Since the onset of COVID-19, public health leaders have emphasized reducing the rate of viral spread to ensure that hospitals did not become overwhelmed. On December 15, 2020, the U.S. Department of Health and Human Services published weekly data on each individual hospital's status on indicators for acute management of COVID-19 patients. These data were analyzed to compare the percentage of hospitalized patients with COVID-19 in rural versus urban hospitals.

Rural hospitals have a higher percentage of patients with COVID-19 than urban hospitals. Figure 1 shows that, although it has been increasing in both urban and rural hospitals, the percentage of patients with COVID-19 has been four to six percentage points higher in rural hospitals since October.

The percentage of hospitalized patients with COVID-19 is higher in rural hospitals than in urban hospitals in most census regions. The percentage of hospitalized patients with COVID-19 is higher in rural hospitals than in urban hospitals in the Midwest and South and about the same in the Northeast and West. Figures 2 and 5 show that the difference between rural and urban hospitals in the South have largely remained constant, and the difference in the Midwest grew considerably.

Policy implications: A higher percent of hospitalized patients have COVID-19 in rural hospitals than in urban hospitals. Because staffing can be more difficult to maintain in rural hospitals, the higher exposure in rural hospitals may put their staffs – and the hospitals they work in – at greater risk to maintain peak care capacity.