Most rural infection rates still fall far short of Blaine County’s, and of the rates in cities like Seattle and New York where the pandemic first hit. But rural doctors and emergency managers watch the wave of contagion rippling out across the country and figure it’s just a matter of time—and not much time—before it hits them hard too.

They’re also afraid their communities aren’t ready to face a pandemic—and acutely aware of the handicaps they bear as this one arrives. Rural residents tend to be older, less affluent and less healthy than the national average, and fewer of them have health insurance. Long distances to hospitals and labs can spell the difference between life and death with an unpredictable disease that can rapidly turn critical. Rural grocery stores, pharmacies and even hospitals are last in line for supplies that chains and big box stores have special access to.

Most worrisome of all, many of the rural hospitals that are the first line of defense as coronavirus goes country were already on the critical list. An average of a dozen a year have folded over the last decade, and many more were on the brink when Covid-19 arrived. Before, if a local disaster or disease outbreak overwhelmed their resources, they could turn to neighbors and big-city medical centers for relief. Now they find themselves competing, at a disadvantage, with their larger counterparts for scarce test kits and protective gear.