Survival of the fittest?
One of the advantages rural life offers that can coax urban folks to give up almost half of their pay and sacrifice other advantages of city life is the notion of rural neighborliness. We rural folks like to portray ourselves as helpful communitarians, folks who know, talk with, and help our neighbors more often than those darned brusque, aloof city folk. That distinction of rural connection from urban isolation does not leap clearly from research… and I will confess my personal faith in my rural neighbors to look out for my well-being and the well-being of others has been shaken hard by South Dakota’s shrugging-to-reckless response to the coronavirus pandemic.
South Dakota’s lazy and wrongly politicized approach to vaccines, masks, and other pandemic-prevention measures typifies rural attitudes nationwide. Those rural attitudes are producing a predictable result—higher death rates from coronavirus:
While the initial surge of covid-19 deaths skipped over much of rural America, where roughly 15% of Americans live, nonmetropolitan mortality rates quickly started to outpace those of metropolitan areas as the virus spread nationwide before vaccinations became available, according to data from the Rural Policy Research Institute.
Since the pandemic began, about 1 in 434 rural Americans have died of covid, compared with roughly 1 in 513 urban Americans, the institute’s data shows. And though vaccines have reduced overall covid death rates since the winter peak, rural mortality rates are now more than double urban rates — and accelerating quickly [Lauren Weber, “Covid Is Killing Rural Americans at Twice the Rate of Urbanites,” Kaiser Health News, 2021.09.30].
I care about you, neighbors. I don’t want you to die. Last spring, I was willing to give up a half hour of my time and get two shots to help reduce your chances of dying. But too many of you are refusing to make the same, simple, safe sacrifice, thus leaving my family’s chances and other rural family’s chances of getting sick and dying significantly higher than it has to be. And now we rural folks are seeing more of the people we care about die from coronavirus than we would if we lived in the big cities.
The problem isn’t just coronavirus. Among the things we sacrifice to live in nice, quiet rural America is easy access to health care:
Access to medical care has long bedeviled swaths of rural America — since 2005, 181 rural hospitals have closed. A 2020 KHN analysis found that more than half of U.S. counties, many of them largely rural, don’t have a hospital with intensive care unit beds.
Pre-pandemic, rural Americans had 20% higher overall death rates than those who live in urban areas, due to their lower rates of insurance, higher rates of poverty and more limited access to health care, according to 2019 data from the Centers for Disease Control and Prevention’s National Center for Health Statistics [Weber, 2021.09.30].
When lots of our rural neighbors refuse to get vaccinated and then predictably get covid and fill up hospital beds, they increase the chance that rural neighbors who suffer heart attacks or other serious illnesses won’t get the care they need to survive:
Additionally, the overload of covid patients in hospitals has undermined a basic tenet of rural health care infrastructure: the capability to transfer patients out of rural hospitals to higher levels of specialty care at regional or urban health centers.
“We literally have email Listservs of rural chief nursing officers or rural CEOs sending up an SOS to the group, saying, ‘We’ve called 60 or 70 hospitals and can’t get this heart attack or stroke patient or surgical patient out and they’re going to get septic and die if it goes on much longer,’” said John Henderson, president and CEO of the Texas Organization of Rural & Community Hospitals [Weber, 2021.09.30].
Things spiral downward from there: hospitals serving rural areas get overloaded with vaccine-preventable covid cases, health care staff get burned out and retire or leave for better pay and better working conditions in the city, the endemic shortage of health care workers in rural America gets worse, more rural hospitals close… and living in rural America requires more and more sacrifices, some of them mortal sacrifices.
Live fast, die sooner in South Dakota? I don’t think that slogan will help South Dakota or any other rural community recruit healthy workers and families who can sustain a thriving economy and culture.
We rural Americans aren’t living up to our professed values as well as our city cousins. And when we refuse to get our shots, we shoot ourselves in the foot.