COVID-19 has been spreading heavily in areas of the country with high political support for President Trump, potentially increasing the disease’s visibility and death toll in areas loyal to the President.
According to data compiled by the Brookings Institution’s Bill Frey, COVID-19 is spreading faster in less populated areas, leaving big cities and entering rural America.
“A big part of the shift is the disease moving to the South, and into the Midwest, into a lot of rural counties,” Frey told TPM.
The trend revealed by his research follows on separate indications that cases have been increasing more rapidly in rural areas. Localized outbreaks in food processing plants and prisons have spurred the increase, along with what Frey described as spread in “rural areas where most of the population is kind of dispersed.”
Data that Frey published in a blog post at the Brookings Institution showed that the number of people residing in”high prevalence” COVID-19 counties — areas with a rate of 100 cases per 100,000 people or more — had tipped in late April from being a majority of counties that voted for Hillary Clinton in 2016 to a majority that voted for Trump.
Frey took county-level case counts compiled by the New York Times and combined it with population data from the Census Bureau, before overlaying it with data showing which counties voted for Clinton in 2016 and which voted for Trump.
As of May 10, the data suggests, Trump counties were leading Clinton counties in having highly prevalent COVID-19 outbreaks by a margin of roughly 6 percent.
“It’s not only that it’s Trump counties — its that a huge portion of the country is now living in high-prevalence counties,” Frey said.
The data reflects a larger trend in the spread of the disease around the country as a whole. For example, on March 29, Frey found that 8 percent of the U.S. population lived in so-called “high prevalence” COVID-19 counties — areas with a rate of 100 cases per 100,000 people or more.
As of May 10, that number had increased to 72 percent of the population. At the same time, only 22.9 percent of people living in high-prevalence areas were urban residents — the rest were either in suburban or rural areas.
“If you look at the map of states that Trump took in 2016, and especially in Wisconsin, Pennsylvania, Michigan — these are small town areas that he mopped up,” Frey added.
Researchers at the Kaiser Family Foundation found that COVID-19 began to increase its rate of spread in rural areas in late April. Separate projections from the Centers for Disease Control and the Federal Emergency Management Agency leaked in early May to the New York Times suggested that the country’s coming hotspots would mostly be in more rural areas than where the U.S. crisis began, in big, urban areas like New York City and Detroit.
The disease’s rural spread has stoked fears that it may catastrophically intersect with the pre-existing rural health-care crisis.
Since 2010, 126 rural hospitals have closed, largely due to financial shortfalls. The providers run on tight margins and have limited space in their intensive care units.
Meanwhile, the rural population in general may be more susceptible to COVID-19 than the population of urban areas. According to data from the National Rural Health Association, chronic respiratory disease cases are 75 percent more common in rural areas than in urban, while the rate of people 65 years and older is far higher than in cities.
One doctor in St. Cloud, Minnesota told TPM that cases were coming in from rural areas around the city of 68,000, but that doctors’ ability to discern the extent of local spread was limited by the continued lack of testing.
“We’re surrounded by a whole bunch of very, very rural areas of farmers, very small communities, and none of those people are tested, so we really have no idea what the community spread is,” Dr. John Mahowald, a cardiologist at CentraCare St. Cloud Hospital, told TPM.
“In the county where I live, in one week there were 50 cases, the next week there were 800,” he said. “And we didn’t know that without testing.”