A recent spate of stories have been covering increased cases in rural America. A recent CNN story is a good example: Long on opinion and story, short on data. I’ve been watching closely and now the data is finally coming in.

We typically see attention paid to states based on the number of cases, or number of deaths. This metric is important, but nearly always ends with focus on New York and New Jersey. But of course these places have the most cases – they have the most people. Worse, they have huge urban density, so not only would we expect a lot of cases, but also a very high infection velocity, so they’d be the first states to really catch fire. Big cities are like a huge pile of dry tinder, and when a match hits them they burn bright and fast.

Rural areas are different; people are spread out, don’t take mass transit, don’t ride elevators. While people there can still catch the disease, we’d expect it to spread more slowly. The good news is this “flattens the curve”. The bad news is these states will still get it.

Their sparse populations given them an advantage, but in many ways they’re very much disadvantaged. They have fewer doctors, fewer hospitals, weaker supply chains, fewer ICU beds. In Seattle we could “surge” and built huge temporary hospitals.

One of two huge temporary FEMA hospital facilities in Bellevue, WA

Where do you put these in Oklahoma, or Rural Wisconsin? Can people get there? Do you have doctors and nurses to staff them?

And rural areas are set up for much higher death rates. Here are some known risk factors for dying from COVID-19.

Obesity in the US by State
Smoking incidence by State
Incidence of Diabetes
Incidence of Diabetes

Rural states – especially the rural south, but also the upper Midwest and Rural West, will see much higher death rates from COVID than the West cost or urban East.

But will they get the COVID? Until recently, red State governors have been able to look at low case loads and feel complacent; many have been soft in their policies and messaging. The President has been calling to “free” rural states. And rural populations are complying with distancing less well than urban ones.

The table below shows the result. Instead of ordering states by cases, I’ve ordered them by whether their case load growth rate is growing or shrinking. Thanks to social distancing, most of the US, and the US as a whole, is slowing down. But a notable group of red states are in fact accelerating their growth rate, which is very dangerous. They’re not just growing faster, their rate of growth is increasing. This in spite of being naturally sparse populations.

If these trends continue, these states are about to get the same lesson in the power of exponential growth that urban areas have: A tiny number growing at a constant – or worse, growing – percentage per day becomes tragically bad very quickly.

If they let up on social distancing now, they’re going to pour gasoline on the fire.