Covid-19’s New Surge Across Rural America

Crowd not social distancing in Alamance County, North Carolina, on Saturday.

Back in early April Alabama governor Kay Ivey said the following: “Y’all, we are not Louisiana, we are not New York state, we are not California,” she said, suggesting that the fate of hard-hit parts of the country would not be shared by Alabama.  Now, Alabama's Capital, Montgomery, has so many covid-19 cases that the infected are being sent to Birmingham since Montgomery lacks sufficient hospital capacity.  Ivey represents the mind-set of far too many residents of rural areas and red states that almost seemed to take glee as the pandemic hit New York City and other large urban areas especially hard,  Now, the pandemic is moving into the very same rural areas and red states, many of which are woefully unprepared and lack hospitals and medical personnel to deal with the crisis.   A piece in the Washington Post looks at the situation, noting that the pandemic "has taken hold in counties where residents flout social distancing guidelines or believe the pandemic to be exaggerated, the virus’s lethality a myth spread by President Trump’s political foes and a liberal media."  Here are article highlights:

The novel coronavirus arrived in an Indiana farm town mid-planting season and took root faster than the fields of seed corn, infecting hundreds and killing dozens. It tore though a pork processing plant and spread outward in a desolate stretch of the Oklahoma Panhandle. And in Colorado’s sparsely populated eastern plains, the virus erupted in a nursing home and a pair of factories, burning through the crowded quarters of immigrant workers and a vulnerable elderly population.

As the death toll nears 100,000, the disease caused by the virus has made a fundamental shift in who it touches and where it reaches in America, according to a Washington Post analysis of case data and interviews with public health professionals in several states. The pandemic that first struck in major metropolises is now increasingly finding its front line in the country’s rural areas; counties with acres of farmland, cramped meatpacking plants, out-of-the-way prisons and few hospital beds.

In these areas, where 60 million Americans live, populations are poorer, older and more prone to health problems such as diabetes and obesity than those of urban areas. They include immigrants and the undocumented — the “essential” workers who have kept the country’s sprawling food industry running, but who rarely have the luxury of taking time off for illness.

Rural counties now have some of the highest rates of covid-19 cases and deaths in the country, topping even the hardest-hit New York City boroughs and signaling a new phase of the pandemic — one of halting, scattered outbreaks that could devastate still more of America’s most vulnerable towns as states lift stay-at-home orders.

In many of those places, where the health-care system is already stretched thin, even a minor surge in patients is enough to overwhelm.

Where and when hot spots arise in America’s most isolated counties is, in part, a matter of chance. But crowded spaces, and populations with poor access to health care, quickly facilitate the spread.

Of the 25 rural counties with the highest per capita case rates, 20 have a meatpacking plant or prison where the virus took hold and spread with abandon, then leaped into the community when workers took it home.

It has taken hold in counties where residents flout social distancing guidelines or believe the pandemic to be exaggerated, the virus’s lethality a myth spread by President Trump’s political foes and a liberal media.

“We’ve got a little bit of everything: folks who feel their rights have been taken away because they’ve been asked to stay home and they lost jobs and they’re really hurting, and we have folks who are very concerned and frightened and won’t leave their house,” said Rebecca Burns, a health officer for the agency that covers Hillsdale County, Mich., which last month topped the state for the highest death toll among rural counties, after a nursing home outbreak. . . . . We have to continue to watch,” Burns added, during a week when members of a conservative militia stood outside a Hillsdale County barbershop, brandishing guns to “protect” its reopening, in defiance of the governor’s orders. “Anyone who thinks this is one and done is probably wrong,” she said.

Lim also fears the outbreak is facilitated by people in the conservative farming community not following preventive measures.  “If you go to the local Walmart, I would say 10 percent of people are wearing masks, and the restaurants … that are open are packed,” Lim said. “I’m a registered Republican, by the way,” he added. “But [people] don’t seem to know the science behind it. Even though they see the news, they just think it’s all overblown.”

To epidemiologists and physicians, this checkerboard spread was all very predictable. It was never a question of whether the virus would hit rural America, but when.

Early on, two warning signals blared from opposite sides of the country.

In Blaine County, Idaho, population 2,200, an outbreak spurred by the annual influx of wealthy tourists seeking ski slopes turned the resort region into one of the first rural hot spots. The infection rate soared and was, at one point in late March, the highest in the nation.

That same month, more than 2,000 miles away, the virus began its siege on southwest Georgia. Most believe it was introduced at a well-attended Dougherty County funeral, an event that soon led to many more funerals. From Albany, the county seat and a regional hub, infections radiated to neighboring locales with ferocious intensity.

Health officials have estimated that urban areas have more than twice the number of physicians per capita as rural areas and more than 8.5 times the number of specialists.

And in many more regions, there are no hospitals for hundreds of miles, the result of closures amid crushing financial pressures. Since 2010, 130 rural hospitals have shut their doors, according to an ongoing study from the University of North Carolina.