COVID-19 deaths hit hardest in rural America

COVID-19 deaths hit hardest in rural America
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The fall surge of coronavirus infections and deaths related to COVID-19 has hit hardest in rural areas across the country that had largely been spared the worst of the initial waves in April and June as health care systems in smaller communities struggle to keep up with so much sickness.

A new analysis conducted by the Pew Research Center finds that rural areas that are sparsely populated now account for about twice the number of coronavirus-related deaths as the most densely populated cities. 

An average of three people are dying each day in congressional districts where fewer than 5 percent of residents live in dense concentrations. Districts where more than 40 percent of residents live in urban or dense suburban neighborhoods are suffering an average of 1.5 deaths each day.


That figure is a stark reversal from the first wave of infections, when big cities like New York, Boston, New Orleans and Detroit suffered the brunt of the disease. Between March and May, congressional districts where more than 90 percent of residents lived in urban or dense suburban neighborhoods lost an average of 5.7 people each day, while the most rural districts suffered 1.1 deaths on an average day.

Both the number of deaths and the number of cases is rising fastest in areas President TrumpDonald TrumpPredictions of disaster for Democrats aren't guarantees of midterm failure A review of President Biden's first year on border policy  Hannity after Jan. 6 texted McEnany 'no more stolen election talk' in five-point plan for Trump MORE won in 2020 and Republican congressional candidates carried in 2018. That may be a function of geography — Republicans perform better in rural areas, while Democrats do better in urban cores. It may also indicate that those living in rural areas are less likely to abide by recommendations from health experts to avoid social gatherings.

“We have people that are less likely to take precautions, and [we] have a lot of pandemic fatigue going on,” said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “A lot of people have given up.”

The diffusion, from an urban core rippling out to suburbs, exurbs and then rural areas, is not unexpected. It mirrors familiar patterns that epidemiologists see with seasonal influenza, which might be introduced into and spread rapidly through cities especially with a hub airport and then filter more slowly through less densely populated communities.

The fall surge has infected far more people than the two zeniths prior, and no state has been able to escape record levels of illness and death. More than 1 percent of Americans tested positive for the coronavirus in November alone, according to William Frey, a demographer at the Brookings Institution’s Metropolitan Policy Program — a figure more than twice as high as any prior month.

“The early perception that COVID-19 was only impacting places ‘somewhere else’ — and that adopting measures such as wearing masks, observing social distancing, and eschewing large gatherings need not be followed — is no longer credible,” Frey wrote.

Nearly 300,000 people in America have died of coronavirus-related causes, a toll that far exceeds any other country. Sixteen million people in America have tested positive for the coronavirus, though the true number of infected is likely multiples higher than that.

Epidemiologists and public health experts worry about a surge of cases in rural communities, where health systems are smaller and more likely to be teetering on the brink of financial disaster. In earlier waves that were more concentrated, hospital staff could deploy to the hardest-hit epicenters across the country; now, as the virus spreads uncontrolled everywhere, health care workers are becoming an increasingly scarce commodity.

“You can always create extra beds. We have step-down units, we have post-op recovery units, we have actual surgical suites that can be turned into ICU beds,” said George Rutherford, an epidemiologist at the University of California-San Francisco. “What we don’t have is the staff.”

Many smaller facilities are shipping the most severe coronavirus cases to larger medical centers in nearby urban areas — but even those medical centers are beginning to fill. 


“You’re going to see [rural hospitals] be the canary in the coal mine,” Adalja said. “Many of these bigger hospital systems are being much more rigorous about who they accept for a transfer.”

More than 109,000 people in America are currently hospitalized with the coronavirus, according to the Covid Tracking Project, a group of independent researches. That number has doubled since Election Day.

Frey’s analysis shows the highest per capita case counts happening in non-metropolitan areas, where nearly 18 in every 1,000 people were infected in the month of November. The per capita infection rate in urban cores stood a little below 12 per 1,000. 

Infection rates are the most substantial in rural counties where a higher percentage of residents are minorities, and where more than a quarter of residents live in poverty. In both cases, those counties recorded new per capita case counts far higher than the national average, Frey said.

In the 54 counties where more than 80 percent of residents are Black, Hispanic, Asian American or Native American, infection rates are almost three times higher than the national average. In 226 counties where more than a quarter of residents live below the poverty line, concentrated in nonmetropolitan areas in states like Kentucky, Mississippi, Louisiana, Georgia and Texas, infection rates have been higher than the national average since May.