COVID-19 Pandemic Arrives Unevenly in Rural America

Photograph of Jessica Carson
Jessica A. Carson. Photo provided by the author

by Jessica A. Carson and reprinted from The Community Psychologist

The COVID-19 pandemic was initially slow to arrive in rural counties across the United States. According to public health data aggregated by the New York Times, the first confirmed rural case was in California’s Humboldt County on February 20, 2020 followed by a case in Grafton County, New Hampshire almost two weeks later. By mid-March, cases emerged in Colorado ski country, and this clustering of cases in rural “destinations” continued to unfold in March and early April, representing the virus’s first real foothold into rural America. This column draws upon and updates research published by the Carsey School of Public Policy at the University of New Hampshire (Carson, 2020) in early April tracking the initial spread in rural “destinations” and notes implications for rural residents both during and after the pandemic.

Rural Places with High Seasonal Housing Initially Linked to Higher COVID-19 Caseloads
In late March and early April, local news from popular rural vacation destination areas, including the White Mountains National Forest in New Hampshire and the Berkshires in Massachusetts, described residents’ fears of visitors fleeing more densely populated urban areas to hunker down in rural second homes and short-term rentals (Jones, 2020; Ropeik, 2020). Residents worried about contracting the virus, but also had concerns about their communities’ food and health infrastructure to keep pace with potentially increasing demand. Some communities debated restricting short-term rentals (e.g., Airbnbs) and encouraged second homeowners to stay home (“Great Barrington implores”, 2020; Jones, 2020). To help inform these decision-making processes, I explored COVID-19 diagnoses per 100,000 residents with a focus on rural counties’ seasonal housing stock, treating this as a proxy for rural “destinations.”

Specifically, using data from the US Census Bureau for population estimates and housing unit details, the US Department of Agriculture’s Economic Research Service for designating counties as rural, and the New York Times for county-level COVID-19 detail, I examined COVID-19 caseloads in rural counties where at least 25 percent of housing units are identified as for “seasonal or occasional” use, versus those with less seasonal housing. Note that the publication uses 25% as a threshold, but identified relationships held true whether “high” seasonal housing thresholds were placed at the rural mean (about 9%), 25%, or 50%.

I found that as of April 5, rural counties with high shares of seasonally vacant housing had higher rates of COVID-19 cases than either urban or other rural areas. In the nation’s 199 rural counties with high seasonal housing, average cases per 100,000 were more than twice as high as in other rural counties and 15% higher than in urban areas (Figure 1).

Figure 1. 1. MEAN COVID-19 DIAGNOSES PER 100,000 BY COUNTY CHARACTERISTICSFigure 1: COVID 19 Rates in Urban and Rural Counties

This work identified a relationship between rural communities’ housing characteristics and concentrations of diagnosed cases but could not indicate a causal link. There are several possible explanations for the patterns seen as of April 5: for instance, rural areas are older than urban areas (Cromrartie, 2018), and places with lots of seasonal housing often overlap with retirement destinations (Mattingly & Carson, 2019). Perhaps, because residents there are older, they are more likely to have been infected, or to have been diagnosed. These communities also have higher incomes than other rural places (ibid.): maybe residents there are more likely to have had access to testing capacity through health insurance and usual care providers than in other kinds of rural places. It also is possible that both high caseloads and high seasonal housing are linked to a third factor – beautiful natural amenities – and as usual recreation opportunities shuttered, day trippers came into these regions not for the housing, but for the hiking, biking, rock climbing, and other outdoor recreation opportunities, perhaps unwittingly bringing the virus with them. It’s possible that each of these factors contributed to the initial spread in rural areas with high seasonal housing.

Rural Places with High Caseloads Change Over Time
Whatever the driver of the relationship in Figure 1, this pattern was specific to a moment in time. By April 9, 2020, rates in urban counties had eclipsed those in rural places with high seasonal housing. By the end of April, the gap between rural counties with higher and lower shares of seasonal housing had closed. Critically, the shrinking gap was due to increasing spread in rural places more broadly, as the virus left fewer communities untouched.

Analysis from The Daily Yonder, published by the Center for Rural Strategies, indicates that the initial spread in rural counties classified as recreation-dependent (which has major overlap with communities with high shares of seasonal housing) has been eclipsed by rising infection rates in other kinds of rural counties, particularly those dependent on manufacturing or government employment. Marema (2020) concludes that rural counties with meatpacking plants and prisons are the new virus “hotspots.” Because “rural” is not a monolith, the spread, short-term outcomes, and long-term implications of the pandemic are likely to remain uneven within and across rural places.

Rural America Not Exempt from the COVID-19 Pandemic’s Magnification of Inequality
In rural America, this pandemic is both highlighting and exacerbating deeply entrenched inequalities. The initial spread into rural “destination” counties, whether due to out-of-town visitors or not, refreshes questions around intra-community inequality. Broadly, there are those who can afford travel, to work remotely or not at all, and to obtain testing and related health care, and those who meet that group’s needs by working as cashiers, health aides, and delivery drivers. Even in usual times, places with beautiful natural amenities bring in tourists, retirees, and second homeowners, without whom local jobs would diminish. But, for those who live in these places year-round, the quality of resulting jobs, often clustered in the service sector, and the pressure on local housing markets, complicate locals’ capacity to thrive (Mattingly & Carson, 2019).

Spread into rural counties dependent on meatpacking highlights many of these same income inequalities but adds an especially important layer of racial and ethnic stratification. Meatpacking plants long have been staffed disproportionately by immigrant workers, often Hispanic and/or Latino (Gouveia & Stull, 1997; Barrón-López, 2020; Ura, 2020). With federal pressure to keep open meat processing plants (Wilkie, 2020), workers must navigate potentially tenuous immigration status, fewer financial cushions against job loss, and higher risks of infection and death from the virus (Farrell et al., 2020; Mays & Newman, 2020; Ura, 2020).

In short, rural America is far from exempt from COVID-19, and as is true nationwide, risks of exposure, patterns of spread, and outcomes of infection are uneven and intersect with existing inequalities. Poor people, people of color, people with chronic health conditions, without health insurance, without savings – all populations for whom entrenched systemic inequities predate the pandemic – are disproportionately vulnerable to the pandemic’s health and economic effects. Mortality risks posed by rural America’s older age structure added to the lack of specialized health care, and the long-term trend of rural hospital closures exacerbate rural risks (Johnson, 2020; Healy et al., 2020). Continuing policy supports for those at most risk, including dedicating funding for rural challenges, will shape outcomes for rural residents in the months ahead.

Barrón-López, L. (2020, April 29). Hispanic Caucus calls on Trump admin to investigate working conditions for meatpackers. POLITICO, Retrieved from

Carson, J.A. (2020). Rural areas with seasonal homes hit hard by COVID-19. Data Snapshot. Carsey School of Public Policy, Durham, NH, Retrieved from

Cromartie, J. (2018). Rural America at a glance: 2018 edition. Economic Information Bulletin No. (EIB-200). Economic Research Service, United States Department of Agriculture, Retrieved from

Farrell, D., Greig, F., Wheat, C., Liebeskind, M., Ganong, P., Jones, D., and Noel, P. (2020, April). How COVID-19 could widen racial gaps in financial outcomes. JPMorgan Chase & Co., Retrieved from

Gouveia, L. and Stull, D.D. (1997). Latino Immigrants, Meatpacking, and Rural Communities: A Case Study of Lexington, Nebraska. JSRI Research Report No 26. Lansing, MI: The Julian Samora Research Institute, Michigan State University, Retrieved from

Great Barrington implores second home owners, tourists to stay away during COVID-19 contagion. (2020, March 28). The Berkshire Edge, Retrieved from

Healy, J., Tavernise, S., Gebeloff, R. and Cai, W. (2020, April 8). Coronavirus was slow to spread to rural America. Not anymore. The New York Times, Retrieved from

Jones, L. (2020, April 3). Bartlett Board to Sununu: Ban short-term rentals. The Conway Daily Sun, Retrieved from

Johnson, K.M. (2020). An older population increases estimated COVID-19 death rates in rural America. (National Issue Brief #147). Carsey School of Public Policy, Durham, NH, Retrieved from

Marema, T. (2020, April 30). Meatpacking and prisons drive the rural Covid-19 infection rate. Rural counties shed a quarter million jobs in March. The Daily Yonder, Retrieved from

Mattingly, M., & Carson, J. (2019). ‘I have a job…but you can’t make a living’: How County Economic Context Shapes Residents’ Livelihood Strategies. Journal of Rural Social Sciences, 34(1), 1-27.

Mays, J. C. & Newman, A. (2020, April 8). Virus is twice as deadly for black and Latino people than whites in N.Y.C. The New York Times, Retrieved from

Ropeik, A. (2020, April 2). Locals bristle as out-of-towners fleeing virus hunker down in New Hampshire homes. New Hampshire Public Radio, Retrieved from

Ura, A. (2020, April 27). Meatpacking workers in Texas Panhandle have little power to avoid the coronavirus. The Texas Tribune, Retrieved from

Wilkie, C. (2020, April 28). Trump orders meatpacking plants to remain open using the Defense Production Act. CNBC, Retrieved from

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