May 6, 2020

A windmill spins amidst the treeless plains of west Texas.  Men visit along the courthouse square in small-town Indiana.  The rustic and rural settings that are situated throughout our country are near and dear to millions of our people.  Chaos and clamor are rarer here, and big-city problems seldom disturb these Norman Rockwell locations.

But then came COVID.  While rural America has for the most part been able to avoid the brunt of the coronavirus during its initial assault upon our shores, recent reports indicate that the disease is now stalking our smaller towns and communities.  Here are some facts and statistics released by HealthcareDive that may prove instructive:

• Though metro and rural areas have had different infection rates since the outbreak began, the mortality rate from the virus is mostly the same in the U.S. But in recent weeks, the infection rate in rural counties has been outpacing urban counties, according to a new analysis of COVID data by the Kaiser Family Foundation (KFF).
• According to KFF, counties with large metro areas have had nearly three times as many coronavirus cases and deaths as rural counties (327.5 cases per 100,000 versus 114.9 per 100,000, even adjusting for population size). Metro counties have also experienced nearly four times as many deaths as of April 27 (17 per 100,000 versus 4.4 per 100,000).
• Nevertheless, the COVID mortality rate is 4.2 percent for metro populations, versus 3.8 percent for rural populations.  The county with the most deaths per capita is in a non-metro area.

So, while the urban areas remain a hotbed of viral incubation and infection, the country’s farm communities and small hamlets are beginning to feel the full effects of the virus.

Delving into the Numbers

The KFF analysis, mentioned above, indicates that the coronavirus is no longer bypassing America’s countryside.  The analysis also provided the following statistical details, which emphasize further the current and continuing danger faced by small-town America:

• There was a 45 percent increase in COVID cases in non-metro counties over the last week in April, compared with 26 percent in metro counties.
• Over a recent two-week period, COVID cases increased by 125 percent in rural counties versus 68 percent among their urban counterparts.
• Deaths are up 169 percent over the past two weeks in rural counties, versus a 113 percent increase in metro counties.

Unsettling Portents

America’s rural areas typically include older citizens, as many younger people tend to head to the cities for educational or vocational opportunities.  Older populations are clearly more susceptible to the ravages of certain viruses.  We would expect, then, to see a higher percentage of serious symptoms in areas with an aging population once the virus has reached those areas.

An added concern for this population group is their access to adequate healthcare.  Rural America contains smaller and less equipped hospitals, which may be ill-prepared to combat the full onslaught of this pandemic once it arrives. A good portion of rural and small community hospitals have been on shaky financial foundations for years, and are less likely to have suitable resources should they become overwhelmed with an influx of COVID patients.  According to HealthcareDive, a recent letter from the Medicaid and CHIP Payment and Access Commission to Health and Human Services (HHS) Secretary Alex Azar suggests that “hospitals with a high proportion of Medicaid and low-income patients are not getting enough emergency federal funding in response to COVID-19, a trend that could also hurt some rural hospitals.”

Meanwhile, the easing of shelter-in-place and lockdown rules in a number of states—including those with large rural populations—may signal more significant consequences down the road. “Georgia has started to reopen certain businesses and allow limited dine-in at restaurants, despite some of its counties rising toward the top of this list of U.S. metro and non-metro counties with the highest numbers of COVID-19 deaths per capita,” the KFF analysis observed.  Indeed, the county with the most deaths per capita in the U.S. is Randolph County—a rural enclave in southwest Georgia, with 278 deaths per 100,000 people.

Hopefully, the $10 billion recently sent to rural hospitals by the federal government to help fund the fight against coronavirus will help turn the tide in these small communities.  These facilities are becoming the new epicenter of the virus’ impact, and they will need all the resources they can get to treat patients and save lives.  We at MiraMed Global Services salute all our hospital workers, executives and clinicians.  We are proud to stand with you during this perilous time.  Please feel free to reach out to us at info@miramedgs.com.