Impact of COVID-19 on Rural North Carolina

Blog | October 22, 2020


Several months into the COVID-19 pandemic, the virus continues to have a dramatic impact on the lives and livelihoods of millions. Rural areas and communities are being hit particularly hard by the pandemic. Residents of rural areas tend to be older and more likely to have chronic health conditions, putting them at increased risk of severe COVID-19-related illness and hospitalization. Americans who live in rural areas are also more likely to be living in poverty and to be uninsured, limiting their access to health care. In addition to the high-risk profile of rural America, there are concerning trends of high rates of infection in rural counties. According to an analysis by the rural news website Daily Yonder published on October 14th, 61% of rural counties[1] in the United States are considered red zones, where there are one-week infection rates of 100 or more new cases per 100,000 population (1 or more cases per 1,000 residents). Within North Carolina, 40 of the state’s 54 rural counties are considered red zones.


A recent nationwide survey conducted by NPR, the Harvard T.H. Chan School of Public Health, and the Robert Wood Johnson Foundation found that people in one in four rural households have had trouble receiving health care for a serious health problem, with more than half reporting adverse health outcomes as a result. Findings from the poll also highlighted that while many are turning to telehealth services to receive care during the pandemic, a third of rural households have issues connecting to the internet, which affects receipt of care via telehealth services. On top of the impact that COVID-19 is having on the health of rural populations, we also see a severe economic impact. Results from the aforementioned survey found that 40% of rural households are facing serious financial problems. The financial impact is starker for Black and Latinx households in rural areas, with around 80% of those households facing severe financial problems, compared to 36% of white households.


Aside from the risk posed by the virus to the health and financial well-being of rural populations, COVID-19 is also having a detrimental impact on the fiscal viability of rural hospitals, which were in a financial crisis before the pandemic. Over the past decade, at least 128 rural hospitals have closed, and an additional 450 have been found to be financially unstable. In North Carolina alone, six rural hospitals have closed since 2014. COVID-19 has only heightened the financial insecurity of many rural hospitals. So far, in 2020, 15 rural hospitals have closed across the country.


Rural hospitals often operate on razor-thin margins and depend on high margin services such as elective surgeries for financial viability. To cope with the pandemic, many hospitals, including ones in North Carolina, are canceling or delaying elective procedures, denying them a key source of revenue. In addition, rural hospitals often have fewer ICU beds, staff, and other necessary resources to cope with the virus than hospitals in metropolitan areas. Just a few COVID-19 patients in some rural hospitals could potentially lead to a substantial strain on resources and finances.


State and federal governments have allocated resources to offset the impact of the COVID-19 pandemic on rural areas and hospitals. In May 2020, the roughly 50 rural hospitals in North Carolina were appropriated 65 million dollars in funds from the federal CARES Act by the North Carolina General Assembly. The funds allocated to rural North Carolina hospitals could be used to cover some of the lost revenue from forgone elective procedures, to purchase supplies and equipment, and to increase the number of patient beds, among other purposes.


As the virus continues to spread in rural America, including in North Carolina, rural hospitals will need further assistance in the near future to stay financially viable as the pandemic continues. In addition, as we see the persistent spread of the virus and economic hardship in rural areas, it is clear that rural North Carolinians will need targeted relief efforts as well.



[1]The Daily Yonder analysis defines rural as nonmetropolitan counties