What do New York City, an Idaho ski resort, the homes of two large Ohio prisons, and a northeastern Nebraska meat packing center have in common?
All of them rank among the American communities most affected by the new coronavirus.
World-Herald analysis of data for the country’s counties shows that the highest rates of COVID-19 infection per capita range from densely populated northeast to deep south and to dispersed food production centers from the Great Plains to the Rockies . .
These include the trendy high-income suburbs of Long Island and the land-poor counties of rural Georgia.
Two Nebraska counties are now among the top 25 counties in the country for confirmed cases per capita. This includes Dakota County, which recently skyrocketed to # 4. And Hall County of Nebraska, which is just outside the top 25 of the spread of the virus, is now in the top 100 counties in the country for the coronavirus mortality rate.
In short, no matter where the bug was allowed to germinate, it shows that it can spread dangerously like wildfire on the Prairies.
“This virus is spread from person to person, so it will infiltrate a community wherever people congregate,” said Dr. Angela Hewlett, an infectious disease expert at the University of Nebraska Medical Center. “We see it everywhere. No community is immune. “
As the coronavirus pandemic in recent weeks has spread rapidly in the meat packaging communities of Nebraska and Iowa, The World-Herald analyzed data from all 3,100 counties in America to find the places where the virus has spread the most.
Not surprisingly, New York City and the many surrounding counties of New York and New Jersey rank high for infection and death rates. Images of refrigerated trucks storing bodies outside overcrowded hospitals will forever cement New York as the zero point for the national pandemic.
But look at the most infected counties today and there are many other trends emerging – sometimes in places where many did not expect the virus to spread so severely.
Five weeks ago, President Donald Trump at a White House coronavirus briefing released a list of states he said were “slightly affected”.
“You look at Nebraska, you look at Idaho, you look at Iowa,” he said. “You look a lot – I could name many countries that manage it very, very well and that are not affected to the same extent, or, frankly, not even almost to the extent of New York. “
Today, Nebraska, Idaho and Iowa all have counties among the top 25 in the country for infection rates.
While the largest cities in Nebraska and Iowa were only slightly affected, the large number of meat conditioning hotspots as of Thursday had propelled the per capita rate of Nebraska State to 18th among 50 states, and Iowa 17th.
Look no further than Blaine County, Idaho – one of the country’s first coronavirus epicentres outside of New York – to see how quickly and easily the virus can spread.
The bug was probably first introduced in early March by one or more of the thousands of tourists who flock to the mountain community where the Sun Valley ski resort is located each winter. And these visitors began to mingle shoulder to shoulder on the elevators and with locals in the crowded lodges and restaurants.
Sun Valley quickly turned into a snow-covered Petri dish.
“There have been many introductions and the epidemic has become quite violent,” said Dr. Andrew Pavia, a pandemic expert at the University of Utah. “It was a way the virus easily sowed much of the rural west.”
Now the biggest hotspots in the country are much closer to home – in midwestern meat packing plants where workers sometimes stay away from the grueling and tough job of processing cows and pigs as food for American tables.
The counties of Dakota and Dawson, in Nebraska, both rank in the top 25 of the country in per capita cases, particularly in the sense that a little more than three weeks ago, the two centers meat packaging had only one confirmed case between them. Hall County is at number 26.
Certainly, these Nebraska counties have seen nothing close to the number of deaths in New York, on a real or even per capita basis. But deaths from COVID-19 tend to be a week or more behind in infections, and the past week has brought worrying signs.
The three county health district, which includes Hall County, reported 10 deaths in one day on Wednesday. In the metropolitan area of eight counties of Omaha-Council Bluffs, this would amount to a day-to-day death toll of 124.
The deaths have been enough to help move Hall – who as of Thursday had seen 28 deaths in total – up to 86th nationally in the coronavirus death rate.
While neighboring Hamilton County was too small to be included in Word-Herald’s analysis, which only classified counties of 10,000 or more, the county’s eight deaths from coronavirus gave it a per capita rate that would rank 30th nationally.
“I think death, unfortunately, can happen,” said Pavie of the land of meat. “People haven’t had time to get sick enough to die.”
After a week in which coronavirus cases in the United States surpassed the million mark, here is a look at some of the trends that emerged during the pandemic. In fact, the vast majority of the most infected counties fall under four distinct trends.
New York area
Officially, the first confirmed case of coronavirus in New York was reported on March 1.
But experts concede today that the virus has almost certainly been going undetected for weeks in the most international city in the United States, likely brought by many foreign travelers. There is no other way to account for the speed at which the virus has spread, despite late efforts to lock down the area.
“What probably happened in New York were multiple introductions, and by the time they appeared on anyone’s radar, there had been significant transmission events,” said Hewlett, medical director of the Nebraska Biological Containment Unit at the UNMC. “When we think of other epidemics in our lifetime, we have never seen anything like it. Although many of us knew it would happen, it took us a bit by surprise with the speed with which it happened. “
New York City and surrounding counties represent 10 of the top 25 counties for coronavirus infection per capita. And the grim list of the top 25 deaths per capita includes eight counties in the region.
Although cases now seem to have peaked, New York and New Jersey still see hundreds of deaths a day.
It remains to be seen why New York was so severely infected. After all, some other major cities in the United States were comparatively slightly affected. No county in the Chicago, Los Angeles, or Atlanta metropolitan area is in the top 50 of the infection rate. Boston has only one county in the top 25.
In comparison, while the number of daily cases in Douglas County has recently reached new heights, New York City has 17 times the Douglas County infection rate and more than 50 times its mortality rate. Douglas County ranks 825th nationally for the per capita infection rate.
But Pavie said that even Chicago or Los Angeles couldn’t really compare to New York. It is by far the densest city, with more people riding together in high-rise elevators and metros.
“Other cities are overcrowded,” said Pavia. “In New York, the amount of time you really spend crowded with others is truly of a magnitude of difference. “
There will also be a second assumption if New York officials acted quickly enough to shut down daily life. California has been quicker to issue a stay order, although the West Coast has never seen the type of exponential spread from New York.
Omaha public school superintendent Cheryl Logan actually decided to extend the spring break and keep district schools closed three days before New York City closed its schools. Pavia said he knew New York officials were reluctant to close schools because of the large number of students who depend on school meals.
While federal health officials were also clearly slow to respond to what came from abroad, New York Governor Andrew Cuomo in a recent interview wondered if the state should have reacted more quickly .
“I wish someone would stand up and blow up the bugle,” he said. “And if no one was going to detonate the bugle, I would feel much better if I were the bugle blower last December and January.”
To date, no inmate from Nebraska prison has tested positive for the coronavirus. But a look across the country shows how explosive it can spread once it enters the prison walls.
Four of the country’s nine major counties for coronavirus rates host the major correctional facilities.
More than 80% of the 2,500 inmates at Marion Correctional Center in Ohio tested positive for COVID-19.
The figures for penitentiary counties are undoubtedly influenced by the high rate of testing, as most of all inmates in these facilities are tested to try to isolate the sick and contain the spread.
The overall prison outbreaks were also not particularly deadly. But an Ohio Pickaway County jail that includes the correctional equivalent of a nursing home has seen the deaths of 18 inmates and a nurse.
“In some of these prisons, the attack rate is close to 100%,” said Pavie. “What will be interesting to see is how far these prison outbreaks have spread in the community.”
Of all the counties that lead the country in terms of infections, none is more frightening than a group of small, mostly contiguous rural counties in southwest Georgia.
They represent two of the top 25 countries in the country and five of the top 50 counties in terms of infection rate. And three others would rank in the top 50 if they weren’t so small to be excluded from the analysis.
The virus has also proven to be extremely deadly there. Five of Georgia’s counties rank in the top 10 national per capita deaths.
Published reports have indicated that a large burial of 200 people in late February would have served as a super spreader in the area. But the region does not have other obvious factors such as unusual industries or social practices that have contributed to the disease. The counties are isolated, tens of kilometers from cities of all sizes.
“Georgia is really strange,” Pavie said of the epidemic.
However, Pavie and other experts have no doubts as to why the disease was so fatal there.
Many counties rank near the bottom nationally in terms of median household income. It is well known in public health circles that poor communities have limited access to health care and much higher rates of chronic diseases, including diabetes and heart disease.
These are also just the types of preexisting conditions that the coronavirus has been shown to enjoy.
This same economic factor is probably the reason why the county of origin of New Orleans and nine others in Louisiana rank in the top 50 of the mortality rate from coronavirus.
A Mardi Gras celebration that, in hindsight, should have been canceled, may have helped to spread the virus widely. But the underlying poor health is what made him so deadly.
“COVID-19 just brought these things to the surface,” said Hewlett.
On April 2, health officials in Louisa County, Iowa reported the first COVID-19 infection in the community.
“Although this is the first case in Louisa County, it may not be the last,” said the local public health administrator that day. It certainly turned out to be an understatement.
In just over two weeks, southeastern Iowa County, home to a pork processing plant in Tyson, had become one of the country’s first coronavirus meat hotspots. And many others have followed.
Today, seven of the top 25 counties in the country for coronavirus rates are meat packing centers, including two in Nebraska, two in Kansas and one in Iowa, Minnesota and Indiana. Often it takes less than two weeks for a community of meat packers to reach the top of the rankings.
“It’s going very fast,” said Hewlett. “It is definitely a disturbing trend. “
It is not difficult to understand either.
Homework is not an option in these facilities, and the demands of the rapidly changing production chain make social distancing difficult. Thousands of workers almost stand shoulder to shoulder to do work that was often grueling and dangerous before the pandemic.
“These are just very difficult installations to maintain social distance and stop the spread,” said Hewlett.
Of all the major epidemics, meat packaging has also been the most controversial.
Workers and their advocates say the plants are not doing enough to protect them from the deadly virus, sacrificing workers’ health for profits. Nebraska Governor Pete Ricketts and others have said that outbreaks are not only the responsibility of plants, but are also a “community problem”.
Most workers in factories tend to be immigrants and refugees, and many live in extended family households and in close-knit communities. But proponents point out that immigrants working in other industries do not see the same types of explosive epidemics, designating packaging factories as the primary driver.
Meanwhile, as diseases escalated, the president signed a decree last week forcing factories to remain open to protect the food supply. Many have nevertheless suspended their operations.
Almost all of the factories report doing the same things to try to stop the virus. They use thermal analyzes to identify employees with high temperatures; distribute more personal protective equipment; the installation of acrylic shields and other barriers; and increasing the amount of cleaning and sanitation.
But the spread continues, hitting more plants each week.
So what is the answer? A team of colleagues from Hewlett’s UNMC worked on it, and last week released a list of recommendations that we hope can make a difference.
Pavie said it would be interesting to see the number of new packaging factory outbreaks in the coming weeks.
Overall, Pavie said that all of the figures in the World-Herald analysis show that there is really nothing like a national epidemic in this pandemic, or even a state epidemic.
In every county in the country where the deadly virus has spread, the reasons, circumstances, victims and results have been somewhat unique.
Pavie said, “Every epidemic tells a story. “
World-Herald editor Erin Duffy contributed to this report.
Top 25 countries with the highest per capita COVID-19 infection rates
Lincoln County, Arkansas
Bledsoe County, Tennessee
Rockland County, New York
Dakota County, Nebraska
Nobles County, Minnesota
Marion County, Ohio
Cass County, Indiana
Westchester County, New York
Pickaway County, Ohio
Nassau County, New York
Passaic County, New Jersey
Louisa County, Iowa
Seward County, Kansas
Suffolk County, New York
Union County, New Jersey
Orange County, New York
Hudson County, New Jersey
Blaine County, Idaho
Early County, Georgia
Ford County, Kansas
New York, New York
Comté de Dawson, Nebraska
Paroisse de Saint-Jean-Baptiste, Louisiane
Comté d’Essex, New Jersey
Comté de Dougherty, Géorgie