Rural areas safer than cities – but not ‘safe’

Bill Knight column for Monday, Tuesday or Wednesday, 4-6, 7 or 8, 2020

The coronavirus COVID-19 is spreading like an untended grassfire, inadequate testing means the number of cases is unclear, and attempts to slow the outbreak struggle to make a difference. So it’s difficult to keep up.

In early March, Liz Carey of the Center for Rural Strategies wrote, “Researchers say rural areas face less risk of coronavirus,” which noted how proximity puts people at risk – a reason social distancing is important, even in small towns where folks are used to going to churches, school activities and taverns. Carey’s story was accurate – then.

Now, new information requires new caution: People in rural areas are generally less vulnerable to the virus, but we’re not protected, much less immune.

The Center on March 24 reported, “So far, nonmetropolitan counties [counties with no city of 50,000 or more] account for only 3% of the total cases.”

“Only” is a loaded word since that statistic means that more than 3,000 rural Americans have become infected, according to Johns Hopkins Center for Systems, Science and Engineering, whose data base said U.S. cases as of midday Friday topped 245,000 (with more than 6,000 deaths). Illinois reported almost 8,000 cases.

Cities are still the “hot spots” for the virus, said Matt Boyce, a researcher at the Center for Global Health Science and Security at Georgetown University.

“Travel to and between cities has played a major role in how this outbreak has spread, but that said, the disease can still spread to rural areas,” he said.

Comparing the number of cases per million people (on March 23), Medium metro areas (250,000-999,999 people) and Small metros (50,000-249,999) had lower rates than big cities – 48.8/million and 42.8/million, respectively, where Major metros were 202.4/million. But statistically, rural areas aren’t that much better off, at 28.4/million.

And it’s worsening.

Between March 26 and 30, deaths from COVID-19 went up 128% nationwide, but more than doubled in rural counties (217%) over the same five days, according to USAfacts.org, a nonprofit news site tracking the coronavirus by compiling government data from more than 70 sources. It says pandemic cases have spread to 941 out of 1,977 rural counties, almost half.

There are dire factors beyond transmission.

“It is important to consider how rural areas may be differently affected,” said sociologist Shannon Monnat from Syracuse University. “Rural parts of the U.S. may be comparatively better off than urban places due to lower population density. On the other hand, there are several features of rural populations and places that increase their risk.”

Those include rural America’s older population, the prevalence of serious health conditions, a health-care infrastructure not as strong as cities’, and economies vulnerable to crises.

The Centers for Disease Control says that about 80% of COVID-19 deaths have been among adults 65 years old and older.

“This is bad news for rural America,” Monnat said. “The average share of the population that is age 65+ is 21.7% in the smallest nonmetropolitan counties.”

Experts say people with underlying medical ailments are at greater risk, and rural Americans have higher incidences of such disorders – respiratory disease, diabetes, heart disease and lung cancer – than city-dwellers.

“This means that although transmission rates may be lower in rural areas, the percentage of cases resulting in death and other serious complications could be higher in rural than in urban areas,” Monnat said.

Also, there are fewer rural hospitals, and the Associated Press reported 51,000 Intensive Care Unit beds in urban counties but 5,600 in rural areas – less than 1% in areas where 19% of Americans live.

Lastly, the virus hitting rural areas – whether the stricken have stayed at home or worked in farm fields (agriculture is an “essential service” under Ill. Gov. J.B. Pritzker’s “shelter-in-place” order) – could ripple over the continent, including urban neighbors.

“Rural America supplies disproportionate shares of the nation’s food, energy, military personnel and natural recreation – these are resources urban America depends upon,” Monnat said. “Rural, urban or somewhere between – we are all in this together.”