https://www.politico.com/news/magazine/2020/04/15/coronavirus-rural-america-covid-19-186031

In rural Washington, hospitals are faltering, stores can’t get supplies and people are staying closer to each other than you’d think.

Dr. Howard Leibrand has had two very different medical careers—29 years as an emergency room physician, then 12 as an addiction therapist. The challenge he’s facing now, as the novel coronavirus slams bucolic Skagit County, Washington, where he lives and works, is like both rolled into one. Covid-19 has struck fast and hard, like the car crashes and mishaps that send victims to the ER. And like opiate addiction, it has spread stealthily through the heartland, even as it was dismissed as a distant, urban problem.

“One of the negatives of living in a rural community is you think it protects you somehow,” says Leibrand, who for years has also been the health officer—a sort of local surgeon general—of the county, a sprawling expanse of rich alluvial farmland, exurban bedroom communities and steep Cascade peaks midway between Seattle and Vancouver, British Columbia. “We get a little bit cavalier, a little lazy about social distancing.” On April 1, Governor Kristi Noem of South Dakota—one of five states, all in the central heartland, without stay-at-home orders—defended her decision to leave South Dakotans “free to exercise their rights to work, to worship, and to play” by saying, “South Dakota is not New York City, and our sense of personal responsibility, our resiliency and our already sparse population density put us in a great position to manage this virus” without resorting to the “draconian” measures taken elsewhere.

Complacency is fast fading, however, as rural residents realize that, far from being immune, they may be uniquely vulnerable when the epidemic reaches them. Even as Noem spoke, Covid-19 was spreading at a Sioux Falls meatpacking plant that subsequently closed after more than 300 workers fell sick, and local officials across the state begged her to issue shutdown and shelter-in-place orders.

As of press time, all but one of Washington’s 39 counties, most of them rural, had reported Covid-19 cases. Nationwide, more than two-thirds of rural counties had confirmed cases as of April 6, a New York Times analysis found, and across rural America, the per capita infection rate “was more than double what it was six days earlier.” That’s as fast as or faster than recent increases in Chicago, Miami, Boston, Los Angeles and New York.The country’s highest Covid-19 rate is in Blaine County, Idaho, home to 22,277 residents and the Sun Mountain ski resort.