The "five pandemics" driving one million U.S. COVID deaths

Rural vs. urban

The beginning of the pandemic hit not only New York, but other big American cities hard. By August 2020 average death rates in non-metropolitan counties surpassed those of metropolitan ones. By December a higher per-capita share of people had died in rural counties than in urban ones. Since then, the gap has widened and rural county death rates have consistently remained higher.

Several factors may help explain this. At the beginning of the pandemic, Covid spread rapidly in densely populated areas and treatment options were limited. By the end of 2020, the overall death rate had already dropped significantly, due in part to better treatment availability and quality of care. Mortality rates for patients hospitalized for Covid declined from 22% in March 2020 to 14% in December 2020.

Access to hospitals can be more challenging for residents of rural counties. Nineteen rural hospitals closed in 2020, more than any other year on record. Rural hospitals that remained open often struggled to meet unprecedented healthcare demand with limited resources.