Covid-19 In the USA: could rural areas be badly hit?

Author(s): I. Hoskins, Source: Syracuse University , Date: 26 March 2020

While rural areas might have a lower population density and therefore slower spread of Covid-19, they have several features that may increase mortality rates and have long-term health impacts warns an Issue brief from Syracruse University. The impacts of coronavirus on rural communities could have major implications for everyone in the USA.

 The brief, written by public health promotion expert Shannon Monnat, says that rural populations in the US tend to be older and have higher rates of chronic disease. Paired with a less robust healthcare system than urban areas this could lead to higher death rates. It is part of a series analysing the impacts of Covid-19.

 Older people have high mortality from Covid-19. Monnat reports that so far during the pandemic, 80% of deaths have occurred in those aged 65 and older. In the rural USA, she explains, 19% of the population is in this age group, 4% more than in urban areas. In nearly 2/3 of nonmetropolitan counties more than 20% of  the population is over the age of 65. Rural populations are also more likely to suffer from depression, diabetes, chronic obstructive pulmonary disease and heart disease, all of which predispose to a more serious covid-19 disease course, Monnat adds.

 The healthcare system in rural areas are not particularly robust. Monnat says that 126 rural hospitals in 31 states closed in the last decade and furthermore, she says the ones that remain don’t have capacity to deal with a surge in cases as they have limited availability of personnel and equipment. Only 1% of intensive care beds are in this kind of hospital. Hospitals will also be hit by dropping revenue from cancelled elective surgery, reduced doctor’s visits and increased costs as they kit out with protective equipment, according to Monnat.

 She also points out that as well as a less robust healthcare system, the supply of informal caregivers is much lower in rural areas and older adults are often quite isolated without access to healthcare and medication.

 Monnat’s analysis shows that rural areas lose out again when it comes to population testing. Availability of tests has been much worse in rural areas, she says, with a few exceptions. While urban areas are benefiting from high-volume mobile test collection sites most rural residents live hours from such places.

 She recommends some quick action to turn this around, and warns that urban America depends on rural America for food, energy, recreation and military personnel.

"Rural, urban, or somewhere in between – we are all in this together."  Monnat concludes.


Why coronavirus could hit rural areas harder, Shannon Monnat, 2020. Issue brief 16, Lerner Centre for Public Health Promotion, Syracruse University, USA.