What do New York City and a northeast Nebraska meatpacking center have in common? They rank among U.S. communities hit hardest by coronavirus -Herald

What do New York City, a ski resort community in Idaho, the homes of two large Ohio prisons and a northeast Nebraska meatpacking center have in common?

All rank among the American communities hit the hardest by the novel coronavirus.

A World-Herald analysis of data for the nation’s counties shows those with the highest per-capita rates of COVID-19 infection range from the densely populated northeast, into the Deep South, and to food production centers scattered from the Great Plains to the Rockies.

They include high-income, fashionable suburbs on Long Island and dirt-poor counties in rural Georgia.

Two Nebraska counties now rank among the nation’s top 25 counties for confirmed cases per capita. That includes Dakota County, which has recently rocketed all the way to No. 4. And Nebraska’s Hall County, which sits just outside the top 25 in virus spread, now ranks in the nation’s top 100 counties for coronavirus death rate.

In short, no matter where the virulent bug has been allowed to go to seed, it’s shown it can perilously spread like prairie wildfire.

“This virus is transmitted person to person, so it’s going to infiltrate a community wherever people are gathered,” said Dr. Angela Hewlett, an infectious disease expert at the University of Nebraska Medical Center. “We’re seeing this everywhere. No community is immune.”

As the coronavirus pandemic in recent weeks has rapidly spread through meatpacking communities in Nebraska and Iowa, The World-Herald analyzed data for all 3,100 counties in America to find the places the virus has most prevalently spread.

Not surprisingly, New York City and numerous surrounding counties in New York and New Jersey rank high for both infection and death rate. The images of refrigerated trucks storing bodies outside overwhelmed hospitals will always cement New York as ground zero in the nation’s pandemic.

But look at the most infected counties today and numerous other trends emerge — at times in places where many didn’t expect to see the virus spread so severely.

Five weeks ago, President Donald Trump during a White House coronavirus briefing reeled off a list of states that he said were “lightly affected.”

“You look at Nebraska, you look at Idaho, you look at Iowa,” he said. “You look at many — I could name many countries that are handling it very, very well and that are not affected to the same extent, or, frankly, not even nearly to the extent of New York.”

Today, Nebraska, Idaho and Iowa all have counties ranked among the nation’s top 25 for infection rate.

While the largest cities in Nebraska and Iowa have indeed been only lightly affected, the large number of meatpacking hot spots as of Thursday had driven Nebraska’s state per-capita rate to the 18th highest among the 50 states, and Iowa’s up to 17th.

Look no further than Blaine County, Idaho — one of the nation’s first coronavirus epicenters outside New York — to see how quickly and easily the virus can spread.

The bug was likely first introduced in early March by one or more of the thousands of tourists who flock each winter to the mountain community, home to Sun Valley ski resort. And those visitors started mingling shoulder to shoulder on the lifts and with the locals in the packed lodges and restaurants.

Sun Valley quickly transformed into a snowy mountain petri dish.

“There were many introductions, and the epidemic became fairly violent there,” said Dr. Andrew Pavia, a pandemic expert at the University of Utah. “That was one way in which the virus easily seeded much of the rural west.”

Now the nation’s biggest hot spots can be found much closer to home — in the Midwest meatpacking plants where workers at times stand feet apart doing the grueling, gritty work of turning cows and pigs into food for America’s tables.

Nebraska’s Dakota and Dawson Counties both rank in the nation’s top 25 in per-capita cases, particularly noteworthy in that just over three weeks ago the two meatpacking centers had a single confirmed case between them. Hall County stands at No. 26.

To be sure, those Nebraska counties have not seen anything close to the amount of death in New York, on either a real or even per-capita basis. But COVID-19 deaths tend to lag a week or more behind infections, and this past week brought some ominous signs.

On Wednesday, the three-county health district that includes Hall County reported 10 deaths in a single day. In the eight-county Omaha-Council Bluffs metro area, that would equate to a one-day death toll of 124.

The deaths were enough to help move Hall — which as of Thursday had seen 28 deaths overall — up to 86th nationally in coronavirus death rate.

While neighboring Hamilton County was too small to be included in the Word-Herald analysis, which only ranked counties with populations of 10,000 or more, the county’s eight coronavirus deaths give it a per-capita rate that would rank it 30th highest nationally.

“I think the deaths, unfortunately, may be coming,” Pavia said of meatpacking country. “People haven’t had time to get sick enough to die.”

After a week in which U.S. coronavirus cases topped the 1 million mark, here’s a look at some of the trends that have emerged over the course of the pandemic. In fact, the vast majority of the most infected counties fall within four distinct trends.

New York City region

Officially, the first confirmed coronavirus case in New York City was reported March 1.

But experts today concede the virus had almost certainly been quietly circulating undetected for weeks in America’s most international city, likely brought in by numerous travelers from abroad. There’s no other way to account for the speed with which the virus spread, despite belated efforts to lock the region down.

“What probably happened in New York is multiple introductions, and by the time it came on anyone’s radar, there were substantial transmission events,” said Hewlett, the medical director in the Nebraska Biocontainment Unit at UNMC. “When you think about other outbreaks in our lifetime, we had never seen anything like this. Although a lot of us knew this would come, it took us a bit by surprise with how rapidly this occurred.”

New York City and surrounding counties make up 10 of the top 25 counties for per-capita coronavirus infection. And the grim list of the top 25 for per-capita deaths includes eight counties from the region.

Though it appears cases have now peaked, New York and New Jersey are still seeing hundreds of deaths daily.

Questions remain as to why New York was so severely infected. After all, some other major cities in the United States have in comparison been lightly impacted. Not one county from metro area Chicago, Los Angeles or Atlanta appears even among the top 50 in infection rate. Boston has a single county in the top 25.

Just for comparison, while Douglas County’s daily case numbers have recently been hitting new highs, New York City has 17 times Douglas County’s infection rate and more than 50 times its death rate. Douglas County ranks 825th nationally in per-capita infection rate.

But Pavia said not even Chicago or Los Angeles can really compare to New York City. It’s by far the densest city, with more people riding together in high-rise elevators and on subways.

“Other cities are crowded,” Pavia said. “In New York, the magnitude of time you spend really crammed together with others is really of a magnitude of difference.”

There will also be second-guessing whether officials in New York acted quickly enough to shut down daily life. California was quicker to issue a stay-at-home order, even though the West Coast never saw the kind of exponential spread that New York did.

Omaha Public Schools Superintendent Cheryl Logan actually moved to extend spring break and keep district schools closed three days before New York City shut down its schools. Pavia said he knows New York City’s leaders were reluctant to shut down schools because of the large number of students who rely on school meals.

While federal health officials were also clearly slow to respond to what was coming from overseas, New York Gov. Andrew Cuomo in a recent interview pondered whether the state should have responded more quickly.

“I wish someone stood up and blew the bugle,” he said. “And if no one was going to blow the bugle, I would feel much better if I was the bugler blower last December and January.”

Prisons

To date, no Nebraska prison inmate has tested positive for coronavirus. But a look around the country shows how explosively the virus can spread once it gets within the confining walls of a prison.

Four of the nation’s top nine counties for coronavirus rate are homes to major correctional facilities.

More than 80% of the 2,500 inmates at Ohio’s Marion Correctional Institution have tested positive for COVID-19.

The figures for the prison counties are no doubt influenced by high rate of testing, as most all prisoners in those facilities are being tested to try to isolate the sick and contain the spread.

The prison outbreaks as a whole have also not been particularly deadly. But a prison in Ohio’s Pickaway County that includes the correctional equivalent of a nursing home has seen the deaths of 18 inmates and one nurse.

“In some of these prisons, you get close to a 100% attack rate,” Pavia said. “What will be interesting to see is how much these prison outbreaks ultimately spread into the community.”

Impoverished regions

Of all the counties that lead the nation in infections, none are more head-scratching than a group of small, mostly contiguous rural counties in southwest Georgia.

They account for two of the nation’s top 25 and five of the top 50 counties in infection rate. And three others would crack the top 50 if they weren’t so tiny to be excluded from the analysis.

The virus has also proven extremely lethal there. Five of the Georgia counties rank in the top 10 nationally in per-capita deaths.

Published reports have said a large, 200-person funeral in late February is believed to have served as a super spreader in the region. But the region has no other obvious factors such as industries or unusual social practices that have helped seed the disease. The counties are isolated, dozens of miles from cities of any size.

“Georgia is really odd,” Pavia said of the outbreak.

However, Pavia and other experts have little doubt about why the disease has proven so deadly there.

Many of the counties rank near the bottom nationally in median household income. It’s long been well-known in public health circles that impoverished communities have poor access to health care and much higher rates of chronic medical conditions including diabetes and heart disease.

Those are also just the kinds of preexisting conditions the coronavirus has proven to feast upon.

That same economic factor is likely why the home county of New Orleans and nine others in Louisiana rank in the top 50 in coronavirus death rate.

A Mardi Gras celebration that in hindsight should have been called off may have helped widely circulate the virus. But underlying poor health is what made it so lethal.

“COVID-19 has just brought those things to the surface,” Hewlett said.

Meatpacking

On April 2, health officials in Louisa County, Iowa, reported the community’s first COVID-19 infection.

“While this is Louisa County’s first case, this may not be the last,” the local public health administrator said that day. It certainly proved an understatement.

Within just over two weeks, the southeast Iowa county that’s home to a Tyson pork-processing plant had emerged as one of the nation’s first coronavirus meatpacking hot spots. And many more have followed.

Today, seven of the nation’s top 25 counties for coronavirus rate are meatpacking centers, including two in Nebraska, two in Kansas and one each in Iowa, Minnesota and Indiana. Often, it takes less than two weeks for a meatpacking community to shoot toward the top of the rankings.

“This is moving really fast,” Hewlett said. “It’s definitely a disturbing trend.”

It’s also not hard to understand.

Working from home is not an option at these facilities, and the demands of the fast-moving production line make social distancing difficult. Thousands of workers stand nearly elbow to elbow doing work that was often grueling and dangerous even before the pandemic.

“These are just very difficult facilities to maintain social distancing in and stop the spread,” Hewlett said.

Of all the types of major outbreaks, those in meatpacking have also proven the most controversial.

Workers and their advocates say the plants aren’t doing nearly enough to protect them from the deadly virus, sacrificing worker health for profits. Nebraska Gov. Pete Ricketts and others have said the outbreaks aren’t solely the responsibility of the plants but are also a “community issue.”

Most workers in the plants tend to be immigrants and refugees, and many live in extended family households and among tight-knit communities. But advocates point out that immigrants working in other industries aren’t seeing the same kinds of explosive outbreaks, pointing to the packing plants as the primary driver.

Meanwhile as the illnesses mounted, the president last week signed an executive order requiring the plants to stay open to protect the food supply. Many have nonetheless suspended operations.

Nearly all the plants report doing the same things to try to arrest the virus. They’re using thermal scans to identify employees with elevated temperatures; handing out more personal protective equipment; installing acrylic shields and other barriers; and increasing the amount of cleaning and sanitation.

But the spread continues, hitting more plants every week.

So what is the answer? A team of Hewlett’s UNMC colleagues have been working on it, last week releasing a list of recommendations it’s hoped can make a difference.

Pavia said it will be interesting to see how many new packing plant outbreaks pop up in the weeks ahead.

Overall, Pavia said what all the numbers in The World-Herald analysis show is there really is no such thing as a national outbreak in this pandemic, or even a state outbreak.

In every county around the country where the lethal virus has taken hold, the reasons, the circumstances, the victims and the outcomes have proven in some way unique.

Said Pavia: “Every outbreak tells a story.”

World-Herald staff writer Erin Duffy contributed to this report.

Top 25 counties with the highest per-capita rates of COVID-19 infection