America’s at-risk rural states braced for coronavirus upsurge

Lincoln County in West Virginia does not have a single hospital or intensive care unit bed

Until last Friday, Lincoln County in rural West Virginia had escaped the scourge of the Covid-19 disease, having yet to record a single case.

But now, with the virus inside the community, local health officials are under no illusion that calamity may lie down the tracks. That’s because the county does not have a single hospital or intensive care unit (ICU) bed.

It's also rural, poor and has an aging population. These are among a plethora of factors worrying Lincoln County health department administrator Sam Suiter. When asked about the extent of the county's healthcare staff, Suiter is particularly dispirited.

“You would probably die if I told you – in the county public health system we only have 3½ total people, the half being a part-time nurse,” he says. “That’s for 21,500 residents.”


While the deadly effects of coronavirus in America have been most keenly felt in urban centres, rural America may find itself in even worse shape as the virus spreads. About 60 million Americans live in predominantly rural states where, in hundreds of counties, ICUs, ventilators and even hospitals are absent.

Over the last decade, 119 hospitals in rural communities have closed due to funding shortages. The state of Louisiana, for example, has an infection rate more than eight times that of California's, which enacted strict physical distancing measures early last month.

In regions with some of the worst healthcare facilities, clusters of five or six neighbouring counties in states such as Missouri, South Dakota and Virginia are without ICU beds and hospitals. Rural counties with large populations of elderly people, such as Custer County, Colorado, where residents aged 65 and over make up almost one-third of the population, are particularly at risk.

Idaho’s isolated Blaine County, a vast area of mountains and plains, has recorded a higher per capita Covid-19 infection rate that New York.


Sam Suiter in West Virginia says that since there are no hospitals in Lincoln County, ventilators are also likely few and far between. As of last Wednesday, he said he knew of just 175 coronavirus tests having been completed in the county, though admits that's likely a low estimate. In the US as a whole more than 100,000 people are being tested every day.

The National Rural Health Association reported on April 6th that more than 1,000 rural communities had been affected by the virus. "The loss of revenue over the last few weeks due to the inability to provide non-emergency care is destabilising core health services in rural America," a recent briefing by the association found.

“The rate of rural hospital closures was at crisis levels prior to the pandemic; it will soon become cataclysmic.”

With the US now the global epicentre of the pandemic, state governments have found themselves forced to take the lead in the face of a muddled response from the White House.

As of Easter Sunday, the state of Wyoming was the only state in the union not to have recorded a coronavirus-related death

On March 24th, the same day President Donald Trump said he envisioned packed churches around the country on Easter Sunday, Ohio's public health system was already well into its own emergency response. Almost two weeks earlier, its Republican governor Mike DeWine had ordered universities to close and major money-spinning events cancelled.

By then, Ohio had already begun converting anaesthesia machines into respirators. A fleet of mobile testing stations was soon up and running across the state of 12 million residents.

When New York – where the Covid-19 death toll approaches 10,000 people – ordered the closure of all schools on March 18th, Ohio, where 251 lives have been lost, had made a similar move four days earlier. Last weekend, DeWine became one of the first US governors to recommend people wear masks in public.

As of Easter Sunday, the sparsely populated western state of Wyoming was the only state in the union not to have recorded a coronavirus-related death. There, politicians and residents alike have broadly ignored pursuing the kind of measures now commonplace elsewhere in the country such as social distancing and working from home.

Data collected through mobile phones shows Wyoming ranking last of all 50 states for reducing vehicular activity over the past month.

Situated in the northeast of the state, Teton County is home to about 25,000 people and has six ICU beds. So far, 53 cases of Covid-19 have been confirmed – the second-highest county-by-county figure in the state.

Millions of visitors

Teton County includes parts of the Yellowstone and Grand Teton National Parks – recreational areas attracting millions of visitors from around the world to skiing and outdoor activities every year. The parks, however, were not closed to the public until March 24th.

Local health officials are deeply worried by the threat of localised outbreaks. The infection rate for Teton County is 178 per 100,000, says director of the Teton County health department Jodie Pond. "The rate for Wyoming is 37 [per 100,000]," she says.

“[Getting] PPE for first responders and healthcare workers continues to be a challenge. The first shipment fit in the back of a Subaru,” says Pond of personal protection equipment. “We have been told we will not be getting any additional orders from the strategic national stockpile.” As of April 12th, the Wyoming state government had yet to issue a stay-at-home order.

Local hospitals, she says, have done a valiant job increasing surge capacity, but once more tests become available readiness will have to be scaled up, too.

“From a public health perspective, we would like to gear up for more testing when that becomes available,” says Pond. “We’re trying to get people on isolation and quarantine orders before we can no longer do that.”

For Sam Suiter in Lincoln County, West Virginia, some progress has been made in getting access to rapid testing equipment, “but we have to be careful who we offer that to”, he says.

“With it completely around us, we know it’s just around the corner.”