Rural Iowa counties hit hardest in COVID-19’s first year

Some of the most horrific scenes early in the COVID-19 pandemic were in places like Italy and New York, where hospitals became overwhelmed with ailing and dying patients.

The images were jarring, but those tragedies were taking place thousands of miles away in large cities.

COVID-19 hit Iowa differently: After nearly a full year of the pandemic here - Monday marks the grim one-year anniversary -- data show the state's rural areas, not its biggest cities, have been hit hardest by the virus.

None of the 18 Iowa counties with the highest rates of COVID-19-related deaths per capita has a total population of more than 17,000 people, according to state public health data and U.S. census figures.

Harrison County, in western Iowa, has the highest COVID-19 death rate among the state's 99 counties. In a county of just over 14,000 people, 70 have died of COVID-19-related causes, state public health data show.

For comparison's sake, that equates to nearly 500 deaths per 100,000 people, which is more than triple the national average.

Five more rural Iowa counties - Ida, Emmet, O'Brien, Ringgold and Adair - also have COVID-19 death rates higher than 400 deaths per 100,000 people. The U.S. average is 155.

Measured in deaths per capita, the state's largest population centers do not show up until the second half of the county rankings:

Black Hawk County, home to Waterloo and a population of over 130,000, has had the 45th-highest COVID-19 death rate during the pandemic's first year.

The virus death rate for Johnson County, home to Iowa City, is 50 per 100,000 people, and the rate in Story County, home to Ames, is 46.

The high COVID-19 death rates in the rural counties may have been driven by outbreaks of the virus at nursing homes and long-term care facilities, and at food processing plants.

HARRISON COUNTY

The symptoms of COVID-19 are more dangerous to individuals who are older or who have serious health conditions.

In Harrison County, which has suffered the greatest death toll per capita in the state, 96 percent of those who died from the virus were at least 60, and 57 percent were at least 80, public health officials said.

The majority of those deaths occurred between late September and November when the county saw positivity percentage rates in the high 20s and low 30s. During that time, there were outbreaks in three of the county's four long-term care facilities, located in Missouri Valley, Woodbine and Dunlap.

Similar outbreaks occurred across the state, especially early in the pandemic. Nearly 2,200 residents of long-term care facilities in Iowa have died of COVID-19-related causes, state public health data show.

Still, the devastation seen in long-term care facilities puzzled Harrison County Home and Public Health Administrator Brian Brake.

'I saw firsthand how careful and cautious those facilities were,” Brake said. 'I don't know if it was sheer number of residents compared to other facilities, that's total conjecture, but we were on those calls (with facility staff and state health officials), and we were with them every step of the way. I can't say why they were impacted more than others.”

In early November, county officials passed a local face-covering mandate - only the third county in the state to impose such a requirement at the time. The mandate did not include penalties for those in violation, but Brake believes it helped.

'You saw the signs on doors of businesses and, over time, there were more (residents) wearing them than not wearing them,” Brake said. 'I'd like to think, because we did get hit so hard, that people are taking those precautions and it has led to the lowering of the numbers.”

Recently, Harrison County is seeing its positivity numbers decrease. As of last Tuesday, the county had 48 active cases of COVID-19, the lowest since mid-September.

The county is vaccinating residents as quickly as it can once the county receives its weekly, 200-dose allotment of the Moderna vaccine, Brake said. The county's long-term care facility clients and staff have received their vaccinations, and he is working with facility administrators to ensure all new clients and staff members receive vaccines as soon as possible.

O'BRIEN COUNTY

Local public health officials also believe long-term care outbreaks were the primary driver of a high death rate in O'Brien County. The northwest Iowa county with just fewer than 14,000 residents has, with its 58 COVID-19-related deaths, the state's fourth-highest COVID-19 death rate per population.

Kim Morran, the director of the O'Brien County Public Health Department, and Misty L. Dulin, the director of MercyOne Primghar Medical Center, pointed to virus outbreaks at long-term care facilities.

All counties in northwest Iowa suffered long-term care facility outbreaks at one point or another, and often were faced with several simultaneously. O'Brien County was no exception.

Morran said every nursing home in the county had an outbreak at some point, although one nursing home in Hartley managed to control the virus.

As with most of the rest of the state, the pandemic picture in O'Brien is much brighter these days. There are no long-term care facilities dealing with outbreaks, and it has been nearly two months since the county has experienced a COVID-19-related death, according to data.

O'Brien County also has been allocated 200 doses of vaccine per week. Numerous, smaller vaccine clinics have been held in the county, and as of Wednesday more than 1,000 residents had completed the vaccine while another 1,600-plus had their first dose.

'There's a lot of anxious people, excited to get the vaccine,” Dulin said. 'Our staff, everybody that chose to get it have received it.”

TAMA COUNTY

With a population of nearly 17,000 and 65 COVID-19-related deaths, Tama County is sixth on the list of deaths per capita in Iowa, according to state public health data.

The county is home to the Sac and Fox Tribe of Mississippi in Iowa, or Meskwaki Nation, which is continuing to hold vaccination clinics for Native Americans, according to the tribe's health director, Rudy Papakee.

The Meskwaki are the only federally recognized Native American tribe in Iowa and are receiving vaccines through the federally funded Indian Health Service.

As of March 1, over 740 individuals had been vaccinated through the Meskwaki clinics. The health clinic receives 100 Moderna vaccines some weeks, but other weeks it has received none.

A year into the pandemic, 329 community members and employees affiliated with Meskwaki businesses have contracted COVID-19, and six have died of COVID-19-related causes. An estimated 1,200 Native Americans live in the Meskwaki community.

'I think one of the biggest challenges was the initial hesitation - people thinking this (COVID-19) can't hurt them or that it's just like the flu,” said Papakee, who has served in the role for a decade. 'Over time, people learned to understand that something serious can happen if you catch or your elders catch it. The loss of six community members is tough for us.”

LOUISA COUNTY

The pandemic hit Louisa County hard, too. With just over 11,000 residents, its 44 deaths makes for the seventh-highest rate in Iowa.

A Tyson food processing plant brought people from different parts of the world to the small community of Columbus Junction. That plant was the site of the state's first confirmed COVID-19 outbreak at a food processing plant, but was far from the last. More than 500 workers were infected during the early April outbreak at the Columbus Junction plant, and two died.

'Tyson brought people from Mexico and a Burmese population, and you just have to walk down Main Street to know the impact,” said Tammy Virzi, editor of the Columbus Gazette, the town's weekly independent newspaper. 'But COVID-19 brought plenty of struggles for all these small businesses. I've been really worried and I'm very relieved to see things opening up again.”

In both Columbus Junction and nearby Wapello, one does not have to go far to find someone who has dealt with the virus in personal terms.

Everyone called James Hill by the nickname 'Pete.” He died April 17, 2020, at age 72 of COVID-19-related causes.

Pete and future wife Carol met in Muscatine, when they worked at what was then a Monsanto plant. They moved to Wapello and back into the home where Pete was born and raised.

'Pete ended up delivering papers for the Wapello Republican,” said Carol Hill, his wife of 40 years. She thinks her husband contracted the virus while on his route.

'He'd stop in gas stations and he had his favorite ice cream shop,” she explained. 'He went into the shop and the lady there told him not to touch anything because a customer who was sick and coughing all over had just been in. The lady said that customer was on the way to Iowa City for a COVID-19 test.”

MITCHELL COUNTY

For Mitchell County, home to roughly 10,600 people and right on the Minnesota border, the worst month of the COVID-19 pandemic was November. With 40 COVID-19-related deaths, the county had the state's 11th-highest death rate.

Laura Huisman, the Mitchell County Home Health Care and Public Health administrator, does not remember tangible specifics from November - things can start to blur together after 365 days of dealing with a pandemic - but she knows for certain she was busy.

Around that time, Huisman said that four of the county's five nursing homes were dealing with COVID-19 outbreaks, which tested not just the facilities' staff but public health staff.

'We don't have much staff. We're a very small entity. It's just been a couple of us here,” Huisman said. 'I would say some of our staff have been working overtime hours since March of last year, from five to 20 or 30 hours overtime” a week.

Despite such a sobering impact, Huisman said she sees worthwhile learning experiences from the pandemic.

'We've taken it on very well, but we've learned what we should've done before all of this,” she said. 'Before the pandemic, we were always known as Home Health and now the tables have turned a little bit.”

Courtney Brummer-Clark, Mason Dockter, Tom Loewy and Jared McNett of Lee Enterprise newspapers in Iowa, and Gage Miskimen and John McGlothlen of The Gazette, contributed to this report.