For the past year, we’ve heard the insistence that one of the best ways to mitigate COVID-19 is to practice “social distancing” and stay home. And across the littlest dots on any map — the rural hometowns and counties with populations well below the national average — citizens are experts in this regard.
Often situated safely in isolated tractor cabs with only occasional nights out to the local Dollar General, it should seem rural America didn’t have as much to worry about the spread of COVID — or was that ever the case?
“While COVID-19 took longer to reach many rural communities, once it reached them, it was harder to control,” Dr. Carrie Henning-Smith tells AGDAILY.
Henning-Smith is an Associate Professor in the Division of Health Policy and Management and the Deputy Director of the University of Minnesota Rural Health Research Center (both are in the University of Minnesota School of Public Health). Her research focuses specifically on rural health, health policy, and health equity.
Henning-Smith attributes many factors to the differences in rural America, including, on average, an older population — especially when compared with urban areas — more underlying health conditions and limited access to care, especially specialty care and ICU beds. Additionally, residents of color, lower income families and individuals, and the many essential workers all residing in rural locations are especially at risk.
As they say, the proof is in the pudding. It didn’t take too long for cases in rural America to soar in 2020. The spurt even made headlines in The New York Times filled with familiar stories of now-overrun rural hospitals and highly infected towns who all thought it wouldn’t happen to them.
Now, with 2021 under way and a few new pandemic weapons in the pocket, rural areas are certainly on the radar for aid. But will it be enough?
It hits here, too
It’s no surprise from the earliest onset, COVID cases skyrocketed in urban, densely populated areas. Look no further than New York City.
“Initially, it took a while for the virus to take hold in rural communities,” says Dr. Chris Huffer, a pulmonologist and fourth-generation farmer from rural Carroll County, Indiana.
He provides his brother, also a farmer, as a prime example spending much of his time “socially distanced” on the farm.
“He didn’t even know anybody that had COVID until June,” he explains. “But COVID has gotten here, and we’re seeing lots of patients from rural communities.”
As the months rolled by and we got deeper into 2020, multiple reports came in citing the surprising acceleration of COVID reports in non-urban areas. In one analysis, the higher per capita rates were in these communities — with infection in about 18 of every 1,000 individuals, compared with 12 per 1,000 in urban areas.
While populations may be smaller, rural citizens are still doing all the same activities as their urban counterparts, such as grocery shopping and attending social activities (even if on a limited basis).
According to many sources, the pandemic was also responsible for a bit of a migration with city dwellers taking refuge in their second country homes or selling and moving to more remote locations.
Lots of individuals and families erroneously saw this as a way to “escape” the pandemic. Instead, it appears it helped to broaden the virus’s footprint. Additionally, more businesses opting to allow employees to permanently work remotely played a big role in this geographical shift of COVID hotspots.
“Movement between rural and urban locations certainly contributed to the spread,” says Henning-Smith. “It’s difficult to quantify this effect exactly, though, because we aren’t always able to track exactly where people contracted COVID-19.”
For example, she says an urban resident may have vacationed in or visited a rural area and unknowingly spread the virus. Afterwards, they may have been tested and treated in an urban area, masking the overall impact of urban-to-rural spread.
Huffer notes his county of just 20,000 people recently went “code red” with a surge of cases. Many other rural areas can relate. In fact, Alabama’s surge received special coverage by ABC News with over 4,700 dead and hospitals at well over 100 percent capacity.
In the remote sprawl that is far West Texas, the Times reported the Big Bend region as being “one of the fastest-growing coronavirus hot spots in the nation.” The article noted Brewster County, home to only 9,2000 people across 6,000 square miles, had over 700 known cases. Similarly, Presidio County, with only 6,700 residents, quadrupled in cases in just two months, jumping from 100 to over 470. As is the case with many rural communities, both counties have a sizeable population over the age of 65.
Ford County Kansas, home of Dodge City with only 27,000 total residents, also made headlines as over 1 in 10 residents contracted the virus, with cases jumping as high as 54 percent more within a week’s time.
Consider Galt, Calif., one of Sacramento County’s smallest cities, had an 87 percent increase in cases in a month’s time and at least 19 deaths.
So, why have there been jumps in towns like these?
“There are particular barriers to rural residents working and learning from home, including some of the types of occupations in rural areas and limited access to broadband Internet,” says Henning-Smith, noting this made it difficult for people to self-isolate. “There was also unclear leadership and messaging at the federal and state levels about the severity of COVID-19, and prevention activities (e.g., mask wearing) became politically charged, which led to additional spread in some rural areas.”
Specific numbers and percentages aside, rural communities are always at some healthcare disadvantages compared to their urban counterparts, even sans-pandemic.
A good portion of rural America qualifies as being a “hospital desert.” In fact, 5 percent of rural hospitals have shut down since 2010, making 16 percent of mainland U.S. citizens 30 miles or more from the nearest hospital.
The pandemic situation has pushed remaining hospitals to their max capacities and strained their resources. This also presents some challenges for vaccine distribution even for people who want to opt in.
The vaccination considerations
One of the biggest pandemic game changers this year is having a vaccine at our disposal. To distribute their vaccines effectively, Huffer explains that the U.S. Centers for Disease Control and Prevention have established a three-phase protocol to distribute vaccines.
The first phase includes healthcare workers, nursing homes and “essential workers.” Huffer notes the CDC is nonspecific in that last regard, but it does include food service and agriculture employees. His hospital receives a certain number of shipments from Pfizer each week, about 2,000 vaccinations each time, to distribute according to their protocols.
Even if vaccine demand in rural America is strong, which health professionals hope for, there are still some accessibility roadblocks. The touchy nature of the vaccine doses (which need to be stored between -112 and -76 degrees Fahrenheit) means they need to be received by facilities that can store them in very cold temperatures. This inhibits some hospitals that don’t have the room or the means to store them, such as in Texas, where certain rural hospitals were excluded from any shipments due to this issue.
People living in hospital deserts also face the challenge of having to go to clinics to receive their vaccines. This can be an issue in areas where there are little to no public transportation options, especially when it comes to the elderly and other at-risk adults.
The next few months will be very telling about how the rest of the year will progress. The vaccine is certainly a considerable factor, but simply having it available is a far cry from a silver bullet solution.
Part of the vaccine’s effectiveness depends on how it is accepted or rejected in rural America. While many remain undecided and/or curious, hesitancy is higher in rural communities at 35 percent, compared with 27 percent of the general public.
As more vaccines are distributed and time goes by, greater acceptance may likely follow. But of course, there are out of human control concerns such as viral mutations, new strains, and developing resistance.
Having a whole year of pandemic experience under out belts, there are worthy reasons to be cautiously optimistic this year. Nevertheless, rural communities are encouraged to pay attention to state and county health alerts and remain vigilant.
The unfortunate truth is our hometowns, small though they may be, aren’t immune.
Jaclyn Krymowski is a recent graduate of The Ohio State University with a major in animal industries and minor in agriculture communications. She is an enthusiastic “agvocate,” professional freelance writer, and blogs at the-herdbook.com.