Covid Is Killing Rural Americans at Twice the Rate of Urbanites

Yves here. This article points out that while Covid vaccination rates are lower in rural areas than in metro areas, it does not fully explain the much greater rural mortality rate. This article focuses on much poorer access to hospitals. Another which this piece ignores is that rural America is older. From a 2018 survey:

In the United States, 19 percent of the rural population is 65 years or older, compared with 15 percent in urban areas. Rural counties make up nearly 85 percent of the 1,104 “older-age counties”—those with more than 20 percent of their population age 65 or older.

I just came back from Bailey Island, Maine, where the median age of the year-round population is 60. And the winters are not nice!

The article puts a key factoid at the end: that hospitals across Texas have had their capacity reduced by a third by staffing shortages.

And please read this tweetstorm (hat tip guurst). It shows how rural non-Covid patients are also sufferingL

By Lauren Weber, Kaiser Health News Midwest correspondent, who was formerly a health policy reporter for HuffPost. Originally published at Kaiser Health News

ural Americans are dying of covid at more than twice the rate of their urban counterparts — a divide that health experts say is likely to widen as access to medical care shrinks for a population that tends to be older, sicker, heavier, poorer and less vaccinated.

While the initial surge of covid-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.

Since the pandemic began, about 1 in 434 rural Americans have died of covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are now more than double urban rates — and accelerating quickly.


In rural northeastern Texas, Titus Regional Medical Center CEO Terry Scoggin is grappling with a 39% vaccination rate in his community. Eleven patients died of covid in the first half of September at his hospital in Mount Pleasant, population 16,000. Typically, three or four non-hospice patients die there in a whole month.

“We don’t see death like that,” Scoggin said. “You usually don’t see your friends and neighbors die.”

Part of the problem is that covid incidence rates in September were roughly 54% higher in rural areas than elsewhere, said Fred Ullrich, a University of Iowa College of Public Health research analyst who co-authored the institute’s report. He said the analysis compared the rates of nonmetropolitan, or rural, areas and metropolitan, or urban, areas. In 39 states, he added, rural counties had higher rates of covid than their urban counterparts.

“There is a national disconnect between perception and reality when it comes to covid in rural America,” said Alan Morgan, head of the National Rural Health Association. “We’ve turned many rural communities into kill boxes. And there's no movement towards addressing what we're seeing in many of these communities, either among the public or among governing officials.”

Still, the high incidence of cases and low vaccination rates don’t fully capture why mortality rates are so much higher in rural areas than elsewhere. Academics and officials alike describe rural Americans’ greater rates of poor health and their limited options for medical care as a deadly combination. The pressures of the pandemic have compounded the problem by deepening staffing shortages at hospitals, creating a cycle of worsening access to care.

It's the latest example of the deadly coronavirus wreaking more havoc in some communities than others. Covid has also killed Native American, Black and Hispanic people at disproportionately high rates.

Vaccinations are the most effective way to prevent covid infections from turning deadly. Roughly 41% of rural America was vaccinated as of Sept. 23, compared with about 53% of urban America, according to an analysis by The Daily Yonder, a newsroom covering rural America. Limited supplies and low access made shots hard to get in the far-flung regions at first, but officials and academics now blame vaccine hesitancy, misinformation and politics for the low vaccination rates.

In hard-hit southwestern Missouri, for example, 26% of Newton County’s residents were fully vaccinated as of Sept. 27. The health department has held raffles and vaccine clinics, advertised in the local newspaper, and even driven the vaccine to those lacking transportation in remote areas, according to department administrator Larry Bergner. But he said interest in the shots typically increases only after someone dies or gets seriously ill within a hesitant person’s social circle.

Additionally, the overload of covid patients in hospitals has undermined a basic tenet of rural health care infrastructure: the capability to transfer patients out of rural hospitals to higher levels of specialty care at regional or urban health centers.

“We literally have email Listservs of rural chief nursing officers or rural CEOs sending up an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and can’t get this heart attack or stroke patient or surgical patient out and they’re going to get septic and die if it goes on much longer,’” said John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals.

Morgan said he can’t count how many people have talked to him about the transfer problem.

“It’s crazy, just crazy. It’s unacceptable,” Morgan said. “From what I’m seeing, that mortality gap is accelerating.”

Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds.

Pre-pandemic, rural Americans had 20% higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to 2019 data from the Centers for Disease Control and Prevention’s National Center for Health Statistics.

In southeastern Missouri’s Ripley County, the local hospital closed in 2018. As of Sept. 27, only 24% of residents were fully vaccinated against covid. Due to a recent crush of cases, covid patients are getting sent home from emergency rooms in surrounding counties if they’re not “severely bad,” health department director Tammy Cosgrove said.

The nursing shortage hitting the country is particularly dire in rural areas, which have less money than large hospitals to pay the exorbitant fees travel nursing agencies are demanding. And as nursing temp agencies offer hospital staffers more cash to join their teams, many rural nurses are jumping ship. One of Scoggin’s nurses told him she had to take a travel job — she could pay off all her debt in three months with that kind of money.

And then there’s the burnout of working over a year and a half through the pandemic. Audrey Snyder, the immediate past president of the Rural Nurse Organization, said she’s lost count of how many nurses have told her they’re quitting. Those resignations feed into a relentless cycle: As travel nurse companies attract more nurses, the nurses left behind shouldering their work become more burned out — and eventually quit. While this is true at hospitals of all types, the effects in hard-to-staff rural hospitals can be especially dire.

Rural health officials fear the staffing shortages could be exacerbated by health care vaccination mandates promised by President Joe Biden, which they say could cause a wave of resignations the hospitals cannot afford. About half of Scoggin’s staff, for example, is unvaccinated.

Snyder warned that nursing shortages and their high associated costs will become unsustainable for rural hospitals operating on razor-thin margins. She predicted a new wave of rural hospital closures will further drive up the dire mortality numbers.

Staffing shortages already limit how many beds hospitals can use, Scoggin said. He estimated most hospitals in Texas, including his own, are operating at roughly two-thirds of their bed capacity. His emergency room is so swamped, he’s had to send a few patients home to be monitored daily by an ambulance team.

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63 comments

  1. TBellT

    I really wish they had included the full graph to show that this was true even before the vaccines. Luckily they link to the paper and its easy to find in figure 3. By eye it looks like during the January centered peak it might have been 25-33% more deadly in the rural areas.

    1. Code Name D

      Ah, so the report dose not say what corpreate media says it says. Why am I not suprized. The corps are running away with this, even calling it “Red Covid.”

      This is no longer about figting Covid, but prosicution of a political class. I am no fan of the MAGAs, but they not to blame for Bidon’s failure of leadership.

      And to think they acused Trump of being devisive. I guese its okay when a “D” does it though.

      1. TBellT

        Well this peak the death rate differential between rural and urban for the current peak is 50% and if you look at the end of the graph up to 100%, so vaccine uptake is definitely playing a role, it’s just not the whole story.

  2. d w

    while there are certainly fewer hospitals, there are also a lot fewer doctors too. even in cities of up to 500k, tend to struggle too, new doctors go there, but dont stay long, leaving for higher pay else where

    in the past medical students would get tuition assistance if they agreed to practice medicine in rural areas, that is probably gone now, so they have no incentive to go rural areas.
    but even ‘large’ cities, are having trouble getting doctors to stay

    and in some rural counties, there are no PCP, some might have a chiropractor, but thats it

    1. lordkoos

      Our local small-town hospital certainly does not attract top medical talent and I have heard some horror stories about their ER. There is no way to know if this increases the rate of rural COVID deaths, but it could have something to do with it.

  3. Make Natural Selection Great Again

    Deplorable morons dying in large numbers. What is the news here?

    Natural selection is working.

      1. Arizona Slim

        Y’know what? I have vaccinated friends and I have unvaccinated friends. And, heavens to Betsy, we get along just great!

      2. TBellT

        >she has a PhD in molecular biology

        Are we supposed to ignore appeals to authority or not?

        “You actually get more severe symptoms when you are vaccinated against one variant and then it mutates and then your body sees another variant. So there’s potential, and the science shows that in fact with the flu if you get vaccinated in multiple years you are more likely to get severe disease, more likely to have more viral replication, and you are more likely to get hospitalized in both adults and children. And we’re seeing the same thing with Covid and the delta variant”

        Can someone else explain this? This doesn’t make sense to me as a layman. I know the flu mutates more rapidly than coronaviruses but to the extent it makes vaccines harmful? Isn’t the immune system adaptable so that it can react to mutations.

        “PhD’s are the most vaccine hesitant”

        I can find only one study to back this up. And they note ” To our knowledge, no other study has evaluated education with this level of 239 granularity, which was possible due to our unusually large sample size (>10,000 participants 240 with PhDs). Further investigation into hesitancy among those with a PhD is warranted” Also this survey data was collected in conjunction with Facebook which concerns me.

        (paraphrasing) “Also data on MMR causing autism has been deliberately destroyed”

        This is way outside the consensus on MMR and makes me even more skeptical on the testimony.

        1. Shonde

          She was basically saying recent research was showing ADE, Vaccine Dependent Enhancement, with our covid vaccines. That was my interpretation.

          GM, IM Doc, please comment and clarify if possible.

        2. Judith

          She may be talking about “original antigenic sin.”

          From Wikipedia:

          Original antigenic sin, also known as antigenic imprinting or the Hoskins effect,[1] refers to the propensity of the body’s immune system to preferentially utilize immunological memory based on a previous infection when a second slightly different version of that foreign pathogen (e.g. a virus or bacterium) is encountered. This leaves the immune system “trapped” by the first response it has made to each antigen, and unable to mount potentially more effective responses during subsequent infections. Antibodies or T-cells induced during infections with the first variant of the pathogen are subject to a form of original antigenic sin, termed repertoire freeze.

          The phenomenon of original antigenic sin has been described in relation to influenza virus, dengue fever, human immunodeficiency virus (HIV) [2] and to several other viruses

            1. YankeeFrank

              I don’t think that’s clear. It depends on many factors, including how specific the vaccine is. The current covid19 vaccines (with the exception of novavax, I think) are only developed with a single spike protein which makes the immune system develop antibodies for just that protein whereas a natural viral infection will contain evolutionary mutations that the immune system will generate a spectrum of antibodies against. Much about the immune system is still unknown and is very complex and there are other factors but I don’t think its controversial to assert that natural infection generally provides more robust protection than this type of vaccine.

        3. Yves Smith Post author

          There is a study which I cannot find readily that showed that that getting the flu vaccine one year out of three was more effective than getting it annually.

          1. José

            This story from 2015 cites “a leading influenza researcher, Derek Smith”, who suggests that “in years when a component of the vaccine — say the part that protects against the influenza A family called H3N2 — had changed little or not at all from the previous year’s vaccine, the second year’s vaccine would induce less protection (…) Smith, now based at Britain’s University of Cambridge, called it negative interference.

            The idea is that the antibodies produced in year one may neutralize some of the vaccine in year two’s shot before it can trigger a full immune response, explained Dr. John Treanor, a vaccine expert at the University of Rochester Medical Center in New York.

            Smith also argued that when the vaccine viruses were quite different from one year to the next the recipient would actually get enhanced protection. Positive interference, he called it”

            https://www.statnews.com/2015/11/11/flu-shots-reduce-effectiveness/

            1. Yves Smith Post author

              You chose to omit everything, which BTW also came at the top of the story and thus was deemed by the writers to be more significant, that supported the thesis that getting vaccinated less often for flu would be more effective. A nice job of cherry-picking, which is a violation of site Policies. From STAT:

              If you’ve been diligent about getting your flu shot every year, you may not want to read this. But a growing body of evidence indicates that more may not always be better.

              The evidence, which is confounding some researchers, suggests that getting flu shots repeatedly can gradually reduce the effectiveness of the vaccines under some circumstances.

              Dr. Edward Belongia is among the scientists who have seen the picture coming into focus. He and some colleagues at Wisconsin’s Marshfield Clinic Research Foundation reported recently that children who had been vaccinated annually over a number of years were more likely to contract the flu than kids who were only vaccinated in the season in which they were studied.

              “The vaccine was significantly more effective … if they had not been vaccinated in the previous five years,” Belongia, an epidemiologist, recounted in a recent interview with STAT.

              That finding is worrying public health officials in the US, who have been urging everyone to get a flu shot each year — and who still believe an annual vaccination is better than skipping the vaccines altogether.

              In other words, bugger evidence, public health official think it’s too complicated to message getting flu shots less than annually.

              1. Dave in Austin

                Interesting article but I’d be interested in knowing if there are significant demographic differences between the “vaccine every year” kids and the “only this year” kids.

                I can think of a lot of potential differences: mobility; parental divorce and exposure to more people; income; rural vs urban; ethnicity; income and education level of family; living with extended family; home schooling; religious exemptions. Since many schools systems require vaccinations, I wonder if the sample of “vaccinated every year” may be very large and the “only this year” very small and largely made up of transfers and immigrants.

                I’m not saying any of these factors is definitely at work, but I’m always suspicious of “a study says…” when the underlying data isn’t shared. This is akin to corporate press releases about wonderful new breakthroughs when there is no audited financial statement, no patent applications, no details about the breakthrough… just PR.

        4. Michael Thomas

          Are PhDs vaccine-hesitant? If i were a high school drop-out anti’vaxxer and participating in a survey, you know what? I’d fib about my education level. Don’t even think about believing that if the PhDs are self-identified.

          1. Yves Smith Post author

            You appear ignorant of the fact that the biggest concentration of anti-vaxxers is in wealthy and Democratic Northern California. One of the most significant “activists”/propagators is Laura Hayes, wife of Rick Hayes, formerly head of PE at CalPERS, now in private equity. Rick and Laura raised money successfully from Rick’s network of contacts in PE (they have a severely autistic child and were unwilling to believe it was bad genetic luck; it had to be “something” and that something was vaccines). I am told by someone who knows rick personally that their evangelizing made a fair number of converts, and they would be at least MBAs, often JDs, as well as scientists.

            And these are hard-core anti-vaxxers, not mRNA vaccine hesitant.

            You seem not to have considered that a scientist might look at the approval process and see that it was sorely wanting. Even the normally pro-pharma STAT severely criticized the FDA for effectively punting on the statistical review, which normally takes a large team 6 to 9 months to perform properly.

    1. ambrit

      You, (if you are a ‘real’ person,) forget that ‘Natural Selection’ works in mysterious ways. An angry mob of country folk waving torches and pitchforks burning the local PMCs chateau down, (with PMC and family still inside,) is also a “force of nature.” Be careful what you wish for.
      The end state of the philosophy of “there is no society” is “there is no civilization.”

    2. m

      Good lord you are sick-make natural selection great again, Hillary is that you? I have worked in rural hospitals before covid. People don’t come unless they are at death’s door. I am sure money, lack of insurance have a lot to do with it. If they come for a wound or break, they end up diagnosed with other things and scripts they cannot afford to fill. How do I know, cause they tell me. USA is a mess & vax/unvax, dem/repub, red/blue is making things so much worse.

  4. flora

    Rural health care deserts.

    ‘Health Care Deserts: Nearly 80 Percent Of Rural U.S. Designated As ‘Medically Underserved’

    https://khn.org/morning-breakout/health-care-deserts-nearly-80-percent-of-rural-u-s-designated-as-medically-underserved/

    There’s rising maternity mortality, too.
    https://www.commonwealthfund.org/publications/2021/sep/restoring-access-maternity-care-rural-america

    See also: private equity buying hospitals.
    https://www.nbcnews.com/health/health-care/private-equity-firms-now-control-many-hospitals-ers-nursing-homes-n1203161

    1. Code Name D

      Transportation is also an unexamend factor. When I go to the hosbital with covid, its a 15 minute trip. But when Rual America has to go, its from many miles away. That means stopping off for gas, maybe even a food stop – when you should otherwise be in quariteen. And even if you are confirmed to have covid, you are still sent home. Rinse and repeat. You may have to make 2 or 3 trips to and from the hosbital while you are infactous.

  5. Bacon

    Having grown up in a rural setting but immediately adjacent to what qualifies as an urban center in this region (midwest), it never ceases to amaze me that rural people expect to have their cake and eat it too.
    If you live far away from the hospital, you may not make it there, that is just reality. Being able to transfer serious cases for better care is great but many of these folks have been voting against funding for much of what heavily subsidizes their rural existence for decades and now it is “unacceptable” that they can’t get a transfer to better healthcare.
    I don’t subscribe the idea in vogue that the unvaccinated shouldn’t receive care, and there is plenty of blame for the current state of things to go around, but surely this is a moment for society to point out that they’re getting precisely what they asked for.

    1. flora

      There used to be many Dr.’s single or small group practice offices in almost all towns. Dr.s offices were used most of the time. The hospital was for serious accident, serious disease, and childbirth. Now, consolidation, new rules favoring expensive tech (EHR the most recent example) and more crazy insurance premium hikes and failures to pay have driven most of those small offices out of business. (Good for the biggest guys in the insurance, PE ‘healthcare’ , mega hospitals biz, though.)

      What’s the phrase? Because markets, go.. something?

      1. ambrit

        I like the Anti Neo-liberal Rules.
        Rule #1: Because society.
        Rule #2: Go “neutralize” neo-liberals. (You might die in the process, but, no one gets out of here alive anyway.)
        Rule #3: Be as a fish swimming in the sea.
        As Saint Buffett said :There is a class war going on.
        The dynamic here as I see it is that no one knows where the “breaking point” of the population is.
        Stay safe! Hull down.

      2. Yves Smith Post author

        Correct. This is a product of Obamacare, which forced pretty much all doctors into Accredited Care Organizations. The only solo practitioners still standing are ones like my GP, who does so by virtue of having what I estimate as about 60% of her income come from services not reimbursed by insurance.

    2. Jeremy Grimm

      “If you live far away from the hospital, you may not make it there, that is just reality.” But what if the hospitals that had been there close down? Is everyone supposed to move closer to the cities near the hospitals that remain? What happens as those close too?

      … “voting against funding for much of what heavily subsidizes their rural existence for decades” …
      That statement seems a little vague. Do you have anything in particular in mind? You have great faith in the power of voting. I voted along with a large majority for change in 2008 but how I voted did not matter for much.

      … “moment for society to point out that they’re getting precisely what they asked for” … that suggestion hardly deserves a response.

      1. coboarts

        The rurals forget that they are required to leave their long-time American homes for UN approved zones of human habitation – didn’t they get the nudge?

  6. Ghost in the Machine

    Rural areas have suffered a type of colonialism the past 40 years or so. It is increasingly unpleasant to live in these areas. What were more diverse economies have become more barren. Children flee. The average age of farmers and ranchers is in the 60s I believe. At some point, it will become a crisis of food production. Who wants to do it? I read about younger people interested in smaller scale organic/regenerative/ecologically minded farming but it seems they can’t get a foothold in a system subsidized for largeness. My family were small ranchers for many generations. When I look at the bigness…The industrial scale, the debt, the exploited labor, feed lots, pesticides, the soil degradation….it is all just soul crushing for anyone who actually cares about land and community. The children flee.

    1. Dwight

      About 20 years ago I visited the farm of my father’s friend, one of the few who stayed and farmed. His house was in a small oasis with fruit trees, surrounded for miles around by a vast desert of monoculture soybeans. Roundup bottles in the barn, and on the refrigerator, a notice from Monsanto of a meeting to discuss anti-GM legislation in the Netherlands. The farms of my father’s youth were small and cash-poor but much richer ecologically and spiritually.

  7. Divadab

    And with vaccine mandates hospitals are being forced to fire critically-needed staff. Just anecdotal but our local hospital in rural Washington has had to hire in very expensive contract nurses to take the place of those fired for not getting vaccinated- most of whom have already had COVID and are thus naturally immune. The Washington vaccine mandate is simple-minded, anti-science, destructive, and utterly disrespectful to the front line workers who have borne the brunt of the pandemic, including catching and recovering from the disease. THEY ARE Naturally Immune already!!!!

    I can’t believe I voted for that Inslee but he is personally responsible for unnecessary suffering with his moronic fascistic un-American vaccine mandate. Utterly disgraceful.

    1. lordkoos

      I voted for Inslee also, but I think he’s generally OK — he’s getting pandemic advice from medical “experts”.

    2. James Simpson

      A healthcare worker who would rather lose their job in caring for the health of others rather than take a vaccine shot which has little or no risk to them strikes me as someone whose priorities are muddled.

      1. flora

        Maybe they’re seeing things we aren’t seeing. Your assumption the thing is ‘of little or no risk to them’ seems unproved at this time considering the VAERS adverse events data increasing.

  8. DF

    The story about Summer Brennan’s father isn’t necessarily a rural issue. IIRC, her father lives in Los Alamos, which isn’t that far away from Santa Fe.

    Also, as she described in the tweet thread, it was a struggle to find an appropriate ICU bed anywhere in the state, even in its largest city (Albuquerque). Generally, the health care in NM sucks, even for city-dwellers.

    1. Yves Smith Post author

      Santa Fe has a population of only 70,000. Albuquerque is only an hour away, and on the other side from Los Alamos. Plus many rich retirees who live there only part of the year. I am highly confident the local hospital deals only with true emergencies like strokes, heart attacks, and car crashes, that anything complicated is done in Albuquerque or a tertiary medical center. The locals ave extremely into alternative care which further dilutes the income potential for a MD. I visited Santa Fe often, I had friends there, and no way would I ever see an MD there.

  9. Kris Alman

    “a population that tends to be older, sicker, heavier, poorer”

    Isn’t this the same explanation for deaths of double vaccinated people?

    https://www.npr.org/sections/goatsandsoda/2021/08/20/1029628471/highly-vaccinated-israel-is-seeing-a-dramatic-surge-in-new-covid-cases-heres-why
    The bad news, doctors say, is that half of Israel’s seriously ill patients who are currently hospitalized were fully vaccinated at least five months ago. Most of them are over 60 years old and have comorbidities.

  10. ambrit

    Am I out of line to suggest that the Pandemic is a “Contributing Factor” to an actual Jackpot? Look at who is dying first and, so far, foremost; the “useless eaters” of Reactionary Disdain fame.
    It is more than depressing.
    No Conspiracy required.

  11. Anthony Stegman

    Perhaps lots of folks need to move out of rural areas. Some rural towns need to be emptied out. Just as it is too expensive to have expansive public transit systems in far flung suburbs and exurbs, it is also too expensive to maintain high quality medical infrastructure in far flung places. That is the simple reality. When folks were young and self sufficient perhaps these rural enclaves worked for them. Now that these same folks are elderly they need to leave and move to the “big city” where they can access transportation, health care, entertainment, etc…

    1. Jeremy Grimm

      I trust you must also be advocating for substantial increases in Social Security support, Medicare, and perhaps a subsidy to help pay for the costs of moving. You also must be in favor of bringing transportation, and affordable health care to the “big city”. I agree strongly with your positions, although if you are willing to pay for these improvements to the safety net and quality of life, it seems odd that high quality medical care is too expensive for rural enclaves. Many older persons become attached to their homes and local community, features of rural life often missing from the “big city”.

      If the “simple reality” [whatever that is … some form of Neoliberal ontology derived from extensive application of Neoliberal epistemology(?)] — is that “it is also too expensive to maintain high quality medical infrastructure in far flung places” … I am frightened to ponder what else you might believe is too expensive. After all, it may be that the Market for high quality medical infrastructure is badly constructed and requires some adjustment.

    2. lordkoos

      That is quite the idea that rural towns should be “emptied out”. People who live in rural areas, most love that life. Cities are not for everyone.

      It is not “too expensive” to take care of people, this country at one time had many more public hospitals, but they have been victims of profit-driven health care.

  12. Jeremy Grimm

    I did not spot any mention of the differences in the wealth and income of rural areas. Is Saratoga County, New York a rural area or are Bozeman, Montana or Jackson Hole, Wyoming rural areas — and if not — exactly what does rural mean? I think it might be a complex code for a combination of distance from the coasts and interior trade centers, a level of poverty and despair, a response to a visceral rejection of the values of city Elites and weak local Elites, a remnant of Northern and Southern Elite disdain for the Southern yeomanry and the poor, combined with a residue of race and age discrimination, mixed with a peculiar disdain for the less savory aspects of food production. Disease has never kindly treated old age, or poverty in our Society — whether rural or urban.

  13. Trustee

    Recognizing that no generalization is worth a damn including this one:

    Early on this was a urban, high density, Democratic problem.

    Post vaccine it is a rural, low density, Republican problem

    In both cases the rich do better than the poor. I wonder why?

    1. Ian Ollmann

      A conspiracy to disadvantage the poor is not required. If there are factors like not attending to important details that can make one poor, they can also lead to poor health outcomes. One study found, for example, that ADHD sufferers may expect to have a lifespan reduced by 20 years! Do all poor people have ADHD? No. Can sliding through life unable to get organized to deliver on promises at work or in health care lead to adverse outcomes? Sure. It just takes a few real factors like this to turn the statistics against an entire demographic.

      Poor people might also have cause to be suspicious of the medical system. It costs more than they can afford and they are less likely to have healthcare coverage. Just visiting might provoke personal economic armageddon. Given that, you’d wait for things to be dire indeed before inviting the inevitable personal bankruptcy. Showing up to the hospital already on deaths door leads to poor outcomes.

      Poor people must take more risks to get by, and sometimes they get smacked.

      1. Yves Smith Post author

        What bigotry. So the poor deserve their outcomes, in a county with no mobility out of the bottom 40%.

        And fabricated as well. The poor are responsible for living in food deserts? Often having to juggle multiple jobs, which leads them with little/no time to exercise and prepare healthy meals? And most important, for being unable to afford medical care except visits to the ER in crisis?

  14. Susan the other

    India, of all places, seems to be handling their rural population much better than we are. There is probably more natural immunity going on there as well. South Africa has benefited from natural immunity. And the timely use of readily available common drugs. I’m sure there are many countries doing a much better, more coordinated, job. One reason might be that we are/were on a trajectory to streamline our healthcare industry. Mostly by using old competition formulas. But those plans didn’t mix well with the popular skepticism about the integrity of the government’s edicts to “trust us; get vaccinated.” Nor did they mix with the long, drawn out austerity being used against rural hospitals. So many of them closing or selling to the highest PE bid. I’d like to think otherwise, but American medicine has become as absurd as American capitalism. There doesn’t seem to be anything here to be proud about.

    1. Maritimer

      “India, of all places, seems to be handling their rural population much better than we are. There is probably more natural immunity going on there as well. South Africa has benefited from natural immunity. And the timely use of readily available common drugs.”
      ********
      No mention in that article about the treatments that are available. So many of these supposedly expert articles that ignore factors such as: natural immunity, treatments available, prophylactics used, etc. How any of these studies can be scientific while ignoring such very obvious factors is beyond me.

      For one such factor, prophylactics, the availability of them has got to be a huge factor. But it is ignored. Just incredible. Just more study cherry picking.

    2. drumlin woodchuckles

      The rural population is still the majority population in India. So the rural population may have some political power in India, at least the power to prevent the urban-based elite from writing them off.

  15. Paul Newman

    “Covid has also killed Native American, Black and Hispanic people at disproportionately high rates”
    I really wish you would look at iowa.
    IA has a very high Hispanic population in rural areas, many towns of 8K up to 80K have over 20% Hispanics. (Storm Lake- Sioux City)
    Yet, Hispanics die at HALF of their representation in the State.
    Same with Iowans of African Roots.
    Must be something other than skin color.
    Take out the very elderly and Iowa does very well -Covidwise.

    1. Yves Smith Post author

      You see the reverse in Texas. Hospitalization and death rates of Hispanics and blacks disproportionate to their level in the population.

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