The highest COVID rates in California move to rural areas


Most of us know the good news: In recent weeks, COVID-19 infection and death rates have dropped in California, falling to levels not seen since the early days of the pandemic. The average number of new COVID infections reported each day has dropped by a staggering 98% from December to June, according to figures from the California Department of Public Health.

And reinforcing this trend, nearly 70% of Californians 12 years of age or older are vaccinated in part or in whole.

But state health officials still report nearly 1,000 new COVID cases and more than two dozen COVID-related deaths per day. So where does COVID continue to look in California? And why?

An analysis of the state data shows some clear patterns at this stage of the pandemic: As vaccination rates increased throughout the state, the overall number of cases and deaths fell. But in this broader trend regional discrepancies are pronounced. Counties with relatively low vaccination rates reported much higher rates of COVID infections and deaths in May and June than counties with high vaccination rates.

There were about 182 new COVID infections per 100,000 population between May 1 and June 18 in California counties where less than half of residents age 12 and older had received at least one dose of vaccination, CDPH data show. show. In comparison, there were approximately 102 COVID infections per 100,000 residents in counties where more than two-thirds of residents 12 years and older had obtained at least one dose.

“If you live in an area that has low vaccination rates and you have few people who start to develop a disease, it spreads rapidly among those who are not vaccinated,” said Rita Burke, assistant professor of clinical preventive medicine at the University of Southern California’s Keck School of Medicine. Burke noted that the highly contagious delta variant of the coronavirus currently circulating in California amplifies the threat of severe outbreaks in areas with low vaccination rates.

While the model is clear, there are exceptions. A couple of sparsely populated mountain counties with low vaccination rates – Trinity and Butterfly – also had relatively low rates of new infections in May and June. Similarly, a few suburban counties with high vaccination rates – among them Sonoma and Contra Costa – had relatively high rates of new infections.

“There are three things that are happening,” said Dr. George Rutherford, professor of epidemiology and biostatistics at the University of California-San Francisco. “One is the vaccine – very important, but not the whole story. One is of course the acquired immunity, which is huge in some places.” A third, he said, is that people are still able to evade infections, either by taking precautions or simply living in areas with few infections.

As of June 18, about 67% of Californians 12 years of age and older had received at least one dose of COVID vaccine, according to the state health department. But that masks a wide variance between the state’s 58 counties. In 14 counties, for example, less than half of residents 12 years of age or older had received a stroke. In 19 counties, more than two-thirds had.

Accounts with low vaccination rates are largely rough and rural. Almost all are politically conservative. In January, about 6% of the state’s COVID infections were in 23 counties where a majority of voters voted for President Donald Trump in November. In May and June, this figure had risen to 11%.


While surveys indicate that policy plays a role in vaccine testing in many communities, access remains a problem in many of California’s rural outposts. It can be difficult, or at least inconvenient, for people living far from the nearest medical facility to get two strokes a month.

“If you have to drive 30 minutes outside to the nearest vaccination site, you may not be inclined to do that versus if it’s five minutes from your home,” Burke said. “And so we, the public health community, recognize it and we’ve really made a concerted effort to eliminate or alleviate that access problem.”

Many of the counties with low vaccination rates had relatively low infection rates in the early months of the pandemic, largely due to their remoteness. But when COVID reaches those communities, this lack of previous exposure and acquired immunity magnifies their vulnerability, Rutherford said. “We’re going to see cases where people aren’t vaccinated or where there’s been a high level of immunity already,” Rutherford said.

When it becomes clear that new infections will be disproportionately concentrated in areas with low vaccination rates, state officials are working to convince Californians hesitant to get a vaccine, even introducing a lottery of vaccines.

But the most persuasive are friends and family members who can help combat rampant misinformation in some communities, said Lorena Garcia, associate professor of epidemiology at the University of California-Davis. Devaluing people for their hesitation or getting into a political argument will probably not work.

Speaking to his skeptical parents, Garcia avoided the policy: “I just explained all the questions they had.”

“Vaccines are a good part of our lives,” he said. “It’s something we’ve been doing since we were kids. So, it’s just something we’re going to do again.”

Phillip Reese is a data reporting specialist and an assistant professor of journalism at California State University-Sacramento.

This story was produced by KHN, which publishes California Healthline, an independent publishing service of the California Health Care Foundation.

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