Things Were Not Okay Before. They REALLY Aren’t Okay Now.

Things are not okay.  I’ve been opening articles and other things I’ve written about rural America with that sentence for months.  I started using it because it’s a concise, snappy assessment of the overall situation in rural communities, like mine.  I wanted to make the point that the general feeling that many people have that “there are things we need to work on, but we’re doing okay” is fundamentally incorrect for most of rural America.  Things were, most definitely, not okay.  Given what has happened in the last couple of months, “things are not okay” seems like a bit of an understatement.  Things were not okay before.  Rural America was in crisis before.  Most rural communities were in a slow, decades-long decline, thanks to fundamental changes in the local and global economy and to populations that were declining in numbers and getting older, poorer and sicker day by day.  These changes meant that many rural communities were becoming less and less viable, moving toward a point where the productive capacity of the community drops below the resource needs of the community, at which point it is no longer viable.  How far down the road that point was varied widely from place to place, depending on many local factors, but it was always coming on the horizon.

Then comes SARS CoV-2.  The novel coronavirus.  COVID-19.  The first true, global pandemic in over a century.  It was inevitable and probably overdue.  We have been able to avoid a few potential pandemics in the recent past, thanks to huge advances in global disease surveillance and public health capacity.  We dodged the first SARS (which stands for severe acute respiratory syndrome) in 2002, the H1N1 flu in 2009, MERS (middle east respiratory syndrome) in 2012, and a couple of major Ebola flare-ups in 2012 and 2018.  In late 2019, our luck ran out.  As of this writing, over 2.2 million people have been confirmed to be infected, worldwide, and 151,000 people have died.  In the US, the case number was 685,000, with over 34,000 dead.  The actual numbers of people infected and killed by the virus are undoubtedly many times these figures, due to limitations in testing and reporting.

The US was very slow and very unprepared to respond to the gathering storm.  The first deaths attributable to the novel coronavirus SARS CoV-2 occurred in China in November of 2019.  The coronavirus itself was identified as the cause and the first large cluster of cases of COVID-19 (the disease caused by the virus) were reported to the World Health Organization on December 31.  The first case appeared in the US on January 21, 2020 in an individual in Washington state who had traveled to the epicenter of the outbreak, Wuhan, China. China introduced a strict lockdown in Wuhan on January 23.  The WHO issued a global health emergency proclamation on January 30.  On February 20, the first major collapse of stock prices hit, with the US stock market eventually dropping over 20%.  The first case of “community spread” COVID-19 (meaning the disease was acquired from the environment, not from travel or direct contact with an infected person) in the US occurred on February 26.  The first COVID-19 death was on February 29.

On March 3, the CDC lifted its restrictions on testing for the coronavirus.  Previously, the only people who could be tested were people who had traveled to a place with an extensive outbreak and who had severe symptoms of COVID-19.  The numbers of people getting tested slowly started to increase, although very slowly.  Testing remains very far behind, so the true number of infections is still not known.  On March 13, two and a half months after China first reported the epidemic and six weeks after the WHO proclamation, the US declared a state of emergency, although no steps were taken.  On March 17, SARS CoV-2 infections were confirmed in all fifty states.  California enacted the first widespread stay-at-home orders in the counties surrounding San Francisco.  As the coronavirus spread around the world and as stay-at-home orders and closings of non-essential businesses expanded, the worldwide economy, predictably, imploded.  In the four weeks following the emergency declaration in the US, over 20% of the workforce has become unemployed, not counting many of those who were self-employed.  Service industries, like hotels and restaurants, as well as small businesses have been particularly impacted.

Hopkins County, my home in rural western Kentucky has been hit hard, both in terms of COVID-19 and economically.  Despite being a rural county with only about 45,000 residents, we have the third-highest number of confirmed COVID-19 cases in the state, trailing only the counties where Louisville and Lexington, our two largest cities, are.  The only saving grace is that we are home to a large, regional hospital that is better equipped than most rural hospitals to deal with the volume of patients the virus will cause.  Paradoxically, the pandemic has actually put a huge strain on many rural hospitals, as they have suspended all elective procedures (which are the primary revenue-generating mechanisms for most hospitals).  Rural hospitals run on extremely thin profit margins (1% or 2%, if they aren’t actually losing money) in the best of times.  Most of them don’t have the financial reserves to weather extended periods of decreased revenues and increased costs incurred by dealing with large numbers of potentially infectious patients.

Humanity has survived many pandemics throughout history, including some that killed as much as 50% of entire populations, as the plague did in Europe in the 16th century.  The influenza pandemic of 1918-1919 killed between 30 and 50 million people, far more than the number of people who died in World War I.  This pandemic, too, shall pass.  It may pass in a few months and disappear into history.  It may trail off and then bounce back later this year, as many similar pandemic diseases do.  It may even become a recurring issue, in the fashion of the seasonal influenza epidemics we see every year.  One way or another, we will, at some point, move on from here.  But what then?  Beyond those who will be dead, beyond the families who have lost members, what’s next as we move back toward “normal”?  What is even the definition of “normal” going to be?  How we answer that question will define those of us who are living this. Are we going to learn the lessons that this global wake-up call has taught us at such cost?

There are all sorts of people in various halls of power who have been discussing how to restart the economy since before the first steps were taken to slow the spread of the disease by issuing the orders to keep people away from one another.  Eventually, there will be a plan, and that plan will outline what will happen, where it will happen and when.  The “when” part of the plan is probably the most important, because if we move too soon, all of the sacrifices of the first few months may be undone by a resurgence of the disease.  If we wait too long, there will just be more economic damage to repair.

Getting the economy moving again is, of course, of immense importance. Without the production of the economy, on all levels (global, national, state and local), we cannot maintain our society, our social infrastructure and services.  However, we also need to give very serious thought to what our “new normal” should look like.  This pandemic has shone a light on many things that we have not done well–things we need to change–and we are paying for the consequences.  Many things that a lot of us thought of as “social issues” are now proving themselves to also be “economic issues” or even “national security issues”.

Thanks largely to who I am, what I am and how I was raised, my conception of “social issues” was pretty rudimentary until I started to get “woke” about seven or eight years ago.  I’ve written before about how that process of awakening began.  In short, when I was still in academia, I went to a meeting that turned out to be about something other than what I thought it was going to be about.  We started talking about ways we, at the university, might be able to help the urban school distract in which our campus was located improve their science and math teaching. Over the course of the next thirty minutes, or so, my worldview of why some things are the way they are were completely blown up.  I realized that when I thought about education issues in struggling schools at all, my thoughts went about an inch deep into an ocean’s depth of interconnected issues.  What I came to realize–and the realization hit me like a baseball bat to the face–was that the main problems facing this school district didn’t lie in the schools.  They were actually in the homes, streets and neighborhoods were the students lived.  Issues that I thought were basically like “ ‘A’ is due to ‘B”, so adjusting ‘B’ will fix it”, are actually more like “’A’ is due to ‘B’, which is connected to ‘C’ and ‘D’, and to ‘E’ which impacts ‘C’ and causes ‘D’, which, in turn, sometimes causes ‘F’, which makes ‘B’ impossible, even though it isn’t directly connected to ‘A’ at all, so fixing ‘B’ won’t do any good, because ‘C’ and ‘D’ will only put ‘B’ back where it was, leading to no improvement in ‘A’, especially if ‘F’ happens, which makes ‘E’ worse, which multiplies ‘B’ by a factor of 10, and ‘A’ becomes irrelevant”.  In short, I didn’t even understand the reality of the problem, so I certainly couldn’t begin to understand how to address it. “Get better teachers” is not the simple and obvious answer to fixing poor outcomes in struggling schools, as I once thought.

Ever since then, I’ve been trying to understand how various causes are connected to effects, many of which would seem, at first glance, to not really be related.  In particular, since I got involved in community health, I’ve been trying to learn about and understand the links between socioeconomic factors and community health and the links between community health and economic prosperity, all colored by the various added complications of being rural.  One thing I’ve learned is that there are many fundamental issues of survival staring us in the face.

In 2019-2020 B.C (before coronavirus), I wrote and spoke quite a bit about the issues that I think are slowly killing rural America.  In 2020 A.C. (after coronavirus), the issues that were dragging rural places and rural people down are all turbocharged.  That horizon where many rural communities would collapse is now not 20 or 30 years down the road, but instead, it’s here.  Now.  We’ve also seen that some of these issues aren’t just rural—they are nationwide, or even global. So the question is, “What can we do about this?”.  Maybe a better question is “What are we willing to do?”  It’s a matter of survival.  Be sure to read my next article for some specific ideas on how we can take the lessons of this crisis and emerge on the other side a stronger, healthier, more prosperous society, particularly in rural America.

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