COVID-19 now spreading fastest in small, rural counties

The coronavirus pandemic is spreading out from urban centers and increasingly infecting residents in small rural counties, even as some of those areas begin to loosen lockdown requirements aimed at stopping its spread.

A new analysis shows nearly three-quarters of Americans live in counties where the virus is now spreading widely. Another 200 counties have seen significant growth in infection trends in the last week, making them high-prevalence counties — areas where the virus has infected at least one in a thousand people.

Like ripples in a pond, the virus is radiating out from its epicenters in large cities. 

An outbreak that started in New York City spread first to New Jersey and Connecticut, then south to Philadelphia, and now to upstate counties in New York like Hamilton and Essex and smaller Pennsylvania counties like Lycoming and Wyoming.

What began as an outbreak in New Orleans has spread across the Deep South, recently arriving in northeast Arkansas, southwest Tennessee and much of Alabama. Hot spots in Detroit and its suburbs are migrating west to the shores of Lake Michigan.

“Most of these counties are small rural counties,” said William Frey, the Brookings Institution demographer who conducted the analysis. “Very very few are what you would call inner city counties or inner suburb counties.”

At the same time rural areas are beginning to see their first real flare-ups of coronavirus, case curves are bending down in some of the areas that were the first to be hit. The number of cases in states like Iowa, Arkansas, Minnesota, South Dakota and Virginia are still substantially lower than early epicenters like New York, Massachusetts and New Jersey, but they are growing at a faster rate.

By the end of March, 83 percent of counties where the coronavirus was highly prevalent were in the Northeast. But for the last five consecutive weeks, the majority of counties newly falling into the highly prevalent category have been in Southern and Western states. This week, Alabama, Texas and North Carolina have all experienced their highest numbers of confirmed cases.

In the last week, Midwestern areas have made up their highest share of newly prevalent counties to date. Almost a third of all counties that are now highly prevalent are in Midwestern states, as parts of Iowa, Minnesota, Nebraska, Illinois and Indiana suffer new outbreaks. Illinois on Tuesday registered 4,045 new confirmed cases, its worst single day so far.

Epidemiologists say the pattern is similar to what they would expect to see during a typical flu season, when a virus lands first in a densely populated area before radiating out to neighboring regions.

“The first wave is in big cities and it travels outwards from there. Isolated rural areas are hit later. This pattern is largely based on the connectivity of populations through human movement,” said Nita Bharti, a biologist at Penn State University’s Center for Infectious Disease Dynamics. 

The slower spread in rural areas may become its own problem: Those counties tend to have smaller health care systems that could become more easily overwhelmed if they are hit with a crush of cases. 

As more and more states take their first ginger steps toward reopening businesses, some scientists are worried that the increasingly political lens through which people view the coronavirus will discourage those most at risk of suffering the worst consequences from taking the steps they need to protect themselves.

Small but increasingly vocal protests against the economic lockdowns, fueled by a mix of conservative and gun rights activists and anti-vaccination proponents, illustrate the growing disconnect between the urban counties hit hard by the first wave and more rural areas where people have seen little or no evidence that the virus that has wrought so much economic devastation is present in their communities.

As President Trump encourages states to reopen their economies, areas where his supporters are more likely to live are now experiencing their first brush with coronavirus cases. The counties that were first hit were some of the bluest in the nation. By the end of March, the counties with high prevalence transmission had given Democratic presidential nominee Hillary Clinton 62 percent of the vote in 2016.

But in the last several weeks, the counties that have been newly hit by the virus are areas Trump is more likely to have won; in the last week, counties where the virus was newly highly prevalent gave Trump 49.7 percent of the vote, compared to 43.8 percent for Clinton.

“This becomes a big problem right now, when states are lifting regulations and behavioral interventions,” Bharti said. “There are a lot of important heterogeneities within states and counties that determine the trajectory of epidemics, so state-wide or even county-wide easing of restrictions will lead to problematic outbreaks in under-resourced rural areas.”