Galax, a small city in Southwest Virginia with less than 7,000 residents, was ranked first among 300 other high-poverty counties for its COVID-19 death rate. (Kate Masters/Virginia Mercury)
Galax, a small city in southwestern Virginia with less than 10,000 residents, is ranked first among 300 other high-poverty localities for its rate of COVID-19 deaths, a new report found.
It’s not the first time the city has attracted attention for the high toll the COVID-19 pandemic has taken on its community. In the summer of 2020, a White House report listed Galax as one of Virginia’s coronavirus “red zones” and The New York Times reported it had the highest case rate in the state. Breanne Forbes Hubbard, population health manager for the Mount Rogers Health District, said in an interview Tuesday that the city had some of the first outbreaks in the region and still has a far higher cumulative case rate than other parts of Southwest Virginia, including the city of Bristol less than two hours away.
But understanding why Galax has been hit so disproportionately is still a major challenge for researchers. The city was ranked as part of a national report on the relationship between poverty and severe COVID-19 outcomes, conducted by the United Nations Sustainable Development Solutions Network in collaboration with other nonprofit partners, including the Poor People’s Campaign and Howard University. Researchers sorted more than 3,000 U.S. counties into 10 different groups by median income, comparing coronavirus death rates by wealth.
People will say, ‘Well, relatively few people have died.’ But the impact of a few people dying in a small community is great, and the loss of any one person is deeply impactful to the people who love them.
– Alainna Lynch, senior research manager for the United Nations Sustainable Development Solutions Network
“What we found is that poor communities grieved more losses than rich communities,” said Alainna Lynch, a senior research manager for the United Nations nonprofit. Across the country, COVID-19 death rates in the lowest-income group were double those of the highest-income group, the report found. And counties with the most people living in poverty had death rates that were 1.5 times higher on average than counties with the least people living under 200 percent of the federal poverty line — a measure that equates to an income of roughly $36,290 a year for a household of two.
Galax had the highest death rate among the poorest tenth of communities ranked across the country. At 1,134 COVID deaths per 100,000 people, the city joined dozens of small, rural localities — including Emporia and Martinsville — with higher rates than urban centers like the Bronx.
For a city of approximately 6,720, it translates to 72 deaths since the start of the pandemic, according to the report (the Virginia Department of Health listed 77 total COVID deaths in Galax as of Tuesday). Forbes Hubbard said the community’s small population contributed to a rapid rise in rates, but the impact of COVID has still had a palpable effect on Galax, despite the seemingly small tally.
“We’re focusing in on these poor counties that have become invisible sometimes because they’re quite small,” Lynch added. “People will say, ‘Well, relatively few people have died.’ But the impact of a few people dying in a small community is great, and the loss of any one person is deeply impactful to the people who love them.”
The report is one of the first to examine the connection between COVID-19 outcomes and county-level poverty data, quantifying the disproportionate impact of the virus on low-income communities. Lynch said that’s become especially important given the emergence of “essential workers,” a category often used to describe low-wage employees who aren’t able to work from home.
Poverty is a risk factor for a range of poor health outcomes, including chronic disease and lower life expectancy. But inconsistent and often low-quality data collection on the part of state and federal health agencies has limited insight into COVID-19 outcomes and the contributing factors.
According to Lynch, information on income, wealth and occupation is rarely — if ever — collected in the case of coronavirus deaths. So while national data can illustrate the discrepancy in poor outcomes between high and low-income communities, it can’t tell us exactly who’s dying and why.
“We still don’t know, even in the richer communities, was it the essential workers who died, was it the very wealthy who died,” Lynch said. “We just don’t have that information.”
The report does underscore racial and geographic disparities, showing that counties with larger populations of Black residents, for instance, experienced disproportionately higher death rates. Poor communities are also disproportionately represented in the southwestern and southeastern United States, where 76 percent of counties with the highest percentage of people living in poverty are located.
But the data doesn’t explain whether essential workers made up a significant share of COVID-19 deaths or whether other factors played a role, from existing health conditions to a lack of transportation or easy access to health care services.
“That’s the type of thing that would be so helpful for us to know,” Forbes Hubbard said. “We have, say, county health rankings, so I can go look and see how many people in Galax are underinsured.”
“But like with all health data, it’s several years old and it’s in aggregate,” she added. “I can’t go look and say, ‘Okay, what are the specific issues that are impacting the community right now?’”
Earliest cases on farms and in factories
Vaccination rates play a role, but Lynch said they don’t fully explain the statistical discrepancies in death rates between different counties and income levels. In Galax, for example, just over 75 percent of adults are fully vaccinated, a figure far higher than surrounding counties and one that speaks to the serious impact of the virus on the community, according to Forbes Hubbard.
The area has an older population, and at least 23 of the city’s deaths occurred among residents of a local nursing home. But income has likely played an important role in case and death rates since the start of the pandemic.
Many of the earliest COVID outbreaks in Galax occurred among the city’s Hispanic community, who help sustain the region’s surviving factories and farms. In August of 2020, Father Herman Katongole, the pastor at St. Joseph’s Catholic Church, said some of his Latino congregants told him they couldn’t take sick leave even if they were actively displaying symptoms.
And while most of the city’s manufacturers closed their doors for a few weeks under Virginia’s initial stay-at-home order, the state was already reopening when Galax recorded its first cases. “I think a lot of people who could work from home did work from home,” Forbes Hubbard said. “But I think we also had a lot of folks in our region who still needed to go into work and were continuing to be exposed.”
The issue isn’t unique to Galax. Lynch pointed to one worker surveyed as part of the report, who said he tried to get tested for COVID-19 but didn’t receive the results for 17 days. With limited leave and few other avenues for testing, he went back to work despite not knowing his status.
“It feels important to note that we found a way to use research and statistics to highlight patterns of inequality nationwide,” Lynch said. “But it’s not like this was the only way to know this was happening.”
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