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(1/ ) I lived in a city now, but I grew up in small towns, and want to talk for a minute about how declarations that #COVID19 won& #39;t affect areas with less population density really doesn& #39;t make sense if you understand the dynamics of small-town life. A 
https://abs.twimg.com/emoji/v2/... draggable="false" alt="🧵" title="Thread" aria-label="Emoji: Thread"> #medtwitter #SoMeDocs
(2/ ) The rural US may have less public transportation and more private residences. But their economies are more dependent on industries like manufacturing and mining, where people work in close quarters and can& #39;t work remotely, than metropolitan areas. https://www.ers.usda.gov/webdocs/publications/85191/err-238.pdf?v=0">https://www.ers.usda.gov/webdocs/p...
(3/ ) We& #39;ve already seen patterns of #COVID19 outbreaks in meatpacking and food processing plants in the rural US. Those are essential industries that have remained open in every state through shelter in place.
https://thefern.org/2020/04/mapping-covid-19-in-meat-and-food-processing-plants/">https://thefern.org/2020/04/m...
https://thefern.org/2020/04/mapping-covid-19-in-meat-and-food-processing-plants/">https://thefern.org/2020/04/m...
(4/ ) But COVID outbreaks have already occurred in other industries like power plants, or this ND wind turbine factory. Any industry where people are working in close proximity to each other could provide an opportunity for COVID to spread. https://billingsgazette.com/news/state-and-regional/officials-covid-19-outbreak-at-north-dakota-wind-turbine-plant-may-overwhelm-system/article_29851a39-7df7-571d-9133-fdfb6c8a486f.html">https://billingsgazette.com/news/stat...
(5/ ) Small town community life is often heavily centered around churches. But even the simple act of singing together can be risky in the era of COVID- look at the Skagit choir outbreak, with 87% of the group sickened after exposure to one person w COVID https://www.cdc.gov/mmwr/volumes/69/wr/mm6919e6.htm">https://www.cdc.gov/mmwr/volu...
(6/ ) This story is an example of how COVID can spread through in the rural US: from a church revival to a power plant, and into the community at large. No high-rise buildings or subways required. https://www.courier-journal.com/story/news/local/2020/04/02/coronavirus-kentucky-hopkins-county-church-revival-led-outbreak/5111379002/">https://www.courier-journal.com/story/new...
(7/ ) And even more than urban centers, rural health systems do not have the capacity for large increases in critically ill people. I was born in a town where the nearest hospital was an hour away. Many US counties have no ICU beds, or no hospitals at all. https://khn.org/news/as-coronavirus-spreads-widely-millions-of-older-americans-live-in-counties-with-no-icu-beds/">https://khn.org/news/as-c...
(8/ ) Albany, GA was an early rural COVID hotspot, and their hospitals were quickly overwhelmed. "All 14 intensive-care beds in the city were full within two days... the hospital went through six months& #39; worth of supplies in less than a week." https://www.businessinsider.com/coronavirus-hotspot-albany-georgia-funderals-covid-19-cases-per-capita-2020-4">https://www.businessinsider.com/coronavir...
(9/ ) And rural communities have a greater proportion of older people, who are at greater risk of death or severe COVID19 disease. https://www.census.gov/library/stories/2019/10/older-population-in-rural-america.html">https://www.census.gov/library/s...
(10/ ) And though small towns can& #39;t have the sheer number of losses of large cities, even a few deaths can change the landscape of a community. Where I grew up, one family owned a movie theater. When they left, there were no movies. When the dance teacher left, there was no dance
(11/ ) Denying that COVID could spread to a given state or community is unhelpful and dangerous. Any politician claiming to care about small-town America should also be very concerned about how #COVID will impact the rural US. #medtwitter #SoMeDocs
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