Why COVID-19 is killing people in rural counties at a higher rate

North Carolina news

RALEIGH, N.C. (WNCN) — North Carolina’s rural counties have a significantly higher per capita death rate due to COVID-19 than the state’s urban or suburban counties, a CBS17.com data analysis found.

The state’s 80 rural counties have combined for 35 deaths per 100,000 people. In urban counties, the per capita death rate was 26 and it was 28 for suburban counties.

And of the 30 counties with the highest per capita death rates, 28 of them are classified as rural by the NC Rural Center. That list includes nine counties in our area: Vance, Northampton, Granville, Chatham, Edgecombe, Wilson, Franklin, Hartnett and Sampson.

Two counties have per capita death rates in excess of 100 per 100,000 people — Jones (107.9) and Hertford (104.1). The highest in the CBS 17 viewing area is Vance County, which ranks fourth at 93.2.

“There’s some really embedded characteristics of rural communities, I think, that has a lot to do with the spike in cases and some of the troubling statistics we see with infection rates and with COVID deaths,” said Patrick Woodie, the organization’s president.

His organization defines a county as rural if its average population density is at or below 250 people per square mile. The 14 regional city and suburban counties have population densities between 250 and 750 people per square mile, while that figure exceeds 750 for the six urban counties.

Woodie says people in those rural counties tend to be older and poorer, and a higher percentage of them lack health insurance — with some making too much money to qualify for Medicaid.

While those rural counties account for just under half the state’s population of 10.6 million, CBS17.com found that hospitals in those counties have just 38 percent of the total general beds in the state. Seventeen rural counties don’t have a hospital while only six counties have two of them.

Woodie also said a high share of workers in rural counties are considered essential workers — including those employed by farms or meat-processing plants, where it’s tough to call in sick and virtually impossible to work remotely.

“The biggest challenges with rural communities … has not just been treatments but also risk of exposures for people who are in jobs where they are in close proximity like a poultry processing plant … or don’t have the ability to isolate if they are exposed to someone who has been infected,” said Dr. Mark McClellan, the director of the Margolis Center for Health Policy at Duke and former commissioner of the Food and Drug Administration.

Labor advocates on Friday called on state leaders to better protect workers and enforce workplace health and safety laws.

“The workers still have to go to work,” said Victor Canales Gamiño of the Levante Leadership Institute, which helps migrant and farmworker youths in the state.

“If they don’t go into work, they don’t eat,” he added. “So it’s kind of like, ‘There’s a pandemic going on, but if we don’t go in, we don’t feed our families.’”

The solution, Woodie said, is for people in those rural counties to follow guidance from state and federal health officials on the best ways to limit the spread.

“They’ve done a good job of giving pretty clear guidance, and we need to follow it,” he said. “I certainly have seen a change in rural attitudes from the early days of this pandemic. … When I went home in the early days, I certainly was not seeing much mask-wearing going on. And now it is pretty well universal that people out in public, even in our rural areas, are wearing masks. I think it’s really important that we don’t let up on that.”

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