Monroe County in southern Alabama is a small but consequential corner of America. It was here that Harper Lee was born and the landscapes of ‘To Kill a Mockingbird’ took shape. It was in Monroe that Truman Capote spent his childhood gestating the mythic imagination that produced ‘In Cold Blood.’ It is here as well that we can see the concerning trend of the coronavirus pandemic taking hold throughout rural America, in what now appears unmistakably like a pattern of resurgent viral spread.
The lower half of the United States is now in the grip of spiking Covid-19 case totals. The state of Florida has averaged around 1,200 cases per day over the past week, a rate not seen there since March. Arizona just saw three of its highest case counts in the past six days. Texas experienced its highest one-day case total, 2,750 new cases, on June 10. And on June 11, Alabama recorded its highest daily coronavirus case total, 848 new cases, which builds upon several weeks of steady growth since early May.
Like much of the rest of the country, the bulk of total cases in Alabama have occurred so far in cities. Roughly one-third of Alabama’s total case count of 22,474, as of June 11, has occurred in the three counties which contain the three largest cities of Birmingham, Montgomery and Mobile. But by examining areas where rapid growth is happening, attention turns towards Monroe.
Over the past three days, Monroe and its neighboring county, Conecuh, have seen a rolling average case growth rate of over 10%, which places them in the highest growth areas of the country. Already, these two counties have a total case rate of 485 per 100,000 population, which places them significantly above the state average of 462 per 100,000. On June 10 and 11, these two counties recorded 42 new coronavirus cases. Each day was more than double their previous highest daily totals, and in combination greater than all the cases recorded in this area prior to May 19. Since mid-May, their case growth trajectory looks increasingly exponential.
The growth rate and case totals are only part of the reason for worry in rural areas like Monroe. What is most alarming is the intersection here between coronavirus infection dynamics, risk factors in the population, and the relative lack of essential health infrastructure. Between Monroe and Conecuh, the diabetes rate in this part of Alabama is just slightly below 20%. Their rate of heart disease is alarmingly high at 466 cases per 100,000 population. Roughly 20% of this area is over the age of 65.
And yet, should the citizens of Monroe and Conecuh require intensive care services, they have only 16 total ICU beds.
While the public health community stays alert throughout the United States and the rest of the world to the signs of continued or resurgent growth of Covid-19, it is imperative not to lose sight of the risks faced by smaller and poorer communities as the pandemic continues.