“Rural Americans are dying of Covid at more than twice the rate of their urban counterparts – a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated.
“While the initial surge of Covid-19 deaths skipped over much of rural America, where roughly 15 percent of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.”
(Lauren Weber. “Covid is killing rural Americans at twice the rate of people in urban areas.” Kaiser Health News. Reported in People. https://people.com/health/covid-is-killing-rural-americans-at-twice-the-rate-of-people-in-urban-areas/ September 30, 2021.)
The study released this month found that the rates of COVID-19 cases and deaths in rural areas have far surpassed those being observed in metropolitan communities, with rural mortality rates more than double that of urban ones.
The study from the Rural Policy Research Institute's (RUPRI) Center for Rural Health Policy found that as the summer ended, the coronavirus infection and mortality rates of rural and urban communities began to diverge.
As of mid-September, metropolitan areas were seeing a seven-day average death rate of 0.41 while rural communities had an average death rate of 0.85.
That means that since the pandemic began, about 1 in 434 rural Americans have died from Covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall Covid death rates since the winter peak, rural mortality rates are now more than double that of urban ones — and accelerating quickly.
“There is a national disconnect between perception and reality when it comes to Covid in rural America. We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public, or among governing officials.”
– Alan Morgan, head of the National Rural Health Association.
It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black or Hispanic people at disproportionately high rates.
What Is Going On In Rural Areas?
Low Vaccination Rates
Vaccinations are the most effective way to prevent Covid infections from turning deadly. Roughly 41 percent of rural America was vaccinated as of September 23, compared with about 53 percent of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates.
High Covid Incidence Rates
Covid incidence rates in September were roughly 54 percent higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-wrote the institute’s report. In 39 states, rural counties had higher rates of Covid than their urban counterparts.
Limited Access To Care
Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.
Since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds.
The nursing shortage hitting the country is particularly dire in rural areas, which have less money than large hospitals to pay the exorbitant fees travel nursing agencies are demanding. And as nursing temp agencies offer hospital staffers more cash to join their teams, many rural nurses are jumping ship.
And then there’s the burnout of working over a year and a half through the pandemic. Audrey Snyder, the immediate past president of the Rural Nurse Organization, said she’s lost count of how many nurses have told her they’re quitting. Those resignations feed into a relentless cycle: As travel nurse companies attract more nurses, the nurses left behind shouldering their work become more burned out – and eventually quit. While this is true at hospitals of all types, the effects in hard-to-staff rural hospitals can be especially dire.
Limited Transfer of Patients
Additionally, the overload of Covid patients in hospitals has undermined a basic tenet of rural health care infrastructure: the ability to transfer patients out of rural hospitals to higher levels of specialty care at regional or urban health centers.
Reasons Behind the Rural Surge
People on the front lines say it’s a perfect storm of personal freedom beliefs, mistrust of the government, a culture that tends toward taking care of things on their own, highly shared misinformation, and, yes, faith.
(Moira McCarthy. “Freedom, Religion, Mistrust: The Recipe Driving the COVID-19 Surge in Rural America.” Healthline. September 07, 2021.)
Personal Freedom
Many people in rural areas develop a true sense of self-reliance, both from what they do, how far they are from cities, and pioneering history. Unfortunately, that translates often to ‘let me make my own choice and don’t tell me what to do.’”
Rural folks tend to have a cultural ethos of independence. People who live and work in rural and remote communities have to deal with hardships such as unpredictable climate and market conditions, financial strain, social isolation, long working hours and reduced access to services.
Rural US residents’ preferences for a limited role for federal governmental in their lives appears even beyond health issues. Most rural US residents (59%) believe that when something is run by the federal government, it is not run too well or not run well at all, with partisan splits in rural opinions similar to those regarding federal involvement in health care: 61% of rural Republicans, 41% of rural Democrats, and 72% of rural independents share this view.
(Alee Lockman, MPH; Robert J. Blendon, ScD. “Rural US Voters’ Views on Health Policy and COVID-19 Before the 2020 Election.” JAMA Health Forum. September 21, 2020.)
Politics
Dr. William Schaffner, an infectious disease specialist at Vanderbilt University, says the political climate put that way of thinking on a pedestal. “It was clear from the start that our national leader at the time was annoyed with COVID,” Schaffner said. “He didn’t want to deal with it and that has had an impact, leaving rural communities unprotected.”
Politics have helped fuel the COVID-19 surge. People accept the fear factor and believe the government is so corrupt they can't believe anything it tells them.
In the first comprehensive examination of coronavirus misinformation in traditional and online media, researchers at Cornell University analyzed 38 million articles about the pandemic in English-language media around the world. Mentions of President Trump made up nearly 38 percent of the overall “misinformation conversation,” making the president the largest driver of the “infodemic” falsehoods involving the pandemic.
In the first three waves of the pandemic, rural populations were spared. Most had a very low rate of infection. People developed a false sense of security by not feeling the impact of those first waves close to home. However, this one is blowing up.
(Sarah Evanega1, Mark Lynas, JordanAdams, KarinneSmolenyak. “Coronavirus misinformation: quantifying sources and themes in the COVID-19‘infodemic.'” Journal of Medical Internet Research. June 2021.)
Religion
Faith, which tends to run strong and forge a bond in rural communities, is a factor in the current COVID-19 surge, some experts say. Many people in rural communities are not afraid to die because of their faith. They develop an attitude of “When it’s my time, it’s my time. I’m not afraid of it.”
“Don’t come knocking on my door with your Fauci ouchi! You leave us the hell alone!”
By far the most prevalent topic of misinformation was “miracle cures,” including Trump’s promotion of anti-malarial drugs and disinfectants as potential treatments for Covid-19, the disease caused by the coronavirus. That accounted for more misinformation than the other 10 topics combined, the researchers reported.
– Rep. Lauren Boebert (R-Colo.) at the Conservative Political Action Conference (Boebert has described her election to Congress as “a sign and a wonder, just like God promised.”)
Faith – and some leaders in the faith industry – are part of the problem rural America has now.white evangelicals are among the least vaccinated Americans. Modern evangelicals are encouraging a sense of epic conflict between the pious and the profane. And over the past few decades, evangelicals’ deep-seated distrust of society’s experts has merged with the increasingly nihilistic themes of the far right, creating a toxic disdain for science in general and public health in particular.
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