Rural America Is Starting To Feel the Impact of the Coronavirus

The Center for American Progress | By Olugbenga Ajilore | April 28, 2020

Policymakers are already discussing plans to reopen the U.S. economy—even though the COVID-19 pandemic is still ravaging the United States and has killed more than 40,000 people.1 While some of the hardest-hit cities may be flattening the curve, these discussions ignore the many parts of the country that have not even come close to reaching the peak of the outbreak. For example, a large pork plant in Sioux Falls, South Dakota, was forced to shut down because of a severe coronavirus outbreak.2 Tribal communities in the Southwest are also beginning to get hit hard.3 While Congress has passed several packages to deal with both the public health crisis and the economic crisis, it is premature to think about an exit strategy before the extent of the pandemic has been realized.

The Coronavirus Aid, Relief, and Economic Security (CARES) Act was the third of these packages, providing resources and relief to the U.S. economy as the country combats the COVID-19 pandemic. The package included direct payment assistance to individuals, expanded unemployment insurance, a $500 billion fund to industries, and $350 billion for small businesses. In addition, the package allocated $150 billion to the states for relief as state and local governments face severe budget constraints.

While $150 billion will help states and localities, their needs call for much more resources. One of the major problems resulting from this pandemic is the decimation of state budgets.4 Due to social distancing and shelter-in-place ordinances, sales taxes are going to fall precipitously. States have followed the federal government and pushed their income tax deadlines to the summer, which means the income tax revenue that is normally expected in the spring will not come until the summer or fall.5 In addition, efforts to combat the outbreak and fight the spread of the virus will strain public services. These issues—coupled with the fact that many states face a balanced budget amendment—mean that an economic disaster is brewing across the country. States will have to cut services, furlough workers, or raise taxes when the economy can least afford these cuts. In fact, falling revenues have already forced states to engage in budget cuts.

The struggles states face will have dire consequences for rural areas. Beyond some funding for rural health care and telemedicine, rural communities were practically left out of the policy debate surrounding all three federal relief packages.7 Supporting rural areas is not something that should be left only to the states; the federal government needs to directly invest in these communities. The spread of the coronavirus is a national challenge, not one that should be left to states by themselves, as the virus does not care where people live.

The coronavirus is already hitting rural America, and existing structural barriers are making the pandemic worse. Rural areas are in need of targeted relief, which has been missing in the previous COVID-19 relief packages. Policymakers must address these omissions by expanding Medicaid in the states that have not yet done so, and the federal government must increase funding to states to support Medicaid. In addition, the lack of a national stay-at-home order is slowing the response, since the virus is spreading in places that have failed to implement these orders.8 Physical distancing is effective at fighting the spread of the coronavirus.9 A national stay-at-home order would take the decision out of the hands of governors who have refused to adhere to the science.10 Policymakers cannot wait to help rural communities because delays in combating this pandemic will lead to an increase in the number of preventable deaths.

The spread of the coronavirus in rural communities

While major metropolitan cities are being hit hard and have the largest outbreaks, COVID-19 has already started to spread in rural communities. Due to the lack of health care infrastructure resulting from hospital closures and a population with a high level of chronic health issues, these communities will be less able to successfully combat the virus.

Kaiser Health News produced a sobering map showing that the vast majority of rural counties either have no intensive care units in their hospitals or no hospitals at all.12 Yet, the problem is more than just a lack of access to health care facilities. Rural residents generally have to travel long distances to access goods and services such as local food markets and educational institutions. Transportation has always been an issue for rural communities, but it takes on a greater weight during this crisis for seniors and people with disabilities.

There are concerns that the number of deaths caused by COVID-19 are underreported. The extent of the spread is unknown, since there are likely people who were not tested but who contracted COVID-19 or people who died due to complications from the disease.14 Figure 1 demonstrates the rapid increase of cases that occurred in March 2020.

Graying America communities are rural areas that have a high prevalence of aging retirees. They are located in recreation-dependent counties predominantly in the western part of the country. These areas have seen a lot of tourism, which has helped boost their economies but has now led to a rise in COVID-19 cases.15 The African American South is a collection of counties synonymous with the so-called Black Belt region of the United States, a series of counties running from the Mississippi Delta, past the Carolinas, and up to Virginia. This area has persistent poverty, low educational attainment, and high uninsured rates.16 These factors make individuals in the region more susceptible to public health crises, and the data now bear this out.

There were very few reported COVID-19 cases in rural areas during the first two weeks of March. Then, the number of cases started to rise, especially in three rural community categories: Graying America, Rural Middle America, and Evangelical Hubs. However, in the African American South, cases did not begin to rise until mid-March. Cases in this region then proceeded to surpass those in Evangelical Hubs and then caught up to those in Graying America and Rural Middle America by the end of the month.

Graying America had its first case on March 6 and, as of April 1, had 1,690 cases. The African American South had its first outbreak on March 10 and, as of April 1, had 1,452 cases. Rural Middle America had its first case on March 2 and, as of April 1, had 1,545 cases. Evangelical Hubs also had their first case on March 6 and, as of April 1, had 802 cases.