The Covid-19 pandemic is spreading across the United States in an uneven way that offers unique insights when viewed through the prism of the American Communities Project. For many Big Cities, the worst is here now. For the rural Aging Farmlands, the worst is likely still to come.
And differences in medical resources in various county types suggest the coming months could bring serious challenges to some communities as the virus moves across the country into different ACP communities. The types are laid out on the map below.
Up to now, stories about the coronavirus have focused on big urban areas and for good reason. As of Monday, the seven counties with the largest numbers of confirmed cases were all in the New York City metro area (four of the five Big City counties in the city and three adjacent Urban Suburbs). But just after those counties were Cook in Illinois (Big City home of Chicago), Wayne in Michigan (Big City home of Detroit), Bergen in New Jersey (Urban Suburb of New York), and Big City Los Angeles.
As of Monday, nearly all of the most urban types in the ACP had at least one case, according to the USAFacts tracker of the virus. In the Urban Suburbs and Exurbs, 97% of the counties had at least one case. In the Middle Suburbs, the figure was 99%. In the Big Cities, all 47 counties had at least one case.
But there is plenty of reason to expect that to change. Over the last three weeks, every one of the 15 types in the ACP has seen big growth in the number of counties with at least one case. In fact, in three weeks, every county type in the ACP has seen the number of impacted counties more than double — except the Big Cities and Urban Suburbs, where the numbers were already high.
As the table shows, some of the growth is massive. The counties of African American South went from being barely affected (29 counties) to more than 90% having a case (344 counties). The pattern looks similar for the Evangelical Hubs, from 16 counties to 311. Even the Working Class Country counties, which tend to be more remote, saw a sharp jump, from 12 counties to 230.
The Spike in the African American South
The Covid-19 jump in the 370 counties that make up the African American South is particularly noteworthy. Outside of the ACP’s urban-oriented types (Big Cities, Urban Suburbs, Middle Suburbs and Exurbs) the African American South had the largest number of cases of the virus as of Monday (more than 15,500) and its high count is not strictly a function of the size of its population.
Rural Middle America holds roughly 5 million more people than the African American South, but those counties only had about 6,100 cases. The College Town communities hold about the same population, but they only had 9,100 cases.
Some of the growth in the African American South may be attributed to those communities holding small towns with somewhat dense populations, making the virus easier to spread. That certainly describes Forrest City Arkansas, in St. Francis County, which the ACP visited last year. St. Francis had 17 confirmed cases of Covid-19 as of Monday.
But another factor is likely the high rates of uninsured people in those communities, about 14% compared to about 10% nationally.
And that growth in cases in the African America South could be particularly problematic because of other health concerns in those communities. The counties of the African American South also have higher than average rates of smoking (21%) and obesity (35%), which are listed as key risk factors for severe cases of Covid-19.
Furthermore, asthma, one of the most serious pre-existing conditions for severe cases of the virus, has a much higher rate of incidence among African Americans. Nearly 11% of that population has asthma and the number is 14% among children.
Challenges in Aging Farmlands and Native American Lands
Some places have seen lower numbers so far. The Aging Farmlands and Native American Lands counties still have fewer than 50% of their counties with a single case, but both have seen big jumps in the last three weeks. The Native American Lands went from two affected counties to 18, and the Aging Farmlands went from one to 37.
And both of those community types face deep challenges if the Covid outbreak hits them hard. County-level figures from Kaiser Health News show a lack of ICU beds in those places.
In the Aging Farmlands, only two counties have any ICU beds at all (Calhoun in Iowa and Walworth in South Dakota), according to the Kaiser Health News data. And there are only six total ICU beds in those counties. That is one for every 29,000 people over the age of 60. (Data show older people are more susceptible to severe cases of the virus).
The ACP recently posted a piece about Covid-19 from the perspective of Gove County, an Aging Farmland community in Kansas that had just recorded its first case of the virus. The concerns there were largely economic. Gove, which relies almost entirely on agriculture, had been struggling of late. But if the coronavirus cases multiply there, the community could face deep health challenges. The Kaiser data show no ICU beds in the county.
The figures aren’t much better for the Native American Lands. The Kaiser data show that only six of those 44 counties have even one ICU bed. There are only 54 ICU beds total in them, that’s one for every 2,800 people over the age of 60. And that doesn’t take into account the other challenges those communities face, including higher rates of diabetes — another condition that can lead to severe cases of the virus.
The American Diabetes Association reports that Native Americans have the highest rate of diabetes of any ethnic or racial group. Roughly 15% of Native American adults have been diagnosed with the disease, compared to about 8% for non-Hispanic whites.
The Native American Lands are particularly interesting to watch because of reservations’ independence from state government. This structure leaves them uniquely positioned to act on their own.
Thus far the response to the virus has been not been the same in all Native American Lands counties. Some have remained largely open to visitors, while others have closed themselves up, placing guards at entry points and checking IDs. For instance, the Northern Cheyenne Nation, in Rosebud County Montana, has implemented a curfew from 8 p.m. to 6 a.m. and is limiting “traveling in and out of the boundaries” of the area.
In an ordinance, the Northern Cheyenne declared the disease is “an ultimate threat to the Cheyenne way of life and the overall balance of society.” Rosebud County has one hospital and one ICU bed, according to the Kaiser data. It has not yet recorded a case.
Does Virus Spread Differently?
But the larger message in these data is about the spread of the virus in the last three weeks. On March 16, Covid-19 could be found in 481 counties, by April 6 it was in 2,461 counties — that’s more than a fivefold increase.
The real question is whether the virus spreads differently in the communities of the ACP. For instance, Big City counties may tend to have more daily interactions between people, but other communities in the ACP, such as Rural Middle America may have more common meeting spaces — local stores, diners, and cafes — even if there are fewer people visiting them.
Does a rural location with a diffuse population provide additional protection from the virus, even in communities with higher rates of poverty, higher populations with risk factors, and lower rates of health insurance?
The ACP will be watching the numbers in the next few weeks for answers.