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The rural death rate for Covid-19 grew by nearly a third last week, reaching levels not seen since early March.

New infections also climbed, but at a more modest pace of 5%.

Covid-related deaths in metropolitan counties also increased, but at a slower pace of 19% for the week. The number of new infections in metropolitan counties fell last week by 3%.

This week’s numbers exacerbate the current gap between rural and urban areas in both new infections and deaths. The weekly death rate as of September 18 was 117% higher in rural areas than in urban ones. The current infection rate is about 60% higher in rural areas. (This story defines rural as nonmetropolitan counties.)

The rural and metropolitan death rates ran roughly parallel from the end of the winter surge in early March until the end of July. Since then, the rural death rate has grown more quickly than the metropolitan rate. (See the graph below.)

The infection rates follow a similar trend. (See graph above.) The metro and rural rates have been roughly equivalent since the winter peak in early January. The rates began to diverge the second half of August, when the rural rate began climbing more quickly than the metropolitan rate. And for two of the last three weeks, the number of new infections in metropolitan counties has dropped while the rural new-case number climbed.

This week’s report on Covid-19 in rural America covers Sunday, September 12, through Saturday, September 18. Our source for data is USA Facts.

Deaths

  • Rural counties reported 2,906 Covid-related deaths last week, up from 2,210 two weeks ago. Metropolitan counties reported 8,208 Covid-related deaths, up from 6,886 two weeks ago.
  • Florida deaths have not been recorded for the past two weeks in the USA Facts reports. That artificially suppresses the death rate. A crosscheck with data from the Centers for Disease Control and Prevention shows that Florida had about 2,500 Covid-related deaths each of the last two weeks, meaning the actual death rates are potentially 20% higher than the USA Facts data. (Data nerds can see more in the note at the bottom of this story.)

 Infections

  • Although the summer surge shows signs of burning itself out, Covid-19 currently has a tight grip on both rural and urban parts of the United States. Ninety-three percent of the nation’s metropolitan counties are in the red zone, meaning they have an infection rate of at least 100 new cases per 100,000 in one week. In rural America, 97% of counties are in the red zone.
  • Twenty-nine states have all their rural counties in the red zone. Another 14 states have more than 90% of their rural counties in the red zone.
  • Only four states have under 90% of their rural counties or county-equivalents in the red zone. These are Alaska, New Mexico, South Dakota, and Utah.
  • A third of rural counties have rates of more than 500 new cases per 100,000 for the week – or five times the red-zone threshold. These counties are shown in black on the map at the top of the page. Only about a fifth of metropolitan counties have new-infection rates that high (those are shown in gray on the map).

Good and Bad

  • As expected, rural counties are overrepresented in the list of counties with the worst infection rates. Of the 100 counties with the highest rates of new infections last week, 83 were rural. Rural counties make up about 63% of all U.S. counties.
  • Two small, rural localities had the worst rates of new infections last week. Caldwell Parish in north-central Louisiana and the North Slope of Alaska each had infection rates over 2,300 per 100,000 residents. That’s equivalent to 2.3% of those locations’ total population. The districts each have just under 10,000 residents, according to 2019 population estimates.
  • Kentucky’s rural Knox County was the next highest in the nation, with an infection rate of over 1,700 per 100,000.
  • Kentucky fared poorly overall last week. Out of the 15 counties with the highest infection rates last week, five were in Kentucky (Knox, Rockcastle, Powell, Leslie, and Whitley – all rural).
  • Tennessee had two counties (both rural) in the top-15 – Scott and Van Buren.
  • On the other end of the spectrum, 29 counties reported no new infections last week. Nine of Alaska’s local jurisdictions (Alaska does not have a county system) had no new cases. Utah reported six nonmetro counties that had no new cases. Texas reported four.

Statewide Rates

  • One swath of very high rates of infections centers on the upper South and Mid-Atlantic states. The pattern is clearly visible in the black and gray counties on the map at the top of the page. These colors represent respectively the rural and metropolitan counties with very high infection rates – greater than 500 cases per 100,000 for the week.
  • Tennessee had the worst rural infection rate, at 947 new cases per 100,000. That means the equivalent of about 1% of the state’s rural population reported a new case of Covid-19 last week.
  • Kentucky and West Virginia each had rural infection rates above 800 cases per 100,000 residents.
  • North and South Carolina each had infection rural infection rates of over 600 new cases per 100,000 for the week.
  • In the West, both Wyoming and Nevada had new infection rates of over 600 in their rural counties.
  • Nevada has stopped reporting Covid-19 data for most of its counties and is not included in this analysis.

Data note: Florida deaths have not been included in USA Facts reports for the past two weeks. We checked data from the Centers for Disease Control and Prevention and found that the CDC reported 2,452 and 2,468 deaths for the weeks ending September 12 and September 19 respectively. Since this data covers a slightly different time period, and since we assume there are methodological differences in the data collection methods of USA Facts and the CDC, we did not include this data in our maps and charts above, except where noted.

If the Florida deaths as reported by the CDC are included in our death-rate tabulations, the rural weekly death rate would climb from 6.31 to 6.46 per 100,000. The metro death rate would rise from 2.91 to 3.76 per 100,000. This would reduce the gap between the rural and urban death rates by 0.7 percentage points. Instead of the rural death rate being 117% higher than the metro rate, it would be 72% higher.

If Florida deaths continue to be omitted from the USA Facts reports, we'll rethink our approach.