Experts Say Pandemic Will Hit Rural Communities Differently

Two infectious disease experts say the COVID-19 pandemic is affecting rural areas differently from cities, and Nebraska is an example of that.

Dr. Andrew Pavia is chief of the division of pediatric infectious diseases at the University of Utah School of Medicine. During a national webinar on the impact of COVID-19 on rural areas this Tuesday morning, Pavia said COVID-19 is hitting different populations differently.

“We’ve talked a fair bit about health disparities between poor people and people of color, but there’s another health disparity that we need to talk about, and that’s between people living in big cities and in rural communities,” Pavia said.

Pavia cited an analysis of the risk of severe disease resulting from the coronavirus that considered poverty, access to care, physicians per capita, the presence of chronic diseases, and age of the population.

“It’s kind of a perfect storm of risk for death when the virus lands in many of these poorer, more rural communities,” he said.

But he said the timing will be different. “We’re going to see sort of a different epidemiology in rural states without the very rapid, high peak that you see in cities, but we’re probably going to see a long, sustained outbreak that means we’re going to be fighting this for weeks and months to come,” he said.

Dr. Angela Hewlett is an associate professor in the division of infectious diseases at the University of Nebraska Medical Center and medical director of the Nebraska Biocontainment Unit in Omaha. Hewlett is worried by what she sees in this state.

“Nebraska as a whole, if you look at our numbers, looks pretty good. It looks like we don’t have a lot of numbers here of positive cases. We’re actually doing fairly well if you strictly look at the numbers. But when you really break it down by county here, it’s a completely different picture that emerges and it’s alarming,” Hewlett said.

Hewlett cited the situation in Grand Island’s Hall County, where the Nebraska Department of Health and Human Services said as of Tuesday morning there were 531 cases, compared to 291 in Omaha’s Douglas County, which has nine times as many people. And in Dawson County, where Lexington is located, the Two Rivers Public Health District said number of new confirmed cases jumped from 10 on Sunday to 127 on Monday.

Hewlett said the state has not reached the peak of the outbreak.

“We have not reached our peak in any way here. We’re not sure what week we are on yet, but we definitely have not reached our peak. And although the vast majority of our state is very, very rural we have not dodged this in any way,” she said.

And she said it will be a while yet.

“We don’t really know when our peak is. We anticipate at either the very end of this month or probably in the first week or two of May is when we’ll see our supposed peak. But that actually depends a whole lot as well on what’s going on in the community, and whether we continue our social distancing, that sort of thing. So I’m afraid what we’re going to see is a peak, a downslope, and then if we go back to business as usual in any way, we’re going to see another peak,” she said.

And Pavia said even within rural communities, the pandemic’s effect will differ, as the economy reopens.

“Is it going to be worse in rural communities than in cities? I think it’s going to vary by community. If, for example, the job that’s opening up is in a manufacturing plant that has tight quarters and poor infection control in a rural community, that’s going to be very dangerous for the people who live there,” he said.

However, he added, “Allowing agriculture and ranching to return a little bit more to normal is something we can probably do pretty safely.”