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The number of new Covid-19 infections in rural America fell last week while climbing in metropolitan areas. The opposing trends evened out the rural and metropolitan infection rates for the first time since early August.

Rural counties had approximately 128,000 new infections last week, a decline of 13%. Metropolitan counties saw an increase of 11%. The rural infection rate fell to 277 cases per 100,000 residents for the week ending Saturday, December 18. The metropolitan rate was 268 cases per 100,000.

The last time rural and urban infection rates were this close was the week of August 7, during the fall upswing caused by the Delta variant. After that, rural and urban infection rates diverged, with the rural rate running as much as 60% higher than the metropolitan rate during the rest of the fall surge.

The decline in rural infections last week is a strong indication that the Omicron variant has yet to establish itself in rural areas (as of December 18). While the highly contagious variant moves into the U.S., we’ll be watching to see whether rural cases surge disproportionately, as they did during the spread of the Delta variant.

Rural areas also saw a 7% decline in deaths, while urban Covid-related deaths grew by 6% last week. Rural counties reported 2,095 deaths, down from 2,253 the week before. Nearly 140,000 rural Americans have died from Covid-19 during the pandemic, according to data compiled by USA Facts and the Centers for Disease Control and Prevention.

The rural death rate moved slightly closer to the metropolitan death rate last week. For the past two months, the rural death rate has been at least two times higher than the metropolitan death rate. Last week the rural death rate was 1.9 times higher than the metropolitan death rate.

The primary cause of the higher rural death rate is lack of vaccinations, according to Carrie Henning-Smith, deputy director of the University of Minnesota Rural Health Research Center. Other factors such as pre-existing conditions and access to healthcare also play a role, she said.

The most recent Daily Yonder analysis of Covid-19 vaccinations found that rural counties have a vaccination rate of 46.8% of total population, 12.6 percentage points lower than the metropolitan rate of 59.5%.

  • Fifteen states had more rural infections last week than they did two weeks ago. Twenty-seven states had more metropolitan cases last week compared to two weeks ago.
  • New Hampshire had the highest rural infection rate last week at just over 600 new cases per 100,000 residents.
  • The large states of Illinois and New York had the next highest rural infection rates.
  • Just nine states accounted for more than half of all rural infections last week. These were Ohio (10,375 cases), Illinois (8,147), Indiana (7,919), New York (7,491), Michigan (7,209), Kentucky (6,577), Pennsylvania (6,560), Wisconsin (5,794), and Minnesota (5,104).
  • New York had the largest raw number increase in rural cases.
  • Half of all states saw double-digit percentage declines in rural infections last week. Iowa reported less than half the number of rural infection last week as two weeks ago. Reported cases fell from 6,511 two weeks ago to 2,788 last week. Wyoming also fell by more than half, declining from 1,042 cases two weeks ago to 443 last week.
  • Other states with large raw-number declines in rural cases were Wisconsin, Pennsylvania, Michigan, and Minnesota. (See the table at the bottom of the story for a list of percentage and raw number changes in rural and metropolitan cases.)
  •  The number of rural counties in the red zone fell by 103 last week. The White House define red zone and as having 100 or more new cases per 100,000 residents in one week. Texas dropped 19 rural counties from the red zone. Montana dropped 13.
  • Only seven states added rural red-zone counties. South Carolina added three, and Florida added two.
  • Alabama added just one rural red-zone county but also added seven metropolitan counties to its red-zone list. Georgia and Louisiana each added seven metropolitan counties to the red zone, and Florida added four.

This analysis covers Sunday, December 12, through Saturday, December 18. Data comes from USA Facts. Death data for Florida and Nebraska are from the CDC and cover a one-week period ending December 17. Rural is defined as nonmetropolitan. Nonmetropolitan counties are ones not included in the Office of Management and Budget 2013 list of Metropolitan Statistical Areas.

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