NASH COUNTY, N.C. (WTVD) -- Nearly twice as many new COVID-19 cases have been reported from rural counties in North Carolina compared to urban or suburban counties, according to a report released by the state Department of Health and Human Services this week.
The report also found COVID-19 related deaths in rural counties increased significantly, accounting for the majority of deaths statewide, compared with deaths in urban and suburban counties.
The report said the increase is driven by community spread, not congregate living settings like nursing homes or jails.
Nash County has 47 cases per 10,000 residents, with a test positivity rate of 8.1 percent. That's about the same as the state's right now but still higher than the state's goal of a 5 percent test positivity rate.
Brenda Dickerson lives in Spring Hope in Nash County.
"I hear of people having (COVID-19) but it's like kind of outside of town but it's still Spring Hope, you know," she said. "It's been interesting to hear when this person has it, this person has it."
Nia Fox lives in a rural part of Nashville.
"Somebody I work with had it but now she (doesn't) have it anymore."
Rocky Mount Mayor Sandy Roberson said people in rural areas might not realize that their casual social interactions can spread the virus.
"You can speculate lots of things," Mayor Roberson said. "Perhaps it just comes down to the fundamentals, you know. If I live in a sparsely populated area, I don't think as much about social distancing. Right, I'm already kind of sparsely populated as it is and so maybe the interactions might be more casual, may be not as seriously taken in terms of the impact of the infection rate that COVID does provide."
But Roberson said he's seeing something promising.
"I think there's been a heightened awareness and a greater seriousness associated with trying to mask up," Roberson said. "So I've seen a compliance rate that I think and feel like is a little bit higher than certainly what it was at the beginning of the pandemic. Perhaps we're seeing the increases, maybe we're just a little bit slower on the adoption curve or have been and maybe that's why we're seeing some of the increases that we are."
Alan Wolf, a spokesperson for Nash UNC Health Care in Rocky Mount, said they opened an additional COVID-19 unit in July and are able to convert other areas of the hospital if necessary.
Wolf said that as the number of COVID-19 cases continues to climb, especially in rural areas, UNC Health is confident all of its affiliated hospitals across the state are prepared to manage additional surges of patients.
He said Nash UNC's COVID-19 Task Force continues to enhance policies and safety measures as they learn more about the virus.
State data shows that in the last 14 days, most of the counties in North Carolina, with at least 40 cases per 10,000 residents, are rural counties.
In Columbus County, the percentage of positive tests spiked over 40 percent on Sunday. That's about five times the state average.
The hospital region spanning the western part of the state is reporting only 54 ICU beds are currently available.
In Central Carolina, Hoke County reported the largest percentage of positive tests at 14 percent.
Sampson, Halifax, Harnett and Johnston Counties are also seeing a high percentage of positive tests, between 7.9 and 9.9 percent.
Wake County's percentage of positive tests is at 5.4 percent, Durham's is at 5.8 percent and Orange County's is only 3 percent.
"All hospitals in our area, including Johnston Health, are running close to full census and have for several weeks," said Tommy Williams, President & CEO of UNC Johnston Health. "The high census is due to a combination of factors: COVID-19, non-COVID related illnesses, and the fact that our area is experiencing high population growth which equates to more demands for healthcare, including inpatient care."
However, Williams added that the region is ready to expand into emergency capacity.
"We have temporary, pandemic, emergency bed capacity that has been granted by the state in the form of 1,135 waiver beds. This allows us to safely expand bed capacity for areas that have the appropriate patient safety requirements; like oxygen, air, suction, and patient call alarms. However, the biggest challenge that all hospitals are faced with is not the bed capacity; but the personnel needed to staff these beds, like nursing, physicians, and respiratory therapists. The newly available COVID-19 treatments that will allow early intervention on an outpatient basis will hopefully help to alleviate some of the inpatient bed demands if it can keep patients from getting sick enough to require hospitalizations."
Health officials also said lack of access to testing and inability to isolate could also contribute to spread.
"We are seeing an increase in cases, some related to small gatherings and household contacts," said Johnston County Public Health Department director Dr. Marilyn Pearson. "There are some that may have difficulty accessing testing and isolating or quarantining per recommendations. To that end, we are working with the state and our partners to increase testing opportunities and to provide support for those isolating and quarantining."