In recent weeks, the coronavirus pandemic has spread to rural America, particularly the Midwest.
Nearly 70% of rural counties have infection rates of 100 per 100,000 population, a rate that the White House coronavirus task force considers to mean that the virus is spreading out of control. Counties that with “rural” population densities overlap with counties where the coronavirus positivity rate exceeds 9%. In Montana, for example, 29 of the 46 least-populated counties have positivity rates over 15%, according to data from the Children’s Hospital of Philadelphia PolicyLab.
Two factors stand out as likely spreaders of the virus to rural areas: harvest time and the start of the school year at universities and colleges.
One reason the virus didn’t spread until fall is that some of the most prevalent crops in the Midwest, such as corn, are harvested in September and October. This brings in a lot of migrant workers who may bring the virus with them and put them in close contact.
“During farming, you’d have lots of people who weren’t protected from the virus,” said Dr. Georges Benjamin, the executive director at the American Public Health Association. “Any time you bring a lot of people together, it is a potential spreader.”
The start of the school year at universities and colleges was likely another factor.
“A lot of college students from rural areas go back to help their parents with harvest or livestock,” said David Peters, a rural sociologist at Iowa State University. “So, they might go to school for the first few weeks in the fall and then go back home to help with the farm, or homecoming, or they have a strong attachment to their hometown.”
In September, universities and colleges from North Carolina to Michigan to California experienced coronavirus outbreaks.
Still, at first glance, it doesn’t seem like rural areas would be virus hot spots, given that they aren’t as densely populated as urban and suburban regions.
But there are underlying conditions that put rural areas at high risk for virus transmission.
For starters, many rural areas are home to meatpacking plants.
“Meatpacking plants have close working conditions, and they are cold,” said Peters. “The work environment isn’t conducive to social distancing.”
There is also a lot of turnover among employees at meatpacking plants, with employees often leaving one plant for another, potentially bringing the virus from one plant to another. Additionally, meatpacking jobs are often low-wage jobs, giving employees a disincentive to quarantine if they do contract the virus.
“If an employee gets the virus, the facility is required to keep them away for two weeks, but the employee doesn’t make enough to go without a paycheck for two weeks,” said Peters. “The employee will just move to a new plant several counties over or in another state, pick up a job, and … if they are not showing symptoms, they will get hired.”
Rural areas also have many nursing homes and other assisted living facilities.
“People were pretty good at sticking with the restrictions for three or four months. But as time goes by, they want to see relatives, they want to see Grandma and Grandpa, and that’s when you started to get outbreaks in nursing homes,” said Peters.
Finally, since most rural areas didn’t experience outbreaks early on in the pandemic, it is possible that many residents had a false sense of security. This may have led to laxness toward proper safety precautions.
“Once the virus gets to rural areas, the question is: Are they using masks and social distancing at the same rate as other places?” said Cyrus Shahpar, the director of the Prevent Epidemics Team at Resolve to Save Lives, a global public health initiative. “A lot of the more rural states are in the center of the country that has lower rates of mask use.”
According to self-reported data collected by the Delphi Group, in most counties in Iowa, Montana, Nebraska, and North Dakota, less than 80% wear masks in public most of the time. In South Dakota and Wyoming, it is less than 70%. The use of masks is over 80% (and in some areas, over 90%) in coastal states such as New York and Oregon.
The pattern of other viruses suggests that the spread of the coronavirus to rural counties was inevitable.
“When I talked to physicians, they suggested that COVID-19 would share a pattern with other viruses,” said Michael Topchik, a national leader at the Chartis Center for Rural Health. “They looked to the common flu as an example and suggested we’d see higher rates of the coronavirus in rural areas just as a matter of time. And that’s what has happened.”