Of the 50 counties with the highest Covid deaths per capita, 24 are within 40 miles of a hospital that has closed, according to a POLITICO analysis in late January. Nearly all 50 counties were in rural areas. Rural hospital closures have been accelerating, with 181 since 2005 — and over half of those happening since 2015, according to data from the University of North Carolina. But that may be just the beginning. Over 450 rural hospitals are at risk of closure, according to an analysis by the Chartis Group, one of the nation’s largest independent health care advisory firms.

Those closures caused shortages of beds, ventilators and medical staff, and left behind patients with high and rising levels of diabetes and hypertension. Now, those communities often also have high rates of unvaccinated people — and that may well be related: In the communities where health resources disappear, so too does confidence in the medical system. Trusted sources of information go elsewhere.

The closure of Haywood County Community Hospital in Brownsville left local resident Jack Pettigrew with a 35-minute trip to the nearest emergency room, thinking Covid-19 was going to kill him.

“Honest to goodness, when we were backing out of the driveway that day, I had the strangest feeling that I wouldn’t be coming home,” he said, recalling how he worried about the long trek to the emergency room.