It’s Thanksgiving, also known as DJ Khaled’s birthday, and COVID-19 is back with a vengeance. We’ve all been cautioned by the CDC to celebrate a socially distanced holidays this year, and the data shows most of us are ignoring them so far. I’m not here to lecture anyone about that — but also you’re all terrible people.
One of the best ways to measure the ever-evolving conditions of COVID is daily new cases. This metric is unstable, so researchers typically take a moving average over a 5-7 day period instead. Daily new cases allows us to easily visually detect the individual “waves” of COVID, as opposed to Total cases, which is always increasing by construction. The following charts illustrate the differing levels of usefulness of each measure:
With that out of the way, let’s look at the daily new cases of COVID over time in rural areas vs. urban areas. Before presenting the graph we might expect that testing rates differ in rural areas and urban areas due to factors like access to healthcare. That means comparing confirmed cases between the two isn’t exactly fair because the number of people getting tested isn’t equivalent. I performed a rough correction for this using state-level testing data to account for this:
Here we can see that rural areas were largely spared from the First Wave of COVID and were hit equally as hard as urban areas during the Second Wave. However, during the unprecedented Third Wave there has been a stark difference between the two. New cases per capita has risen much more rapidly in rural areas and is currently roughly 0.8 per 1000 people, compared to 0.5 for urban areas. That means the virus is spreading 60% faster in Rural Areas as compared to Urban Areas right now. Obviously, this seems counterintuitive, as rural areas are less densely populated, and your average rural resident interacts with fewer people. You would imagine a virus to spread more quickly in a metropolis like Chicago than Emporia, Virginia (where nearly 0.6% of the population has died of COVID so far, good for third in the country).
Measuring the Impact
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.
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 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.