Rural Communities Are Not Safe From COVID-19, Researchers Warn 

Princeton researchers have determined that rural counties concentrated in the western U.S., the northern Midwest, Florida, and northern New England have elderly populations that could be the most vulnerable to COVID-19. 

The new report titled “Mapping the Burden of COVID-19 in the United States” suggests that rural communities with high concentrations of baby boomers (people over 60) and limited access to health care facilities could “eventually be among the hardest hit by the coronavirus pandemic.”

“The burden is still going to be high in urban areas and the absolute number of cases will be highest in cities, but we could see rural areas have a higher per capita burden and a higher ratio of cases to hospital beds,” said author Ian Miller, who is a graduate student in ecology and evolutionary biology at Princeton.

Miller and co-author Alexander Becker, another graduate student at the university, said intensive care units are lacking in many rural communities that are critical medical devices to save lives during the pandemic.

“We’re hoping that our study will prompt state and public health officials to keep an extremely close eye on rural areas,” said Miller, who has been talking with state governments about vulnerable counties. 

“If they know where the vulnerable counties are, they can allocate resources to those counties, or try to help direct cases originating in those counties to health systems with more adequate capacity,” he said. 

Researchers used a combination of the American Hospital Association and Census data to determine where the most at-risk population in rural communities resided. 

“The researchers conducted an epidemiological simulation that compared how many hospital and ICU beds each county currently has — according to the American Hospital Association — to the number of coronavirus cases they would experience if the infection rate reaches 20% of the county’s population.

Using 2018 demographic data from the U.S. Census Bureau, the researchers broke down each county’s population by age group, starting at 0-9 and continuing every 10 years through the final designation of 70-plus. Their model then factored in the proportion of each age group that has been likely to become severely ill, with people over 60 being the most vulnerable.”

Miller and his team developed two disease transmission models, one slow and one fast, that determined the western U.S., the northern Midwest, Florida, and northern New England emerged as the most at risk.

“In the “optimistic” scenario, disease transmission was relatively slow, people had contact mostly with those within their age group, and people presenting symptoms of coronavirus were effectively quarantined. In contrast, the “pessimistic” scenario was characterized by a high transmission rate, homogenous contact between different age groups, and people showing signs of infection being quarantined too late or not at all. 

The counties that became overwhelmed in both the optimistic and the pessimistic scenarios are those that the study authors identified as most vulnerable to the current outbreak.”

The study comes as the US reports 671,273 confirmed cases and 33,286 deaths on Friday (April 17). 

Becker said rural communities are not immune to the virus. 

“Because people’s needs are so different within a state, that motivated us to look at the county level to get as high a resolution as we could,” he said. “Maybe these results can be used as a preparation guide for officials in counties that are at risk, especially if there’s a large distance between a rural area and an urban area with greater access to health care.” 

“We’re not trying to tell public health officials to focus only on rural areas or only on urban areas,” Miller said. “We’re trying to give them a holistic picture of the burden all of the different parts of their state might face so they can try to provide equitable care.”

While everyone is focused on the pandemic sweeping across major metro areas, could the next big health crisis be rural America?