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Rural America saw mixed progress in the containment of Covid-19 last week. New infections were down while Covid-related deaths were up. In both infections and deaths, rural areas did not perform as well as urban ones.

Meanwhile, an additional 784,000 rural Americans became fully vaccinated against Covid-19 last week.

Modest Improvement in Cases

A total of 42,462 new Covid-19 infections were reported in rural counties last week, a decline of about 5% (or 2,200 fewer cases) from the week before. In urban areas, the number of new infections dropped by 15%, from about 357,000 two weeks ago to 303,000 last week.

An additional 734 rural residents died from Covid-related causes last week. That’s 14% higher than two weeks ago. In urban areas, Covid-related deaths climbed by only 0.6%, to 4,272 for the week.

Another piece of contradictory data is that even though the number of new infections dropped last week, the number of rural counties on the red-zone list increased by 24 to 565. The red zone is defined as having 100 or more new infections per 100,000 residents in a one-week period. The White House Coronavirus Task Force has said localities on the red-zone list should take additional measures to contain the virus.

Despite the increase in rural red-zone counties, less than a third of the nation’s rural counties are on the red-zone list. At the height of the winter surge in December, nearly 95% of the nation’s rural counties were on the red-zone list.

This week’s Covid-19 report, based on data from the nonprofit USA Facts, covers Sunday, April 25, through Saturday, May 1.

Rural Red-Zone Counties Increase

  • Twenty states had an increase in the number of rural counties on the red-zone list. Sixteen states had a decrease. Eleven had no change.  
  • Texas added the most counties to the red-zone list, up 15 from last week. South Dakota added seven counties, and North Dakota added six. Illinois, Pennsylvania, and Virginia each added five.
  • Iowa had the largest decrease in the number of red-zone counties, dropping 10. Tennessee dropped nine, while New York dropped five.
  • Michigan had the nation’s worst rural new-infection rate, with 250 new cases per 100,000 in population. The metropolitan rate of new infections in Michigan was higher, at 289 per 100,000.
  • Seven states had higher rates of new infections in rural areas than urban ones (Massachusetts, South Carolina, Montana, Virginia, Vermont, Wyoming, and California).
  • California had the biggest gap between its rural infection rate (59 new cases per 100,000) and its metropolitan infection rate (31 per 100,000).


  • The number of rural Americans fully vaccinated against Covid-19 grew by 784,000 last week, an increase of 1.8 percentage points from the week before.
  • As of May 1, 26% of rural Americans (approximately 11.1 million) had completed their vaccinations. In metropolitan counties, 29.7% of residents were fully vaccinated.
  • The gap between rural and urban vaccination rates increased last week. Two weeks ago, the vaccination rate was 2.5 percentage points higher in urban areas than rural areas. Last week, the urban rate was 3.7 percentage points higher.
  • Nine states had a rural-urban vaccination gap of more than 5 percentage points. These were the following:
    • Florida — 20.4% of rural residents vaccinated vs. 29.8% urban, for a gap of 9.4 points.
    • Massachusetts — 25.6% rural vs. 33.4% urban, for a gap of 7.8 points.
    • Nebraska — 24.3% rural vs. 31.6% urban, for a gap of 7.4 points.
    • Louisiana – 19.4% rural vs. 26.5% rural, for a gap of 7.1 points.
    • North Dakota – 28.3% rural vs. 35.1% urban, for a gap of 6.8 points.
    • Missouri – 21% rural vs. 27.1% urban, for a gap of 6.1 points.
    • Ohio – 27.6% rural vs. 33.5% urban, for a gap of 6 points.
  • Connecticut had the highest rural vaccination rate in the nation – 40.9%, a point higher than the state’s metropolitan rate.
  • Georgia had the worst rural vaccination rate in the nation last week, with only 8.9% of rural residents vaccinated. But a large number of the state’s vaccinations are not allocated to specific counties, meaning the rural rate could be higher. Nationally, Georgia ranks fifth from the bottom in its statewide vaccination rate, which includes unallocated data.
  • Virginia and West Virginia, which also had large numbers of unallocated vaccinations, also had low rural vaccination rates.
  • Rounding out the worst states for rural vaccinations, Tennessee, Missouri, Florida, Alabama, and Louisiana had fully vaccinated only about a fifth of their rural residents as of May 1.

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