Pandemic's New Phase: Spreading to Rural and Urban Areas Alike

A top public health expert in the Trump administration warned that the U.S. is in a "new phase" of the pandemic, different from March and April when the coronavirus largely affected a few big cities. Now urban and rural areas alike are vulnerable.

3 minute read

August 9, 2020, 7:00 AM PDT

By Irvin Dawid

Social Distancing

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“What we are seeing today is different from March and April — it is extraordinarily widespread,” Dr. Deborah L. Birx, the Trump administration’s coronavirus coordinator, said on CNN’s “State of the Union” news program on Sunday, August 2 (see transcript). “It’s into the rural as equal urban areas. So everybody who lives in a rural area, you are not immune.” 

"And that is why we keep saying, no matter where you live in America, you need to wear a mask and socially distance, do the personal hygiene pieces."

Sarah Turner, a public health specialist with Barron County, Wisconsin, a county of 45,000 people about 75 miles northeast of Minneapolis, confirmed Birx's assertion. 

“We were hoping that being rural and being more spread out” would protect the county, “but that’s proving not to be the case,” she told the Associated Press on August 4. “Like everywhere and anywhere right now, there are people who don’t buy into health measures."

Birx took the warning even further, advising that under certain living conditions due to the asymptomatic aspect of COVID-19, it may be advisable to wear a mask at home.

"But, more importantly, if you're in multigenerational households, and there's an outbreak in your rural area or in your city, you need to really consider wearing a mask at home, assuming that you're positive if you have individuals in your households with comorbidities."

Community spread

"Anthony S. Fauci, the nation’s top infectious disease expert, defended and amplified Deborah Birx’s statements about what she characterized as a 'new phase' of the pandemic in the United States, reported The Washington Post on Aug. 3.

Speaking to reporters Monday, Fauci said that the kind of spread some states are experiencing is extremely difficult to contain. “When you have community spread it’s insidious, there are people who are spreading it who have no symptoms at all ... It’s difficult to do identification, isolation and contact tracing,” Fauci said.

Health recommendations rejected

Birx told CNN that each state needs a "dramatically tailored" approach to Covid-19, with a "set of recommendations based on what we are seeing at the community level, what we are seeing relevant to the hospitals."

"If you have high case load and active community spread, just like we are asking people not to go to bars, not to have household parties, not to create large spreading events, we are asking people to distance learn at this moment so we can get this epidemic under control," Birx responded, though she deferred to CDC guidelines on school reopenings.

However, Birx's advice was rebuffed earlier by Gov. Bill Lee (R) of Tennessee, reported Brett Kelman of the Nashville Tennessean on July 27.

Dr. Deborah Birx...said Monday that Tennessee should close bars and limit indoor restaurant dining to prevent a looming escalation of the coronavirus outbreak.

Moments later, Gov. Bill Lee said he had no plans to follow this recommendation. Lee said he would not close bars or limit restaurants or give county mayors the authority to take these actions locally.

Birx said she traveled to Tennessee because the state teeters on a precipice from which other Southern states had already fallen: The virus has spread among asymptomatic young people into rural areas, and it now threatens to reach new levels of infection.

Tennessee ranks 14th in the country in terms of total cases per 1 million people, according to Worldometer, but it ranks eighth in terms of cases per 100k people in the last seven days, according to The New York Times tracker.

Harvard's COVID-19 Risk Levels dashboard places it as one of 10 "red" states where daily new cases are transmitting at >25 per 100k people (7-day moving average). "At the red level, jurisdictions have reached a tipping point for uncontrolled spread and will require the use of stay-at-home orders and/or advisories to mitigate the disease," according to Harvard's "Key Metrics for COVID Suppression: A Framework for policy makers and the public" [pdf].

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