After pandemic supply troubles left tribes without meat, some decided to invest in their own slaughterhouses

Workers cut steaks at Three Rivers Meat Company, whose majority 
owner is the Choctaw Nation. (Photo by Todd Price, Offrange)

U.S. meat supplies for Indian populations were unreliable during the pandemic, which led at least 18 Native American tribes to invest in building their own slaughterhouses, reports Todd Price for Offrange.

The Osage Nation in northern Oklahoma was one of the first tribes to decide that "they would build their own USDA-inspected meat processing plants," Price explains. Other Oklahoma tribes, including the Cherokee Nation, Choctaw Nation, Miami Nation, and Muscogee Nation, have also invested in their own meat plants.

Before the pandemic, many tribes owned land, raised livestock, or oversaw marine tracks. Following the pandemic-era slaughterhouse closures and meat supply bottlenecks, "Many tribes recognized the urgency of taking control of their food supply so they could always ensure their people would be fed," Price reports. "An estimated 18 tribes now operate plants that process meat and seafood."

Although slaughterhouses are expensive to build and have slim profit margins, Native tribes use "vertical integration" to leverage benefits. Price explains, "They own the animals and then sell the meat to their casinos or food assistance programs. And they do not always define success in dollars like a private business. Bringing good jobs to rural areas and meat to food deserts is part of the goal."

For tribes, being able to raise and process enough food to feed their people isn't just about making sure no one goes hungry. "It is also an important step towards food sovereignty — controlling the food supply and deciding what they will eat," Price reports. "And sovereignty, the power to govern themselves, is a right that tribes have long fought to preserve."

Quick hits: Fall leaf color predictions; Texas water crisis; rural movie for 2020 pandemic; opioid meds for jails

Map from SmokyMountains.com shows fall leaf color projections. Red indicates peak color. 

As autumn begins across much of the U.S., many Americans and tourists plan day trips or vacations to take in nature’s stunning fall colors. "Parts of the U.S. will soon start to see — if they haven't already — leaves and shrubs trade their green hues for vibrant shades of orange, yellow and red as the days get shorter and temperatures get chillier," reports Rachel Treisman of NPR. Explore Fall, TheSmokyMountains.com and Almanac websites offer some of the best "estimates [for] when leaves will change and colors will peak across the country."

Faced with ongoing population growth, an aging water system, and intermittent droughts paired with scorching temperatures, Texas officials and lawmakers are working to address the state's water crisis. But even as solutions are hammered out in Austin, the "state's regional diversity and patchwork of governments complicate matters further," reports The Texas Tribune. "Texas voters will be asked this fall to approve a $20 billion package to protect the state’s water supply. . . . The $20 billion is just a fraction of what some experts believe the state needs to invest going forward." 

In a bid to help balance pharmacy payments, Optum Rx "has increased reimbursement minimums for brand drugs for approximately 2,300 independent pharmacies," reports Heather Landi of Fierce Healthcare. The company's shift to a cost-based model is helping the bottom line of the "more than 24,000 independent and community pharmacies it works with. . ." More than half of all independent pharmacies operate in rural areas of the U.S., but many have closed or struggle to stay afloat due to high operational costs and low reimbursement rates.

When it comes to remembering 2020, many Americans would probably prefer not to recall the year at all. But film director Ari Aster doesn't want anyone to forget. In his latest film, "Eddington," Aster takes viewers back to the early days of the pandemic through the lens of a rural town drama set between a town sheriff and its mayor. Eddington captures the "anxiety, confusion, listlessness, and frustration of those first few months of lockdown as the backdrop for a dark and twisted story of a man, a town, and a country gone crazy," writes Anya Petrone Slepyan of The Daily Yonder. "Ari Aster’s latest rural thriller will give you something to think about."

When individuals suffering from opioid addictions are released from jail or prison, they face a high risk of overdose; however, a recent study shows that medication treatment during incarceration can lower their chances of overdosing upon release. "Use of medication for opioid use disorder (OUD) in jail was strongly associated with lower risks for overdose, death, and re-incarceration after release into the community," reports Shannon Firth of MedPage Today. The observational study was conducted in Massachusetts correctional facilities.

No matter where adults live, it may seem like kids have a different language that includes words that don't mean what they meant even three years ago. Keeping up with what young people are saying can feel impossible for anyone attempting to stay "hip," but not knowing kid-jargon can be a particular nightmare for parents. "As a little bit of an explainer, here’s a quick guide to slang terms that have made a mark in recent months," writes Paul Anthony Jones for Mental Floss. A few "explainers" are shared below.

Kid-jargon can mystify adults. (Graphic by Justin Dodd, Mental Floss)

W in the chat! "W has been used as a slang abbreviation for a win for over 50 years — although nowadays it’s used not just of victories, but of anything that could be regarded as laudable or impressive."

What the sigma?!? "As Merriam-Webster has noted, [the word] sigma has become increasingly ironic, pejorative, and jokey. . . This phrase in Gen Z and Gen Alpha vernacular is roughly the 2020s equivalent of 'What the heck?!'"

Do it for the plot! "If you imagine your life as one big movie, 'doing something for the plot' means doing something bold or risky that, in the retelling of your life story, would act as a major plot point."

Making sense of bird flu virus H5N1, from its risks to why there's reason to be hopeful

Bird flu H5N1 can kill chickens in 48 hours, but the
infection is less severe in humans. (J. Whitt photo, Unsplash)

As avian flu spreads among birds, cows, and people, understanding the virus can help lessen unnecessary worry and build support for virus containment, testing and possible vaccination efforts.

David Leonhardt of The New York Times demystifies the bird flu virus through questions and answers. The answers have been lightly edited.

1. What is bird flu?
It’s an influenza virus officially known as H5N1 (and sometimes called avian flu). It attracted global attention in the late 1990s after an outbreak among chickens in southern China. . . . That outbreak was especially worrisome because it included the first documented human cases of the virus. At least 18 people were infected, six of whom died.

2. Why the recent concerns?
The virus has recently expanded in two ways: across regions and across species. Rather than being concentrated in Asia, bird flu has moved across much of the planet. And it has infected a wider variety of animals, including mammals. Dairy cows in many parts of the United States have tested positive.

Most concerning, at least four people have tested positive without evidently having had contact with a sick animal. . . . These infections raise the possibility that the virus can move from one human being to another, rather than only from an animal to a person. Human-to-human transmission can lead to a much more rapid spread of a disease.

3. What are the reasons to be hopeful?
First, it’s not yet clear whether those four recent cases stemmed from human-to-human transmission.

Second, H5N1 seems to have become less severe in human beings recently. The reasons aren’t clear. . . . As my colleague Apoorva Mandavilli says, 'Very few people known to be infected with bird flu in the United States have become seriously ill, and none have died.'

4. How can the U.S. reduce the risks?
More testing — of birds, cows and farmworkers — would help. “We know very, very little about how far this virus has spread and how many people and animals have been infected,” Mandavilli said. Testing could allow farms to isolate infected animals and people.

What about a vaccine?
A vaccine for bird flu exists, but the supply is modest. Jennifer Nuzzo, director of the Pandemic Center at Brown University, believes the government should help expand production and make the vaccine available to farmworkers who want to receive it.

The bottom line:
Caitlin Rivers, an epidemiologist at Johns Hopkins, recently published a book on preventing outbreaks called "Crisis Averted." In it, she argues that one of the most effective public health strategies is honesty: Experts should level with people, rather than telling selective truths intended to shape behavior in paternalistic ways (as happened during Covid).

Wild pigs are a seemingly unstoppable pestilence, but their threat could become exponentially more dangerous

Feral pigs eat crops and degrade water quality wherever
they invade. (Photo by Adam Dixon, Ambrook Research)

When feral pigs invade the countryside, they go hog wild eating farm crops, tearing up the ground, prolifically reproducing and spreading diseases to other animals and humans. As if that scourge wasn't enough, federal officials are preparing for the possible arrival of African Swine Fever in wild hogs and its possible spread to domestic pigs and maybe even humans. The concern is so viable that officials and stakeholders have completed simulations to prepare for ASF, reports Michael Crowe of Ambrook Research. "For two days, groups discussed the ins and outs of emerging pig diseases like African Swine Fever and the potential for feral hogs to help spread them."

Highly contagious and deadly for all pig breeds, ASF cannot spread to humans yet, but its travels across the globe make it a human health and pork industry concern. "Researchers have warned the animals can serve as a reservoir that can spill over into domesticated herds. This makes feral pigs not just a damage concern, but a food security issue," Crowe writes. "It’s one of the top threats to U.S. pork production, which exported $7.7 billion of product in 2022."

Should ASF be detected in the United States, the protocol is simple: shut all pig operations down. Crowe explains, "A single infected domestic or wild pig could lead the Department of Agriculture to pause all live pig and semen shipments for 72 hours to try and contain it, a massive stoppage considering we have a million hogs on U.S. roads every day. And being shut out of international trade, even temporarily, is a serious concern."

Kevin Morgan from the Office of Health Security, part of the Department of Homeland Security, told Crowe, "We need to get better at shared awareness across borders because these types of emerging pathogens — there’s no line on a map that they respect. . . . We need to be on the same page on surveillance and early warning." Crowe reports, "Beyond building connections, officials are also looking to help producers protect their herds at a local level."

Currently, the USDA’s Animal & Plant Health Inspection Service is "running active ASF surveillance across 12 states — the entire U.S./Mexico border and the Florida Gulf Coast," Crowe reports. But there is no way for officials or scientists to predict how people will react. 

Consumer response to eating beef during the mad cow disease crisis serves as an example. Pig farmer Paul Klingeman Jr. asked Crowe, "How many people are going to think they might get this if they eat pork?"

Worry over bird flu prevents some states from allowing dairy cow showings; for other states, the fair goes on with testing

Fair competitor Emerson Wemark, 10, reclines with a cow.
(Photo by KC McGinnis, STAT)

For many farming families, more than a year of planning and work can go into having their farm animals compete at summer fairs. Adults and children look forward to getting their animals all gussied up and judged with excitement on par with a major holiday. But this year's showings are a bit different, with vets and animal farmers sharing concern over bird-flu, or H5N1, spreading from lactating cattle, reports Eric Boodman of STAT. Some states or counties have canceled their lactating dairy shows, but other fairs, like many in Iowa, will include lactating cattle showings with required testing as bird flu remains a worry and an annoyance.

The Iowa State Fair takes place in August, and its dairy shows might include hundreds of lactating cows "from a long list of dairies scattered across six different states," Boodman explains. "Just as authorities fretted about Christmas Covid spikes, so vets are trying to prevent trailers from clanking back home with microscopic stowaways replicating in udder cells."

Vets and animal farmers want to prevent H5N1 spread while still holding a binding community event that people have worked all year to enjoy. "They’re hoping to avert inter-species spread. Cow-to-chicken could wipe out a whole poultry flock. Cow-to-pig could put the virus into an efficient mutation machine," Boodman reports. "Though the handful of human infections documented so far in farmworkers have been mild, cow-to-human is a real risk, too. The longer H5N1 circulates in cattle, the more it poses a pandemic risk for us."

Michigan took the step of prohibiting all lactating dairy cow showings, but states such as Iowa, Wisconsin and Minnesota have taken a testing route, which allows lactating dairy cows to show, if they’re tested for Influenza A within the seven days before they arrive.

Earlier this month the Winneshiek County Fair in Iowa was held and despite testing regulations and some bird-flu anxiety, many families chose to participate. John and Peggy Sparrgrove along with the grandchildren opted to attend. Boodman writes, "These were the events their grandkids had spent all year working toward, and to them, the current threat didn’t justify scrapping the whole idea."

When it came to bird-flu opinions, Winneshiek dairy attendees offered varying degrees of skepticism and agreement. "A dairyman might give a reflexive eye roll about some rules, but also describe them as necessary; you can resent something that makes a tough business tougher and also see why it’s in place," Boodman reports. "One used the word 'propaganda,' then corrected himself, saying the virus is real and must be taken seriously."

The USDA has worked to entice dairy farmers to allow bird flu testing; anonymous testing is the latest pitch

Dairy farming is expensive and labor intensive. Cows have to be
milked twice a day. (Wisconsin Dairy photo)

Department of Agriculture scientists want to sample U.S. dairy herds for bird flu infections, but many dairy farmers won't allow testing. As a workaround, the USDA is suggesting anonymized testing, reports Tina Reed of Axios. "Many farmers are refusing to test their herds, fearing the economic consequences, while concern builds that the relatively benign virus could morph into a much bigger risk to humans."

Ashish Jha, who is dean of Brown University's School of Public Health, is among a small group of public health officials who would like universities to work with dairy farmers to facilitate herd testing. Reed explains, "Results from individual farms would be anonymized and sent to the USDA to offer snapshots about disease spread and how the virus is mutating, Jha said. . . . The idea has limitations, starting with the difficulty of zeroing in and addressing transmission at the source, experts said."

To date, the USDA has documented 140 U.S. herds across 12 states that have been affected by bird flu, or H5N1. "But prevalence is thought to be higher because many farmers are refusing to test," Reed reports. "Positive tests could be 'financially ruinous' for farms and individual workers, while the consequences of not testing so far appear to be limited to mild illness that can be treated with antivirals, Jha said." Jha told Axios: "It's not really clear for [dairy farmers] why they should engage."

But testing herds isn't the only method to assess bird flu's prevalence in dairy cows. Reed writes, "Another way of getting a better picture of bird flu activity in an anonymized way would be through the use of what's known as market basket surveys, Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota told Axios. . . The surveys, which have been used in Europe and Canada during this outbreak, are routine scans of pasteurized milk samples for traces of inactivated virus."

Osterholm told Reed, "The movement of milk is very, very closely monitored. While a sample couldn't necessarily be traced back to a specific farm, it could get close. It could give us a sense if there are certain areas of activity."

Cases of bird flu in cattle and humans are on the rise; researchers disagree on vaccinations for farmworkers

Dairy cows or milk could infect humans
with bird flu. (Photo by A. Kipp, Unsplash)

As cases of bird flu increase in cattle, some experts believe the United States should follow Finland's example and offer vaccinations to workers who are likely to be exposed. "Veterinarians and researchers have taken note of Finland’s move to vaccinate farmworkers at risk of infection. They wonder why their government doesn’t do the same," report Amy Maxmen and Arthur Allen of KFF Health News.

Many farmworkers may handle infected birds or raw milk products, which could leave them vulnerable to catching the virus. Kay Russo, a livestock and poultry veterinarian in Fort Collins, Colorado, told KFF Health News, "Farmworkers, veterinarians, and producers are handling large volumes of milk that can contain high levels of bird flu virus. . . . If a vaccine seems to provide some immunity, I think it should be offered to them.”

Testing results from Colorado may support the move to vaccinate workers who could be in contact with cows, raw cow milk or chickens. Amy Maxmen of KFF Health News reports, "Five people who work at a poultry farm in northeastern Colorado have tested positive for the bird flu, the Colorado public health department reported July 14. (One of the cases awaits confirmation by the federal Centers for Disease Control and Prevention.) This brings the known number of U.S. cases to nine."

Extreme heat may have played a role in the virus' spread in Colorado because farmworkers' protective gear, such as goggles and masks, makes the work even hotter. "Jennifer Nuzzo, director of the Pandemic Center at Brown University, posted on X, 'You don’t send farm workers in to cull H5N1 infected birds without goggles and masks. Period,' Maxmen reports. "If it’s too hot to wear those protections, it’s too hot to cull. We need vaccines to be made available to farm workers. We have to stop gambling with peoples’ lives.'"

So far the CDC has remained reluctant to pursue bird flu vaccinations. "Some researchers side with the CDC recommending against vaccination for now," Maxmen and Allen write. "There’s no evidence that this year’s bird flu virus spreads between people or causes serious disease in humans. And it’s unclear how well the available vaccine would prevent either scenario. . . . In considering vaccines, the agency takes a cue from a 1976 outbreak of the swine flu."

So far, it has been difficult to gauge how many people have been infected with H5N1, but some researchers in Michigan are working on testing for it. "To understand whether cases are going undetected, researchers have sent the CDC blood samples from workers on dairy farms," Maxmen reports. 

Bird flu continues to infect cattle, but national testing for humans is stymied; only about 45 people have been tested

So far, H5N1 has not spread from human to human.

Despite studies showing Americans have little to zero immunity to H5N1, the strain of bird flu that has infected more than 100 herds of dairy cows and at least three farm employees, the Centers for Disease Control and the Food and Drug Administration are distributing bird flu tests at a snail's pace. "The U.S. has tested only about 45 people across the country," reports Amy Maxmen of KFF Health News. Without more testing, knowing how many dairy workers are infected is impossible. "A lack of testing means the country might not notice if the virus begins to spread between people — the gateway to another pandemic."

The CDC has around 1 million tests available, but the channels for getting the tests aren't the norm. Nirav Shah, principal deputy director of the CDC, "is concerned because the CDC and public health labs aren't generally where doctors order tests from. That job tends to be done by major clinical laboratories run by companies and universities, which lack authorization for bird flu testing," Maxmen explains. "Researchers cite testing failures as a key reason the U.S. fared so poorly with Covid."

Testing is critical to stemming a pandemic, but the U.S. needs to include clinical laboratories in the testing supply chain. Alex Greninger, assistant director of the University of Washington Medicine Clinical Virology Laboratory, told KFF News, "Clinical labs are part of the nation's public health system. . . . Pull us into the game. We're stuck on the bench."

Meanwhile, H5N1 will continue to evolve, and the virus could begin to spread from person to person vs. cow to person, which is yet another reason "to involve clinical laboratories. . . so the nation can ramp up testing," Maxmen writes. "The fastest way to get clinical labs involved, Greninger said, is to allow them to use a test the FDA has already authorized: the CDC's bird flu test. . . . The CDC opened up that possibility by offering royalty-free licenses for components of its bird flu tests to accredited labs."

While several commercial labs requested those licenses, getting FDA approval has hampered progress. "The CDC has given seven companies licenses for its tests — although none have been cleared to use them by the FDA," Maxmen reports. "Greninger said the delays and confusion are reminiscent of the early months of Covid, when federal agencies prioritized caution over speed. Test accuracy is important, he said, but excessive vetting can cause harm in a fast-moving outbreak like this one."

To learn more about the evolution and transfer of viral zoonotic diseases, click here. 

The U.S. and Europe are considering bird flu vaccinations for high-risk citizens; preparations are underway

Countries are considering bird flu vaccinations for
high-risk of exposure professions. (Adobe Stock photo)

As avian flu travels around the globe, infecting birds, wildlife, cows and people, some countries are considering vaccines for citizens in high-risk professions. Julie Steenhuysen and Jennifer Rigby of Reuters report, "The United States and Europe are taking steps to acquire or manufacture H5N1 bird flu vaccines that could be used to protect at-risk poultry and dairy workers, veterinarians and lab technicians . . .  moves influenza experts say could curb the threat of a pandemic."

The U.S. is "moving bulk vaccine from CSL Seqirus that closely matches the current virus into finished shots that could provide 4.8 million doses of vaccine," Steenhuysen and Rigby write. "European health officials told Reuters they were in talks to acquire CSL's pre-pandemic vaccine." Canada and the United Kingdom are also meeting with their vaccine suppliers to plan for pre-pandemic vaccines.

The newest strain of bird flu, also called H5N1, belonging to clade 2.3.4.4b, was detected in late 2020 and "caused unprecedented numbers of deaths among wild birds and domestic poultry and has begun infecting many mammal species," Reuters reports. "In March, U.S. officials reported the first outbreak of the virus in dairy cattle. . . .The Food and Drug Administration has estimated that 20% of the U.S. milk supply shows signs of the virus, indicating a wider spread is likely."

As more humans are exposed to H5N1, the chance that it may mutate and be able to spread more aggressively in human populations increases. Matthew Miller, co-director of the Canadian Pandemic Preparedness Hub at McMaster University, told Reuters, "All of our efforts need to be focused on preventing those events from happening. Once we have widespread human infections, we're in big trouble."

Reuters reports. "Dr. Richard Webby, a St. Jude Children's Research Hospital virologist who studies flu in animals and birds for the World Health Organization, said the situation in dairy cattle merits vaccine use." He told Reuters, "If we look at the exposure levels that some of these farmers are getting, it's high."

More Americans are opting out of Covid-19 vaccinations; survey shows the choice can be based on political views

Pew Research Center graph

It has been four years since the U.S. rolled out lockdowns and mask mandates to slow the spread of Covid-19. Many Americans, both Republican and Democrat, received the country's first Covid-19 vaccine in fairly equal numbers. However, after that initial jump-off point, Covid-19 vaccines have become more partisan, and many Americans seem less concerned about the virus despite its continuing presence in the population.

"A new Pew Research Center survey finds that just 20% of Americans view the coronavirus as a major threat to the health of the U.S. population today, and only 10% are very concerned that they will get it and require hospitalization," report Alec Tyson and Giancarlo Pasquini for the Pew Research Center. "This data represents a low ebb of public concern about the virus that reached its height in the summer and fall of 2020, when as many as two-thirds of Americans viewed Covid-19 as a major threat to public health."

While it's hard to explain why so many U.S. citizens seem indifferent to the disease, vaccination numbers speak to an overall lack of public interest. "Just 28% of U.S. adults say they have received the updated Covid-19 vaccine, which the Centers for Disease Control and Prevention recommended last fall to protect against serious illness," Pew reports. "This stands in stark contrast to the spring and summer of 2021, when long lines and limited availability characterized the initial rollout of the first Covid-19 vaccines. A majority of U.S. adults (69%) had been fully vaccinated by August 2021."

Historically, political affiliation hasn't been a factor in vaccination status. A Pew survey from 2023 reported: "Robust public confidence in the value of childhood vaccines for MMR, with no decline in the large majority who say the benefits outweigh the risks compared with surveys conducted before the coronavirus outbreak." The Covid-19 vaccination does not have that kind of unilateral support, but instead vaccine choices fall along party lines. Tyson and Pasquini write, "Democrats and Democratic-leaning independents remain more likely than Republicans and GOP leaners to say they've received an updated Covid-19 vaccine (42% vs. 15%). This 27-point gap in recent vaccination is about the same as in January 2022."

The gap is even more distinctly party-affiliated among Americans 65 and older, who are ironically more at risk of dying from the disease. Pew reports, "In the current survey, 66% of Democrats ages 65 and older say they have received the updated Covid-19 vaccine, compared with 24% of Republicans ages 65 and older. This 42-point partisan gap is much wider now than at other points since the start of the outbreak."

Tyson and Pasquini add, "Still, the virus continues to circulate widely in the United States, with wastewater data suggesting that cases in the early part of 2024 were among the highest they have been since the first omicron wave in 2022."

Covid-19 vaccination rates are 'abysmal' overall in the United States, and even lower in rural areas

In January 2021, four in 10 U.S. adults (41%) polled said that when a Food and Drug Administration-approved vaccine for Covid-19 was available for free, they would get it as soon as possible.

Fast forward to fall 2023, and times have changed. As Katelyn Jetelina writes in her newsletter, Your Local Epidemiologist: "Data is starting to roll in on Covid-19 vaccine inequities this fall. And it's not pretty. . . . Access. Cost. Outreach. Education. All of these changed once the federal emergency ended in May. Vaccines are no longer purchased or distributed by the government, and funding ran out to support vaccine campaigns. This means the U.S., once again, faces the pre-pandemic privatized and fragmented healthcare and public health systems. And one could argue an even worse system, given the loss of trust. Unfortunately, our communities continue to feel it disproportionately."

Even in 2021, Americans did not universally accept Covid-19 vaccines, with some Americans adopting a "wait and see" approach and "rural residents among the most resistant to getting vaccinated," KFF Health News reported. According to Jetelina, rural Covid-19 vaccination rates have not improved. She cites a Centers for Disease Control and Prevention analysis from last week that "found adults in rural areas were less likely to have gotten a Covid-19 vaccine (10%) vs. those in urban (15%) or suburban (14%) areas."

YLY graph, from CDC data

When compared to other countries, U.S. Covid-19 vaccination rates are strikingly poor. Jetelina writes, "U.S. rates of Covid-19 vaccination this fall are, overall, abysmal. This is especially apparent when we compare it to counterparts like the United Kingdom, where 68% of people over 65 years old are vaccinated (compared to 31% in the U.S.).

Jetelina adds that disparities also fall along race and ethnicity lines, "Communities of color continue to have much lower rates of vaccination." Jetelina states that gaps matter and impact national health for two primary reasons.

1. Those who are more likely to lack access to healthcare are even more likely to be infected and get seriously ill once again.
2. The commercialization of vaccines has only amplified gaps in access and uptake. This is cause for concern about our national vaccine system during non-emergency times.

What's the bottom line? "When the nation's health is at stake, we need public health to ensure our resources are fairly distributed and get to those who need it most," Jetelina writes. "The 'marketplace' doesn't do this naturally. In fact, it works against many of our communities. These inequities will continue unless we make big, systemic changes. One would hope that a pandemic would jumpstart these changes, but it seems we are quickly falling back to our pre-pandemic ways."

When Americans no longer trust each other, the problem can be deadly. It hits rural areas the hardest, study shows

An unhealthy mistrust has spread across the U.S.
(ProMarket photo, University of Chicago)

Not being able to trust our neighbors or our country's leaders not only feels rotten, it can lead to physical illnesses. "People died in the pandemic because they didn't trust the government or their neighbors to do the right thing," reports Frank Morris of KCUR in Kansas City. "And it's not getting better. Today, distrust is making people sicker, especially where health care is fragile across giant swaths of rural America. . . . Tom Bollyky, director of the global health program at the Council on Foreign Relations, said while the worst of the pandemic has passed (for now), the United States' deadly epidemic of mistrust is raging unchecked."

Bollyky was the lead author of a large study published in The Lancet this year, "taking a fine-grain look at Covid death and infection rates across the United States and the many factors that contributed to the differences," Morris writes. Bollyky told him: "This pandemic has been less about the microbe spreading around and more about the people to which it's spreading. It's about us, and how we feel about each other, and how we hang together as a community."

Morris reports, "Covid death rates varied wildly between states. The government tracked these rates as deaths per million people. New Hampshire lost 218 residents per million to Covid during the research period. New Hampshire has the highest rate of interpersonal trust in the U.S., as measured by long-running surveys testing trust between individuals. . . . Covid-19 was almost twice as deadly in Missouri as it was in New Hampshire. Almost a dozen other states fared even worse, partly due to distrust."

The pandemic years didn't just erode interpersonal trust, it decreased Americans' faith in vaccines overall. Brock Slabach, chief operations officer at the National Rural Health Association, told Morris, "And then, to add insult to injury, we have lower rates, for example, of childhood immunization that directly comes out of the pandemic and mistrust in vaccines generally. And so we're going to see childhood diseases that we thought we'd eradicated returning."

During and continuing after the pandemic, patient-doctor trust plummeted, and that distrust could make the next pandemic worse. Slabach told Morris: "Through the pandemic, we've added this issue of mistrust in the very professionals that for centuries we've valued as an important source of information for health and healthcare. . . . If we have another health crisis, this will come right back because we've not addressed some of the underlying issues. And so we're still going to be facing higher rates of disease, higher spread of death because of this misinformation and the lack of trust that we have in those areas of our system that know what to do in response."

Reflecting on the pandemic as Covid-19 comes back, Iowa editor writes: 'This is a lot for any nation to absorb'

Art Cullen

As U.S. pharmacies roll out updated Covid-19 booster vaccines, it might be a good time to look at how much the pandemic still alters daily life around the planet. The trauma and changes brought on by Covid-19 still cast a long shadow, Iowa editor Art Cullen writes for his Storm Lake Times Pilot.

"It's impossible to forget: I was on the phone one dank morning in the spring of 2020 with brother John, who lives just a block east. We were isolating at home, trying to figure out what to do with the newspaper. Should we just shut it down? . . . We decided we couldn't quit. . . . . We're okay now, but the thought of it still traumatizes me. . . . People were dying every week. Some businesses never came back.

"We're still living it. The latest iteration of Covid spreads as classes resume. The psychological trauma persists. Friendships eroded through isolation and political extremity. Eating habits changed from dine-in to carry-out. Church attendance dropped even farther. . . . Shocks to the food system continue to ripple. . . The pork and poultry industries are beset by trouble as supply chains work out the huge whipsaws of the past four years. Food prices have moderated but continue to fire inflation sparked by the pandemic shutdown.

Cullen writes that changes go well beyond the United States. "The pandemic rewired world trade. China is reeling. Brazil has become the most-favored soybean trader with Asia. . . . These are huge changes that have not been fully digested. . . . 

"This is a lot for any nation to absorb. We are still working through it. . . . Early polling that confirms a general angst over everything — call it the blues or clinical depression. . . . The pandemic casts a shadow over our personal lives, our communities and politics. Supply shocks, inflation, rewriting world trade, and unkinking food supply chain links all are moving parts in this complex machinery. . . . American resilience is amazing. Democracy and justice have prevailed so far," Cullen writes.

"Still, we are not post-pandemic. It colors everything. Gov. [Kim] Reynolds last week rejected the idea of any more lockdowns. 'My answer—not on my watch,' she said. Not that anybody in Iowa was actually suggesting another shutdown. It just shows how the trauma of it still animates us."

Southern rural counties gained 200,500 people in 2021, IRS data shows, but that's not the whole picture

Chart by Sarah Melotte, The Daily Yonder, from IRS data

In 2021, the pandemic changed more than life expectancy in the U.S., it also altered where people chose to live, with more than 325,000 Americans moving from metropolitan areas to rural counties, reports Sarah Melotte of The Daily Yonder.

The South, which is the major region with the most rural population, “also had more in-migration to rural counties than other regions on a per capita basis,” Melotte reports. “Out of all the people who moved from larger cities to rural areas in 2021, two-thirds wound up living in the rural South, a Daily Yonder analysis of IRS data shows.” Southern rural counties gained 65% of the number of people who moved from metropolitan to nonmetropolitan counties in 2021. The Midwest came in second place at 25% for regions with rural in-migrant gains.

“Our analysis revealed that most urban expats in 2021 came from neighboring metros in the same state,” Melotte explains. “The pie chart shows that an overwhelming majority (98%) of people who contributed to rural growth in the Southern U.S. came from cities and suburbs within the South.” People from Mid-Atlantic counties represented a tiny fraction of movers at 1%, and less than a percent came from the Southwest.

Chart by Sarah Melotte, The Daily Yonder, from IRS data

Despite 200,500 people moving into Southern rural counties, the gains determined by IRS data don’t include the number of deaths and births. Melotte reports, “For example, 379 people moved to rural Rabun County, Georgia, in 2021, but the county’s total population change that year only added up to 174 people, according to Census estimates. That’s because some residents moved out, and others died that year." When out-migration and deaths were considered, the net gain in rural population in the South was about 20,500 residents, representing a 0.12% increase from the previous year.

Chronic absenteeism in schools in 2021-22 was nearly twice as high in 2018-19, the last year before the pandemic

Chronic absenteeism in U.S. schools in the 2021-22 academic year was 91 percent higher than it was in 2018-19, the last year that was not affected by the Covid-19 pandemic, according to a national study done at Stanford University with the help of The Associated Press.

"The large and broad increases in chronic absenteeism suggest many students are failing to re-engage in schooling as in-person instruction returned," writes Thomas Dee, the Stanford education professor who conducted the study.

"The data from 40 states and Washington, D.C., provides the most comprehensive accounting of absenteeism nationwide," AP reports. However, Dee's statistical analyses of the data were unable to find a pattern that explained the wide differences among the states. He found little if any correlation between chronic-absenteeism growth and a state's infection rate, its classroom masking policies, enrollment losses or differences in how "chronic absemteeism" is defined.

The Economist has some notions: "Having experienced remote learning, some students—and perhaps their parents—no longer think it essential or even worthwhile to sit in a classroom. 'It’s the same thing as in the workplace,' says a teacher in New Orleans. 'Once you’ve gone down to only being there two or three days a week, coming back all five is hard.' His classrooms are especially empty on Fridays, he says, so he avoids scheduling the most important lessons then. After the pandemic, people 'started catering to their mental-health needs,' says Tieshia Robinson, a principal at Chicago Collegiate, a public charter school in the city. For parents, that might mean allowing children who are unhappy at school to skip days. Pupils have also grown used to staying at home at the slightest sign of physical illness, says Greg Frostad of New Mexico’s education department."

The highest 2021-22 chronic-absentee rates, 49% and 48%, were found in Alaska and the District of Columbia, which also had the highest rates in 2018-19, 30% and 29%, respectively. The third-highest rate, 40%, was in New Mexico; that was more than double its 2018-19 rate of 18%. Arizona's rate also more than doubled, from 13% to 34%, the eighth highest in 2021-22. Most of those places have high shares of miniority populations. "The pandemic growth in chronic absenteeism exacerbated pre-existing inequalities," Dee writes, noting that the increases were larger "among economically disadvantaged students as well as Black students and Hispanic students."

Other states where the rate doubled or more than doubled: Washington, 15% to 33%; California, 12% to 30%; Mississippi and Massachusetts, 13% to 28%; Texas, 11% to 26%; Iowa, 13% to 26%; and Connecticut, 10% to 24%. Dee reports that figures for 2022-23 from Massachusetts and Connecticut show continued high absenteeism, and The Economist reports a like pattern in England and Australia.

Graph adapted by The Rural Blog from "Higher Chronic Absenteeism Threatens Academic Recovery from the Covid-19 Pandemic," research paper published by OSF Preprints, Center for Open Science. 

Fact-checking the first presidential debate of the 2024 race

The first debate of the 2024 presidential race, among eight Republicans, featured some claims that were false or "misleading at best," CNN reports.

Florida Gov. Ron DeSantis said the federal government locked down the economy during the pandemic while Florida "kept our state free and open," when in fact he "imposed significant restrictions" at the start of the pandemic, CNN's Daniel Dale said on the cable channel's post-debate report. The restrictions were imposed by states, not by the then-President Trump.

Former Vice President Mike Pence said the Trump-Pence administration spent money "to backfill on the military cuts of the Obama administration," but that's misleading, CNN’s Haley Britzky writes: "While military spending decreased under the Obama administration, it was largely due to the 2011 Budget Control Act, which received Republican support and resulted in automatic spending cuts to the defense budget." Pence, an Indiana congressman at the time, voted for the law.

Former South Carolina Gov. Nikki Haley said Trump, who did not participate in the debate, added $8 trillion to the national debt. The figure is accurate, but "The increase in the debt during any president’s tenure is not the fault of that president alone," CNN notes. "A significant amount of spending under any president is the result of decisions made by their predecessors – such as the creation of Social Security, Medicare and Medicaid decades ago – and by circumstances out of a president’s control, notably including the global Covid-19 pandemic under Trump."

U.S. Sen. Tim Scott of South Carolina said the Biden administration is calling “parents that show up at school board meetings . . .  domestic terrorists.” That is false, CNN’s Hannah Rabinowitz writes: "The claim stems from a 2021 letter from the National School Boards Association asking the Justice Department to 'deal with' the uptick in threats against education officials and saying that 'acts of malice, violence, and threats against public school officials' could be classified as 'the equivalent to a form of domestic terrorism and hate crimes'." Attorney General Merrick Garland issued a memo encouraging federal and local authorities to work together against such harassment campaigns "but never endorsed the 'domestic terrorism' notion," Rabinowitz writes.

Trump, who counter-programmed the debate with an online interview, "did not receive any pushback from pundit Tucker Carlson after promoting false statements about the 2020 election," reports Dominic Mastrangelo of The Hill.

Quick hits: Family pickle canning; rural trilogy-inspired songs; pandemic gun buyers; hearing aids; Dutch farming

Hannah Klitz visits her herd. (Photo by Chris Simpson, Successful Farming)

Where's the beef? Some of it's with Hannah Klitz. "She started her direct-to-consumer beef business as a college sophomore. Now, she sells premium products across the United States," reports Courtney Leeper-Girgis for Successful Farming. "Klitz started Oak Barn Beef, offering Nebraska-raised, dry-aged beef from cattle DNA-tested for premium carcass traits, such as marbling, tenderness, and ribeye size."

August is a month for canning, catching up with and enjoying family, writes Lovina Eicher for AgWeek. "Yesterday, I helped sister Verena (and daughter) with the pickles. We canned 40 quarts of sweet dills and made 20 quarts into freezer pickles. They are still in the refrigerator, and then tomorrow, they will be ready to pack into containers for the freezer. A very easy way to put up pickles if you have freezer space. They taste very crisp."

The "power of the ring" has captured many a musician.
(Photo by Davidsonluna, Unsplash)

Celebrating J.R.R. Tolkien's very rural trilogy, The Lord of the Rings can bring many precious things to bear, including a litany of musical delights that only magical travels through wide open spaces can create. Ellen Gutoskey of Mental Floss gives us clippings of these adventurous tunes.

The pandemic was full of "firsts" for remote work, touchless delivery and for some people, gun ownership. In 2020, "Some 22 million guns were sold that year, 64 percent more than in 2019. More than eight million of them went to novices who had never owned a firearm, according to the firearm industry's trade association, the National Shooting Sports Foundation," reports Roni Caryn Rabin of The New York Times. "Self-defense is the top reason Americans purchase handguns." Rabin reviews studies with more definition on who bought firearms and why.

Would you like a four-day workweek? If you said "yes," you're not alone. "More than half of American employers offer a four-day workweek, or plan to, according to a survey released Tuesday," reports Daniel de Visé of The Hill. "A poll of 976 business leaders by ResumeBuilder.com, the job-seekers website, found that 20 percent of employers already have a four-day workweek. Another 41 percent said they plan to implement a four-day week, at least on a trial basis."

Hearing aids help people listen to nature's sounds again--
like barking tree frogs. (Photo by Gary Tresize, Unsplash)

Being able to hear the world around you is a gift. "Birdsongs. Chorus frogs. Children's voices. . . . . Sheets flapping on the clothesline. . . .The rustle of corn stalks. The low rumble of thunder in the distance," writes Donna Kallner of The Daily Yonder. But as we age, hearing becomes more challenging. "I chose a Medicare Advantage plan that includes hearing aid coverage. We're hoping for a bulk discount since my husband's hearing is also now more impaired than selective."

Checking out what's going on "across the pond" isn't limited to getting British insights; it's good to see what other European countries are up to, such as the Netherlands' commitment to sustainable farming. "Almost two decades ago, the Dutch made a national commitment to sustainable agriculture under the rallying cry 'Twice as much food using half as many resources," reports Frank Viviano of National Geographic. "Since 2000, farmers have reduced dependence on water for key crops by as much as 90 percent. They’ve almost completely eliminated the use of chemical pesticides on plants in greenhouses."

Excess deaths, those above the expected numbers, grew in pandemic Year 2 despite vaccines; rural vax rate blamed

Scientists generally believe that the number of deaths attributed to the Covid-19 pandemic has been understated, and they point to what they call "excess deaths," the number of deaths above the number that would have been expected if the pandemic hadn't occurred, based on recent trends. A new study shows that excess deaths in the U.S. increased in the second year of the pandemic even though that is when Covid-19 vaccines became widely available, and that they went up largely because of increases in rural counties, where fewer people were vaccinated.

"In rural counties across the United States—where vaccines were harder to obtain, where vaccine skepticism remained higher, and where access to good health care is often more challenging—excess deaths in year two of the pandemic actually increased, despite the presence of vaccines," Boston University says of the study, done mainly by BU faculty and published in Science Advances. "The study provides the first look at monthly estimates of what the researchers call “excess deaths” for every U.S. county in the pandemic’s first two years."

Andrew Stokes, an assistant professor of global health at BU and corresponding author of the study, pointed to a shortage of rural vaccinations as the main cause. The study reports, "In urban areas, 75% of people aged 5 years and older were vaccinated as of January 2022 compared to only 59% of people aged 5 years and older in rural areas. This urban-rural difference in vaccination rates more than doubled since April 2021." Stokes told the BU public-relations staff, "Inequalities in mortality outcomes in the second year of the pandemic were fundamentally shaped by patterns of vaccine uptake at the community level. . . . There was less vaccination happening in rural areas and that gap between urban and rural areas grew as the second year progressed." The difference rural and urban death rates largely disappeared early this year, The Daily Yonder reported in February.

There were other factors, the study says: "The emergence of partisanship and misinformation further disadvantaged small metropolitan and rural areas during the second year of the pandemic. This partisanship even went as far as deteriorating the quality of surveillance data by affecting the certification of Covid-19 deaths, which were systematically undercounted in rural communities."

The study found that nonmetropolitan counties in the South "had the highest cumulative relative excess mortality by July 2021," with just over 25% estimated excess deaths by February 2022. Large metro areas in the West ranked second, followed by small and medium Southern metros, then large Southern metros. 

The study says county-by-county data are important "because counties are the administrative unit for death investigation, excess mortality estimates have the potential to help identify counties where Covid-19 death rates differ from excess mortality rates and who might benefit from additional training and other resources around cause-of-death certification. These estimates may also be valuable for informing local public health workers, community organizations, and residents of the true impact of the pandemic, thus potentially increasing vaccination and uptake of other protective measures."

Here are county-by-county maps from the study, in chronological order; clicking on each map will produce a slightly larger version. The high-resolution originals can be downloaded here. The study says these are estimates, and are uncertain in small counties.

In a first, rural people in a national survey say mental health and addiction treatment are the top needs in rural health

Researchers asked rural stakeholders to name their most important public-health
priorities through 2030.  (Rural Healthy People 2030 chart; for a larger version click on it)

For the past 20 years, primary-care access was listed by health-care stakeholders as the top concern for rural people, but a recent survey shows that for the first time in two decades, the focus has changed mental health and addiction treatment, reports Liz Carey of The Daily Yonder. "Rural Healthy People 2030, released by the Southwest Rural Health Resource Center, surveyed a national sample of people. . . . Participants included people working in health care, public administration, education, human services, and other fields. . . . While access to health care remained one of the top five issues according to survey respondents, researchers said, the growing impact of mental health and addiction took the number one and two spots on the list regardless of age, race, region or occupation."

Survey researcher Timothy Callaghan told Carey, "For the past two decades, health-care access has been, far and away, the most important topic no matter how we cut the data. The fact that mental health and addiction came out ahead of health-care access this time certainly surprised us, but when you start thinking about the context of the past decade and the context of the pandemic in which you launched the survey, the findings are a bit less surprising."

The pandemic's impact highlighted mental health needs. Carey writes, "A survey done by the Kaiser Family Foundation and CNN found that 90% of the American public felt the country was facing a mental health crisis. Adults across the country during the pandemic reported increased symptoms of anxiety, depression, hopelessness and sadness and suicidal ideation, as well as increased drug and alcohol use." The crisis hit rural areas more dramatically due to a lack of services before 2020, Carey reports: "Behavioral health providers were scarce in rural areas even before the coronavirus pandemic hit. . . . The need for their services is rising while access to providers is declining . . . . For people with substance-abuse problems in rural areas already under-served by mental health and behavioral health professionals, as clinics close, practitioners move to telehealth, and funding for services runs out, experts say."

Callaghan told Carey that the study shows where rural-health stakeholders want rural health systems to focus their efforts: "We now have a better sense of the areas that are particularly in need of rural health investment. We now know that addressing addiction and addressing mental health issues have become increasingly important to rural experts over the past decade, and while health-care access remains important. . . . We nonetheless have to start prioritizing the issues that are most important, which are addiction and mental health."

The pandemic turned many employees into remote workers; some are moving to less costly states and rural areas

Harvard Joint Center for Housing Studies map, adapted by The Rural Blog

Joint Center for Housing Studies table, from Census Bureau data; click on it to enlarge

One of the most significant changes wrought by the pandemic was expansion of remote work, which allowed many people to move to states with lower costs of living. "The U.S. housing map is being redrawn as work-from-home makes renters and home buyers more mobile and more likely to choose a place to live based on factors such as weather and tax rates," reports Meg Cunningham for Investopedia. They are "increasingly relocating to less-expensive areas, according to a report from the Joint Center for Housing Studies at Harvard University, leading to increased demand for housing in lower-cost areas."

Expensive, often coastal, urban areas have seen the largest declines as remote workers prioritized moving places with cheaper overall living costs. "While the trend was especially popular [to move to] the suburbs across the country, rural areas also had an increase in demand. At 57%, more than half of all rural counties recorded more people moving in than out last year, according to the Harvard report," Cunningham writes. "The South had the largest net inflows of any U.S. region last year, with the biggest gains in Texas, Florida, and North Carolina. . . . Montana and Wyoming also experienced a similar influx, according to the Harvard report. . . . The Sun Belt has remained popular for those looking to leave big city life, with states such as Florida, Arizona, and Texas seeing massive influxes."

Domestic migration has become "the largest source of population growth in 20 states and the largest source of population decline in 23 states," Cunningham reports. "Because of their tendency to prioritize remote work and more flexibility, younger Americans are leading the way when it comes to domestic migration trends across the country. . . . . And migration shows no signs of slowing down. . . . . A record 25.2% of Redfin users nationwide are looking to relocate, up from 22.8% last year, according to a report from earlier this year. Many buyers are looking to leave their hometowns or move to more affordable areas. . . . Five of the top 10 destinations are in Florida, and nearly all of them are in the Sun Belt. Florida was the fastest-growing state in 2022, with warm weather, affordability, and low taxes enticing those from out-of-state."