While measuring the public health and economic impact of the current COVID 19 crises like trying to describe a roller coaster ride, rural communities, with a small population density should have fewer public health cases if the residents follow proper public health criteria.  When COVID 19 invaded the United States, it hit urban areas first with a population density that made transfer of the virus easier than less densely populated rural markets.  However, as the virus has progressed, rural communities, who moved more slowly adopt public health prevention measures such as wearing masks have grown in the number of COVID 19 cases they have. Although the prevalence of COVID-19 cases remains lower in nonmetro areas, the share of cases in nonmetro areas has grown since late March.[i] The share of confirmed U.S. COVID-19 cases in nonmetro areas grew from 3.6 % on April 1 to 12.7 % on October 7.[ii]  By October 7, the regions with the highest prevalence of COVID-19 cases included much of the eastern coastal region, most of the South, and large parts of the Midwest, the Great Plains, and the West. Less affected areas generally included many areas of the Northeast, Appalachia, the Mountain West, Hawaii, and Alaska—though many exceptions are evident in these regions.[iii] Among metro counties, COVID-19 case rates are highest among mining-dependent counties, nonspecialized counties (those with a diverse economic base), and recreation counties. Metro case rates are lowest in farming-dependent metro counties.[iv]

The U.S. Center for Disease Control (CDC) notes several important points related to rural communities and COVID 19. Long-standing systemic health and social inequities have put some rural residents at increased risk of getting COVID-19 or having severe illness.[v] In general, rural Americans tend to have higher rates of cigarette smoking, high blood pressure, and obesity as well as less access to healthcare which can negatively affect health outcomes.[vi] They are also less likely to have health insurance.[vii]  Rural communities are also becoming more diverse racially and ethnically and are at increased risk of getting COVID-19 and having severe illness.[viii]  Rural areas can face different health challenges depending on where they are located, and each rural community should assess their unique susceptibility and social vulnerability to COVID-19.[ix] Many rural communities are considered highly vulnerable according to CDC’s Social Vulnerability Index (SVI).[x] The SVI includes factors such as housing, transportation, socioeconomic status, housing, race and ethnicity, and language which can be helpful in determining how to help support rural communities before, during, and after COVID-19.[xi]  Rural hospitals do not have the capabilities of their urban hospital market based upon their smaller size and lack of facilities.  Questions have arisen whether rural hospitals are truly prepared for a major COVID 19 outbreak.[xii] The CDC notes rural communities also have strengths, assets, and protective factors that public health can use to tailor policies and messages designed to: reduce the risk of COVID-19 community spread and improve the general health of rural populations, which may minimize the severity of COVID-19.[xiii]  The reality is COVID 19 is not just a global public health crisis but an economic challenge as well. Regions that address the challenge effectively with proven public health measures such as restricting large gatherings, wearing masks, good hygiene and other efforts will benefit economically.  The converse is true.  Rural markets with a lower population density should have a natural advantage long term in appearing attractive to corporate site location projects if they address head on the spread of COVID 19.

[i] https://www.ers.usda.gov/webdocs/charts/98872/Rural_America_Figure_3-01.png?v=2133

[xii] See https://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2020/10/20/covid-19-patients-swamp-rural-hospitals