Rural America Could Be the Region Hardest Hit by the COVID-19 Outbreak

The COVID-19 pandemic has already swept through cities and urban centers.

Now, the illness appears to be building like an infectious prairie fire in rural America, as well as in larger towns in the Midwest.

That wasn’t the case just a month ago.

“Many rural communities aren’t seeing anything. They’re simply having to prepare for what they know is coming,” Dr. Randall Longenecker, the assistant dean for rural and underserved programs at Heritage College of Osteopathic Medicine at Ohio University, told Healthline in late March. “[But] it will come, no matter what.”

Longenecker’s prediction appears to be coming true.

A May 7 White House document obtained by NBC News reported spikes in COVID-19 in communities across the middle of the country.

Among the areas with increasing COVID-19 cases were Nashville, Tennessee, Des Moines, Iowa, and Central City, Kentucky.

In addition, the number of COVID-19 cases in Minnesota, Wisconsin, Iowa, North Dakota, and South Dakota have been increasing since the beginning of April.

Iowa has surged past Minnesota and Wisconsin and now has the highest number of confirmed cases of those five Upper Midwest states with more than 12,000 cases.

Black Hawk County is the state’s hot spot right now with more than 1,700 confirmed cases. Many of those cases are connected to the Tyson Foods plant near Waterloo as well as long-term care facilities in the region.

In South Dakota, more than 3,700 residents have now tested positive for COVID-19. Almost 900 of those cases are linked to the Smithfield Foods meat processing plant in Sioux Falls that was closed in mid-April. That plant, however, is expected to reopen this week.

Despite the increase in COVID cases, there are 32 states, 10 of them in the middle of the country, that have partially lifted shelter-in-place orders.

In Iowa, Gov. Kim Reynolds has defended her decision to allow malls, restaurants, retail stores, fitness centers, churches, and libraries to reopen in most areas.

The Nebraska Crossing mall held a “soft reopening” for employees and shop owners in late April. The mall owners opened 11 of their 80 stores on May 1. That complex sits along Interstate 80 between the population centers of Lincoln and Omaha.

In addition, President Donald Trump signed an executive order in late April mandating that meat processing plants remain open to avoid a disruption in the nation’s food supply.

All of this has experts worried about what’s in store for the middle of the country.

A potential recipe for disaster

Rural areas may end up being among the hardest hit regions due to their demographics and lack of resources.

The 15 percent of people in the United States who live in rural areas are largely a higher-risk population that’s particularly vulnerable to serious outcomes with COVID-19.

In addition, many people in rural areas live 30 or more miles away from the nearest hospital.

“Systems that are under stress during routine times will be more stressed during disasters and times of crisis. Sometimes we forget those systems that are at the brink,” said Tricia Wachtendorf, PhD, director of the Disaster Research Center at the University of Delaware.

Rural health systems already stretched financially are therefore particularly vulnerable, but so are rural areas that don’t have as deep a bench of resources to tap when times get tough.

“When you start thinking about recovery trajectories and impacts, the extent to which there is community functioning before a disaster has strong implications in that recovery trajectory post-disaster,” Wachtendorf told Healthline in late March. “That goes right down the spectrum: transportation systems, employment support, hospitals and public health, food security — all the key systems. If those are low pre-disaster, those are going to have substantial effects on what communities experience during the disaster, as well as their post-disaster recovery.”

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