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COVID-19 disproportionately impacts North Carolina's poorest counties, especially in the northeast, which tend to be more rural and rely on farming and animal processing plants for economic growth, according to a study by UNC Public Policy. Nine of the top 10 counties with the greatest probability of death after infection are in the eastern part of the state.

The COVID-19 pandemic is far from an urban issue in North Carolina.

The disease disproportionately impacts poor and rural counties with higher concentrations of Black and Latino residents, according to data compiled by UNC Public Policy. As a result, high-poverty areas are more exposed to health, economic and education crises than more affluent communities.

“Our biggest takeaways as we did research …of the health impacts of the COVID pandemic were that the probability of death once infected with COVID-19 is higher in counties with greater concentrations of animal farms and meat processing plants,” said researcher Aditi Adhikari. “Additionally, counties with that same higher death to case ratio tend to have higher percent of the population living under the federal poverty line. And lastly, urban areas tended to follow the stay at home order a little bit more closely than rural areas.”

As of July 7, nine of the top 10 counties with the greatest probability of death after infection – at least 5.75% of cases – are in the eastern part of the state. Six counties have at least five animal farms or meat processing plants, which researchers believe can increase infection rates due to the lack of physical distancing among workers.

Seven of those counties – Northampton, Vance, Gates, Pasquotank, Hertford, Perquimans and Washington – are in the northeast near the Virginia border.

“A good number of the cases with very high death to case ratios are located in northeastern North Carolina,” researcher Coleman Evans said. “Additionally, six out of 10 of these counties have six or more animal farms, which we use as a proxy [for] their reliance on the meat processing and agricultural industries. Seven out of 10 of them have more than five, so we can see that these counties are highly agrarian and reliant on the meat processing industry.”

Another factor in the disparity of infection is adherence to Gov. Roy Cooper’s stay at home order, which urban residents were more likely to follow than their rural counterparts.
Using Apple Maps data to determine how often people used their mobile phones to locate destinations, usage fell more in cities.

“We saw that there was a sharp decrease in a lot of urban areas, cities such as Raleigh Charlotte and Greensboro, and overall North Carolina saw a decrease of about negative 24% in mobility during the stay at home order time from March 31 to May 8 with a sharp decrease in urban counties compared to rural counties,” researcher Valerie Lundeen said. “However, it's important to note that it's possible that just because you're in a rural county, you might have still been [likely to adhere] to stay at home orders but still have greater mobility because it takes a longer time simply to get places. The nearest grocery store might be 20 miles away instead of 10, so while we do have faith in these findings, it is important to take it with a grain of salt in the realities of urban spaces versus rural spaces.”

The economic impact has been pronounced on the poor, especially in food deserts. According to data from the Bureau of Labor Statistics and the state Department of Commerce, unemployment was higher in May than at the height of the Great Recession of 2008-10, especially in the west. Urban areas also lost more jobs – primarily in retail and service.

“We also looked at longer term mass layoffs those have soared to and over 21,000 jobs are not expected to return to North Carolina anytime soon,” researcher Valerie Lundeen said. “We saw that over 600,000 people were unemployed in North Carolina in May 2020. That translates to a 12.89% labor force unemployment rate compared to 10.6% in June 2009. Now, we did see some recovery in June 2020. The unemployment rate in North Carolina was 7.6%. So, who is unemployed.? Largely folks in the western half of the state have higher unemployment rates in April, which was when the spike occurred.”

As some jobs disappear for good, more unemployed people are leaning on stopgap measures to make do. Even that shows signs of disparity as poorer households are forced to spend more of their federal stimulus checks and unemployment benefits on necessities.

“The majority of North Carolinians use that check for expenses, meaning that there is not financial flexibility to be able to put that check into savings,” Lundeen said. “However, there's 82% of black residents had to spend their check whereas that number was only 53% of white residents and 18% of white residents were able to save their check. Thirty-seven percent of Hispanic or Latino respondents did not receive a stimulus payment at all, and this indicates that attempts to buffer the financial impact of this pandemic on households have not reached all groups equally.”

With job loss comes more reliance on social programs such as federal health insurance and food stamps.

“We've seen an enormous uptick in Medicaid enrollment,” Lundeen said. “From March to June 2020, there was a 4.8% increase in Medicaid enrollment. Another part of the social safety net is the SNAP program for grocery assistance participation. In the summer, it generally declines.”

From March to June, participation in the food stamp program jumped 14% compared to a 6% drop over the same period last year – fueled in part by eligibility expansion as a COVID-19 response by the state Department of Health and Human Services.

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