The media often portray the novel coronavirus pandemic as an urban problem. But the North Carolina counties with the highest COVID-19 infection rates actually have more pigs and poultry than people. In these rural communities with large populations of poverty and people of color, there is a little-noticed COVID-19 crisis.

Duplin County in eastern North Carolina is the state’s No. 1 producer of hogs and now also has by far the highest COVID-19 infection rate. There are 2 million pigs and 59,000 people in Duplin. Amazingly, more than 1 in every 44 Duplin residents has tested positive for COVID-19. Its infection rate is five times that of Guilford County’s and three times that of Forsyth County’s.

More than 1,300 Duplin residents are COVID-19 positive. Twenty have died. The Duplin County Health Department has not yet released demographic data on those infected. But 48% of Duplin residents are people of color — largely Black and Hispanic; 26% of Duplin’s residents live below the poverty line.

Next door to Duplin, Sampson County has more than 7 million turkeys and 63,000 residents. One in every 71 of its residents has tested positive for COVID-19. Forty-eight percent of the population is also people of color; 24% of residents live below the poverty line. The Sampson County Health Department has released some demographic dataon COVID-19 infections. Hispanic residents make up 20% of the county’s population but recently accounted for 46% of its COVID-19 cases.

Across the entire state, the Hispanic infection disparity is even wider. Hispanics make up 10% of North Carolina’s population, but the N.C. Department of Health and Human Services says Hispanics make up 46% of COVID-19 infections. This as a third of the state’s infection data lacks any information on race or ethnicity.

“I will tell you that we have a very disjointed, independent health care system across the state,” Gov. Roy Cooper said recently and vowed to improve race and ethnic reporting data in a recent executive order.

Many of these residents work in agricultural industries deemed essential by the federal government. Duplin County’s five largest private employers all deal in agriculture and/or meat processing. The work inside hog and poultry plants is fast-moving and physical, done in tight quarters, and pays poorly. Many workers don’t get paid sick time. Social distancing is not easy here. Kenneth Sullivan, the chief executive officer of Smithfield Foods, admitted as much.

“Social distancing is a nicety that makes sense only for people with laptops,” Sullivan wrote to Nebraska’s governor.

ProPublica has reported meat-packing plants as living in a regulatory limboland and said that President Donald Trump’s executive order to keep meat-processing plants open has led to less corporate cooperation with county health departments. Many of these rural county health departments have been overwhelmed by the number of infections and stymied by corporations dragging their heels in sharing testing results, as ProPublica reports happened in Wilkes County with the Tyson Foods chicken plant.

Meantime, the people in these communities often struggle for health care. Duplin County’s 2018 Community Health Needs Assessment shows that 1 in 5 residents lack health insurance. Another 27% of Duplin residents receive health coverage through Medicaid, the state and federal health program for the poor and disabled. The assessment suggested that a staggering 65% of Duplin County’s Hispanic population has no health coverage at all. These are grim numbers for a county with the state’s highest COVID-19 infection rate.

Local data also suggest that not enough COVID-19 testing is happening in some rural counties. The World Health Organization says if more than 10% of people test positive for COVID-19, more testing is needed to identify the true scope of virus’ spread. North Carolina’s positive test rate is 9%, but Sampson County’s is 37%. Duplin County has not released local testing data.

These numbers show rural communities are in some ways even more vulnerable than big cities to COVID-19. During this pandemic they need more health care access. Medicaid expansion would help.

So would passage in Congress of the HEROES Act— another round of federal stimulus funding directly to states, cities and counties to fill budget holes brought on by the pandemic’s recession. It contains a number of health care supports, including an increase in Medicaid funding to the states to avert the looming Medicaid cuts.

Bolstering public health and health care programs will help slow the virus spread of the virus and lead to a quicker reopening of the economy. The U.S. Senate must insert more Medicaid funding in its stimulus package for state and local governments. North Carolina’s rural counties and their COVID-19 infection rates reveal a burning need Congress must meet.

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