COVID-19s Sun Belt surge has recast the pandemics impact – Brookings Institution

Just as all 50 states reopen from their public health lockdowns, a new wave of COVID-19 cases is hitting parts of the nations Sun Belt, areas that had not felt much impact during the pandemics early months. In the three weeks following Memorial Day, new cases have ticked up sharply in southern and western states. This Sun Belt surge has led to new rates of high COVID-19 prevalence in many smaller-sized rural counties that are less racially diverse, have more middle-income residents, and lean Republican.

This analysis extends our monitoring of the spread of counties with a high COVID-19 prevalence from April and May. Even more so than in earlier reports, the new surge is hitting parts of the country that national and local leaders thought to be immune to the pandemic just one month ago.

While its true that the nationwide number COVID-19 cases has declined in recent weeks, that has not been the case for every part of the country, especially states in the Sun Belt region. For the three weeks between Memorial Day (May 25) and June 14, 27 states showed an increase in COVID-19 cases compared to the three previous weeks. Twenty-four of these states are in the Sun Belt, with the greatest increases in California, Arizona, Florida, Texas, and North Carolina. States showing the greatest declines in new cases include the earlier hotspots of New York, Illinois, New Jersey, and Massachusetts.

A notable aspect of the Sun Belt surge is its dispersion into outer suburban, smaller, and nonmetropolitan counties. Figure 1 depicts the contrast in regional shifts over the six-week period between May 3 and June 14 for new COVID-19 cases per 100,000 population.

Nationally, the biggest shift is the downward trend of new cases for urban core areas, along with lower levels but modest recent gains for mature inner suburbs, outer suburbs, and small and nonmetropolitan areas.

Not surprisingly, the national declines in urban cores are most represented in counties in the Northeast and Midwest region. Among those showing large declines in the three weeks after Memorial Day were counties associated with metropolitan New York, Boston, Philadelphia, and Chicago.

Sharply countering this pattern is the uptick in COVID-19 cases among counties of all urban categories in the South and West. Over the same three weeks, the urban core and inner suburb counties of Miami, Atlanta, Houston, Phoenix, and Charlotte, N.C. registered notable gains.

A more dominant feature of the Sun Belt surge, however, is the increase in COVID-19 cases in outer suburban and smaller-sized counties. Among the 342 counties where cases of COVID-19 increased by more than 100 per 100,000 residents during the three weeks after Memorial Day, nearly four out of five are located in the Sun Beltthe vast majority of which (252 counties) lie outside urban cores and inner suburbs. Large numbers of the latter counties are located in Alabama, Georgia, North Carolina, Mississippi, and Texas.

This new surge of COVID-19 cases is also noteworthy because of the demographic attributes of residents in newly impacted counties, which are much different than those of earlier months. To examine this shift, we extend our earlier analysis to compare counties which reached high COVID-19 prevalence between May 25 and June 14 with those that reached high prevalence in April and early May. (We define high prevalence as at least 100 cases per 100,000 population based on case data reported by The New York Times and 2019 population data reported by the U.S. Census Bureau.)

Map 1 provides a spatial overview of the evolution of high COVID-19 prevalence counties from late March to June 14. On March 29, 59 countiesconstituting just 8% of the U.S. populationhad reached high-prevalence status. These were heavily concentrated in select large metropolitan regions, including New York, Detroit, Seattle, and New Orleans.

During the four-week period between March 29 and April 26, new high-prevalence counties spread further across the country, eventually housing 57% of the population. These included an array of metropolitan areas such as Chicago, Atlanta, Miami, San Francisco, Los Angeles, and Washington, D.C.but also large swaths of counties in the Deep South and Midwest.

The four-week period between April 27 and May 24 saw greater COVID-19 spread into the South and West, dipping into some smaller areas in all regions and extending into Texas, Virginia, and other parts of the interior South. By then, 83% of the nation resided in the nearly 1,700 high-prevalence counties.

The most recent three-week period between May 25 and June 14 added 436 counties to high-prevalence status. As noted earlier, they represent a new surge into the South and West, with 270 counties located in those regions and large representations in Texas (46 counties), Kentucky (35), Tennessee (23), and Arkansas (20). While some of these counties are located in and around larger metro areas such as Sacramento, Calif., Portland Ore., and Ogden, Utah, the vast majority lie within smaller areas.

The contrast in demographic profiles between these new high-prevalence counties and those from late March and early April is striking. As Figure 2 indicates, less than 2% of new high-prevalence county residents live in urban core areas, with nearly three-fifths in small or nonmetropolitan areas. This differs sharply from the heavily urbanized picture of COVID-19s impact as of March 29, when four-fifths of the affected population lived in urban cores. Similarly, the newly designated high-prevalence counties are more heavily located in the South and West (78%) than earlier groups of counties.

The contrast is also apparent when looking at counties race-ethnicity attributes, foreign-born residents, and household income rates. Newly designated high-prevalence counties are nearly 70% white, but in high-prevalence counties from the end of March, more than half of residents identified with a racial or ethnic group other than white. Similarly, the new counties show the lowest representation of foreign-born residents (8.2%) and the lowest share of households with incomes above $100,000 (23.2%) out of all the groups of counties previously designated with high COVID-19 prevalence.

Perhaps the most pronounced difference between the early high-prevalence counties and those reaching high-prevalence between May 25 and June 14 is their political orientation. Early high-prevalence counties were strongly Democratic when looking at how their residents voted in the 2016 presidential election, with Hillary Clinton besting Donald Trump by a margin 62 to 34 in those areas (See Figure 2). But among residents of the new high-prevalence counties, Trump bested Clinton by a margin of 58 to 36.

One can see COVID-19s spread to red America in the counties that reached high prevalence between April and early May. In counties designated with high prevalence between March 30 and April 26, Clintons lead was reduced to a margin of 53 to 41. Among counties designated between April 27 and May 24, Trump took a 50 to 44 lead. This change coincides with shifts of high COVID-19 prevalence to redder states and smaller, more Republican-leaning counties within those states.

When looking at the number of counties designated as high-prevalence, Table 3 makes plain that the ratio of Trump counties to Clinton counties increases with each period. In general, Trump counties tend to be smaller, so for each period since late March (even including the March 30 to April 26 period, when Clinton was still besting Trump in the voter margin) there were more Trump counties than Clinton ones among those newly designated with high COVID-19 prevalence.

That ratio increased over time, and among the newest tranche of 436 high-prevalence counties from May 25 to June 14, Trump won all but 32. Over half of these Trump counties are located in the South, with large representations in Texas, Virginia, North Carolina, and Tennessee. Over a third are in the Midwest, with many in Iowa, Kansas, Minnesota, and South Dakota. COVID-19s spread to more Republican counties should change early assumptions that the pandemic has been confined to largely Democratic states and areas.

COVID-19s post-Memorial Day surge to new areas of the Sun Belt casts a light on where and who the pandemic will impact in the months ahead. The reopening of many states and communities thought to have overcome exposure may need to be reconsidered. In addition, the early politicization of the pandemic by the president and other public officials (which suggested that red parts of America need not be concerned with excessive protections) is looking like bad adviceand could become political fodder for their electoral opponents in November, should the virus continue to spread.

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COVID-19s Sun Belt surge has recast the pandemics impact - Brookings Institution