Rural COVID cases growing quickly

Is official state strategy setting up rural Iowa for a coronavirus surge?


NOTE: The map and table below include updated data analysis by Peter Fisher, showing that now 10 counties are appear to be potential trouble spots for the spread of COVID-19 despite being among the 77 counties where Governor Reynolds has relaxed restrictions. This uses data provided May 8 by the Iowa Department of Public Health. The original backgrounder from May 6 is below these graphics.

By Peter Fisher, Research Director, Iowa Policy Project

Eight of the counties where the governor has begun reopening businesses are among those with the fastest growing number of cases of COVID-19. Governor Kim Reynolds has noted that, in terms of the number of cases, the vast majority have been in the 22 counties — generally the more populous and urban counties — where restrictions remain in place.

But in many rural counties, the virus has just begun to spread, and the rates at which it is spreading are high. Focusing on the total number of cases misses the point: There will always be more cases in our urban areas where most of the state’s population resides. But the incidence among the population — the percent of residents with COVID-19 — is what matters to the residents of Iowa’s small towns and rural counties. In a number of those counties, the incidence is equal to or higher than in Iowa’s metro areas.

There have been 657 new cases of COVID-19 reported in the last 14 days in the 77 counties where social distancing requirements are being relaxed or eliminated. But over half of those new cases — 374 — are in just eight counties.[1] Those eight counties had experienced 76 cases as of April 21; a week later that number had grown to 128, a 68 percent increase. By May 5, another 322 cases were reported, a 252 percent increase, to bring the total to 450.

In the 22 counties where restrictions have remained in place, and where the largest number of cases have been reported, the number of cases grew 87 percent from April 21 to April 28, then slowed to 49 percent growth the next week. In contrast, the rate of growth is increasing in the 77 other counties, from a 40 percent increase two weeks ago to a 97 percent increase in the most recent week. At that rate, some rural portions of the state could soon begin to look like their more urban counterparts. In the last two weeks there were 331 new cases per 100,000 population in the 22 restricted counties. In the eight counties with the most growth among those where restrictions are being relaxed, there were 110 new cases per 100,000 population. In six of those eight counties the rate exceeded 50, high enough to earn the highest score of 3 on the Governor’s metric.

The eight counties that appear to be the most likely trouble spots are Boone, Crawford, Guthrie, Plymouth, Pottawattamie, Sioux, Story, and Wapello. Two major factors appear to be at work here. Neither is surprising.

The first factor is proximity to a county with a large number of cases and also substantial commuting between those counties. Guthrie, Boone, and Story are all on the periphery of the Des Moines Metro area. The adjacent core of the metro area — Polk, Dallas and Jasper counties — accounts for 2,700 COVID-19 cases, a quarter of the state’s total. Pottawattamie is part of the Omaha-Council Bluffs metro area, and Plymouth County is part of the five-county tri-state Sioux City metro area, a major hot spot with over 1,300 cases in Woodbury County alone.

The second factor is proximity to a meat packing plant. Sioux County is home to a Smithfield plant and to SiouxPreme packing company in Sioux Center, which is also just 20 minutes from Premium Iowa Pork in Hospers. Wapello has at least one reported case at the Swift (JBS) pork plant in Ottumwa, and Wapello cases overall have shot up in the last week. Crawford County is home to a Smithfield plant in Denison; another Smithfield plant is in neighboring Carroll County. Guthrie County is next door to Dallas County, where the Tyson plant in Perry has experienced a major outbreak; Perry is just 37 minutes from Guthrie Center. There is a Tyson plant in Council Bluffs in Pottawattamie County. Story County is next door to Marshall County, home to a Swift pork plant with a substantial outbreak.

Pottawattamie had just 15 cases April 16, doubled to 30 in 13 days, but then doubled again in just six days and is now at 63. Wapello County went from six cases to 125 in two weeks. Crawford County went from six cases on April 20 to 21 cases April 28, then 103 cases May 5. The number of cases there has been doubling every three or four days.

There was never a good reason to believe that the virus would not spread significantly outside Iowa’s urban areas. Iowa’s metro areas are certainly more dense than rural areas, but they are still nothing like New York City. A neighborhood in Cedar Rapids is not that different from a neighborhood in Ottumwa in terms of social proximity. Why would we expect the disease to spread in one community and not in another?

Nor should we have thought that any meat packing plant would somehow be exempt from an outbreak, when the federal government failed to require basic safety procedures in a work environment highly conducive to the spread of disease, and with a state government unwilling to impose requirements on these facilities while insisting that they stay open or reopen as quickly as possible. And clearly an outbreak at a meat packing plant will be followed by community spread, in all the places where the infected workers live.

The reopening of 77 counties, and the general failure to take adequate proactive measures to stem the pandemic, appears to have been guided by a combination of wishful thinking, failure to look ahead, trust in the Trump administration’s approach to the pandemic, allegiance to business interests at the expense of workers, and a self-centered ideology of individual liberty without individual responsibility to the larger community. This policy will end up failing everyone.

[1] These were the eight counties with 18 or more new cases in the past 14 days.