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Covid-19 is surging in small-town America

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CNN's Erica Hill reports on the rising number of Covid-19 hospitalizations states are seeing as the US continues to see a steady rise in cases.

Posted: Oct 21, 2020 3:01 PM
Updated: Oct 21, 2020 3:01 PM

After more than half a year of fighting the novel coronavirus, many countries, including the United States, are now experiencing a calamitous upward turn in Covid-19 cases. Last week saw consecutive days of over 50,000 cases nationwide pushing the total number of diagnosed cases over 8 million.

The current surges across the nation, though, are occurring in different areas than the initial spring months of the pandemic, which was most pronounced in large northern cities, or the summer increase among southern states.

According to information from the US Centers of Disease Control and Prevention, the Autumn, 2020 wave of the pandemic is being led by small towns in rural areas.

From the start, Covid-19 data has been tracked according to county population as categorized by the Economic Research Service of the United States Department of Agriculture. The least populous two groups are "micropolitan counties" with 10,000 to 49,999 people and "non-core areas" with fewer than 10,000 people. These less populous counties constitute over 60% of the 3,143 counties in the US, though less than one-sixth of the country's population.

The CDC data reveals that for the last month, the micropolitan and non-core counties have had a sustained, multiweek run of the highest rate of Covid-19 cases per 100,000 population for the first time in the pandemic. In contrast, the new infection rate for large metropolitan areas, once by far the highest, now is the lowest in the country.

In other words, the current increase in the US Covid-19 pandemic is, for now, being felt most acutely by small-town America. Alarmingly, the death rate per 100,000 people for the "non-core" counties is now the highest in the US.

It is unclear why the pandemic is rising so rapidly in these areas but surely it is not because the rest of the country is "immune:" even in the areas hardest hit in spring and summer, the vast majority of the US population remains susceptible to infection.

Perhaps the adherence to social distancing in rural areas is weaker, given that the population density already is so low. Perhaps there is less belief in masking and other interventions to decrease the risk of viral spread. The role of the ongoing outbreaks across colleges also must be considered since many campuses are in small towns.

Another plausible explanation is the impact of the extensive network of correctional facilities in sparsely-populated areas throughout the country. In many small US towns, a correctional facility is a key local employer.

The correctional facility outbreaks in the state of Oklahoma are representative. More than 15,000 prisoners are incarcerated in the state's 32 Covid-19-affected facilities. According to the CDC, as of Tuesday, 4,597 inmates have developed Covid-19 and 22 have died in Oklahoma. In addition, 105 detention facility staff members have been infected. In the last month, many facilities have seen a substantial rise in cases.

The largest outbreaks to date have occurred at the Eddie Warrior Correctional Facility, a woman's minimum-security facility in tiny Taft, Oklahoma, where 781 of the more than 900 prisoners developed Covid-19 and at least one died and, across the state, in the William S. Key Correctional Center in the even tinier town of Fort Supply, Oklahoma, where there have been at least 900 positive Covid-19 tests among inmates, though most of the infected individuals have since recovered.

That's not all: in September, Craig County, home to the Northeast Oklahoma Corrections Center, had an outbreak affecting almost half of the prisoners, and at one point ranked as the county with the second highest new infection rate in the country.

This phenomenon is occurring in other states. Toole county in Montana, home of Crossroads Correctional Center, spent time in the first half of October at or near the top of the same New York Times' hot-spot list and Bon Homme County in South Dakota, where Mike Durfee State Prison has a Covid-19 test positivity rate of 85%, sits near the top of the list now.

The national impact is alarming. The incarcerated population in the US is over 2 million with an additional 423,050 correctional staff. The CDC reports that, as of Sunday, 1,302 correctional facilities in the US have diagnosed 154,398 cases among residents with 1,151 deaths and 33,459 cases among staff, including 59 fatalities.

The specifics of prison life make this not just a humanitarian but an epidemiologic crisis. Many prisons are overcrowded, provide uneven access to medical care, lack capacity to isolate, and are the object of societal neglect. In addition, prison employees may both introduce infection to the facilities or else catch Covid-19 at work and bring it into the community.

The current spike of Covid-19 cases in small, sparsely populated areas is evidence of the interconnectedness of communities, which makes the spread of this contagious respiratory virus an easy piece of business. Surely new investigations will lead to new guidelines and this latest pandemic wrinkle will come under better control, though probably later rather than sooner.

But the endless stream of outbreaks here, there, and everywhere will not stop until we have an actual evidence-based, thoughtfully enforced national plan to reduce spread at places -- prisons, nursing homes, meatpacking facilities, schools, stadiums, political rallies -- where people gather.

Until then, we should anticipate that every few months will just be déjà vu all over again.

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Illinois Coronavirus Cases

(Widget updates once daily at 7 p.m. CT)

Cases: 674089

Reported Deaths: 12261
CountyCasesDeaths
Cook2871246389
DuPage42201754
Will36082532
Lake34915612
Kane29870449
Winnebago17843248
McHenry13332150
Madison13291229
St. Clair12340255
Champaign1031652
Sangamon938390
Peoria8388124
Rock Island8152121
Kankakee799996
McLean786950
Tazewell616992
Macon6121117
Kendall583342
LaSalle5687127
DeKalb471445
Adams449046
Boone364230
Vermilion355344
Whiteside3510100
Williamson332777
Coles316058
Clinton303556
Ogle266026
Knox259956
Grundy253916
Effingham252518
Jackson250334
Henry245313
Stephenson231834
Marion228344
Livingston209521
Randolph205924
Morgan204734
Macoupin198817
Bureau198337
Monroe193144
Franklin187422
Christian177640
Lee172224
Jefferson170859
Woodford158926
Iroquois153325
Logan152412
McDonough151339
Fayette146328
Fulton131910
Douglas126916
Shelby125824
Jersey114923
Union112026
Montgomery105819
Saline105122
Crawford10509
Jo Daviess101816
Warren100620
Carroll100124
Perry96820
Pike96623
Bond93610
Lawrence92410
Hancock90412
Cass90021
Moultrie82810
Wayne82432
Greene77426
Clay75817
Clark74519
Edgar73315
Piatt7215
Ford69821
Mercer67710
Richland67419
Johnson6653
Mason64916
Washington6112
Jasper60511
De Witt58814
Cumberland58013
White5648
Massac5112
Wabash4918
Menard4211
Pulaski3862
Hamilton3663
Marshall3625
Unassigned3620
Brown2983
Henderson2610
Alexander2482
Schuyler2431
Putnam2360
Calhoun2250
Scott2230
Stark2183
Edwards2123
Gallatin1803
Hardin1310
Pope791
Out of IL140

Indiana Coronavirus Cases

(Widget updates once daily at 8 p.m. ET)

Cases: 306538

Reported Deaths: 5435
CountyCasesDeaths
Marion41953849
Lake26872453
Allen17621295
Elkhart16905219
St. Joseph16524223
Hamilton12696167
Vanderburgh9552115
Tippecanoe844927
Porter813785
Johnson6231165
Vigo597979
Hendricks5944156
Monroe530349
Clark504077
Madison4858121
Delaware4820103
LaPorte457194
Kosciusko455739
Howard334975
Warrick319572
Floyd311477
Bartholomew308462
Wayne301367
Cass295831
Marshall293744
Grant262949
Noble249846
Hancock246551
Boone240254
Henry240237
Dubois234631
Dearborn215730
Jackson212633
Morgan204443
Gibson181725
Knox181419
Shelby178254
Clinton177821
Lawrence174047
DeKalb172829
Adams166422
Wabash158020
Miami157814
Daviess154643
Fayette147733
Steuben143513
Jasper142111
Harrison141824
LaGrange140129
Montgomery139027
Whitley133412
Ripley128114
Decatur124643
Huntington123510
Putnam123027
Randolph120719
Wells120428
White120321
Clay119822
Posey119616
Jefferson116216
Scott103219
Greene101353
Jay96413
Starke90621
Sullivan88916
Fulton83518
Jennings83214
Spencer8198
Perry81521
Fountain7738
Washington7417
Franklin68626
Carroll67913
Orange66628
Vermillion5993
Owen5987
Parke5606
Newton55312
Tipton55226
Rush5317
Blackford51912
Pike50318
Pulaski37710
Martin3515
Benton3362
Brown3353
Crawford2881
Union2671
Switzerland2555
Warren2382
Ohio2307
Unassigned0266