Health IT experts urge Senate to make pandemic telehealth regs permanent; FCC vows to update broadband maps

Health-care internet technology experts told a Senate subcommittee Thursday that many rural hospitals won't be able to take advantage of telehealth services if they can't afford or access broadband internet. The Subcommittee on Communications, Media, and Broadband convened the hearing to examine barriers to telehealth access.

Deanna Larson, president of telehealth company Avel eCare, testified that affordability is the biggest barrier to broadband adoption, and urged lawmakers to broaden telehealth regulations so more hospitals can use it. "Larson urged Congress to extend or make permanent their regulatory flexibility toward telehealth especially as it relates to being neutral on the kinds of telemedicine, such as phone-only care, asynchronous care, and remote patient monitoring," Riley Steward reports for Broadband Breakfast, a site that advocates for better broadband access. "An economic benefit of which would be keeping medical commerce local, she said. Patients wouldn’t be required as often to move to a higher level of care out of town."

Widespread telehealth availability could save the health care system an estimated $305 billion a year, Federal Communications Commission member Brendan Carr said at the hearing, Steward reports. He also endorsed several Senate bills that would enhance telehealth access, including the bipartisan Protecting Rural Telehealth Access Act, which was introduced in June by Sens. Joe Manchin (D-W.Va.), Joni Ernst (R-Iowa), Jeanne Shaheen (D-N.H.) and Terry Moran (R-Kan.).

The bill, along with its House companion, the Protecting Telehealth Access Act, focus on specific changes to telehealth that have proven successful during the pandemic, Eric Wicklund reports for mHealth Intelligence. Both bills call on Congress to allow audio-only telehealth appointments to receive the same payments as other appointments, permanently waive Centers for Medicare & Medicaid Services geographic restrictions so patients can be treated in their homes, permanently allow rural health clinics and federally qualified health centers to provide telehealth services, and allow critical access hospitals to bill directly for telehealth services.

However, even if the bills pass, they can only help if hospitals can access affordable broadband. The FCC awards rural broadband buildout contracts to companies based on maps meant to identify who lacks broadband access. But those maps are inaccurate, a problem the commission has vowed to fix. Subcommittee members at the hearing pressed Carr to complete the improved maps so more rural areas can get the broadband access they need, Maria Curi reports for Bloomberg Law.

Quick hits: Future of farm shows; ghost towns sold; defining rurality; doulas increasingly popular in rural pregnancies

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 heather.chapman@uky.edu.

Farming experts have a web discussion on YouTube about the future of farm shows, what needs to change, and what needs to be preserved. Read more here.

What happens when a town is abandoned? Sometimes real-estate agents sell the whole thing as a ghost-town package. Read more here.

A Daily Yonder piece discusses why it's so difficult to define rurality, and lays out the most common definitions of "rural," who uses them, and why. Read more here.

Rural residents often have less access to childbirth services, but a specialized health-care worker called a doula is becoming increasingly popular in rural communities to help provide support to mother and child during pregnancy and after birth. Read more here.

New rural Covid-19 deaths and infections fell last week for first time since June, but rural rates still dwarf metro rates

New coronavirus infections, in ranges by county, Sept. 26-Oct. 2
Daily Yonder map; click the image to enlarge it or click here for the interactive version.

"For the first time since early June, both Covid-related deaths and new infections declined last week in rural counties, according to a Daily Yonder analysis. New infections in rural (nonmetropolitan) counties dropped by about 20%, to a total of 159,204. It’s the second consecutive week of declines in new infections," Tim Murphy and Tim Marema report for the Yonder. "Surprisingly, fewer Covid-related deaths were reported in rural counties last week. Deaths fell by a modest 3%, to 3,102. After previous surges, the number of Covid-related deaths continued to climb for several weeks after new infections had peaked."

The rural infection rate is still two-thirds higher than the metropolitan rate and the rural death rate is 90% higher. There are regional variations: "The rural infection rate is higher than the metro rate in 37 of the 47 states that contain nonmetropolitan counties. The rural death rate is higher in 38 states," Murphy and Marema report. Though the number of red-zone counties fell by 29, more than 90% of rural and metro counties remain in the red zone, meaning they have at least 100 new infections per 100,000 residents in one week.

Click here for an interactive county-level map, regional analysis and charts from the Yonder.

Dispatch from Iowa: What happens when a newspaper chain lets a community's small daily newspaper deteriorate

The building is for sale. (Photo by KC McGinnis for The Atlantic)

All across America, small newspapers are shriveling, mainly because digital media have taken much of their advertising base. Quantifying that on a national scale would be very difficult; the U.S. has more than 6,000 newspapers, most of them small. But a story about one, The Hawk Eye of Burlington, Iowa, is emblematic of the problem, which is worst for small daily papers bearing a burden of debt incurred by hedge-fund buyers like GateHouse Media, which took over Gannett Co. and its name.

Elaine Godfrey, who grew up near the Mississippi River town of 24,000, writes for The Atlantic about The Hawk Eye under the new Gannett: "Its staff, now down to three overstretched news reporters, still produces a print edition six days a week. But the paper is dying. Its pages are smaller than they used to be, and there are fewer of them. Even so, wide margins and large fonts are used to fill space. The paper is laid out by a remote design team and printed 100 miles away in Peoria, Illinois; if a reader doesn’t get her paper in the morning, she is instructed to dial a number that will connect her to a call center in the Philippines. Obituaries used to be free; now, when your uncle dies, you have to pay to publish a write-up. These days, most of The Hawk Eye’s articles are ripped from other Gannett-owned Iowa publications, such as The Des Moines Register and the Ames Tribune, written for a readership three hours away. The opinion section, once an arena for local columnists and letter writers to spar over the merits and morals of riverboat gambling and railroad jobs moving to Topeka, is dominated by syndicated national columnists."

Using the recently created Burlington Breaking News Facebook page to solicit comments, Godfrey got dozens: "Readers noticed the paper’s sloppiness first—how there seemed to be twice as many typos as before, and how sometimes the articles would end mid-sentence instead of continuing after the jump. The newspaper’s remaining reporters are overworked; there are local stories they’d like to tell but don’t have the bandwidth to cover. The Hawk Eye’s current staff is facing the impossible task of keeping a historic newspaper alive while its owner is attempting to squeeze it dry."

Social-media sites that pop up when a newspaper withers "can be a useful resource, and a good source of community jokes and gossip. But speculation and rumor run rampant" on the Facebook page, Godfrey writes. "When a member hears something that sounds like gunshots nearby, she’ll post about it, and others will offer theories about the source. Once, I read a thread about an elementary-school principal suddenly skipping town. Some thought he might have behaved inappropriately with a student; one person said he’d been involved with a student’s mother; another swore they’d seen security-camera footage of the principal slashing tires in a parking lot at night. I checked The Hawk Eye and other outlets, but I couldn’t find verification of any of those stories."

The guessing is hard for Dale Alison, former Hawk Eye editor, to watch. "He often interjects in the comments to correct false information. Sometimes he posts news himself. . . .  People want to know what’s going on, Alison told me; they just don’t know how to find the answer, whom to call, where to look. That’s what reporters are for."

Godfrey touches on another national trend seen all over the country: "In the absence of local coverage, all news becomes national news: Instead of reading about local policy decisions, people read about the blacklisting of Dr. Seuss books. Instead of learning about their own local candidates, they consume angry takes about Marjorie Taylor Greene," the radical Republican congresswoman from Georgia.

And she senses an even more disturbing trend, relayed by Mayor Jon Billups, who was fired as The Hawk Eye's circulation director in 2017: "Since the purchase of the paper, he’s noticed a growing negative self-image among residents, he told me. Fewer people see Burlington as a nice place to live; they seem to like their neighbors less. 'We’re struggling with not having [this] iconic thing.' As mayor, he helped start a newsletter to keep residents updated on city projects. 'It’s a matter of time before our local paper does not exist.'"

Like many towns with shriveled papers, Burlington has an online news site, the Burlington Beacon, founded by Jeff Abell, soon joined by William Smith, both former Hawk Eye reporters. "The Beacon is far from profitable. Until recently, Abell paid Smith from his own pocket. The two work out of Abell’s comic-book store in downtown Burlington," Godfrey reports. “Jeff and Will are doing their best,” Alison told her in an interview at the newspaper's building, now for sale. “But doggone it, it would take 150 years to build up what they had here.”

Godfrey reflects, "When people lament the decline of small newspapers, they tend to emphasize the most important stories that will go uncovered: political corruption, school-board scandals, zoning-board hearings, police misconduct. They are right to worry about that. But often overlooked are the more quotidian stories, the ones that disappear first when a paper loses resources: stories about the annual Teddy Bear Picnic at Crapo Park, the town-hall meeting about the new swimming-pool design, and the tractor games during the Denmark Heritage Days. These stories are the connective tissue of a community; they introduce people to their neighbors, and they encourage readers to listen to and empathize with one another. When that tissue disintegrates, something vital rots away. We don’t often stop to ponder the way that a newspaper’s collapse makes people feel: less connected, more alone. As local news crumbles, so does our tether to one another."

Many users of popular church app spread misinformation

Vaccination misinformation is an epidemic in its own right, especially among Republicans and evangelical Christians. And just like a pandemic, misinformation spreads along vectors. One of them is Subsplash, a popular tech app that aims to help evangelical churches create websites, apps, podcasts, livestreams, and more.

"Founded in 2005, the company now has 14,000 clients around the country from major cities to rural areas. The company boasts that it gives individual churches full control over their content. But there’s a dark side to the company’s hands-off approach. Since the beginning of the pandemic, Subsplash has given voice to and amplified messages from many religiously affiliated anti-vaccine activists," Kiera Butler reports for Mother Jones. "Subsplash’s hosting of anti-vaccine ideology isn’t limited to churches. In addition, the company also developed an app for Texans for Vaccine Choice, a powerful anti-vaccine PAC that has helped Republican state representatives who oppose vaccines to win elections."

Subsplash's culpability in the dissemination of such misinformation is debatable, since the company doesn't control how individuals use their tech, but it's part of a larger conversation: "from politics to medicine, the online spread of conspiracy theories has called into question the role of technology companies as gatekeepers," Butler reports.

It should also be noted that Subsplash states in its Terms of Use that the company values "integrity, truth, and respect for others" and reserves the right to reject any user content that it deems objectionable. Users must agree not to use the platform to knowingly promote "false or misleading information.

Rural arts scenes can boost economies and more; annually published index shows how your local area ranks

SMU DataArts' Arts Vibrancy Index, published in Sept. 2020; click the image to enlarge it.

The pandemic has hurt the arts in most communities, but many rural towns have vibrant arts and culture scenes. Done right, they can deliver a wealth of benefits to their communities, says the director of a New Hampshire nonprofit who led the arts and culture track at the Radically Rural summit in September.

Jessica Gelter, executive director of Arts Alive!, spoke with Caroline Tremblay of The Daily Yonder about how rural arts and culture scenes can best serve their communities. It's important to make sure artists are leading the way, and that even the poor can access the arts, she said. And she believes right now is a good time to reassess as public events get back on track.

How is your community's arts scene? One way to measure is Southern Methodist University's annual Arts Vibrancy Index, which weighs a number of factors to assign a score to counties. Below are the 10 small communities with the best arts and culture scenes; the report has detailed information about what makes each successful. All are micropolitan statistical areas whose principle city has a population of 10,000 to 50,000:

1. Jackson, Wyoming
2. Steamboat Springs, Colorado
3. Heber, Utah
4. Hailey, Idaho
5. Glenwood Springs, Colorado
6. Vineyard Haven, Massachusetts
7. Oneonta, New York
8. Hudson, New York
9. Bennington, Vermont
10. Hood River, Oregon

Living near oil booms is correlated with lower lifetime earnings and later retirement, USDA research finds

People who live near booming oil-production areas may earn less over their lifetimes and retire later than others their age, says new research by the Agriculture Department's Economic Research Service, the University of Oregon, and the University of Wisconsin-Madison. The research aimed to assess the long-term affects of boom-and-bust cycles on households in top oil-boom areas in 1980. From the report:

"Although incomes rose for both boom and non-boom households during the oil boom, they increased by an average of about $5,000 more annually for boom households during the early boom (1975–79) and $6,900 more each year during the late boom (1980–84) compared with similar households in counties that were not producing oil. The subsequent bust, however, saw incomes rise by an average of $8,000 less annually from 1985 to 1992 for households in boom counties compared with households in non-boom counties. The lower average household gains were driven in part by increased unemployment and the dissipation of relative wage gains during the boom. The oil boom and bust appeared to have no effect on relative changes in household income after 1993. Aggregating across all years, cumulative income for the average household in a boom county was $7,600 lower than for an average household in an otherwise similar non-boom county between 1975, the beginning of the boom, and 2012, the final year of the study."

Poll: Vaccine holdouts come around for four big reasons, which are most effective in combination, not independently

Kaiser Family Foundation chart; click the image to enlarge it

A recent Kaiser Family Foundation poll of people vaccinated against the coronavirus since June 1 showed the reasons people who weren't sure about it finally got their shots. The biggest were the Delta variant, worries about hospitals filling up, seeing an acquaintance or friend get seriously ill or die from Covid-19, and wanting to take part in activities that required vaccination.

What's most interesting in the poll is that "none of these approaches work very well in isolation," says Yale University physician and public-health lecturer James Hamblin. "Hesitant people don't get vaccinated because of one 'main' reason, so much as because of a gradual accretion of reasons. They add up to eventually create the necessary urgency and eventually tip us toward responsible action."

That's no different than how most people make major life decisions, he writes, and it's reason for optimism: "Point being, small things matter, even if you don't see the impact right away. If you've had conversations with friends or family—or even just shared an article or study, or sent simple notes to people you know saying you care about them and hope they'll reconsider—and yet you don't feel it helped, you're not alone. And ultimately it still may help. You just might not know what part you played."

Pandemic roundup: Insurers billions behind on payments, hurting rural hospitals; Sen. Graham booed for urging shots

Here's a roundup of recent news stories about the pandemic and vaccination efforts:

Major health insurers are billions of dollars behind on reimbursements, particularly hurting rural hospitals and doctors when they can afford it least. Read more here.

Vaccines are linked to preventing more than a quarter of a million coronavirus cases and 39,000 deaths among American seniors, according to a new Department of Health and Human Services report.

Hospitals overwhelmed with Covid-19 patients have had to delay treatments and surgeries for people with other conditions such as cancer or heart disease. Many of those patients say they don't feel optimistic about being able to access treatment in time. Also, the glut of Covid patients means rural hospitals are having a much harder time transferring critical patients to larger hospitals. A Florida woman had to call 169 hospitals to find one to provide the intensive, last-ditch Covid-19 treatment her husband needed to live. Telehealth can help rural intensive care units care for critical patients instead of having to transfer them, though, as one rural Alabama hospital has found.

Sen. Lindsey Graham was booed over the weekend when he encouraged a crowd of Republicans in Summerville, S.C., to get the coronavirus vaccine. Read more here.

An appeals court has ruled that New York health-care workers must temporarily be allowed to claim a religious exemption from the coronavirus vaccine while the three-judge panel considers whether the mandate as a whole is legal. Read more here.

Eastern Kentucky has some of the highest infection rates in the country, but its hospitals—like those in many other rural areas—face a severe employment shortage. So to sweeten the pot for potential workers, insurer Anthem Blue Cross and Blue Shield has launched an endowment-funded scholarship program at two Eastern Kentucky colleges. In return for the scholarship, nursing students must work in rural communities for at least three years after graduation. Read more here.

For employers that mandate vaccines, it can be difficult to judge whether an exemption request is based on "sincerely held" religious beliefs. Read more here.

Few who spread misinformation have faced real consequences (though Alex Jones was found responsible for damages related to his false claims on the Sandy Hook shooting), but an Oregon doctor has had his medical license revoked after he falsely said mask-wearing could trigger carbon dioxide poisoning. The rise of an Ohio attorney who spread misinformation shows how vaccine misinformation can be a lucrative path to right-wing celebrity.

A psychologist offers tips for helping children cope with pandemic anxiety. Read more here.

A Colorado-based health system says it will almost always deny organ transplants to patients who haven't been vaccinated against the coronavirus, because those patients will have suppressed immune systems and will be much more likely to die if they get Covid-19. Read more here.

Baseball-goods factory moving from Minn. town to China

Star Tribune photo by John Reinan

As Major League Baseball's playoffs begin, the residents of Caledonia, Minnesota, in the state's southeastern corner, may feel a little soured on the sport. That's because their baseball-equipment factory is shutting down and moving most of its jobs to China, The Caledonia Argus reports.

The Miken Sports plant, which makes baseball helmets and bats, has operated in Caledonia since 1999. It provides about 80 jobs in the community of 2,800, and is partly owned by MLB and Rawlings Sporting Goods. But Miken announced over the summer that the factory will close down over the next 18 to 24 months, and 59 of the jobs will go to China (the rest will go to Missouri), John Reinan reports for the StarTribune in Minneapolis.

An MLB spokesperson told Reinan that it owns less than 20% of the factory, and that Rawlings made the decision independently. The spokesperson also noted that batting helmets will continued to be made in the U.S.

"We'll miss the jobs," Caledonia resident Nick Stadtler told Reinan. He added that baseball "will lose their fans in this area. That's for sure."

USDA surveys find more big farmers embrace cover crops

Just over half of the nation's largest farms said they planted cover crops in 2017, showing increased acceptance of the practice's benefits for soil health and water retention, according to a newly released Agriculture Department survey of 400 producers with production worth at least $500,000 a year (putting them in the top 7.4 percent of farms). Here are some takeaways from the poll:

• In 2017, farmers reported planting 15.4 million acres of cover crops, a 50% increase from 2012.
• 81% of growers with cover crops said the practice improved soil health and crop yields. One in seven said it improved soil health but not crop yields.
• 48% of farmers polled said they abandoned cover crops in the past or have never planted them before.
• Field-level surveys of crop fields found that expanded adoption of cover crops is highest on fields that include corn silage in the rotation and lowest on fields that include wheat.
• In 2018, about one-third of the acreage planted with a cover crop received a financial assistance payment from either federal, state, or other programs that support cover-crop planting.
• Most of the farmers who planted cover crops were fairly new to the practice. Half the farms with cover crops reported doing so for five years or less, and on 25% or less of their land. Only one-fourth of the growers who plant cover crops had done so for more than 10 years.

October brought the largest permanent increase in SNAP, helping rural residents

On October 1, the largest permanent benefits increase in the Supplemental Nutrition Assistance Program's 60-year history took effect, marking "a significant turning point" in efforts to eliminate hunger in the U.S., writes Jennie Day-Burget of the Robert Wood Johnson Foundation.

The program, which is disproportionately used by rural Americans, has been "extremely effective at increasing food security, improving children’s health and academic performance, supporting economic growth, and lifting people out of poverty," especially during the pandemic, she writes.

Day-Burget sat down with Jamie Bussel, who oversee's RWJF's childhood nutrition work, to discuss the significance of the program increase and how they and other organizations can best leverage the program to maximize its potential to help.

The permanent increase was critical, Bussel explained, because the average SNAP recipient in more than 96% of U.S. counties couldn't afford a modest meal with their benefit. Even after the increase, more than 40% can't afford a meal, but it's still dramatic progress.

The reality of food costs was key to the program's benefit update, Bussel said. USDA calculates benefit payouts using the Thrifty Food Plan, which takes into account metrics such as food costs, dietary guidelines and nutritional content of various foods. But the formula makes a lot of assumptions that haven't been changed since 1975. Updating the formula means the average SNAP benefit is going up by about 25% compared to pre-pandemic averages. Read more here.

Rural hospitals that joined chains were more likely to stop maternal and neonatal services, limit mental-health access

Average number of hospital stays for maternal/neonatal care, surgical services and mental health/substance-use disorder, for merged and independent hospitals (Health Affairs graph; click on the image to enlarge it)

Rural hospitals that were acquired in mergers from 2009 to 2016 were more likely than their independent peers to shutter their maternal, neonatal and surgical services, and more likely to limit access to mental-health care, on-site diagnostic technologies, and non-emergency outpatient services, according to a newly published study in the journal Health Affairs.

In essence, the researchers found, a merger might save a hospital from closing, but make it less responsive to community needs. Merged hospitals were also less likely to be critical-access hospitals, and more likely to be privately owned, have more beds than average, and be located in the South.

The study compared 172 rural hospitals that merged with larger systems between 2009 and 2016 and compared them with 549 hospitals that remained independent, using data from annual American Hospital Association surveys. In the year after hospitals were acquired, the average number that provided any maternal or neonatal services fell 6.7 percentage points more than independent hospitals. Two years afterward, that gap increased to 7.2 percentage points, but at three years post-merger and beyond, the gap virtually vanished.

One year after being acquired, merged hospitals were 5 percent less likely like to offer surgical services than independent hospitals. The statistical gap became insignificant two and three years after merger. Analysis showed that locals weren't accessing those services elsewhere nearby, so the data suggests that the merger didn't generally hurt patient access to inpatient care.

Admissions for patients with mental-health issues or substance-use disorders stayed about the same for the first two years after hospitals were acquired, but increased during the same time period for independent hospitals. That and other data suggests that communities with merged hospitals may have reduced access to behavioral health care.

The study is the second from the federal Agency for Healthcare Research and Quality and IBM Watson Health to examine the benefits and consequences to health-care access for people whose local hospital was acquired. The first one found that merged rural hospitals had lower overall lower death rates, especially from heart attacks.

USDA launches $500 million loan guarantee program for small meatpackers in hopes of easing supply-chain woes

The U.S. Department of Agriculture is offering new loan guarantees for small, independent meatpackers, Secretary Tom Vilsack announced Monday. The $500 million program is meant to expand capacity for meat and poultry processors and alleviate supply-chain bottlenecks caused by the pandemic. 

"The Agriculture Department, along with the White House, has been targeting the meat and poultry sector for months, blasting the industry for heavy concentration that contributed to supply chain disruptions during the pandemic and following other shocks, such as the recent hack of JBS beef plants by Russian cybercriminals," Ximena Bustillo reports for Politico's Weekly Agriculture.

"A loan guarantee often means lower interest rates for a project because the USDA promises to repay most, but not all, of a loan if the borrower defaults," Chuck Abbott reports for the Food & Environment Reporting Network. "Often, the USDA guarantees 90 or 95 percent of a loan. Lenders may be more willing to extend financing since they have assurance of repayment. Loan guarantees are a way to magnify the power of USDA funding because comparatively little money is expended for each project; the borrower has to compile the funding for the project."

New coronavirus vaccinations in rural counties fell 20% last week; rural rate stays 11.8 percentage points below metro

Vaccination rates as of Sept. 30 compared to the national average, adjusted to account for vaccinations not assigned to specific counties, Map by The Daily Yonder; click the image to enlarge it or click here for the interactive version.

"After increasing for five out of the last six weeks, the pace of new vaccinations in rural counties fell last week by about 20%. The number of new vaccinations in metropolitan counties was down by nearly a third," Tim Murphy and Tim Marema report for The Daily Yonder. During the week of Sept. 24-30, about 348,000 rural Americans completed their coronavirus vaccinations, down from about 448,000 the week before. About 2.2 million Americans in metropolitan counties completed their vaccinations, down from about 3.1 million the week before.

"As of September 30, 42.1% of the nation’s rural population was fully vaccinated. In metropolitan counties, 54.0% of the population is fully vaccinated," Murphy and Marema report. "The gap between the rural and metropolitan vaccination rates remained steady at about 11.8 percentage points."

Click here for more charts, maps and regional analysis from the Yonder, including an interactive map.

Manning-Stone OKd to lead Bureau of Land Management

Tracy Stone-Manning during Senate testimony
(Associated Press photo by Graeme Sloan)

"The Senate narrowly approved Tracy Stone-Manning on Thursday to lead the Bureau of Land Management, capping months of efforts by Republican lawmakers to block her confirmation because of her connection to a decades-old tree spiking incident," Lisa Friedman reports for The New York Times. "Stone-Manning steps into an agency that has been stretched thin ever since the Trump administration moved the BLM headquarters to Colorado last year, and will soon be faced with decisions over the future of oil and gas leases on federal land in Western states."

As part of its mission to protect natural resources, the Interior Department agency manages grazing, logging, drilling and mineral rights on public lands. "It is responsible for balancing oil, gas and coal extraction with recreation and the protection of natural resources," Friedman reports. "It also is key to President Biden’s goal of phasing out oil and gas drilling on federal lands. That plan has been in limbo since a federal judge ruled in June that the administration did not have the authority to suspend leases."

Rural Covid death rate spikes to more than twice urban rate

University of Iowa College of Public Health graph, adapted by The Rural Blog

Rural deaths from Covid-19 have spiked to the point that the latest rural death rate is twice that of the overall rate in metropolitan areas, according to a report from the Rural Policy Research Institute.

Fred Ullrich and Keith Mueller of the College of Public Health at the University of Iowa tracked Covid-19 mortality rates from the beginning of the pandemic and found that counties outside metro areas began showing higher rates in June, with a wider separation beginning in August.

Over the course of the pandemic, the non-metro mortality rate, 231 deaths per 100,000 residents, has been only moderately higher than the metro rate, 195 per 100,000, Ullrich and Miller report.

The researchers also tracked the rates in micropolitan areas, which are outside metros but have cities with populations between 10,000 and 50,000. Their death rates were usually about the same as those in rural areas until last month, when the rural rate clearly exceeded it.

Ullrich and Mueller's report also tracks the rate of new cases since the start of the pandemic. It shows that on Sept. 15, the seven-day average of new cases in metro areas was 43.3 per 100,000 residents, and in non-metro areas (rural and micropolitan) it was 66.8 per 100,000.

The overall non-metro vaccination rate is 41.4 percent, while the metro rate is 53.3%.

Some rural states that got a fast start on vaccination against the coronavirus have hit a wall of resistance

Stateline chart, based on Centers for Disease Control and Prevention data

Some states with large rural populations got off to a fast start getting their residents vaccinated, but recently "have hit a wall," reports Stateline, a service of the Pew Charitable Trusts.

"Those less populous states outhustled bigger ones using innovative distribution schemes such as flying vaccines on small airplanes to remote areas, tapping into existing rural health systems and eschewing the county-by-county model that slowed larger states’ distribution," Elaine Povich writes., noting Alaska and West Virginia. "The plummet is a combination of the unsustainability of early distribution methods and less demand for vaccines among the remaining, largely rural population, experts say."

Jennifer Tolbert, state health reform director for the Kaiser Family Foundation, told Povich, “More recently, what you are coming up against are ideological issues in more conservative states. Vaccines are available, but absent mandates and requirements for people to get vaccinated, if there is hesitation or reluctance in large sectors of the population, the vaccines are going to plateau.”

William Galston, a senior governance-studies fellow at the Brookings Institution, a nonpartisan think tank, "noted that white people without a college degree, who generally make up more of the vaccine-resistant U.S. population, are a higher share of the rural population." He told Povich, “I won’t say demography is destiny, but when you are looking at vaccines, it’s way up there.”

The wall is also political. Several research reports have noted the negative correlation between states' vaccination rates and their percentage of vote for Donald Trump last year. Here's one graph, from The Washington Post:

U.S. Postal Service is charging more for poorer service; you can look up the predicted effect in your postal area

Washington Post chart; for a larger version, click on it.

This week, the U.S. Postal Service starts operating on new delivery standards this week, and it's not good news. On top of recent postage-rate increases, USPS is giving itself more time to deliver the mail.

Just how much more time, where you're concerned? You can find out on an interactive site created by The Washington Post. The contractions and shifts in speedy-delivery areas can be fascinating; this comparison for Pike County, Kentucky, shows that the USPS is making it part of West Virginia, in postal terms. The changes appear to have a disproportionate effect on many rural areas.

Washington Post maps, based on software by Mapbox; for a larger version of the image, click on it.

"Seventy percent of first-class mail sent to Nevada will take longer to arrive, according to The Post’s analysis, as will 60 percent of the deliveries to Florida, 58 percent to Washington state, 57 percent to Montana, and 55 percent to Arizona and Oregon," The Post's Jacob Bogage reports. "In all, at least a third of such letters and parcels addressed to 27 states will arrive more slowly under the new standards.

Bogage notes that the changes are "core components of Postmaster General Louis DeJoy’s 10-year plan for the agency, a program designed to cut costs and raise new revenue to fix its many financial problems."

Reports of anti-vaccine preachers spur weekly to use its 'bully pulpit' and forswear 'neutrality in times of moral crisis'

Crittenden County, Kentucky (Wikipedia map)

Some newspapers are making extra efforts to increase vaccination against the coronavirus, by fighting misinformation with the facts. Chris Evans, the editor and publisher of the only paper in Crittenden County, Kentucky, population 9,000, reported to colleagues what he and his wife Allison have done:

"The Crittenden Press has published a first-person article from a local M.D. encouraging vaccines; an article about a nurse practitioner whose husband was hospitalized and unvaccinated and she changed her tune on the vaccine in a hurry; and we have had a couple of recent op-ed pieces, too. Allison wrote a very well-received column a couple of weeks ago comparing it to smallpox and polio." (See below.)

The Crittenden Press spotlighted the Covid-19 deaths of a local couple.

"Last week, we began a front-page feature where businesses and/or agencies, including local government, are encouraged to tell us how many of their folks are vaccinated. Then we publish what they tell us. City council went first. We have had good response to that so far. Today I attended the funeral of a husband and wife, both unvaccinated, who died last week. The wife previously worked for us for several years."

Evans concludes, "If Covid hasn’t hit your doorstep yet, it’s coming, and we have heard about pastors who are preaching against the vaccine from the pulpit. I told Allison today, they may have a big audience, but ours is bigger. You probably know that I am a church-going conservative, but it’s time to use my bully pulpit. I have been somewhat reluctant until now to stick my nose squarely into the middle of this, but I think it is time. I am reminded of the phrase in Dante’s Furnace that 'The darkest places of hell are reserved for those who maintain their neutrality in times of moral crisis.'"

Allison Mick-Evans

The column by Allison Evans, headlined "Polio to Covid," noted the "greater public acceptance of and willingness to receive the polio inoculation" in the 1950s. "One of the reasons, historians say, was that Americans had a deep respect for science. A chorus of social media opinions did not exist back then to confuse the public. A campaign of disinformation and skepticism about the Covid vaccine has clearly created pockets of deep-rooted resistance, doubt and insecurity." She addressed one source of doubt, the much quicker development of Covid vaccines, which "was the result of years and years of research in the scientific archives on SARS vaccines. Because Covid and SARS are both coronaviruses diseases, scientists has a head start on dealing with the new strain, which led to the relatively quick creation of a Covid-19 vaccine."

Evans concluded, "I understand the fear of the unknown. It’s a weakness I share. Being fearful of making the wrong decision is what creates hesitancy, sometimes with serious consequences. But we trusted scientists in the 50s to protect our children from polio. Science worked. And now it’s time to let science protect us again. The rollout of a life-saving vaccine is something we might only see once or twice in our lifetime. Hopefully no more. Folks in the '50s who trusted the process of eradicating polio should be our guide. It’s time we do the same so our kids and grandkids won’t live with Covid-19, but instead will need to Google it."

The Rural Blog invites other editors to share their recent special efforts to battle the pandemic. Email al.cross@uky.edu and heather.chapman@uky.edu.