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    The Worst Virus Outbreaks in the U.S. Are Now in Rural Areas



    New reported cases by day in the United States, 7-day average

    Rural areas

    200 per million

    Metro areas

    New reported cases by day in the United States, 7-day average

    Rural areas

    200 per million

    Metro areas

    New reported cases by day in the United States, 7-day average

    Rural areas

    200 per million

    Metro areas

    New reported cases by day in the United States,

    7-day average

    Rural areas

    200 per million

    Metro areas

    Note: Rural areas are those counties located outside of metropolitan areas, as defined by the United States Department of Agriculture’s Economic Research Service. They may include small cities and towns.

    The coronavirus was slow to come to Foster County, N.D., a community of just over 3,000 people in the eastern part of the state. When virus cases surged in the Northeast in the spring, the county recorded just one positive case. When national case counts peaked in mid-July, it had recorded just two more.

    But by Tuesday, about one in every 20 residents had tested positive for the virus. More than half of those cases were reported in the past two weeks.

    Most of the worst outbreaks in the United States right now are in rural places like Foster County. Where earlier peaks saw virus cases concentrated mainly in cities and suburbs, the current surge is the most geographically dispersed yet, and it is hitting hard remote counties that often lack a hospital or other critical health care resources.

    Since late summer, per capita case and death rates in rural areas have outpaced those in metropolitan areas.



    New reported deaths by day in the United States, 7-day average

    10 per million

    Rural areas

    Metro areas

    New reported deaths by day in the United States, 7-day average

    10 per million

    Rural areas

    Metro areas

    New reported deaths by day in the United States, 7-day average

    10 per million

    Rural areas

    Metro areas

    New reported deaths by day in the United States,

    7-day average

    10 per million

    Rural areas

    Metro areas

    Note: Rural areas are those counties located outside of metropolitan areas, as defined by the United States Department of Agriculture’s Economic Research Service. They may include small cities and towns.

    The total number of coronavirus cases and deaths in rural places remains smaller than those in cities because of the comparatively low population in rural areas. But the rural share of the virus burden has grown over time.

    Now, about one in four deaths from the virus is recorded in a rural county. That stands in contrast to March and April, when almost every death was in a metropolitan area, as the virus tore through the Northeast, after early clusters in the Seattle area and populous parts of California.

    These maps show the case rates in rural areas at different points of the national outbreak:



    Avg. daily cases per million in the past week

    Few or

    no cases

    Rural counties

    Cases in rural areas now

    Metro areas

    are not shown

    Cases in rural areas when cases peaked over the summer

    Navajo County, Ariz.

    The summer surge spread

    to many rural counties

    in the South.

    Cases in rural areas when cases first peaked

    Clusters at

    meatpacking plants

    in Iowa

    Counties outside

    Albany, Ga.

    Avg. daily cases per million in the past week

    Few or

    no cases

    Rural counties

    Cases in rural areas now

    Metro areas

    are not shown

    Cases in rural areas when cases peaked over the summer

    Navajo County, Ariz.

    The summer surge spread

    to many rural counties

    in the South.

    Cases in rural areas when cases first peaked

    Clusters at

    meatpacking plants

    in Iowa

    Counties outside

    Albany, Ga.

    Avg. daily cases per million in the past week

    Few or

    no cases

    Rural counties

    Cases in rural areas now

    Metro areas

    are not shown

    Cases in rural areas when cases peaked over the summer

    Navajo County, Ariz.

    The summer surge spread

    to many rural counties

    in the South.

    Cases in rural areas when cases first peaked

    Clusters at

    meatpacking plants

    in Iowa

    Counties outside

    Albany, Ga.

    Avg. daily cases per million in the past week

    Few or

    no cases

    Cases in rural areas now

    Metro areas

    are not shown

    Cases in rural areas when cases peaked

    over the summer

    Cases in rural areas when cases first peaked

    Avg. daily cases per million in the past week

    Few or

    no cases

    Rural counties

    Cases in rural areas now

    Metro areas

    are not shown

    Cases in rural areas when cases peaked over the summer

    Navajo County, Ariz.

    The summer surge spread

    to many rural counties

    in the South.

    Cases in rural areas when cases first peaked

    Clusters at

    meatpacking plants

    in Iowa

    Counties outside

    Albany, Ga.

    During the summer surge, rural outbreaks occurred more often than they had in the spring, but reported cases per million remained higher in cities and their suburbs than in rural counties.

    It was not until August, when the outbreak was receding from Sun Belt cities like Houston, Miami and Phoenix that per capita rates of cases and deaths in rural areas surpassed those in metropolitan areas.

    Now, with the national case count and hospitalization rates approaching a third peak, none of the country’s biggest hotspots are in a large city. Almost all the counties with the largest outbreaks have populations under 50,000, and most have populations under 10,000. Nearly all are in the Midwest or the Mountain West.

    Though the outbreak’s geographic spread is expanding, many of the same kinds of places remain at risk for clusters of infections. In Norton County, Kan., the hardest-hit county in the country relative to its population, all 62 residents of one nursing home have been infected with the virus, and 10 have died. A state prison in the county also has an outbreak.

    Hospitals across the Upper Midwest and the Mountain West are also feeling the surge. Facilities are struggling with capacity, and in some cases residents are finding that the nearest hospital with available beds is hours away, or in another state.

    Earlier this month, hospitals in North Dakota had to turn patients away. Bismarck, the state’s capital, had one staffed I.C.U. bed available as of Monday.

    Overwhelmed by the record case numbers, North Dakota suspended its contact tracing program this week. New Mexico’s governor, also seeing hospital beds fill up in her state, plans to put in effect new restrictions on restaurants, bars and retail stores.

    And Alaska, which is experiencing record numbers, provides a cautionary tale: Even with extensive testing and robust contact tracing, the virus is poised to thrive as temperatures drop and people move activities indoors.

    Most of the counties with the worst per capita outbreaks now have fewer than 10,000 people

    COUNTY POPULATION AVG. DAILY CASES,
    LAST 7 DAYS
    AVG. DAILY CASES
    PER 10,000
    1 Norton, Kan. 5,486 24 44
    2 Bon Homme, S.D. 6,969 22 32
    3 Miner, S.D. 2,229 7 31
    4 Sheridan, Kan. 2,506 7 29
    5 Harding, S.D. 1,311 4 27
    6 Carter, Mont. 1,318 3 23
    7 Webster, Neb. 3,571 8 22
    8 Faulk, S.D. 2,322 5 20
    9 Menominee, Wis. 4,579 9 20
    10 Blaine, Mont. 6,727 14 20
    11 Foster, N.D. 3,290 6 20
    12 Buffalo, S.D. 2,053 4 19
    13 Sheridan, N.D. 1,405 3 19
    14 Valley, Mont. 7,532 14 18
    15 Oliver, N.D. 1,837 3 18
    16 Madison, Idaho 38,705 69 18
    17 Turner, S.D. 8,264 14 17
    18 Oglala Lakota, S.D. 14,335 25 17
    19 Osage, Mo. 13,619 23 17
    20 Logan, N.D. 1,927 3 17
    21 Carroll, Miss. 10,129 17 17
    22 Mercer, N.D. 8,570 14 17
    23 Hill, Mont. 16,439 28 17
    24 Eddy, N.D. 2,313 4 17
    25 Towner, N.D. 2,246 4 17
    26 McIntosh, N.D. 2,654 4 16
    27 Hayes, Neb. 943 1 15
    28 Burleigh, N.D. 93,737 142 15
    29 Sully, S.D. 1,331 2 15
    30 Campbell, S.D. 1,435 2 15
    31 Morton, N.D. 30,544 45 15
    32 Langlade, Wis. 19,164 28 15
    33 Todd, S.D. 10,146 14 14
    34 Walworth, S.D. 5,510 8 14
    35 Coke, Texas 3,275 5 14
    36 Hettinger, N.D. 2,576 4 14
    37 Bowman, N.D. 3,195 4 14
    38 McLean, N.D. 9,608 13 14
    39 Izard, Ark. 13,559 19 14
    40 Golden Valley, N.D. 1,882 3 14
    41 Dewey, S.D. 5,779 8 14
    42 LaMoure, N.D. 4,100 6 14
    43 Big Horn, Mont. 13,376 18 14
    44 Dickey, N.D. 4,970 7 14
    45 Deer Lodge, Mont. 9,100 12 14
    46 Glacier, Mont. 13,699 18 13
    47 Bottineau, N.D. 6,589 9 13
    48 Kingsbury, S.D. 4,967 6 13
    49 Cassia, Idaho 23,615 30 13
    50 Minidoka, Idaho 20,615 26 12

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