Millions of Vulnerable Rural Americans Live in COVID-19 Testing Deserts

Rural Black Americans are nearly three times more likely to live in highly vulnerable testing deserts than rural Americans overall.

Since the start of the COVID-19 pandemic, health experts have been unanimous about the most important step in confronting the disease — “Test, test, test”, as the World Health Organization’s chief said in March.

Testing for coronavirus makes it possible to treat those who are sick, isolate their contacts to prevent community spread, and direct healthcare resources to where they’re most needed.

But, where access to testing is concerned, there’s a big gap in the experiences of rural and urban Americans. Our research has found that nearly two-thirds of all rural counties in the U.S. are without a COVID-19 testing site, leaving 20.7 million people (almost half the rural population of the U.S.) in a “testing desert”. Conversely, only 28% of urban counties — home to just under 6% of the country’s urban populace — don’t have a site.

There are troubling inequalities even within rural states, too. Here’s what we found:

1. When it comes to COVID-19, not all rural counties are created equal.

Our COVID-19 Community Vulnerability Index (CCVI) identifies highly vulnerable rural counties that are far less likely to overcome a COVID-19 outbreak due to a number of socio-economic, health, and structural factors. Within these counties, a troubling pattern is emerging: they now have as many new COVID-19 cases per week, on average, as urban counties. But with so many COVID-19 testing deserts in rural America, the true spread in these hot spots could be even higher.

As the red lines in the graph below show, the counties ranked most vulnerable on the CCVI have consistently faced a faster spread of infection and rise in the number of deaths. But while rates in urban areas declined following their mid-April peak, cases have consistently increased in rural counties — and they are growing particularly rapidly in highly vulnerable rural counties, compared with their less vulnerable counterparts (top left panel in the graph). And though we might expect less densely populated rural counties to have a lower rate of infection than urban ones, by the beginning of June, the infection rate in highly vulnerable rural counties matched the rate in highly vulnerable urban areas.

2. More than 40% of those living in testing deserts are also in highly vulnerable counties.

Of the 20.7 million rural Americans living in counties without a COVID-19 testing site, 8.5 million (41%) live in areas ranked as highly vulnerable on the CCVI. One-third of these highly vulnerable rural populations are concentrated in just four states: Kentucky, Mississippi, North Carolina, and Arkansas.

*Showing only states with >5% of population

3. Rural Black Americans are more likely to be living in a highly vulnerable testing desert with increasing COVID-19 deaths.

Drilling deeper, 1.27 million rural Black Americans (that’s 35% of the rural Black population) live in highly vulnerable testing deserts. This makes them 1.7 times more likely to live in these areas compared to all rural Americans. And rural Black Americans are 2.7 times as likely to be living in a highly vulnerable area with both a lack of testing sites and increasing deaths from COVID-19.

The racial disparities continue when we look at the top 20 highly vulnerable rural testing deserts with the most COVID-19 deaths per capita. Three-quarters of these counties have a higher proportion of Black residents than the national average of around 13%.

1, 2 U.S. national rates are 654.8 cases per 100K, and 35.8 deaths per 100K.; * Worth, GA; Panola, TX; and Lee SC have since added one test site each since analysis was done on June 17, 2020.

The data are clear: rural communities — and many Black Americans within them — are at high risk from a lack of COVID-19 testing infrastructure.

We simply can’t afford to ignore rural communities in our fight against both coronavirus and its racial inequities.

Testing deserts leave all residents of a rural county vulnerable to COVID-19 because they are less likely to access testing, which increases the risk of community spread of the coronavirus. The fact that 41% of testing deserts are also highly vulnerable counties on our index indicates that they also face significant vulnerability in terms of epidemiological factors, strength of health systems, and other factors. This makes the need for access to coronavirus testing all the more urgent.

And the higher-than-average Black population within these counties is an indication that the structural inequalities faced by Black Americans are present — and potentially deadly — in the midst of the COVID-19 pandemic.

This work was made possible by everyone at the Surgo Foundation, including but not limited to (in alphabetical order): James Baer, Bethany Hardy, Hannah Kemp, Tichakuna Mangono, Sema Sgaier, Peter Smittenaar, Nick Stewart, and Staci Sutermaster.

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We use all the tools available from behavioral science, data science, and artificial intelligence to unlock solutions that will save and improve people’s lives.

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