In Rural America, Covid Hits Black and Hispanic People Hardest

The coronavirus pandemic engulfed rural America last year, prompting a surge in deaths among white residents as the virus sparked a longstanding health shortage there.

But in smaller towns and farms, new research has found, Covid kills black and Hispanic people at significantly higher rates than their white neighbors. At the end of the pandemic’s second year, in February 2022, overcrowded healthcare systems, poverty, chronic diseases and low vaccination rates forced non-white people to bear the burden of the virus.

Black and Hispanic people in rural areas faced an extraordinarily high toll, dying at a far higher rate than in cities during the second year of the pandemic.

In towns and cities of every size, the racial gap in Covid deaths has narrowed. This has been especially true recently, when large gains in population-wide immunity have eased the kind of pressure on health systems that hurt non-Americans the most.

However, with deaths from the coronavirus climbing, and health officials bracing for an even more deadly cold, scientists warn that efforts so far to close the racial gap in vaccination rates are leading to non-white people being infected with the virus. The waves weren’t enough to save them from the ravages.

Nowhere were those difficulties more apparent than in rural areas. Black, Hispanic and Native American people in those places recorded the second deadliest pandemic of any major racial or ethnic groups anywhere in the United States, according to new research, led by Andrew Stokes, assistant professor of global health. . at Boston University.

In those communities, the Biden administration assures that every Covid death is now a preventable jar with the difficulties of obtaining medical care.

Rural pharmacies are often few and far between, making it difficult for poor and less mobile residents to obtain vital antiviral pills.

Doctors said some black patients, especially those who are not insured or who are away from hospitals, wait too long before seeking help to take advantage of new treatments.

And black and Hispanic people have received booster shots at lower rates, resulting in what some physicians describe as a lack of awareness, from cutbacks to public messaging, especially in conservative states.

Cuthbert, Ga. “The national vibe is that everyone should now be in a position to do what they need to to protect themselves from the virus,” said Mayor Bobby Jenkins. Epidemic. “But not everyone is in a position to do that yet.”

Scientists said that the racial disparity in Kovid deaths has reduced due to several reasons. The initial vaccine rollout gave priority to older Americans, who are disproportionately white. But during the past year, primary vaccinations for blacks and Hispanics increased nearly twice the pace of white rates.

The rate for Hispanic people, 54 percent, is now higher than the 50 percent for white people. The black vaccination rate, 43 percent, still lags behind, but the gap has narrowed.

The virus also infected and killed black and Hispanic people at such high rates in the first year of the pandemic – at one point in 2020, black rural residents were dying at nearly six times the rate of white residents – that it would fall short of the target by the year. Could be 2.

According to data from the Centers for Disease Control and Prevention, these changes are so profound that among the oldest Americans, the white COVID death rate has recently exceeded that of black people.

But the shrinking of the racial gap is partly due to the worsening of the pandemic for white people rather than serious progress for black or Hispanic Americans. The CDC found that the white COVID death rate increased by 35 percent from the first to the second year of the pandemic. Over that period, the death rate fell by only 1 percent among Hispanics and 6 percent among black people.

“This is not a movement toward equity,” said Alicia Riley, a sociologist at the University of California, Santa Cruz. “It’s that white people started getting over and dying from Covid.”

Dr. Stokes said that the national picture has also hidden a change that has as much to do with geography as it is with race. As the brunt of the pandemic shifted from large cities to rural areas in late 2020, which have a large proportion of white residents, more white people naturally added to the national number of Covid deaths.

But within rural areas, Covid deaths were split at higher rates for non-white people than they were in large cities and small or medium ones, Dr. Stokes’ team found it. They used the CDC count of Covid death certificates as of February, avoided recent and potentially incomplete data, and took into account the older age of the white population.

At the worst of the Omicron wave this winter, black and Hispanic death rates exceeded white people in towns and cities of every size, just as they were at the peak of every previous virus outbreak.

The death rate for black people at the peak of this winter was 34 percent in rural areas, 40 percent in small or medium cities, and more than 57 percent in large cities and their suburbs. The racial gap in cities was so large because white urban people died from COVID at a much lower rate than white people in rural areas for most of the pandemic.

Dr. Stokes said the findings suggest that whether people live in a big city or a small town, sometimes as the part of the country where they lived, COVID had a lot to do with their experience. . In the second year of the pandemic, ending in February 2022, rural parts of the West, South and Northeast all experienced white COVID deaths, despite differences in containment strategies in those regions.

“Looking at Massachusetts versus Texas is not enough,” Dr. Stokes said. “You have to look at rural Massachusetts versus rural Texas.”

Moving into a significant fall booster campaign, Dr. Stokes said, the results spoke of the need for more proactive vaccination plans tailored to black Americans, especially rural ones. “In order to adopt equitable vaccine strategies we need to go above and beyond just making them available,” he said.

In small and medium cities and rural areas across the South, where protective policies were scarce, blacks faced the highest COVID mortality rates of any racial or ethnic group in any region in the second year of the pandemic, Dr. Stokes found it.

Among those killed were 28-year-old Jacqueline Lowery, a middle school science teacher and single mother of two in Darlington, SC, a mostly black city of 6,000. Having just given birth to a son, Ms. Lowy was hesitant to get the vaccine because she was concerned – without need – that the vaccine would contaminate her breast milk.

When she called a cousin, Jessica Brigman, a nurse, in September to say she had become ill, Ms Brigman urged her to see a doctor. But Ms. Lowery, who had obesity and gestational diabetes, had another priority: She had not yet tested positive for the virus, and needed it from her employer before she could qualify for COVID pay. . Meanwhile, she was making use of precious sick days.

“She was the only provider, and she had to pay the bills, and she wasn’t being paid because she missed a solid week of school,” Mrs Brigman said of her cousin’s concerns. “They kept telling her that she needed proof of positive COVID status.”

By the time she got a positive Covid result, Ms. Lowy was hospitalized, Mrs. Brigman said. About a week later, with a blood clot near her lungs, she died of Covid as she was being taken to a better equipped North Carolina hospital. Mrs Brigman recalled her cousin’s concern as she became weak as she was qualifying for a COVID-related time off.

“She was like, ‘I need to test a positive, I need to do a test,'” Mrs Brigman said. “She never focused on anything else.”

Dr. Morris Brown III, who practices nearby primary care, said financial concerns often kept patients from seeking care in a state that refused to expand Medicaid coverage to low-income people. Have given.

However, even deciding to seek treatment does not guarantee finding it. Dr. Tony Graham III, who was admitted to a hospital in South Carolina, said his orders for Paxlovid antiviral pills were declined until he found a nearby rural pharmacy that stocked it. He said that whatever public education campaigns related to Covid once existed, they left people in the dark about boosters and treatments.

“There’s been a big drop in communication,” Dr. Graham said.

Non-white people have generally suffered the most severe losses in surviving COVID-19 in young and middle age, partly due to differences in the burden of chronic disease and workplace risks.

Theresa Andrasafe, a postdoctoral scholar at the University of Southern California, said the return to workplaces by white people could help narrow the racial gap in transition across age groups. But as long as non-white workers are in close contact with customers and coworkers and can reduce their risk of being sick at home, she said, workplace-related inequalities will persist.

Black people also masked at higher rates, national polls indicate, with rural residents saying a division was still on sharp display. “It’s more blacks who wear their masks,” said Roy Lee McKenzie, 78, from South Carolina, who is still recovering from a 2020 COVID case.

In rural areas, health problems resulting from hospital closures, job losses, low vaccination rates and poor medical access have increased the impact of the pandemic. Vaccination rates were much lower in rural counties that voted more for Donald Trump, the research showed, but also in rural areas with health worker shortages and more black residents.

Janice Probst, who studies rural health at the University of South Carolina, said the state’s strategy of funneling vaccines first through hospitals and then through large chain pharmacies had the effect of leaving behind more disadvantaged rural residents whose towns had I was neither.

In some places, however, progress has not been enough to vaccinate even non-white communities.

In Minnesota, black, Hispanic and Asian adults under the age of 65 were more vaccinated than white residents during the first Omicron wave, according to research led by Elizabeth Wrigley-Field, an assistant professor of sociology at the University of Minnesota. . But middle-aged non-white people were killed more often by Covid anyway. Black people had twice the death rate of white people.

Dr. Wrigley-field said, “The way the pandemic is designed now is much more than political leaders allow people to choose their level of risk.” But, she said, “the risk to social groups that doesn’t come in lock step with their vaccination. Everything else in our society has alienated it from what puts some people at greater risk than others.” .