The worst virus outbreaks in the U.S. are now in rural areas.


With the U.S. case count and hospitalization rates approaching a third peak, none of the country’s biggest hot spots are currently in a large city. Almost all the counties with the largest outbreaks have populations under 50,000, and most have populations under 10,000. Nearly all are in the Midwest or the Mountain West.

Among the counties with the worst per capita outbreaks, seven of the top 20 were in South Dakota — six of which have fewer than 10,000 people.

Leading the nation was Norton, Kan., — population 5,486 — with an average of 44 new daily cases a day per 10,000 people.

The shift to rural areas is a stark contrast to earlier in the pandemic, when previous peaks saw virus cases concentrated mainly in cities and suburbs. The current surge is the most geographically dispersed yet, and it is hitting hard remote counties that often lack a hospital or other critical health care resources.

Since late summer, per capita case and death rates in rural areas have outpaced those in metropolitan areas.

The total number of coronavirus cases and deaths in rural places remains smaller than those in cities because of the comparatively low population in rural areas. But the rural share of the virus burden has grown over time.

Now, about one in four deaths from the virus is recorded in a rural county. In March and April, almost every death was in a metropolitan area, as the virus tore through the Northeast, after early clusters in the Seattle area and populous parts of California.



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