With COVID-19, rural testing deserts should be our immediate priority

With COVID-19, rural testing deserts should be our immediate priority
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Whether you call what’s happening across America right now the second wave of COVID-19, or an unfinished first, one thing is certain: not all communities are impacted by the virus in the same way. A community in Monroe County, Ala., for example, which has large swaths of poverty and people with pre-existing illnesses, may suffer more lasting economic damage from a COVID-19 outbreak than a similar-sized community in San Juan County, Wash., where residents’ economic security and employment is more stable.

Or a community in Lincoln County, Ark. — with spotty health system capacity, less access to transportation, and more crowded households — would have a harder time coping than Kent County, Md., where people have better housing and transit options, and hospitals are more prepared.

All of these elements contribute to vulnerability, a term we define as a community’s ability to weather a COVID-19 outbreak based on a number of structural, socioeconomic, and health-related factors. This notion of vulnerability is such an important factor to consider in response efforts that the CDC now features our COVID-19 Community Vulnerability Index as a resource for federal, state, and local responders.


And these days, while we’re hearing more about how the virus is infiltrating rural communities, we aren’t hearing enough about the most vulnerable of these areas — the little towns hit hard by hospital shutdowns, diseases of despair, or record unemployment. Imagine a COVID-19 outbreak compounding this mix of problems in a rural town. This is exactly what’s happening across pockets of rural America.

While 15 percent of America’s urban population lives in counties we’ve deemed “highly vulnerable” to COVID-19, more than a third (41 percent) of America’s rural population does. The scale-up of COVID-19 testing in these counties has also been inadequate — and shows yet another dimension of racial disparities. 

Of the entire rural population with no access to a COVID-19 testing site, 8.5 million people live in highly vulnerable rural communities. More than a quarter (34 percent) of this population in testing deserts live in four states: Kentucky, Mississippi, North Carolina, and Arkansas. And rural Black Americans are 1.7 times more likely to live in these testing deserts and nearly three times more likely to live in a vulnerable testing desert than other rural Americans.

These are the places where we should focus the next front in our fight against COVID-19. But how do we start?

Admittedly, the very issues that make any community vulnerable present challenges that won’t be easily be solved. We see many facets of this vulnerability in the counties that ranked highest on our list of the 20 rural testing deserts hit hardest by COVID-19.  


In the top county on our list — Terrell County, Ga. — socioeconomic and healthcare system factors are the driving factors of vulnerability, while in Northampton County, Va.— second on our list — vulnerability is derived primarily from greater minority and non-English speaking populations and access to housing and transportation.

Addressing those broad, systemic issues that contribute to vulnerability is important, but that takes time we just don’t have. Right now, we must focus on emergency solutions we can implement quickly: allocating our limited resources on “high-vulnerability” rural areas where COVID-19 prevalence is low but could increase quickly.

As we explained in a recent white paper to Congress, ramping up testing, contact tracing and social isolation (TTSI) is highly vulnerable areas that have yet to be hit hard by the virus will save lives and keep COVID-19 from exploding in areas that can’t afford for that to happen. 

We also know, based on analyses we’ve conducted of Americans’ assessment of COVID-19 risk and social distancing behavior, that people in these highly vulnerable rural areas tend to be more politically conservative, less likely to see themselves as at-risk and do less social distancing. In these areas, we must supplement our TTSI strategy by encouraging more responsible communications from local officials we know residents trust — in other words, no more fights about, or shaming people for, wearing masks. 

While urban areas, when considered per capita, still have more COVID-19 cases and deaths than rural areas, the pattern we are seeing in rural America is troubling. With vulnerable rural counties now seeing as many new cases per week as urban America, the damage inflicted on these communities will be devastating. We must immediately prioritize rural testing deserts. We can’t afford to ignore the best tool we have in our arsenal — speed. If we fail now, it’s a clear sign that we have not learned from our early mistakes.

Dr. Sema Sgaier is co-founder and executive director of Surgo Foundation and adjunct assistant professor at the Harvard T.H. Chan School of Public Health.