Poorly tailored public-health messaging could play a role in lower rural mask-wearing rates

The coronavirus pandemic is disproportionately hitting rural America, where the population is older, sicker, and at a greater risk of poor outcomes from the infection. The Centers for Disease Control and Prevention recommends wearing a face mask to reduce disease transmission, but rural residents are less likely than the general populace to do it.

"This may be partly due to public health messaging that hasn’t been tailored to rural communities," Nickloas Zaller and George Pro report for Stat. "Retention of health messaging is lower in rural areas than it is in urban or suburban areas, suggesting that there is no such thing as a one-size-fits-all approach when it comes to disseminating crucial health information to the public."

One big problem: many rural people believe their risk of catching the coronavirus is relatively low. That perception may increase skepticism toward and noncompliance with mask mandates or recommendations, and it may be partially responsible for the current rural spike in cases. "The current and projected increases in covid-19 cases in rural areas may have resulted from people not following recommended preventive measures during the summer months when covid-19 cases in these areas had not yet made headlines," Zaller and Pro report.

Stat did some data-crunching to explore that hypothesis, which you can read more about in their story, but here's the upshot: "We found that intentions to wear a mask became significantly less likely as the level of rurality increased, even after adjusting for daily covid-19 incidence during the two weeks before the mask survey," Zaller and Pro report. "This is consistent with our findings that many rural counties were not experiencing significant covid-19 outbreaks during the summer and many of these counties had lower proportions of residents reporting regular mask-wearing."

Public-health messaging could help increase mask-wearing in rural areas, but it must be done correctly. "Public health messaging is not monolithic. It must be tailored to communities, recognizing cultural norms and engaging local community leaders in its dissemination. For example, distrust of medical providers and outsiders can be a norm embedded within the culture of some rural communities," Zaller and Pro report. "Mask-wearing in rural communities, like other preventive behaviors, does not occur in a social vacuum. It is critically important to understand local community norms and values to effectively disseminate life-saving public health messaging."

Expert says lax public-health restrictions caused rural coronavirus spike; surge hurts cash-strapped rural hospitals

New rural infections, Nov. 1-7. Daily Yonder map; click the image to enlarge it or click here for the interactive version with figures on urban vs. rural new infections. 

Lax measures earlier in the year may be partly responsible for the surge in rural coronavirus infections, especially in the Northern Rockies and Upper Midwest, says one expert, Kirk Siegler reports for NPR.

Andrew Pavia, head of infectious diseases at the University of Utah Hospital, said the rural surge in those areas can be traced to state governments that imposed few restrictions and do not enforce bans on large gatherings, Siegler reports. Pavia also blames the re-opening of in-person classes at colleges and schools—along with sports and most extracurricular activities—earlier in the year.

"Because of the local politics, they're probably not as drastic or as firm measures as we really needed to turn the tide. So I think the situation in two to four weeks is going to be grim," Pavia said.

Many rural hospitals in Upper Midwestern and Rocky Mountain states say they're at or near capacity. "In North Dakota, covid-19 hospitalizations are up 60 percent over this time last month. And it's not just ICU capacity that's stretched," Siegler reports. "This week, the state said it would begin allowing medical staff who test positive for the virus but are asymptomatic to keep treating covid patients."

Many rural hospitals can't afford more staff, Liz Carey reports for The Daily Yonder. One Nebraska hospital administrator told her that local staffing shortages, statewide hospital bed shortages, nationwide nursing shortages, and funding problems are all making the pandemic much worse for rural hospitals.

The pandemic has worsened an existing nationwide nursing shortage. That hits rural hospitals especially hard, since they have a hard time attracting nurses in the first place, Carey reports. Traveling nurses can step in to help, but they're an expensive proposition, earning up to $150 an hour.

New Ron Howard-directed film 'Hillbilly Elegy', based on controversial J.D. Vance memoir, mostly panned by critics

Glenn Close and Amy Adams in Hillbilly Elegy

Most critics are panning the film version of J.D. Vance's controversial memoir Hillbilly Elegy, which debuts on Netflix and in theaters Nov. 24. The film, about Vance's childhood in an Appalachian migrant family in Ohio and his bootstrapping rise to success, boasts formidable star power, with Ron Howard directing and Amy Adams and Glenn Close starring as a feuding mother and daughter. But that wasn't enough to carry the film, many critics said.

The film would be "almost laughably bad—if it weren't so melodramatic," Michael O'Sullivan of The Washington Post writes. "From one side of its mouth, the film tries to suggests that the values J.D. was imbued with — perseverance, self-sufficiency — fueled his success. (The author is now a venture capitalist.) And yet those same values don’t seem to have saved many in his family — or, frankly, the larger Rust Belt community. From the other side of its mouth, the film hints that J.D. is who he is because he’s something of an anomaly: a chubby, ambitious, fact-spewing nerd who’d rather watch a news show on the Clinton-Lewinsky scandal than sit through a cable broadcast of Terminator 2: Judgment Day with his grandmother for the umpteenth time."

Alissa Wilkinson of Vox is less charitable, calling it "possibly the worst movie I've seen in years." The memoir was widely criticized for seemingly dismissing the role of sociocultural ills in personal success, writes Wilkinson, who says she comes from a similar background, but she writes that "whatever your opinion of the book, the movie is a different animal, and a startlingly terrible one." In the book, Vance's background makes him intriguing to others, but in the movie it's played for embarrassment; that rings false, Wilkinson writes: "It is distractingly Hollywoodified, a rich person’s idea of what it is like to be a poor person, a tone-deaf attempt to assuage a very particular kind of liberal guilt by reifying the very thing that caused the guilt in the first place. And, perhaps worst of all, it’s a very dull movie."

G. Allen Johnson of The San Francisco Chronicle praises Adams' and Close's performances, and gives it a somewhat kinder review: "A strength is that focusing on the past defuses the inevitable burden of representing the complex politics of Trump country. A weakness is that it is about as relevant to the current moviegoer as Fried Green Tomatoes or Steel Magnolias. The movie feels defanged, a film that won’t quite go there."

The film is "exactly the kind of milquetoast and capital-'E' Empathetic movie you would expect a bunch of Hollywood liberals to make from Vance’s memoir," David Ehrlich writes for IndieWire. But it's not true to the book, he writes. Vance's memoir "read like a tortured account of survivor’s guilt from someone desperate to justify his success and make peace his their one-way transition from yokel to yuppy," Ehrlich writes. It became a political football, but the film is "anodyne and somehow apolitical" and seems like "it's trying to sand the edges off this story and do Vance the favor of making him seem like a good example."

Justin Chang of the Los Angeles Times calls the film a "wobbly sociological treatise by way of a tough, harrowing personal story" and writes that the film has been "denuded of any meaningful politics to speak of" despite Vance’s "harsher assessments" of the people he grew up around. Director Ron Howard, who as a boy played Opie in The Andy Griffith Show, is "a political liberal but an aesthetic conservative" who "has never been one to rock the boat or advance a provocative point of view," Chang notes. "Which is not to say there are no real-world ideas or insights to be gleaned here, only that they’re mostly glancing, incidental ones."

Quick hits: Rural Oregon threatens to join Idaho . . .

Here's a roundup of stories with rural resonance; if you do or see similar work that should be shared on The Rural Blog, email us at heather.chapman@uky.edu.

QAnon won big in the recent election. Read more here.

The latest rural secession threat comes from rural Oregon counties that want to join Idaho. They have their eyes on some in California, too. Read more here.

The tiny community of Rabbit Hash, Kentucky, traditionally elects a dog as its mayor. Meet the new one.

Rural registered nurses share stories of caring for their communities. Read more here.

Free social-media platform for farmers releases new features aimed at helping members share advice more easily. Read more here.

When one rural Colorado doctor caught the coronavirus, the repercussions extended far beyond his own health. Read more here.

Thursday, Nov. 19, National Institutes of Health seminar to explore rural health challenges during pandemic

On Nov. 19 the National Institutes of Health will host a virtual seminar from 1 to 5 p.m. ET dedicated to exploring rural health and challenges in the pandemic era.

The event is co-sponsored by the National Institute on Minority Health and Health Disparities and the National Center for Advancing Translational Sciences, and will feature speakers from other federal agencies and academic institutions. 

Seminar sessions include "Rural Population Impact and Response in the Time of Covid-19" and "Researchers and Community Partners respond to the Challenges of Covid-19."

The seminar is free but registration is required. Click here for more information or to register.

Georgia reporter's unpaid, all-night coverage of vote tallying, backed by donors, shows the importance of local journalism

Robin Kemp at her home office in Forest Park, Ga. (Washington Post photo by Kevin Liles)

The same day Georgia's Clayton News laid off reporter Robin Kemp in April, the suburban Atlanta journalist started her own news website, The Clayton Crescent. That dedication to covering local news catapulted her into the international spotlight during the election and underscored the importance of local journalism, Reis Thebault reports for The Washington Post.

Kemp, 56, "was the only journalist to watch all 21 hours of Clayton County’s marathon tabulation of absentee votes, from about 9 a.m. Thursday to 5 a.m. Friday," Thebault reports. "During that span, a record number of absentee ballots helped Biden close the statewide gap with Trump. And it was votes from Clayton County — the heart of the late civil rights icon Rep. John Lewis’s old district — that pushed Biden into the lead" and helped him flip Georgia blue for the first time in nearly 30 years.

Through Twitter and Facebook Live, Kemp kept followers updated on ballot-counting and on Republican observers. People began to pay attention. "When she set out that morning, Kemp had just a couple hundred Twitter followers and less than $2,000 in a GoFundMe she started in April. By the next day, she was at well over 10,000 followers and dollars," Thebault reports.

Kemp’s all-night coverage, which Thebault calls "public service journalism in its purest form" is not an unusual workload for her. She "sometimes works 20 hours a day, as both writer and photographer, using a camera she bought used on eBay. She works alone, with no editor and no staff," Thebault reports. She has no savings and her only income is $300 a week in unemployment.

But Kemp keeps going with the Crescent because nobody else covers local issues. The Clayton News, hit hard by the pandemic, mostly publishes wire content now, Thebault reports, while the Crescent, "already has 38 pages of articles, including coverage of the coronavirus’s toll, crime and zoning issues. In an April 28 editorial, she promised Crescent readers three things: hyperlocal journalism, no survey walls to hurdle before reading her stories, and no clickbait."

The Crescent "is emblematic of the sort of journalism that is vanishing by the day," Thebault reports, citing research by University of North Carolina journalism professor Penny Abernathy. "The pandemic has only accelerated that dire trend," he notes. "In April and May alone, at least 30 papers closed or merged, dozens went online-only and thousands of journalists were furloughed or laid off."

Kemp has received nearly $18,000 in GoFundMe donations, but says she won't accept them until she finishes the paperwork to make the Crescent a non-profit. Donations are proof that people want more local journalism, according to Richard T. Griffiths, a former CNN vice president and president emeritus of the Georgia First Amendment Foundation, who is helping Kemp set up a board of directors.

Griffiths said Kemp's real challenge will be finding local donors to sustain the paper after her viral fame ebbs, though he is confident she can do it. "It is in every community’s interest to have a strong, healthy accountability-journalism operation going," he told Thebault.

Appeals court deals Mountain Valley Pipeline another blow

"The Mountain Valley Pipeline’s legal limbo continued Monday as a panel of federal judges granted a stay of construction of the pipeline across about 1,000 waterbodies in West Virginia and Virginia," Mike Tony reports for The Herald-Dispatch in Huntington, W.Va. "The 4th U.S. Circuit Court of Appeals granted the stay following oral arguments as it considered whether to grant a previous request by conservation groups for a longer stay barring construction of the pipeline across streams in West Virginia and Virginia. The court had granted a temporary administrative stay Oct. 16, and its Monday stay, via a brief order without explanation, will remain in effect until it decides whether to overturn water permitting from the U.S. Army Corps of Engineers for the project."

Pipeline developers recently pushed back the completion date and increased the price tag for the project, blaming legal and regulatory challenges from environmental groups, Tony reports. The pipeline was originally meant to launch in late 2018, but now that's been moved to late 2021. The estimated cost, meanwhile, has risen to at least $5.8 billion, over 50 percent higher than originally projected.

$4 billion in EU tariffs on jets, farm products etc. to hit Tue.

Starting Tuesday, the European Union will impose tariffs on $3.99 billion in U.S. good annually, including agricultural goods. The move, sanctioned last month by the World Trade Organization, is part of a long-running dispute over airplane subsidies for Boeing and Airbus jets, Laurence Norman and Daniel Michaels report for The Wall Street Journal.

"On Monday evening, the EU said the U.S. products to be targeted with the 25% duty would include tobacco, nuts and seeds, spirits, sauces, soups and syrups, self-propelled shovel loaders, tractors and proteins," Norman and Michaels report.

Racial, ethnic disparities persist in rural education levels

Educational attainment rates for racial and ethnic minorities have improved over the past two decades, but large gaps persist for rural nonwhites. Rural Hispanics, Blacks, Native Americans and Alaska Natives were only half as likely as their white counterparts to have a bachelor's degree or higher in 2018, the most recent year of data available. That's according to a newly published study by the U.S. Department of Agriculture's Economic Research Service.

Among all rural residents 25 and older, "the percentage who had completed a bachelor’s degree or higher rose from 15% in 2000 to 20% in 2018. Conversely, the share of that population without a high school degree or equivalent dropped from 24% in 2000 to 13% in 2018," Tracey Farrigan reports. "Among racial and ethnic groups in rural America, Hispanics continued to have the highest percentage (35 percent) without a high school degree, despite significant gains in high school and higher educational attainment rates between 2000 and 2018.

Meanwhile, African Americans "had the largest decrease (20 percentage points) of rural individuals without a high school degree," Farrigan writes. "This change eliminated the gap between the shares of Blacks/African Americans and Whites who had graduated from high school but had not completed a bachelor’s degree. Nevertheless, the share of Blacks without a high school degree remained nearly double that of whites in 2018."

Rural hospitals say they can't afford ultra-cold freezers needed to store Pfizer's coronavirus vaccine

Pfizer Inc. has a promising coronavirus vaccine, but most rural hospitals can't afford the ultra-cold freezers to store it, so rural residents may have a harder time getting it, Olivia Goldhill reports for Stat. That means some of them may have to wait for other vaccines that don't need special handling.

Pfizer's vaccine has to be stored at -94 F., -70 C. "Typical freezers don’t get that cold, making distribution of this vaccine a logistical nightmare," Goldhill reports. "The Centers for Disease Control and Prevention has advised state health departments against purchasing ultra-cold freezers — which cost $10,000 to $15,000 each — saying other vaccines with less demanding storage requirements will be available soon. Hospitals with money to spare are flouting this guidance. Four major health care systems, from North Carolina to Ohio, North Dakota, and California, told Stat they had bought additional ultra-cold freezers, while Jefferson Health in Philadelphia said it has leased five units."

"This purchase is out of reach for poorer hospitals, especially those in rural areas that can barely manage daily expenses," Goldhill writes, noting that nearly half of rural hospitals in the U.S. lost money in April, and the pandemic has continued to hurt their bottom lines, according to Alan Morgan, chief executive of the National Rural Health Association. But rural people need the shots the most, he said.

“Hundreds of rural, small towns all across the U.S. have a higher percentage of elderly, low-income [residents], a higher percentage of the community with multiple chronic health issues,” Morgan told Goldhill. “In this financial environment, you can imagine that there is simply no consideration of rural hospitals purchasing storage equipment for this ultra-cold distribution.”

Another problem is that Pfizer will ship the vaccine in dry-iced containers with at least 1,000 doses. Once the containers have been opened, the vaccines are good for more than 15 days, and only then with scrupulous attention to re-icing and limited box opening. "The time pressure is more intense in rural areas, where the longer delivery time eats into the number of days when the vaccine can be safely stored in their boxes upon arrival," Goldhill reports. "Regions with smaller populations will struggle to use the 1,000-dose supply in the necessary time period, creating a risk some of the vaccines will go to waste, though Pfizer plans to have smaller boxes available by early 2021. In contrast, the vaccine can be stored in ultra-cold freezers for six months."    

New rural coronavirus infections hit new high for seventh straight week; 80% of rural counties now federal 'red zones'

Coronavirus zones, Nov. 1-7. Daily Yonder map; click the image to enlarge it or click here to view the interactive version.

From Nov. 1 through 7, new coronavirus infections in rural counties grew 30 percent, setting a record for the seventh week in a row. "There were 144,043 new infections in rural counties last week, up from about 110,000 the week before," Tim Murphy and Tim Marema report for The Daily Yonder.

Also last week, 97 more rural counties were added to the red-zone list to bring the total to 1,599. That's four-fifths of all non-metropolitan counties, the Yonder notes. Red zones are defined by the White House Coronavirus Task Force as those with at least 1 new infection per 1,000 people in a week. 

"The current surge originated in rural areas two months ago and more recently has spread into metropolitan counties," Murphy and Marema report. "Previously, metropolitan counties had their worst new infection rates in July. But those counties surpassed those summer peaks for the past two weeks."

Click here for more data and analysis, including the latest county-level infection numbers.

Fact check: Trump makes false claims about vaccine

President Trump has made several false claims about a coronavirus vaccine from Pfizer Inc., Hope Yen, Lauran Neergaard and Linda A. Johnson report for The Associated Press. Here's a summary:

Trump falsely tried to take full credit for Pfizer's announcement that its vaccine might be 90 percent effective. In a tweet Tuesday, Trump quoted Fox Business anchor Maria Bartiromo to imply he should get credit for the vaccine. However, his suggestion "that he stood alone in saying a covid-19 vaccine was possible by year’s end is incorrect," AP reports. "Actually, top health experts said they considered that possible, though far from certain, and were more skeptical of Trump’s claim that a coronavirus vaccine would become available before the Nov. 3 election. The vaccine isn’t expected to become widely available to the general public before 2021."

Dr. Anthony Fauci, the government's top infectious-diseases expert and head of the National Institute of Allergy and Infectious Diseases, had previously said he was "cautiously optimistic" that a vaccine would be ready by late 2020 or early 2021. On Monday, he lauded Pfizer's news, but cautioned that it didn't mean an immediate cure-all for the coronavirus, AP notes.

Pfizer says it will apply to the Food and Drug Administration for "emergency use authorization" to allow limited distribution later this month, then seek approval for wider use, and neither request is guaranteed to be granted, AP reports. Fauci told CNN that there are still questions about the vaccine's effectiveness and durability; it requires two doses, 21 days apart, and must be kept at 94 below zero.

In several tweets, Trump also claimed that Pfizer and the FDA withheld vaccine information until after the election, implying that it was done to harm him politically. That's false, the AP reports: "The company itself learned of the interim results on Sunday, and the FDA was not involved in Pfizer’s decision to announce its early results."

All vaccine studies such as the one Pfizer is conducting are overseen by independent data and safety monitoring boards. DSMBs "include scientists and statisticians who have no ties to the vaccine makers," AP reports. "Before a study is complete, only the DSMB has the power to unlock the code of who got a real vaccine and who got a placebo, and to recommend if the shots are working well enough to stop testing early. Those boards take sneak peeks at predetermined times agreed to by the manufacturer and the FDA. It provided the first interim analysis for Pfizer on Sunday." Several Pfizer officials, including CEO Albert Bourla, have asserted that the announcement's timing had nothing to do with the election.

Vice President Mike Pence and Congressman-elect Ronny Jackson (R-Texas), Trump's former White House physician, sent tweets crediting the president for the vaccine; Trump retweeted them. However, Trump and Pence "are wrongly seeking full credit for forging the partnership that made the potential breakthrough possible. Pfizer notably did not accept government money to develop, test or expand manufacturing capacity under Trump’s Operation Warp Speed initiative to quickly find a vaccine and treatments for the disease sweeping the country," AP notes. "In fact, Pfizer partnered with the vaccine’s original developer, Germany’s BioNTech, in March," before Warp Speed was announced.

Though Pfizer hasn't accepted Warp Speed funding, it must follow the same vaccine-development requirements as competitors that did take government money. "The company says it has risked $2 billion of its own money on vaccine development and won’t get anything from Washington unless the effort is successful," the AP reports. But Pfizer signed an agreement with the U.S. government in July to supply 100 million doses for $1.95 billion if the vaccine works and gains FDA approval.

Rural-urban voting divide is greater than ever, analysis says

Trend line shows rural-urban divide: Democratic margin had a strong tendency to increase with population

An analysis by The Economist "suggests that the partisan divide between America’s dense cities and sparsely populated places is greater than ever," the magazine reports. Preliminary results from Decision Desk HQ, a provider of data, show that voters in most rural counties voted for President Trump by 35 percentage points, up from 32 points in 2016. "These are the bottom 20% of counties by population density," the magazine explains. "Counties with more than 10% Hispanics, who shifted to the right for reasons unrelated to density, have been excluded."

Voters in the most urbanized counties, the top 20 percent, went for Joe Biden by 29 points, "up from Hillary Clinton’s 25-point margin in 2016," The Economist reports, "More broadly, the greater the population density, the bigger the swing to the Democratic candidate (see chart). Even after controlling for other relevant demographic factors, such as the proportion of whites without college degrees or Hispanics in each county, the data suggest that urban and rural voters are more divided today than they were in 2016."

The Economist also observes, "Biden will win the national popular vote by about five percentage points. But his margin in the 'tipping-point' state that ultimately decided the election, Wisconsin, will be less than one point. That four-point advantage for the Republicans is the biggest in at least four decades. So long as Democrats continue to be the party of the cities, and Republicans the party of small-town and rural America, those biases will persist."

One other interesting point: Preliminary results show that Biden "gained most ground in counties that swung hardest toward Democrats between Barack Obama’s re-election in 2012 and Hillary Clinton’s failed bid for the White House in 2016," The Economist reports. "One possible explanation for this trend is the tendency for Democrats and Republicans to live among their own kind. Americans are increasingly sorting themselves into politically like-minded communities. For liberals, this means diverse, densely-populated cities; for conservatives it is places that are mostly white, working-class and sparse." For more on this phenomenon, see Bill Bishop's book, The Big Sort: Why the Clustering of Like-Minded America is Tearing Us Apart.

How Trump won over Latino voters in the Rio Grande Valley

While Joe Biden was competitive in Texas, President Trump was able to win over the heavily Latino, reliably Democratic counties in the Rio Grande Valley along the border, helping him carry the state. 

"The bluest of blue counties along the river, Zapata County, flipped to President Trump, who won 52.5 percent of the vote. It was the first time since Reconstruction that a Republican presidential candidate won Zapata County," Arelis Hernandez and Brittney Martin report for The Washington Post. That may seem odd to outsiders who may see voters as Latinos first and rural residents second, but rural conservatism is nothing new, said University of Texas-San Antonio political scientist Sharon Navarro.

The difference, she says, is that this year Republicans did the work to court these voters and tailor their message about the election around the economy and jobs. Republicans won those Rio Grande counties by "taking advantage of the habitual underinvestment and lack of infrastructure there, as well as neglect from the state and national Democratic parties," the Post reports. "The shift extended through the more than 1,200-mile border, from the populous lower delta of Brownsville and McAllen to the sparse ranchland near Laredo and the high desert of El Paso."

Biden won most of the valley counties, but by much smaller margins than Hillary Clinton did in 2016. "The story of Trump’s performance and Biden’s backslide along the Texas border, experts say, shows the importance of cultivating deeper relationships with a diverse Latino population that continues to claim a growing and dominant share of the Texas electorate," Hernandez and Martin write.

Courting the Latino vote, especially in Texas, is more important than ever. Latinos make up about 40% of the Texas population and about 30% of its voters, and that number is rising. Each year, more than 203,000 Latinos come of voting age in Texas, Rogelio Saenz, a UT-San Antonio demographer, told the Post, which reports: "While White migration to the state has slowed, Saenz said, there has been a significant increase in Latinos and African Americans moving to Texas in recent years."

Applications open for paid USDA summer internships for high school and up, virtual and in-person

Applications are now open for U.S. Department of Agriculture summer internships through the federal Pathways Program. The program offers a wide range of paid internships for students in high school through the graduate level with on-the-job experience, mentorship, and training tailored to each student's interests and needs.

The internships span a wide range of occupations, including veterinary science, engineering, natural resources management, finance and more. Positions are open in almost every state, and some are virtual. 

The deadline for summer 2021 internship applications is Nov. 16. Click here for more information.

Veterans Day, which has deep ties to rural areas, is a good time to make sure veterans feel connected to community

Wednesday is Veterans Day. It originally was a celebration of World War I's Nov. 11, 1918, armistice, and has long and closely held ties with rural Americans.

"According to the Defense Department, rural recruits — especially those with farm backgrounds — are likely to become good soldiers because these recruits — both males and females — tend to tolerate adversity well, possess many practical skills, are comfortable with the rigors of a demanding lifestyle, respond readily to training, and willingly choose military careers for at least part of lives," Mike Rosmann writes for the Yankton Daily Press & Dakotan. "Persons with urban backgrounds are less likely to pursue military lifestyles, even though many are highly qualified."

Moreover, "The Veterans Administration reported that 24 percent of all veterans choose to live their subsequent years in rural communities," Rosmann writes. And "11 percent of all U.S. farmers have served — or are serving — in the military even though only 2 percent of Americans are engaged in agriculture as their chosen way of life."

But veterans have relatively high rates of suicide and mental-health disorders, Military.com reports: "As of 2017, an average of 20 veterans and service members die by suicide every day. This represents a 7% increase in the rate of suicide among veterans in just over a decade. Some reports indicate that suicides among service members have increased as much as 20% this year, when compared to previous years."

So, Military.com encourages you, on this Veterans Day, to reach out to the veterans around you and make sure they know they're part of your community.

Colorado rural and urban hospitals collaborate to combat pandemic overcrowding; transfers can go both ways

Coronavirus rates are rising not just in rural areas across the nation, but in many urban areas too, filling up hospitals. That has meant trouble for critical rural patients, who would usually be transferred to larger, more well-equipped urban hospitals. But what about transferring less critical patients to rural areas to make room for them?

The Colorado Hospital Association has a new system to facilitate that, KCNC-TV in Denver reports. The system could be a model for other states. Its Combined Hospital Transfer Center "will be a centralized resource where hospitals can coordinate patient care, should one start nearing capacity or reach capacity," Karen Morfitt reports. "It will help rural areas in need of more critical care space and larger centers looking to release patients."

Less-critical urban patients can be moved to less-specialized rural hospitals so critical rural patients can be moved to the urban hospitals if necessary, CHA spokesperson Cara Welch explained: "We are all in this business for the same reason: We want to take care of patients and we have to work together to be able to do it. When you get to this level of volume, no one should be working on an island."

Rural county's entire health department staff resigns over lack of support from county government during pandemic

Pondera County, Montana
(Wikipedia map)

The Pondera County Health Department in Montana has four employees, and all of them have resigned in desperation, citing lack of support from the county commissioners during the pandemic, Liz Carey reports for The Daily Yonder. The move, effective Nov. 27, would leave a gaping hole in the local health-care system that would be hard to fill as coronavirus cases surge in the county of just over 6,000.

Nicki Sullivan, who was the department's director, wrote in her resignation letter that the decision was the hardest of her life, and that helping families brings her joy. But "Sullivan said she was most concerned with the commissioners’ lack of support for her and her department," Carey reports. "In her letter, she cited the lack of help doing contact tracing and being able to hire people to fill positions that would help with contact tracing.

The decision wasn't out of the blue: Sullivan sent the commissioners a letter Oct. 29 saying they needed to address issues that made her job impossible, and if they did, she would "consider staying." Otherwise, she implied that she would leave, and said it would be difficult for the next director to do a good job unless the commissioners address the problems, Carey reports.

Between Oct. 20 and Nov. 2, the other three employees resigned in solidarity, also effective Nov. 27, Carey reports.

What to know as ACA lawsuit is argued in Supreme Court

The Supreme Court heard oral arguments Tuesday "in a case that, for the third time in eight years, could result in the justices striking down the Affordable Care Act," Julie Rovner reports for Kaiser Health News. However, initial reporting on the oral arguments indicates that the court is unlikely to do that.

"The case, California v. Texas, is the result of a change to the health law made by Congress in 2017. As part of a major tax bill, Congress reduced to zero the penalty for not having health insurance. But it was that penalty — a tax — that the high court ruled made the law constitutional in a 2012 decision, argues a group of Republican state attorneys general. Without the tax, they say in their suit, the rest of the law must fall, too."

The court could rule in a number of ways, Rovner notes: It could declare the whole law unconstitutional, refuse to decide the case on the grounds that the plaintiffs don't have the legal standing to sue; rule that, by eliminating the penalty but not the rest of the mandate, lawmakers didn't intend to coerce citizens, so there's no constitutional conflict; or that, without the tax, the requirement to have health insurance is unconstitutional but the rest of the law is legally sound.

Many rural conservatives dislike the ACA because they insist that the open-market premiums are too expensive. But some aspects are popular, including Medicaid expansion in many states and protections for pre-existing conditions and a requirement that insurers provide coverage to everyone who wants it. "But throughout the attempts to eliminate the ACA, politicians who oppose the law have promised that people with preexisting conditions will still be able to access health insurance if the law is overturned," Lauren Peace reports for Mountain State Spotlight. "But that’s easier said than done."

In West Virginia, for example, more than a third of the state's people under 65 have medical conditions that would have made it difficult to get affordable private insurance before the ACA, Peace reports. Patrick Morrisey one of the attorneys general pressing the case, won re-election last week over a Democratic challenger who supported preserving the ACA. Morrisey has not yet proposed a plan to replace the Medicaid money and other federal dollars the law brings into the state, but promised in a January 2020 interview with MetroNews that, should the ACA be overturned, "people will be protected if they have pre-existing conditions."

In essence, "The ACA offers three tiers of protections. Preventing the denial of coverage is just one," Peace reports. "But requiring insurance companies to cover everyone regardless of medical history doesn’t mean by itself that coverage will be affordable, or prevent insurers from charging some people more if they have conditions that are expensive to treat."

National Rural Health Day, Nov. 19, is a chance to spotlight inequalities and local health issues in rural areas

National Rural Health Day, coming up on Nov. 19, is an excellent opportunity to shed a spotlight on rural health inequalities and local health issues in rural areas. Newspapers could take the opportunity to produce special sections, spreads or pages underwritten by local health-care providers -- and insurers, since the observance falls in the open enrollment period for Medicare and Affordable Care Act plans.

It is the 10th annual observance, coordinated by the Health Resources & Services Administration's Office of Rural Health Policy. They say nearly 57 million Americans, or 17 percent of the population, live in rural areas; they frequently face problems getting health care and the best health outcomes, and as a whole they are older and sicker than the general population. That's especially noteworthy as the pandemic burns through rural areas.

The Payson Roundup in central Arizona did a good job of using the observance to focus attention on rural health. For resources and statistics that can help with coverage, visit the National Organization of State Offices of Rural Health website or the National Rural Health Day website.

HRSA will host a variety of events next week to call attention to rural health issues. All are open to the public, though registration is required for some. Click here for a list of webinars, recordings, and virtual workshops on topics such as HIV, coronavirus testing at rural health clinics, death-rate disparities in rural areas, telehealth, Native American health, a virtual job fair, and more.

Though rural Republican support increased in many areas, small blue shifts added up to help Biden win

Republican support increased in many areas in the Nov. 2020 election, but small shifts helped Joe Biden take the presidency from Donald Trump. 

Stacey Abrams, who lost the race for Georgia governor in 2018, arguably helped swing Georgia to Biden, Ryan Lizza reports for Politico. She created a non-profit dedicated to increasing voter turnout in the state and though most of her efforts netted urban and suburban voters, rural Black voters in the southeastern part of the state may have been listening.

Trump won rural voters 2 to 1 in Georgia, but Biden performed slightly better in rural areas than Hillary Clinton did in 2016. That helped him take the state, Tim Marema, Tim Murphy, and Bill Bishop report for The Daily Yonder.

"In the three 'Northern battlegrounds' that Biden flipped — Wisconsin, Michigan and Pennsylvania — Trump boosted rural turnout, while Biden amped up his performance in the cities. But in many of those areas, each side managed to limit the other’s margins, canceling out any gains," Griff Witte reports for The Washington Post.

In Iowa, "the alignment of Democratic voters to Iowa’s urban centers and Republican voters to the state’s rural areas continued to sharpen in the 2020 election," Erin Murphy reports for the Sioux City Journal. "Iowa’s urban-rural divide has been in the works for a decade now, and it’s no longer a growing trend: It’s the new normal. Democrats own the five counties with the largest populations; Republicans own all but one of the rest."

In North Carolina, which Trump will win, the rural-urban political divide also persisted, Andrew Carter reports for the Raleigh News & Observer. Part of the divide falls along lines of poverty and education, but part of it is less easily quantifiable and more about conflicting worldviews.

Post-election fact check: President Trump and his allies make bogus claims of interference and fraud

Democrat Joe Biden has been elected, but President Trump has not conceded, and has continued to spread false claims of election interference and fraud, FactCheck.org reports. Here's some fact-checking on that and more.

In a Thursday appearance at the White House, Trump made baseless allegations of illegal voting in several swing states, D'Angelo Gore and Eugene Kiely report for FactCheck.org. He also falsely claimed that he won certain states "despite historic election interference from big media, big money, and big tech. . . . The U.S. intelligence community has publicly identified three actors that it warned were trying to interfere in the 2020 presidential election: Russia, China and Iran — not 'big media, big money and big tech,' as Trump falsely alleged," Gore and Kiely report.

At the same appearance, Trump also falsely said that Republicans didn't lose any House races and that the Republicans have held onto their Senate majority. Though Republicans had a net gain in House seats, some lost. And Senate control will likely be determined by runoff elections in Georgia in January, Gore and Kiely report.

The Washington Post reports, "Republicans have made claims of election irregularities in five states where President-elect Joe Biden leads in the vote count, alleging in lawsuits and public statements that election officials did not follow proper procedures while counting ballots in Tuesday’s election. So far, they have gone 0 for 5."

Analysts predict what's likely and possible for farming, mining and other industries under the Biden administration

With President-Elect Joe Biden set to take office in January, Bloomberg journalists and analysts have put together some predictions on how the new administration will affect U.S. sectors such as agriculture, manufacturing, retail, health care, and more. Here are some with rural resonance:

"Any Biden rollback of tariffs on Chinese goods could clear the way for more shipments of U.S. farm products to Asia," Kevin Miller and Melinda Grenier report. "But there’s concern a transition away from oil under Biden could erode demand for corn- and soy-based biofuels, which are mixed in with petroleum-based motor fuels. Some more left-leaning Democrats also may try to take a harder line against big agriculture companies. Senators Elizabeth Warren and Cory Booker have said the U.S. response to coronavirus outbreaks at meat plants this year was 'feckless'."

Telecommunications giants such as AT&T and Verizon have enjoyed a friendly relationship with the Trump administration's Federal Communications Commission, led by former Verizon attorney Ajit Pai. Such companies lobby hard to win federal contracts to build out rural broadband, but often save money by installing cheaper, slower DSL broadband instead of fiber-optic cable. The Biden administration will likely reimpose net-neutrality regulations and work to expand high-quality internet service in rural areas, Bloomberg reports.

Biden has vowed to ban new hydraulic fracturing on public lands and help the U.S. energy sector transition from fossil fuels to renewable energy sources. He may also tighten emissions standards, which could raise costs for the oil and gas industries.

Biden's win could hasten federal legalization of cannabis, allowing producers better access to electronic banking, tax deductions, and capital from lenders, Miller and Grenier report. 

Biden aims to expand coverage and subsidies under the Patient Protection and Affordable Health Care Act, which will help more people afford it, and says he will roll back some Trump administration changes that weakened it.

For manufacturers, "Major watch items include perennial concerns such as taxes and regulation, as well as trade — especially whether Biden will seek to improve global ties after four years of tensions stoked by Trump," Miller and Grenier report.

Purina to launch pet food with protein from bugs, Asian carp

Nestle Purina PetCare is launching a new line of cat food and dog food made with larvae of black soldier flies, and plans to offer other lines soon based on Asian carp. It's all part of a push to find protein from cheaper, more sustainable sources.

The Beyond Nature's Protein line will hit stores in Switzerland this month, and the company plans to expand to other European markets, Jaclyn Diaz reports for NPR. Purina spokesperson Lorie Westhoff said the company will offer U.S. customers an insect-based dry dog food in January, sold online only, along with several other formulas using protein alternatives such as Asian carp, an invasive species.

Purina "is embracing what the company views as a growing trend among consumers seeking protein alternatives for their cats and dogs, company representatives told NPR," Diaz reports. "A desire to be more environmentally conscious drives the consumer change, as does a perceived health benefit from a diet that substitutes meat."

The United Nations has warned that it will be increasingly difficult to find cheap, reliable protein sources as the world's population grows and resources are stretched, and recommends insects as a meat alternative. That could help with global warming too, the UN says, since meat production is responsible for releasing large quantities of the greenhouse gas methane, Diaz reports.

Scientists have had their eyes on fly larvae for a while now. "That’s because of the black soldier fly larva’s remarkable ability to transform nearly any kind of organic waste — cafeteria refuse, manure, even toxic algae — into high-quality protein, all while leaving a smaller carbon footprint than it found," Christopher Ingraham reports for The Washington Post. "In one week, a soldier fly colony of modest size can turn a ton of waste into 100 pounds of protein and 400 pounds of compost . . . In one year, a single acre of black soldier fly larvae can produce more protein than 3,000 acres of cattle or 130 acres of soybeans."

Asian carp could be a promising source for pet-food protein too. State and federal agencies have spent more than $600 million since 2004 trying to halt the spread of the invasive species, but they're having a hard time figuring out what to do with all the fish. A pioneering public-private program in Kentucky pays anglers for carp and auctions the catches online, mostly to Chinese buyers.

Some farmworkers, with little or no financial security, must decide whether to keep working or risk dangerous infection

The Trump administration declared farm laborers "essential workers" in the spring, but hasn't provided much guidance on how to keep them from getting sick or spreading the infection to others, and that has forced some of them to make tough choices between working and risking infection, Frank Hernandez reports for the Midwest Center for Investigative Reporting.

"While some people work from home during the covid-19 pandemic, agricultural workers pick and pack the fruits and vegetables Americans rely on," Hernandez writes. "They do so in potentially dangerous conditions — they often live in cramped housing, ride in crowded buses to job sites and work close to others — and without the federal government guaranteeing coronavirus protections," 

Some counties and "states such as Virginia, Oregon and Washington have created their own enforceable rules to control, prevent and mitigate the spread of the virus among farmworkers," Hernandez reports. "But federal mandates are necessary to ensure that employers are doing enough to protect workers, advocates said."

At least 16 farmworkers have died from covid-19, but there could be many more because of weak monitoring. The Occupational Safety and Health Administration doesn't keep track of covid-19 reports involving agricultural workers, who are mostly migrants with temporary H-2A visas. But OSHA does track such complaints from farm-labor contractors who hire such workers and transport them to job sites, Hernandez reports.

"As of Sept. 6, OSHA has closed nine complaints about covid-19 that involve farm-labor contractors," Hernandez reports. "Twelve complaints about farm-labor contractors remain open. There have also been two COVID-19 complaints related to migrant camps, where some workers live; one has been closed."

Among farmworkers, the virus has disproportionately hit Latinos, who make up more than 60 percent of farm labor. About three-quarters of the nation's 3 million farmworkers were foreign-born as of 2018, most  of them from Mexico, Hernandez reports.

The Mexican government says nearly 2,400 Mexican nationals had died from covid-19 in the United States as of Sept. 14, but didn't keep track of job descriptions for the deceased, Hernandez reports.