County classification system -- Major Metro Core: Central counties of Metropolitan Statistical Areas (MSAs) with a population of 1 million or more. Major Metro Suburbs: Suburban counties of major MSAs. Medium Metro: MSAs with a population of 250,000 to 999,999. Small Metro: MSAs with a population of 50,000 to 249,999. Nonmetro (Rural): Counties that are not part of an an MSA (this story defines “rural” as Nonmetro). (Daily Yonder using #USAFacts pandemic data and 2019 Census population estimates.)

Rural counties helped lead the way in making December the pandemic’s deadliest month on record, ending the year with an emphatic reversal of the urban-focused manner in which the pandemic began in the U.S. in early 2020.

More than 16,000 Covid-related deaths were reported in December in nonmetropolitan (rural) counties, about a fifth of the total 73,578 deaths that occurred in the U.S. last month.

The rate of Covid-related deaths in rural America was nearly twice the death rate of major metropolitan areas (ones with a million or more residents).

That’s the opposite of the trend we saw in April. At the start of the pandemic, deaths in the New York City metro resulted in a major-metro death rate five times higher than the rural death rate for month.

Cumulatively in 2020, 51,221 rural Americans died from Covid-related causes.

At the close of 2020, all but 10 of the 100 counties with the worst cumulative death rates were rural.  

Deaths in 2020

The rural counties with the highest death rates show that patterns of the pandemic’s spread across the U.S. The highest death rates cluster in the Great Plains, from North Dakota down to the Texas Panhandle. Other hotspots include the Four Corners region, the Black Belt South, and the Texas borderlands.

These regions were all part of earlier phases of the pandemic, which initially spread in rural areas through meatpacking plants, prisons, and nursing homes. Counties with large percentages of non-white population also had higher infection and death rates in earlier phases of the pandemic.

Many rural counties in these regions have also been part of a late fall surge, as the virus has moved from institution-based infections to community spread.

(Popup data is available for all counties, including metropolitan ones, which are shaded gray.)

A Deadly December

December, the deadliest month on record, accounted for a third of all pandemic deaths in 2020. The map shows the percentage of 2020 deaths that occurred in each county in December. In nearly 700 counties, the number of Covid-19 deaths doubled or worse during the month.

The December surge deepened the pandemic in regions like the Great Plains. In North Dakota, for example, 10 counties doubled their number of deaths or worse in December. Pierce County saw its deaths increase from seven to 21 during the month. Renville County grew from two to 12 deaths.

In South Dakota, Hamlin County went from only four deaths to 34 in the month. Grant County grew from 12 to 35. Brown County from 21 to 60.

Eastern counties were also part of the December surge. In central Pennsylvania, Jefferson County saw a seven-fold increase in deaths in one month, growing from six to 43. Verango County, Pennsylvania, had a six-fold increase, from eight deaths to 47.