As Covid-19 spills beyond major metropolitan areas, federal, state, and local officials across the country are scrambling to prepare for an onslaught of cases in smaller communities. The dashboard below uses a host of factors — everything from the relative age of the population to the number of nearby hospital beds and staff — to determine which counties are best prepared for an outbreak and which might need more help.

This tool will be updated with new datasets in the future, based on additional reporting and reader input. You can participate by sharing your ideas. What kind of data should we explore next? Let us know.

To produce this dashboard, STAT partnered with Applied XL and the Center on Rural Innovation to come up with a way to assess every U.S. county’s level of preparedness for the Covid-19 pandemic.

The map takes into account a number of different factors, including residents’ access to care, their risk for severe Covid-19 infections, and a county’s overall vulnerability. It also incorporates data from a Covid-19 model that forecasts the impact of the pandemic at the state level to the county level. The overall county preparedness score is an unweighted average from five pillars that is scaled from 1 to 100.

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The aim was to help others anticipate which specific areas of the country were most susceptible to the dangers of the pandemic, said Matt Dunne, the executive director of the Center on Rural Innovation. And the data highlight the looming challenges for rural communities, which often have particular vulnerabilities.

“A lot of the early analysis was both reactive and urban in nature, because that’s where the pandemic spread earliest,” Dunne said. But with case counts rising in rural areas, he said, these places could start feeling the full effect of the pandemic soon.

The model is based on five variables:

  1. The number of licensed hospital beds within a 40-minute drive. This was used to estimate the physical capacity of a community, as a way to assess how ready hospitals are to handle a surge of cases. The pandemic comes after years of dozens of rural hospital closings.
  2. The number of critical care staff within a 40-minute drive — a measure of the human resources. In addition to lacking the health infrastructure of cities, rural areas have fewer specialists, nurses, respiratory therapists, and other health care workers who would be needed to handle local outbreaks.
  3. The percentage of the population age 65 and older. Older people who contract the coronavirus are more likely to need medical care and to die from the infection than others.
  4. The county’s score on the Social Vulnerability Index, a ranking from the U.S. Centers for Disease Control and Prevention that measures resiliency to natural disasters and disease outbreaks. The score takes into account such factors as poverty, access to transportation, and housing.
  5. Data from the University of Washington’s Institute for Health Metrics and Evaluation’s Covid-19 model. The developers of the STAT tool used the model’s estimate of the ICU bed shortage to assess the severity of the pandemic in each county at a given time and to forecast how bad it could get.

Because the IHME’s model changes, the map that lives on this page will be updated as well.

“The impact of health conditions is often out of proportion in rural areas,” said Robert Greene, a population health expert and former executive at UnitedHealthcare and New Hampshire’s Dartmouth-Hitchcock Medical Center, who consulted on the project. “Rural areas already have issues with access, being older, more chronic diseases. That makes them a vulnerable population.”

The methodology underlying the map does not take into account other important factors, such as rates of insurance coverage or the migration of people from cities to rural areas, a movement that centered on places where there are lots of vacation homes. It also does not directly factor in choices of local and state governments or how well-funded local agencies are.

The IHME model that the map relies on is just one of several forecasts for the pandemic. It is influential, reportedly guiding aspects of White House decision-making, but it also offers rosier views than some other models.

— Andrew Joseph

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