By on 10.6.20 in Health & Environment, NC in Focus

Nationally, rural counties reported a record number for new COVID-19 infections between September 20-26, according to a recent report from the Daily Yonder. More than half of rural counties nationwide—990—were in the red zone, meaning that they had more than 100 new cases per 100,000 residents in a one-week period.

Defining the 'Red Zone'

According to the White House Coronavirus Task Force, the red zone corresponds to 101 or more cases per 100,000 residents, the orange zone to 51-100, yellow to 10-50, light green to 5-9, and dark green to less than 5.

In North Carolina, this share was much higher. Among our state’s 54 rural (non-metro) counties, 40 or 74% were in the red zone. More critically, this number had increased by 18 counties from the previous week. Our state’s urban counties saw similar trends.

What happened in North Carolina between mid- and late-September?

North Carolina now in the red zone

Between September 20-26, North Carolina added 13,815 new COVID-19 cases, an increase of 132 per 100,000 residents. This was the 17th largest increase per capita of any state and above the national average of 94 new cases per 100,000 residents observed over this time. Compared to the previous week period, North Carolina added 5,306 more cases, an increase of 62.4%.

COVID-19 infections rising most in rural counties

Statewide, COVID-19 infections are rising in both rural and non-rural counties, but they are rising faster in rural areas. While 21% of North Carolina population lives in a rural county, 33% of new infections were in one of these counties in the most recent week of data.

Between September 20-26 there were:

  • 9,296 new COVID-19 infections in non-rural counties. This is 3,060 more than they had the week before.
  • 4,519 new COVID-19 infections in rural counties. This is 2,246 more than they had the week before.
  • 204 new infections per 100,000 residents in rural counties compared to 112 in non-rural counties.

Sampson County had the largest per capita increase in COVID-19 infections—745 new cases per 100,000 residents—followed by Scotland (709), Yancey (520), Greene (489), and Watauga (445) counties. All of these counties are rural.

Rural counties also topped the list of counties with the largest percent increase in new cases from the prior week. Yancey County had the largest increase in reported cases (1,778%), followed by Duplin (1,041%), Jackson (892%), Sampson (745%), and Mitchell (717%).

Higher rates of COVID-19 in rural areas pose both immediate and potentially long-term challenges. The consequences of COVID-19 may be heightened in rural areas for multiple reasons, including relatively older populations, higher rates of chronic conditions, lower rates of health insurance, and lower access to health care infrastructure. These factors increase the risk of more profound immediate impacts of Covid-19 (e.g., higher mortality) and have the potential to have long-term negative impacts on health outcomes.

COVID-19 Cases by County

County NameMetro or Rural2019 Population EstimateNew Cases, 9/20-9/26New Cases Per Capita, 9/20-9/26New Cases, 9/13-9/19New Cases Per Capita, 9/13-9/19% Growth in New Cases
Alamance CountyMetro169,50922113016910031%
Alexander CountyMetro37,497391041232225%
Alleghany CountyNonmetro (Rural)11,1371090436150%
Anson CountyNonmetro (Rural)24,44648196441809%
Ashe CountyNonmetro (Rural)27,2032177726200%
Avery CountyNonmetro (Rural)17,5573419463359-46%
Beaufort CountyNonmetro (Rural)46,99412626857121121%
Bertie CountyNonmetro (Rural)18,947432272814854%
Bladen CountyNonmetro (Rural)32,722782382061290%
Brunswick CountyMetro142,820113795136122%
Buncombe CountyMetro261,1912579811644122%
Burke CountyMetro90,48592102596556%
Cabarrus CountyMetro216,4532601201748049%
Caldwell CountyMetro82,1781001224150144%
Camden CountyNonmetro (Rural)10,867764328133%
Carteret CountyNonmetro (Rural)69,473861243550146%
Caswell CountyNonmetro (Rural)22,6043716449217-24%
Catawba CountyMetro159,5511941221549726%
Chatham CountyMetro74,470801072736196%
Cherokee CountyNonmetro (Rural)28,61252182481688%
Chowan CountyNonmetro (Rural)13,943433083424426%
Clay CountyNonmetro (Rural)11,23187176214%
Cleveland CountyNonmetro (Rural)97,94720821218118515%
Columbus CountyNonmetro (Rural)55,50863114591067%
Craven CountyMetro102,139382374120118218%
Cumberland CountyMetro335,50942812833510028%
Currituck CountyMetro27,763321151554114%
Dare CountyNonmetro (Rural)37,0091335514160%
Davidson CountyMetro167,609168100159956%
Davie CountyMetro42,84632751228167%
Duplin CountyNonmetro (Rural)58,74124040921361041%
Durham CountyMetro321,48822269220681%
Edgecombe CountyMetro51,4729518597189-2%
Forsyth CountyMetro382,29520654207540%
Franklin CountyMetro69,68530434057-25%
Gaston CountyMetro224,52931914229113010%
Gates CountyMetro11,562181561513020%
Graham CountyNonmetro (Rural)8,4413237916190100%
Granville CountyNonmetro (Rural)60,44343714981-12%
Greene CountyNonmetro (Rural)21,06910348927128281%
Guilford CountyMetro537,17447789457854%
Halifax CountyNonmetro (Rural)50,01065130367281%
Harnett CountyNonmetro (Rural)135,97622316415611543%
Haywood CountyMetro62,3173048274311%
Henderson CountyMetro117,41711195806839%
Hertford CountyNonmetro (Rural)23,677662794519047%
Hoke CountyMetro55,23495172951720%
Hyde CountyNonmetro (Rural)4,9371201200%
Iredell CountyMetro181,80641522811764255%
Jackson CountyNonmetro (Rural)43,9381192711227892%
Johnston CountyMetro209,33926312610952141%
Jones CountyMetro9,41914149221601%
Lee CountyNonmetro (Rural)61,77966107579216%
Lenoir CountyNonmetro (Rural)55,94968122458051%
Lincoln CountyMetro86,11116218810312057%
Macon CountyNonmetro (Rural)35,85814392159-33%
Madison CountyMetro21,7551464628133%
Martin CountyNonmetro (Rural)22,440381692410758%
McDowell CountyNonmetro (Rural)45,756992162248350%
Mecklenburg CountyMetro1,110,3561,1481036505977%
Mitchell CountyNonmetro (Rural)14,96449328640717%
Montgomery CountyNonmetro (Rural)27,173279945166-40%
Moore CountyNonmetro (Rural)100,8801461455959147%
Nash CountyMetro94,29824125617618737%
New Hanover CountyMetro234,47339316826611348%
Northampton CountyNonmetro (Rural)19,483492522613389%
Onslow CountyMetro197,93835517913066173%
Orange CountyMetro148,4768356694720%
Pamlico CountyMetro12,726413221186273%
Pasquotank CountyNonmetro (Rural)39,82442106369017%
Pender CountyMetro63,06068108641026%
Perquimans CountyNonmetro (Rural)13,46316119139723%
Person CountyMetro39,49025632666-4%
Pitt CountyMetro180,74239722023713168%
Polk CountyNonmetro (Rural)20,72454261734671%
Randolph CountyMetro143,6671761237452138%
Richmond CountyNonmetro (Rural)44,8291142548919928%
Robeson CountyNonmetro (Rural)130,62526620419314838%
Rockingham CountyMetro91,010111122899825%
Rowan CountyMetro142,0881991401359547%
Rutherford CountyNonmetro (Rural)67,029921374364114%
Sampson CountyNonmetro (Rural)63,5314737455688745%
Scotland CountyNonmetro (Rural)34,82324770996276157%
Stanly CountyNonmetro (Rural)62,80616526376121117%
Stokes CountyMetro45,5912759173759%
Surry CountyNonmetro (Rural)71,7834563334636%
Swain CountyNonmetro (Rural)14,27153542825%
Transylvania CountyNonmetro (Rural)34,38528811441100%
Tyrrell CountyNonmetro (Rural)4,0165125125400%
Union CountyMetro239,8592259423096-2%
Vance CountyNonmetro (Rural)44,53525563988-36%
Wake CountyMetro1,111,761673615935314%
Warren CountyNonmetro (Rural)19,73125127157667%
Washington CountyNonmetro (Rural)11,58086965233%
Watauga CountyNonmetro (Rural)56,17725244964114294%
Wayne CountyMetro123,13123118813310874%
Wilkes CountyNonmetro (Rural)68,41272105507344%
Wilson CountyNonmetro (Rural)81,80116620312114837%
Yadkin CountyMetro37,6673490266931%
Yancey CountyNonmetro (Rural)18,069945205281778%