Kansas National Guard members wait for cars during a lull in people seeking tests at a coronavirus testing site May 20 in Dodge City, Kan. (Charlie Riedel/AP)

By Reis Thebault and Abigail Hauslohner of The Washington Post
May 24 at 9:50 AM

The novel coronavirus arrived in an Indiana farm town mid-planting season and took root faster than the fields of seed corn, infecting hundreds and killing dozens. It tore though a pork processing plant and spread outward in a desolate stretch of the Oklahoma Panhandle. And in Colorado’s sparsely populated eastern plains, the virus erupted in a nursing home and a pair of factories, burning through the crowded quarters of immigrant workers and a vulnerable elderly population.

Fourteen counties in New York, Michigan, Louisiana and Washington accounted for about half of the nation’s coronavirus-related deaths through mid-April. Since then, deaths in other parts of the country have increased and are now where most of the fatalities occur.

In these areas, where 60 million Americans live, populations are poorer, older and more prone to health problems such as diabetes and obesity than those of urban areas. They include immigrants and the undocumented — the “essential” workers who have kept the country’s sprawling food industry running, but who rarely have the luxury of taking time off for illness.

Many of these communities are isolated and hard to reach. They were largely spared from the disease shutting down their states — until, suddenly, they weren’t. Rural counties now have some of the highest rates of covid-19 cases and deaths in the country, topping even the hardest-hit New York City boroughs and signaling a new phase of the pandemic — one of halting, scattered outbreaks that could devastate still more of America’s most vulnerable towns as states lift stay-at-home orders.

“It is coming, and it’s going to be more of a checkerboard,” said Tara Smith, a professor of epidemiology at Kent State University in Ohio. “It’s not going to be a wave that spreads out uniformly over all of rural America; it’s going to be hot spots that come and go. And I don’t know how well they’re going to be managed.”

America’s largest and most densely populated cities and suburbs still suffer more infections and deaths per capita, but those overall rates are increasing faster in smaller, rural counties where the virus has spread rapidly in the past month, the Post analysis found.

In many of those places, where the health-care system is already stretched thin, even a minor surge in patients is enough to overwhelm.

There are still more than 180 counties across 25 states that have yet to report a positive case, according to The Post’s analysis. Nearly all of them are among the least populous places in the country. Experts say it’s possible such locales have avoided the virus, but a lack of testing can also allow an outbreak to fester silently.

A University of Texas study found last month that in counties with no reported cases, there’s about a 10 percent chance the virus is spreading undetected. Elsewhere, it may only be a matter of time.

Where and when hot spots arise in America’s most isolated counties is, in part, a matter of chance. But crowded spaces, and populations with poor access to health care, quickly facilitate the spread.

Of the 25 rural counties with the highest per capita case rates, 20 have a meatpacking plant or prison where the virus took hold and spread with abandon, then leaped into the community when workers took it home.

Infection has raced through immigrant worker communities, where poverty or immigration status prevent some of the sick from seeking care and language barriers hinder access to information. It has taken hold in counties where residents flout social distancing guidelines or believe the pandemic to be exaggerated, the virus’s lethality a myth spread by President Trump’s political foes and a liberal media.

“We’ve got a little bit of everything: folks who feel their rights have been taken away because they’ve been asked to stay home and they lost jobs and they’re really hurting, and we have folks who are very concerned and frightened and won’t leave their house,” said Rebecca Burns, a health officer for the agency that covers Hillsdale County, Mich., which last month topped the state for the highest death toll among rural counties, after a nursing home outbreak.

“We can’t let our guard down. We have to continue to watch,” Burns added, during a week when members of a conservative militia stood outside a Hillsdale County barbershop, brandishing guns to “protect” its reopening, in defiance of the governor’s orders. “Anyone who thinks this is one and done is probably wrong,” she said.

Close confines, chilled temperatures and sometimes spotty sanitation standards make meatpacking plants “the perfect storm as far as transmission events go,” Smith said. A Centers for Disease Control and Prevention report this month found nearly 5,000 covid-19 cases in workers at 115 meat and poultry processing plants across 19 states.

That tally is likely an undercount, as testing varies widely among facilities and some companies and state officials have refused to release detailed data. The United Food and Commercial Workers Union, which represents those who handle about 75 percent of the beef and pork processed in the United States, says that at least 10,000 workers have so far contracted the virus — and at least 35 have died.

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