies after weeks of stay-at-home orders.

A new analysis by Brookings Institution demographer William Frey shows two-thirds of Americans live in counties with a high prevalence of coronavirus spread, where more than 100 cases have been diagnosed per every 100,000 residents.

The analysis illustrates the spread of the virus from early epicenters in New York, Seattle, New Orleans and Albany, Ga., into neighboring and more sparsely populated areas, both inside state boundaries and across state lines.

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"There is no doubt that COVID-19 has made its impact felt in 'red states,' especially over the past three weeks," Frey wrote. The fastest spreads through Midwestern and Southern states have come in largely smaller counties, he told The Hill in an email.

More than 40 percent of the population in 39 states live in counties with high prevalence of the coronavirus, such as Arizona, Nebraska, Oklahoma and South Dakota, where the virus has only begun to take a serious toll. More than 45 percent of the new high prevalence counties are in Western states, and 38 percent are in the South.

Arizona began allowing retail stores to do in-person business last week. Restaurants will open for dine-in service on Monday, though the state’s stay-at-home order remains partially in effect until Friday.

Oklahoma Gov. Kevin Stitt (R) allowed the first businesses to open April 24, and restaurants, movie theaters and gyms were allowed to reopen May 1.

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Neither Nebraska nor South Dakota issued stay-at-home orders, but Nebraska allowed limited retail and restaurant sales starting May 4.

Just 2.3 percent of newly high prevalence counties are in the Northeast, in part a reflection of just how hard that region was hit by the virus at the outset. At the end of March, 83 percent of high prevalence counties were in Northeastern states.

Of the 25 counties experiencing the highest per capita growth rates in confirmed cases, just one — Stearns County in Minnesota — has a population larger than 100,000. Eleven of those 25 counties have populations under 10,000, and 12 have populations smaller than 50,000.

The coronavirus's spread into smaller areas has long been a concern of epidemiologists tracking the pandemic. While big cities like New York, Boston and Seattle have been able to ramp up hospital capacity to bolster their health systems, rural areas do not have that capability, leading to worries that those health systems might be overwhelmed if they're hit with a flood of new patients.

"A greater expansion into smaller towns with fewer hospitals or medical professionals is of high concern, as is the impact on less-well-off white and racial minority populations, especially those with preexisting conditions," Frey wrote.

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Residents of those areas, too, are most likely to be on the move. Data from the University of Maryland shows fewer than a quarter of residents are staying home on a daily basis in states like Alabama, Iowa, North Carolina, Oklahoma and South Dakota — all areas where the virus is newly prevalent in both rural and exurban counties.

Texas has seen an increase in cases across its diverse landscape, from Chambers and Montgomery counties in the Houston suburbs to Fort Worth's Denton County, from tiny Wheeler and Hansford counties in the northern panhandle to Cameron County and El Paso County on the Mexican border. Texas has reported more than 1,000 new cases of the coronavirus in each of the last three days, even as the state begins reopening for business.

North Carolina has experienced a significant spread through suburban counties outside of Charlotte, in Davidson County just south of Winston-Salem and in Nash and Halifax counties outside of Raleigh.

Even in states like California, where lockdown orders remain in effect, the virus is expanding to new areas. The coronavirus is spreading widely in both large metropolitan areas like San Diego and Oakland and in more agriculture-heavy regions in the Inland Empire like San Bernardino and Kern counties.

Counties that voted for President TrumpDonald John TrumpDemocrat calls on White House to withdraw ambassador to Belarus nominee TikTok collected data from mobile devices to track Android users: report Peterson wins Minnesota House primary in crucial swing district MORE in 2016 were more likely to see new influxes of coronavirus cases in the past week, underscoring the power Trump could wield if he used the bully pulpit of the White House to warn residents of the impending spread of the virus.

Those residents are the most likely to be chafing under stay-at-home orders, after going weeks without seeing significant viral spread in their areas. But they are now growing increasingly at risk, even as Trump pushes governors and local officials to allow more businesses to resume normal or at least reduced operations.

Map of coronavirus spread by county courtesy of the Brookings Institution.