Early in the course of the pandemic, the health impacts were felt most severely in dense urban centers. From March to May, congressional districts in the most urbanized parts of the country were experiencing about five times as many deaths on average compared with those in the least dense parts of the country, and in some places this disparity was much larger.
However, by the summertime the urban-rural split had largely disappeared, and over the last several months, those districts with small shares of residents in densely populated places have been experiencing twice as many deaths as those in the parts of the country where all or nearly all residents live in urban neighborhoods.
Confluence Health is a health system that covers north-central Washington, including Tonasket. It has a dozen clinics across a wide swath of the region. Incoming CEO Dr. Douglas Wilson says as his hospitals fill with COVID-19 patients, they're crowding out victims of car accidents, heart attacks and head injuries.
"You hate to put someone on a helicopter or in an ambulance and fly them over the mountains in the winter, when they would've done better had they been able to receive care here locally without traveling," Wilson says. "That's a difference between life and death sometimes."Carrie Henning-Smith is with the University of Minnesota Rural Health Research Center.
"Rural residents on average are older than urban residents," Henning-Smith says. "Rural residents have more underlying health conditions. And rural residents are less likely to have health insurance and reliable access to health care. And you put all those together it means that once COVID gets into a rural area — and it's in virtually every rural area — it's more volatile."