This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. Methods: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. Findings: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. Conclusion: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.

Purpose COVID‐19 mortality rates are higher in rural versus urban areas in the United States, threatening to exacerbate the existing rural mortality penalty. To save lives and facilitate economic recovery, we must achieve widespread vaccination coverage. This study compared adult COVID‐19 vaccination rates across the US rural‐urban continuum and across different types of rural counties. Methods We retrieved vaccination rates as of August 11, 2021, for adults aged 18+ for the 2,869 counties for which data were available from the CDC. We merged these with county‐level data on demographic and socioeconomic composition, health care infrastructure, 2020 Trump vote share, and USDA labor market type. We then used regression models to examine predictors of COVID‐19 vaccination rates across the USDA's 9‐category rural‐urban continuum codes and separately within rural counties by labor market type. Findings As of August 11, 45.8% of adults in rural counties had been fully vaccinated, compared to 59.8% in urban counties. In unadjusted regression models, average rates declined monotonically with increasing rurality. Lower rural rates are explained by a combination of lower educational attainment and higher Trump vote share. Within rural counties, rates are lowest in farming and mining‐dependent counties and highest in recreation‐dependent counties, with differences explained by a combination of educational attainment, health care infrastructure, and Trump vote share. Conclusion Lower vaccination rates in rural areas is concerning given higher rural COVID‐19 mortality rates and recent surges in cases. At this point, mandates may be the most effective strategy for increasing vaccination rates.

Since late-2020, COVID-19 mortality rates have been higher in rural than in urban America, but there has also been substantial within-rural heterogeneity. Using data from USA Facts, we compare COVID-19 mortality trends between U.S. urban (nonmetro) and rural (metro) counties from March 2020 to May 2021. We then compare trends within rural counties across different types of labor markets defined by county economic dependence (farming, mining, manufacturing, government, recreation, and nonspecialized) and by metropolitan adjacency. As of May 22, 2021, the cumulative COVID-19 mortality rate was 199.3 per 100,000 population in rural counties compared to 175.8 in urban counties. Net of controls, rural counties experienced a 3% higher average daily increase in COVID-19 mortality rates than urban counties over the study period. Rural mortality rates have been highest in the South, Southwest, and Great Plains. Both overall and within rural counties, mortality rates were highest in farming-dependent counties and lowest in recreation-dependent counties. Interaction models demonstrate that the protective buffer for recreation counties was even stronger for remote rural counties (those not adjacent to metro areas.

Tertiary to home and work, “third places” serve as opportunity structures that transmit information and facilitate social capital and upward mobility. However, third places may be inequitably distributed, thereby exacerbating disparities in social capital and mobility. The authors use tract-level data from the National Neighborhood Data Archive to examine the distribution of third places across the United States. There were significant disparities in the availability of third places. Higher poverty rates were associated with fewer third places. Tracts with the smallest shares of Black and Hispanic populations had comparatively more third places. However, this racial disadvantage was not linear, suggesting potential buffering effects in places with the largest shares of Black and Hispanic populations. There was also a rural disadvantage, except in the most isolated rural tracts. This study demonstrates the value of conceptualizing and measuring third places to understand sociospatial disparities in the availability of these understudied opportunity structures.

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Aging services were poised to play an important role in supporting the COVID-19 vaccination rollout for older adults. In this study, we use ordinary least squares regression models of county-level data ( N = 3086) to examine if density of aging and disability services is associated with COVID-19 vaccination rates for older adults in rural and urban areas of the United States. We find that net of compositional characteristics, county-level density of aging and disability services is associated with higher older adult vaccination rates. However, in the rural-urban stratified models, this only remained consistently true for rural counties. Given higher risk of COVID-19 mortality for older adults and larger relative shares of older adults in rural areas, rural counties with low vaccination rates should invest in supporting and/or expanding older adult services to facilitate vaccination.

The authors examine how two state-level coronavirus disease 2019 (COVID-19) policy indices (one capturing economic support and one capturing stringency measures such as stay-at-home orders) were associated with county-level COVID-19 mortality from April through December 2020 and whether the policies were more beneficial for certain counties. Using multilevel negative binominal regression models, the authors found that high scores on both policy indices were associated with lower county-level COVID-19 mortality. However, the policies appeared to be most beneficial for counties with fewer physicians and larger shares of older adults, low-educated residents, and Trump voters. They appeared to be less effective in counties with larger shares of non-Hispanic Black and Hispanic residents. These findings underscore the importance of examining how state and local factors jointly shape COVID-19 mortality and indicate that the unequal benefits of pandemic policies may have contributed to county-level disparities in COVID-19 mortality.

Background: The pandemics of coronavirus disease 2019 (COVID-19) threatens both human lives and health care system. COVID-19 patients may differ in their capability in spreading the causative virus, the severe acute respiratory syndrome-corona virus 2 (SARS-CoV-2). Methods: In this study, oropharyngeal swabs specimens from 43 patients admitted to our hospital during the COVID-19 peak time in Wuhan, China were obtained to survey temporal profiles of the viral loads in their upper respiratory tract. An internal and an absolute mRNA control were included in the real-time RT-PCR analysis and RNA extraction step to remove the potential influence of experimental variations on the result interpretation. Results: We found about one third of the hospitalized COVID-19 patients were never tested as SARS-CoV-2 positive during the course of this study. One patient with mild symptoms displayed constant high levels of viral loads after hospitalization, which were orders of magnitude higher than all other positive patients. Conclusions: We propose that if pharyngeal viral loads in a patient could indicate its ability in spreading the virus to others, then identification and strict separation of the high viral load patients should provide an effective mean in restricting viral spreading and protect health care workers from infection.