Three of every four rural counties in the U.S. are in what the White House Coronavirus Task Force defines as a “red zone.”

The virus is spreading out of control in rural America, and it’s getting worse by the day https://trib.al/VyeEHLO 

The 10 counties with the highest number of cases per resident are all nonmetropolitan areas with fewer than 50,000 people.

To some extent, resistance to wearing masks and social-distancing has played a role in these outbreaks http://trib.al/VyeEHLO 

But the explosion of Covid in rural communities isn’t a simple morality tale.

In most of these areas, the virus has intensified vulnerabilities decades in the making, and worsened chronic problems that can’t be solved with public-awareness campaigns http://trib.al/VyeEHLO 

In Minnesota, the 21 most unhealthy counties are all rural. In Itasca County, the following activities exceed both state and national averages:

Smoking
Obesity
Physical inactivity
Excessive drinking
Alcohol-impaired driving deaths
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Similar patterns have emerged from coast to coast.

Mortality rates for the five leading causes of death — heart disease, cancer, stroke, unintentional injury and chronic lower respiratory disease — are all higher in rural areas http://trib.al/VyeEHLO 

Common indicators of mental illness, including suicide rates and drug overdoses, are also higher in rural areas.

There’s no one cause behind these bleak statistics, but several factors are clearly contributing http://trib.al/VyeEHLO 

People in rural America tend to be older and poorer than average, making it less likely that they’ll have access to decent health care in the first place. Poverty contributes to:

Social isolation
Drug abuse
Mental illness
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These problems are only compounded by the glaring inequities of the U.S. health-care system.

Rural hospitals have struggled for years to stay afloat: Since 2005, 175 rural hospitals have closed, with 19 shutting down last year alone http://trib.al/VyeEHLO 

Hospital closures can be devastating for isolated communities:

They’ve been shown to significantly increase mortality for people who have conditions that require immediate help, and they contribute to an acute shortage of intensive-care unit beds http://trib.al/VyeEHLO 

Even when a bed is available, a doctor may not be: Rural areas on average have only about 40 physicians for every 100,000 people, compared to about 53 in cities.

In short, rural America is a very bad place for a pandemic to spread http://trib.al/VyeEHLO 

Some lessons have been learned during the crisis that could mitigate what’s likely to be a bleak winter of infection ahead. Rural areas need:

Hospital upgrades
Larger supply of staffers
Expanded capacity for telemedicine
Rural broadband
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In the meantime, rural Americans will need to mask up and socially distance.

Until vaccines are widely available, it may be the best these struggling areas can hope for http://trib.al/VyeEHLO