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COVID‐19 has impacted the United States along with many other countries in the world. As of June 30, 2020, just in the United States alone, there have been more than 2 million confirmed cases and greater than 150,000 people have died from COVID‐19. These numbers are rising daily with hotspots identified throughout the country.1 This virus is highly transmissible and may lead to acute lower respiratory distress, possibly resulting in death.2 The elderly and/or individuals with certain underlying preexisting conditions are more vulnerable and have an increased likelihood of requiring hospitalization for treatment and intensive respiratory management.3 While there is no argument that COVID‐19 threatens individuals’ lives, this virus also has detrimental consequences on the effectiveness of public health system infrastructure and the country’s economy.

Regardless of the overall increase in the prevalence of and mortality from COVID‐19 across the United States, there are disagreements about the consequences of exposure and contracting COVID‐19, specifically in rural areas.4, 5 On one hand, there is an assumption that rural areas are at higher risk than their urban counterparts. The rationale supporting this claim is (1) rural areas have a higher percentage of older populations and a higher prevalence of chronic diseases than urban areas, which increases the vulnerability of rural populations during the COVID‐19 pandemic,2, 6, 7 and (2) the limited infrastructure, poor access to health care facilities, and finite public health resources in rural areas may be unable to manage and keep up with the forecasted surge of COVID‐19 patients.5, 7, 8 Under this assumption, rural areas are expected to have a higher death rate when compared to urban areas.

On the other hand, there are claims of lower prevalence and mortality from COVID‐19 in rural areas. Since rural areas are sparsely populated and have a geography that naturally supports social distancing and isolation, it is believed that the combination of these factors protect rural residents by reducing both the rate of exposure and contraction of the COVID‐19 virus, thereby leading to fewer confirmed COVID‐19 cases and deaths.4 To further support this explanation, rural hospitals, despite both the limited capacity and availability of resources to treat COVID‐19 patients, may be better able to manage the fewer number of cases in rural areas with improved outcomes. This is contrary to their urban hospital counterparts, which are overwhelmed with the rising number of confirmed COVID‐19 cases.

Since the first documented case of COVID‐19 in the United States in January 2020, the total number of confirmed cases and deaths have been accelerating at different rates in both urban and rural areas. There have been conflicting reports describing these rates. One report stated that…

Read More: Deaths From COVID‐19 in Rural, Micropolitan, and Metropolitan Areas: A

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