Coronavirus in rural America (Part XCIX): Urban and rural places compete for hospital beds

That's the gist of this NPR story today out of Kansas City, Missouri, reported by Alex Smith.  Here's the salient excerpt:    

Dr. Marc Larsen leads COVID-19 treatment at Saint Luke's Health System in Kansas City, where a recent count showed a quarter of the hospitalized COVID-19 patients came from outside of the metro.

MARC LARSEN: Not only are we seeing an uptick in the patients in our hospital from the rural community, they're sicker when they - when we get them because they're able to handle, you know, the less-sick patients.

SMITH: Larsen says that two-thirds of patients coming from rural areas need intensive care and stay in the hospital for an average of two weeks.

LARSEN: And we get the sickest of the sick.

SMITH: Dr. Rex Archer is the head of Kansas City's Health Department. He warns that the city's 33 hospitals are put at risk by the influx of rural patients.

REX ARCHER: We've had this huge swing that's occurred because they're not wearing masks. And, yes, that's putting pressure on our hospitals, which is, you know, unfair to our residents that might be denied an ICU bed.

Here's another story by Smith for the Kansas City NPR affiliate, this one from three weeks ago.   

Coronavirus in rural America (Part XCVIII): The news out of rural places gets worse

NPR featured this story by South Dakota journalist Seth Tupper this morning.  It contrasts the South Dakota response to the virus (nil) with the Vermont response (robust), noting that both states are by some measure rural AND governed by Republican executives.  

Also, I recommend this very powerful podcast from The Daily (New York Times), about the situation in rural Wisconsin, where a Democratic state legislator in a very red/Republican area has been hyper-prepared for the pandemic since March, when she rented a refrigerated van in case it was needed if funeral homes could not accommodate all of the bodies.  

Among other stories I heard or read today that had a rural angle:  hospitals in Kansas City turning down requests for ICU transfers from places "as far away as Arkansas."  (Do reporters realize that Arkansas is contiguous with Missouri?).  Also, the news out of Arkansas, my home state, is frightful:  The governor only yesterday put in place the state's first mandatory precaution:  bars and restaurants that serve alcohol must close by 11 pm.  Seems a day late, a dollar short.  And/or, as my more crass relatives might say, half ass and piss poor. 

Small town government run amok (Part VIII): New Mexico county literally loses (as in, misplaces) a fire truck

The Albuquerque Journal reported today out of Mora County, New Mexico, population 4500.

Fake invoices, stolen records, a firetruck gone missing and thousands of public dollars paid to family members for little to no work.

Those are just some of the findings against the Mora County Volunteer Fire Department issued by the state Auditor’s Office on Wednesday. The 86-page report details years of alleged fiscal misappropriations by county officials, which could eventually result in future arrests.

In total, investigators found an estimated $335,000 in unsubstantiated purchases and numerous violations committed by employees of the county, including potential embezzlement and fraud.

Here are quotes from the State Auditor, Brian Colon, and his report:

It appears a particular family and group of friends dishonestly benefited from the county’s taxpayers’ public funds.  

At the end of the day, it all just adds up to a complete breakdown in the system.  People who were placed in supervisory positions failed to do their job.

A fire truck valued at $81,000 is among the assets missing.  

The story also quotes county County Attorney Michael Aragon, who initially brought the issues to the attention of the state after his office completed an initial investigation in 2019. 

It’s even more offensive because these funds were specifically allocated to provide public safety and protection. It’s just heartbreaking.

My own theory on this is well known to those who read the blog:  too little human capital in such locales and therefore too few checks and balances on those with power.  You can find a few other posts about volunteer fire departments here on Legal Ruralism, too.  

Fox News highlights Obama "Bittergate" comments from new memoir

Bradford Betz reports under the headline, "Obama says controversy over infamous ‘bitter’ comments about small-town Americans still ‘nags at me’":  

Former President Barack Obama says the controversy sparked by his infamous comments about white working-class voters being “bitter” and clinging “to guns or religion” still nags him because it misconstrued his genuine sympathy for the same people who perceived him to be out of touch.

Obama made the comments in a passage from his new book, “A Promised Land,” the first volume of his presidential memoirs, released Tuesday.

The former commander in chief addressed controversial comments he made on April 6, 2008, while on the campaign trail. During a fundraising event in San Francisco that evening, Obama was recorded making off-the-cuff remarks about white working-class voters in small towns.

Obama made the comments in a passage from his new book, “A Promised Land,” the first volume of his presidential memoirs, released Tuesday.

The former commander in chief addressed controversial comments he made on April 6, 2008, while on the campaign trail. During a fundraising event in San Francisco that evening, Obama was recorded making off-the-cuff remarks about white working-class voters in small towns.

* * * 

In his memoir, Obama said he wished he could take his comments back and offered an amended version: “It’s not surprising then that they get frustrated … and they look to the traditions and way of life that have been constants in their lives, whether it’s their faith, or hunting, or blue-collar work, or more traditional notions of family and community. And when Republicans tell them we Democrats despite these things — or when we give these folks reason to believe that we do — then the best policies in the world don’t matter to them.”

I wrote nearly a whole law review article about these comments, The Geography of the Class Culture Wars, published in 2011.

Coronavirus in rural America (Part XCVII): Distributing a vaccine to remote locales

Pro Publica reported a few days ago on the challenge of distributing the coronavirus vaccine to remote locales, like those in Indian Country. The headline is "Most States Aren’t Ready to Distribute the Leading COVID-19 Vaccine," and Isaac Arnsdorf, Ryan Gabrielson and Caroline Chen report:  

As the first coronavirus vaccine takes a major stride toward approval, state governments’ distribution plans show many are not ready to deliver the shots.

The challenge is especially steep in rural areas, many of which are contending with a surge of infections, meaning that access to the first batch of COVID-19 vaccines may be limited by geography.

* * * 

The Pfizer vaccine is unusually difficult to ship and store: It is administered in two doses given 21 days apart, has to be stored at temperatures of about minus 100 degrees Fahrenheit and will be delivered in dry ice-packed boxes holding 1,000 to 5,000 doses. These cartons can stay cold enough to keep the doses viable for up to 10 days, according to details provided by the company. The ice can be replenished up to three times. Once opened, the packages can keep the vaccine for five days but can’t be opened more than twice a day. The vaccine can also survive in a refrigerator for five days but can’t be refrozen if unused.

Health officials haven’t figured out how to get the ultracold doses to critical populations living far from cities, according to a ProPublica review of distribution plans obtained through open records laws in every state. Needing to use 1,000 doses within a few days may be fine for large hospital systems or mass vaccination centers. But it could rule out sending the vaccine to providers who don’t treat that many people, even doctors’ offices in cities. It’s especially challenging in smaller towns, rural areas and Native communities on reservations that are likely to struggle to administer that many doses quickly or to maintain them at ultracold temperatures. 

How higher ed helped flip five states (and other socioeconomic and geographic spins) on the 2020 election

Here's today's story from the Chronicle of Higher Education, by Audrey Williams June and Jaquelyn Elias: 

Higher education has increasingly become a marker of partisan identification. Among white voters especially, a college degree has come to be seen as predictive of voting patterns. And counties with flagship institutions in them have increasingly swung toward Democrats in presidential elections.

What did the presence of a college in a county say about how that county voted in 2020?

To answer that question, we zeroed in on Arizona, Georgia, Michigan, Pennsylvania, and Wisconsin — the five states that moved from Donald J. Trump in 2016 to Joseph R. Biden Jr. in 2020, and looked at what happened in the counties that had colleges in them. Here’s what we found.

Trump won most of these counties. 

In those five states, 136 counties include four-year public or private nonprofit colleges that have at least 100 students and, in normal years, in-person classes. Trump carried 87 of them, while Biden took 49, according to unofficial results.

This is but one bit of class-based analysis I've seen so far on the 2020 election.   

Here's a story by Benjamin Fearnow for Newsweek, "Trump Counties Make Up Just 29 Percent of U.S. Economic Output, 2020 Election Study Shows."  This story, too, focuses on the link between class and political affiliation.  Here's an excerpt: 

Counties won by Democratic President-elect Joe Biden make up 70 percent of all U.S. economic output—or gross domestic product (GDP)—a new post-election study finds.

Biden has repeated the phrase "there are no blue states or red states, just the United States" in several appeals to President Donald Trump's voters since being named President-elect Saturday. But the more than 75.6 million votes Biden won in the 2020 election led him to victory in nearly all of the country's top 100 most powerful local economies. Meanwhile, Trump voter counties make up less than one-third of the country's economic output, a Brookings Institution study said. The president's unsuccessful re-election bid hinged on his touting of the pre-pandemic economy. But his railing against urban areas as "crime infested" rather than centers of American wealth only allowed him to amass more rural county voters.

"Trump's losing base of 2,497 counties represents just 29% of the economy," the post-election analysis co-authors found.

Finally, here's a piece from the New York Times Upshot, "Election Showed a Wider Red-Blue Economic Divide."  Jed Kolko reports, with this lede:  

Local voting patterns in the presidential election showed a narrowing of several traditional divides. Preliminary vote totals indicate that the partisan gap of urban versus suburban places shrank, along with the traditional Democratic advantage in heavily Hispanic counties. Whites and nonwhites are now in somewhat greater alignment in how they vote.

That makes the resilience of the economic divide all the more striking. In fact, the gap between red and blue counties in their education levels, household incomes and projected long-term job growth did not just persist; it widened.  

And here's a paragraph that hints more at the salience of both education and geography, in particular the exurbs--or certain types of them. 

More educated places, which leaned strongly blue to begin with, voted even more Democratic in 2020 than they did in 2016. Highly educated Republican-leaning counties, like Williamson County near Nashville and Forsyth County near Atlanta, have become rarer with each recent election.

Read the full story for more.   

The Washington Post ran this shortly after the election, "How independents, Latino voters and Catholics shifted from 2016 and swung states for Biden and Trump."  The story is by Chris Alcantara, Leslie Shapiro, Emily Guskin, Scott Clement and Brittany Renee Mayes.   I was intrigued by this graphic in particular, because it sums up so much about the incomes of voters for the respective candidates, and how those of differing income levels moved in some different directions in 2020, compared to 2016.  In particular, it shows that people with incomes over $100,000 moved into Trump's camp by 7 points and those with incomes between $50K and $99K, the income group that supported Trump by the widest margin in 2016, moved to Biden by 11 points: 

Meanwhile, the New York Times reports that "Counties that experienced more job losses during the first wave of the pandemic voted for Biden."  Here's an excerpt:

The counties won by President-elect Joseph R. Biden Jr. experienced worse job losses, on average, during the initial wave of pandemic layoffs than the counties where President Trump was strongest in his bid for re-election.

After the worst of the downturn in April, many of the most affected red counties recovered far more swiftly than blue counties did. By September, as unemployment fell nearly everywhere, blue counties were more likely to have higher unemployment rates.

Cross posted to Working Class Whites and the Law.  

Coronavirus in rural America (Part XCVI): The impacts at both ends of the age spectrum, from nursing homes to schools

Here's a piece on rural nursing homes from the Wall Street Journal.  Tom McGinty and Anna Wilde Mathews report today:

Covid-19 deaths among vulnerable nursing-home residents are surging again, with the virus increasingly spreading to rural facilities that are struggling with staff shortages and other challenges.

Nursing homes reported more than 1,900 resident deaths from Covid-19 in the last week of October, as well as more than 32,000 confirmed and suspected cases among staff and residents, according to newly released federal data analyzed by The Wall Street Journal. Those nationwide totals at the facilities were the highest since early August, when states including Texas and Florida were seeing increases.

And here's one on rural schools, by Dan Levin in the New York Times.  In particular, it highlights the problem of rural broadband "dead zones," which has schools delivering lessons on a flash drive.  The dateline is Robeson County, North Carolina, population 134,000, and here's an excerpt focused on the digital divide:

The technology gap has prompted teachers to upload lessons on flash drives and send them home to dozens of students every other week. Some children spend school nights crashing at more-connected relatives’ homes so they can get online for classes the next day.

* * *

Millions of American students are grappling with the same challenges, learning remotely without adequate home internet service. Even as school districts like the one in Robeson County have scrambled to provide students with laptops, many who live in low-income and rural communities continue to have difficulty logging on.

About 15 million K-12 students lived in households without adequate online connectivity in 2018, according to a study of federal data by Common Sense Media, an education nonprofit group that tracks children’s media use.

Before the coronavirus, that was mainly an obstacle for students doing homework, and it was an issue that state and federal officials struggled to address. But the pandemic turned the lack of internet connectivity into a nationwide emergency: Suddenly, millions of schoolchildren were cut off from digital learning, unable to maintain virtual “attendance” and marooned socially from their classmates.

Coronavirus in rural America (Part XCV): North Dakota finally makes masks mandatory (albeit overnight, under cover of darkness)

 Here's an excerpt from the story, provided by Inforum (news in the Fargo/Moorhead area):

BISMARCK — North Dakota has put in place a statewide mask mandate, occupancy limits on public-facing businesses and the suspension of most high school winter sports as the state’s worst-in-the-nation COVID-19 outbreak continues to spiral out of control.

The mask order, announced in a news release late Friday night, Nov. 13, means residents of the state must wear face coverings in businesses, indoor public places and outdoor public settings where social distancing cannot be maintained. The order includes exemptions for children under five years of age, people attending religious services and those with disabilities that make mask-wearing unreasonable.

The order from interim State Health Officer Dirk Wilke goes into effect on Saturday, Nov. 14, and will remain on the books through Dec. 14.

Violators of the mask order can be cited for an infraction, which could come with a fine up to $1,000 for a first offense. However, Gov. Doug Burgum urged law enforcement to prioritize education and reserve penalties for the most egregious infringements.

North Dakota will join 34 other states, including Minnesota, that have already mandated mask-wearing. 

The statewide order comes after most of North Dakota’s largest cities, including Fargo, Grand Forks and Bismarck, implemented mandates of their own in recent weeks. A handful of counties and at least four of the five American Indian reservations in the state also passed mask requirements, though most of the local mandates had no penalties.

North Dakota's COVID-19 crisis has been very much in the national news in recent days, as the per capita rate of infection has exceeded most states, including at the spiring and summer peaks of the pandemic.  

Coronavirus in rural America (Part XCIV): speeding up poultry processing production lines

Hard to know whether to classify this under "coronavirus" posts-- or to "file" elsewhere, but the Bloomberg headline from yesterday is "Trump Makes Last Push to Speed Up Chicken Lines Despite Pandemic."  Mike Dorning and Michael Hirtzer report for Bloomberg News.    Here are the first few paragraphs:

Coronavirus cases are rising, but the Trump administration is making its last push to allow chicken slaughterhouses to speed up production lines, potentially threatening social distancing that’s crucial to keeping workers safe.

Three days after President Donald Trump lost his re-election bid, the U.S. Department of Agriculture submitted a proposal to raise the maximum line speed by 25% to the White House Office of Management and Budget for review. That’s typically the last step before a proposed regulation is published.

The move risks bringing back a wave of coronavirus infections that shut several meat plants earlier this year just as the winter kicks in and cases surge across the U.S. Critics also say it’s a lame-duck payoff to poultry producers that have been long-time supporters of Trump, who is fighting to keep office. It’s unclear if a final rule could be issued before President-elect Joe Biden takes over.

Coronavirus in rural America (Part XCIII): The aftermath of the Sturgis Motorcycle Rally

The rally is a major annual event in the western South Dakota town of Sturgis, population 6,627, each August. When the announcement was made that it was going ahead this year in spite of the pandemic, I also heard lots of folks express concern that it  could spread the virus.  A few months later, evidence emerged that it had, in fact, done just that.  

Here's a Washington Post story from October 17, "How the Sturgis Motorcycle Rally may have spread coronavirus across the Upper Midwest."  The subhead is, "Within weeks of the gathering that drew nearly half a million bikers, the Dakotas, along with Wyoming, Minnesota and Montana, were leading the nation in new coronavirus infections per capita."

Here's a New York Times story from just this week, "A Motorcycle Rally in a Pandemic? ‘We Kind of Knew What Was Going to Happen.’"  Mark Walker and Jack Healy report, with the subhead "Infectious-disease experts warned about the risk of cramming revelers into the Black Hills of South Dakota. But it was the annual Sturgis rally, and bikers were coming no matter what."  

Carsey School of Public Policy: Biden’s Victory Due to Increased Support Along the Entire Rural-Urban Continuum

Here's the executive summary for the policy brief by Ken Johnson and Dante Scala:

To become the forty-sixth president of the United States, Joe Biden excelled at the margins. In swing state after swing state, he won small majorities that were just slightly larger than Trump’s winning percentages four years earlier, and he performed just a bit better than his predecessor, Hillary Clinton, particularly in large metropolitan areas where he received his strongest support. President Donald Trump’s greatest success occurred in the remote parts of rural America, though in 2020 his majority here was smaller than in 2016. 

 
Voting Along the Rural–Urban Continuum

As political observers expected, Biden did best in the core counties of large metropolitan areas of 1 million or more (referred to here as “large core” metropolitan counties; see Box 1), where he received 64.5 percent of the vote (Figure 1).2 Democrats have consistently been most successful in these large urban core counties.3 Further along the continuum are the suburbs of these large metropolitan areas, then the smaller metropolitan areas of less than a million residents. Biden’s support was more modest in these places, but he still received a majority of votes (51.3 percent) in the suburban counties of large metropolitan areas and a near majority (49.1 percent) in the core counties of smaller metropolitan areas. Together, these three groups of counties produced 119 million (79.7 percent) of the 150 million votes cast so far. Biden received 55.3 percent of these votes, compared to Hillary Clinton’s 52.4 percent in 2016 and Barack Obama’s 54.3 percent in 2012.