In-Depth Analysis

Unpacking the CCVI: Why COVID-19 Will Hit Some Communities Harder Than Others

As COVID-19 ravages the United States, overwhelming towns and cities from New York to Seattle, a harsh truth grows apparent: certain communities are worse-equipped to cope with the pandemic than others.

The risks that COVID-19 poses to Americans are amplified by numerous socio-economic, health, and structural factors that are not equally distributed across the country. To capture and quantify the disproportionate impact this virus can have throughout the US, we developed the COVID-19 community vulnerability index (CCVI).

The CCVI identifies the communities that will be most vulnerable once COVID-19 hits. These may be the communities with the fewest hospital beds, or whose residents’ immune systems are already compromised by high rates of pre-existing medical conditions. The CCVI quantifies these risk factors (and many more), and maps vulnerability to the state, county and census tract levels.

With a better understanding of how vulnerable their communities are to COVID-19, decision-makers and leaders can take steps to better protect people from the impact of the pandemic.

So, let’s look at what we’ve learned so far about vulnerability in the US:

1. Many of the most vulnerable communities have yet to be hit hard, and they’re concentrated in the South.

The map below displays the county-level CCVI scores for the whole country. The darkest counties are the most vulnerable.

Scores are grouped into five categories of vulnerability: Very Low, Low, Moderate, High, and Very High, with an equal number of counties in each category.

Source: https://precisionforcovid.org/

The map’s patchwork of colors shows that there’s a great deal of heterogeneity in community vulnerability across the United States. However, the menacing swatch of dark purple at the bottom of the map reveals another important finding: 71% of all vulnerable communities are concentrated in the South. (When we refer to vulnerable communities we mean the 40% of all US counties that fall into the High and Very High vulnerability categories in the CCVI.)

What does this mean for the future of the pandemic? The Northeast has been the hardest hit region so far, yet it only contains 1% of the vulnerable communities in the US. The worst is yet to come for many of the nation’s most vulnerable communities.

The chart below is another way to look at what’s in store for the South. The dark parts of the bars show clearly that nearly two-thirds of counties in the South are vulnerable.

As we can see, the South has the highest proportion of vulnerable states (high and very high categories). In fact, the top 6 most vulnerable states (and 8 of the 10 most vulnerable) are all Southern states.

By contrast, there are no Southern states among the top 10 least vulnerable. The Midwest fares best on this front: It has 48% of all counties considered to be low vulnerability, the largest proportion across the US.

2. Southern states also have the highest proportions of vulnerable counties.

Southern state vulnerability isn’t driven by a few particularly vulnerable counties dragging scores down. Instead, not only is the South the most vulnerable region in the country at the state level on our index, but it also has states with the highest proportions of vulnerable counties.

The chart below represents the proportion of counties per state falling into each vulnerability category (Very Low, Low, Moderate, High, Very High).

Nine out of the 10 states with the largest proportion of vulnerable counties are in the South. (The percentage figures show the proportion of counties within that state that are in the High or Very High vulnerability categories).

1. Mississippi (South): 93%
2. Louisiana (South): 92%
3. Alabama (South): 88%
4. Arkansas (South): 88%
5. Oklahoma (South): 87%
6. New Mexico (West): 84%
7. South Carolina (South): 78%
8. West Virginia (South): 76%
9. Kentucky (South): 73%
10. North Carolina (South): 70%

By contrast, the states with the highest proportion of low vulnerability counties are dispersed among the Northeast (6 states), the Midwest (2 states), and the West (2 states). (The percentage figures show the proportion of counties within that state that are in the Low or Very Low vulnerability categories).

1. New Hampshire (Northeast): 100%
2. Connecticut (Northeast): 100%
3. Rhode Island (Northeast): 100%
4. Vermont (Northeast): 88%
5. Wisconsin (Midwest): 85%
6. Maine (Northeast): 81%
7. Minnesota (Midwest): 79%
8. California (West): 79%
9. Wyoming (West): 78%
10. Pennsylvania (Northeast): 75%

3. High vulnerability afflicts counties both small and large.

As the two lists below demonstrate, although many vulnerable counties are found in rural parts of the South, vulnerability is not confined to small, sparsely populated counties. While the South has the nation’s most vulnerable counties, and these all have small populations, some of the largest counties in the US by population are also highly vulnerable.

These counties range in size from 203,000 people (Harrison, MS) to 1.44 million (Bronx, NY). The 10 most populous counties with very high vulnerability (ordered by CCVI score), and the 10 most vulnerable counties of any size, are listed below:

Largest Very High Vulnerability Counties

(CCVI score)[population size]

1. Bronx, NY (0.97) [1.44 million]
2. Cameron, TX (0.95) [422,000]
3. Cumberland, NC (0.94) [332,000]
4. Harrison, MS (0.93) [203,000]
5. Hinds, MS (0.88) [242,000]
6. Caddo, LA (0.88) [248,000]
7. Hidalgo, TX (0.84) [850,000]
8. Dona Ana, NM (0.84) [215,000]
9. Montgomery, AL (0.83) [227,000]
10. Mobile, AL (0.80) [415,000]

Highest Vulnerability Counties

(CCVI score)[population size]

1. Quitman, MS (0.99) [7,400]
2. Humphreys, MS (0.99) [8,500]
3. Tunica, MS (0.99) [10,100]
4. Sharkey, MS (0.99) [4,500]
5. Clark, ID (0.99) [1,100]
6. Clay, GA (0.99) [3,000]
7. Sunflower, MS (0.99) [26,500]
8. Noxubee, MS (0.99) [10,800]
9. Brooks, TX (0.99) [7,200]
10. Claiborne, MS (0.99) [16,200]

While many of these large counties are also found in the South, we see that other regions hold pockets of vulnerability as well. The scatter plot below displays the CCVI of each county by its population size.

General regional patterns in population and CCVI emerge. The Northeast has generally low vulnerability with large population sizes, but certain Northeastern urban metropolitan areas have higher vulnerability, such as the Bronx, King County (home of Queens), and Philadelphia.

The Midwest has generally low to moderate vulnerability, with moderate population sizes.

Again, the South is highly vulnerable, with moderately-sized populations.

The West is evenly dispersed both in vulnerability and population.

So what’s next?

Assessing the pandemic through the lens of vulnerability provides important insights for policymakers across the nation.

In recent days, we’ve seen more and more alarms raised about the unique threat and perfect storm that COVID-19 poses in the South. The CCVI paints an even darker picture. Our analysis shows that the South holds a shockingly disproportionate percentage of communities that will be least able to fight COVID-19.

We must turn our attention to the South — to counties both small and large — and rally resources and support for those who will be hardest hit. However, while the South shows the greatest need, we must also support our most vulnerable communities across the country, be they the Bronx or rural Quitman County, Mississippi.

What’s next? In the coming days and weeks, Surgo Foundation will be releasing additional analyses of the CCVI and the pandemic. We explore what the COVID-19 caseload looks like across vulnerable counties, how much they’re socially distancing, and dive deeper into specific states and drivers of vulnerability. Follow us on Medium to stay up to date on our upcoming analyses.

This work was made possible by everyone at the Surgo Foundation, including but not limited to (in alphabetical order): Yael Caplan, Vincent Huang, Hannah Kemp, Tich Mangono, Sema Sgaier, Peter Smittenaar, Nick Stewart, and Staci Sutermaster.

Technical Notes:

• Vulnerability is defined as having a CCVI score greater than 0.6, falling into the High and Very High Vulnerability categories.
• Want to find out how we created the CCVI? All methodology can be found on our website here.
• Want to analyze the numbers for yourself? The CCVI data is publicly available at census, county, and state level (link).
• Questions, concerns, comments? Get in touch at covid19@surgofoundation.org.