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Rural America Hit Especially Hard by Last Summer’s COVID-19 Surge

A new study provides stark evidence of how lagging vaccination rates in rural America have resulted in more severe COVID-19 outbreaks, especially this past summer with the Delta variant. The authors pinpoint the areas with low vaccination rates and demonstrate how that fed the progression of the infection upsurges. Here is more information.

CINCINNATI – If pharmacists in rural areas thought last summer was especially tough with the upsurge in COVID-19 cases, they weren’t just imagining it.

A new study demonstrates that the third wave of the COVID-19 pandemic, which occurred in the summer of 2021, spread significantly faster in rural America. Part of the explanation is the lower rates of vaccination there, according to University of Cincinnati researchers.

Their research letter in JAMA Network Open reports that rural counties had 2.4 times more infections per 100,000 people than urban areas between July 1 and Aug. 31, 2021, when the delta variant was on a rampage across the United States.

Background information in the articles points out that, according to public health officials, about 82% of rural America has a vaccination rate lower than 30%, while rural counties made up just 131 of the 376 areas with vaccination rates of 50% or more.

Lead author Diego Cuadros, PhD, director of UC's Health Geography and Disease Modeling Lab, said it was important to understand where vaccine uptake remains low, especially since areas with low vaccination rates experienced a more intense surge of new cases during the third wave of the pandemic in the United States.

"We found that infections from the delta wave increased much faster in low-vaccination areas. Not only did we have more cases per capita in low-vaccination areas but the epidemic infection spread much faster compared to high-vaccination areas," said Cuadros, an assistant professor of geography in UC's College of Arts and Sciences.

"Our study underscores the importance of vaccination to mitigate the rate of spread of COVID-19 in the United States," added study co-author Phillip Coule, MD, associate dean at the Medical College of Georgia at Augusta University.

"Although we have long known that the COVID-19 vaccine is safe and effective, this study concludes that communities with higher vaccination rates have slower rates of community spread when an outbreak of COVID-19 does occur," said Coule, vice president and chief medical officer for Augusta University Health System.

Researchers determined that, in areas with vaccination rates lower than 30%, COVID-19 infections per 100 000 people increased from 190 infections (95% CI, 188-193 infections) during July 1 to 15 to 1272 infections (95% CI, 1263-1280 infections) during August 16 to 31. At the same time, COVID-19 infections per 100 000 people in areas with vaccination rates higher than 50% increased from 71 infections (95% CI, 70-72 infections) from July 1 to 15 to 531 infections (95% CI, 529-532 infections) during August 16 to 31.

Rural counties accounted for 369 of 449 areas with lower vaccination rates (82.2%), they add.

The study points out that Western and northern parts of the country, along with Florida, were areas with increased percentages of vaccination rates. The authors recount how an increased number of new COVID-19 cases emerged in July 1 to 15 in Missouri and Louisiana, two states with a decreased percentage of vaccination, and grew in most states in the southern part of the United States, including Arkansas, Oklahoma, Mississippi, Tennessee, South Carolina, and Florida, in July 16 to 31 to August 1 to 15. The epidemic intensified in these areas by August 16 to 31 but also grew in the western United States. Some states were excluded from the analysis because of incomplete information and might have had higher or lower infection rates than those discussed, the researchers point out.

“In this cross-sectional study, we found a negative ecological association between vaccination rates and the surge of COVID-19 infections,” the authors explain. “Areas with low vaccination experienced a more intense surge of new cases during the third wave of the pandemic in the US, primarily driven by the Delta variant,” adding, “Rural areas in the US face many challenges in responding to the pandemic, including lower health care resources, compared with urban communities. These areas have been characterized by vaccination hesitancy, limited vaccine availability, and hospital staff shortages that can be associated with the successful distribution of vaccines and hence the vaccination campaign’s overall outcome.^”