What’s really concerning about this divide in new COVID cases is another, related divide between rural and urban areas: rural areas have less access to healthcare than their urban counterparts. This implies that rural areas may not have the healthcare infrastructure to handle the influx of patients brought in by the Third Wave, leading to a collapse of systems in certain areas. 

Ideally, we would measure this through metrics like hospitalization rates, patients turned away, etc. However, it’s impossible to collect this data nationally at a county level. At least not in the middle of the pandemic. We can, however, look at the ultimate outcome metric: mortality rates, or how many people are dying of COVID per capita. As per our earlier discussion, we must look at “new mortality rates”, or daily new deaths per capita to see what’s happening. If mortality rates are holding steady despite increasing COVID infection rates, that implies the healthcare system is probably coping with the influx of cases. If not, there is some evidence that the healthcare system is struggling to keep up:

In this chart we see a massive spike in new mortality rate, especially in urban areas, during the First Wave as hospitals struggled to both keep up with the initial influx of patients and treat the novel disease. The Second Wave, which was worse than the first in terms of the expected influx of patients, had a lower new mortality rate “bump” — indicating that hospitals adapted and became better at dealing with the virus. Remarkably, despite the unprecedented gravity of the Third Wave, new mortality rates in urban areas have risen much more slowly than new cases, indicating that healthcare systems are somewhat managing to cope with the influx of patients. That should be taken with a grain of salt — this could be attributed to a “lag effect” where it takes a couple of weeks for people to die of Coronavirus, however. 

However, in rural areas, we see another story. New mortality rates are skyrocketing with the Third Wave. Recall that the virus is spreading 60% faster in rural areas. In contrast, people are dying of COVID at a 120% faster rate in Rural Areas than Urban Areas. Even though we don’t have granular hospitalization data, this signals that rural healthcare systems are struggling to cope with their new patients compared to their urban counterparts. These data conclusions are in-line with prior real world news articles.

 

It’s notoriously difficult to define “Rural America.” I used a metric developed by the Office of Management and Budget and USDA, which defined roughly 46 million Americans as “rural.” To help contextualize this number,  earlier I found that there were an additional 0.3 daily COVID cases per 1000 people in rural areas than urban areas. That means rural areas alone are collectively coping with an additional 100,000 cases a week than if they had the same infection rate as urban areas. And the gap between the two grows every day. 

It’s somewhat interesting to note that the counties defined as “rural” under my metric collectively voted +32 for Trump in the 2020 presidential election (65% for Trump, 33% for Biden). Them’s landslide margins. It’s pretty well known that the Trump campaign has downplayed the severity of the virus, with Trump himself often neglecting to wear a mask — even going so far as to publicly mock Joe Biden for wearing a mask too often. As such, Trump and his movement have become associated with a chronic downplaying of the virus, which includes not wearing masks in public spaces and avoiding social distancing — both of which would help spread COVID. I also wrote a previous article that there appeared to be pretty serious evidence that the GOP as a whole was not taking COVID seriously — it wouldn’t be unreasonable for their voters to follow suit. This may be partially contributing to the disparity we are seeing here — in contrast, the Urban areas voted +10 for Biden, whose campaign had virtually the opposite messaging regarding the virus.

No matter what, the reality is that COVID is overwhelming Rural America more than Urban America. For a myriad of factors (less population, poorer, etc.), Rural America gets a lot less media coverage than other areas of the country. It’s important that despite this, we pay attention to things like health trends in rural areas, because they can quickly (and silently) get out of hand because of poor healthcare infrastructure — see the opioid epidemic. And if you don’t care because you live in a city, you should because overwhelmed rural hospitals are sending their sickest patients to your hospitals, which means they might not have space for you if you get sick. Right now, our best bet is that measures like Joe Biden’s plan to depoliticize mask-wearing will work so that residents in mostly-red Rural America will take steps to combat the spread of COVID. 

P.S. For my friends who live in Virginia, rural Virginia has been hit especially hard compared to Central Virginia and Northern Virginia. It’s tragic. Two of the top 10 municipalities with the highest mortality rates of the pandemic in the U.S. are located in the Commonwealth, and there are (rural) counties where nearly 10% of the population has had COVID so far. Right now, Southwestern Virginia is being hit especially hard by the Third Wave. I’ve thought about doing a separate write-up about Virginia. I have some in-depth code on the inequalities in the state, but I’m not sure what to do with it. Entertaining suggestions.