Staff photo by C.B. Schmelter / Nurse Melissa Bailey collects a sample at DeKalb Regional Medical Center's drive thru COVID-19 testing site on Thursday, July 16, 2020 in Fort Payne, Ala.

Rural counties surrounding Chattanooga are experiencing their own spikes in COVID-19 cases in the past two months as the city reported a downward trend.

While fewer people live in rural areas, the impact of the virus can be even larger in less densely populated places. Residents of rural communities typically skew older, experience higher rates of chronic disease and are less likely to have health insurance or access to quality medical care — factors that put them at higher risk for serious and fatal COVID-19 infection.

According to an analysis by the Times Free Press, Grundy County, Tennessee, and DeKalb County, Alabama, are reporting the most serious spikes in new cases in the past week when accounting for differences in population.

As of Wednesday, the pandemic had killed at least 482 people in a 21-county region including Tennessee, Georgia and Alabama. On Monday, longtime Manchester, Tennessee, Mayor Lonnie J. Norman died of COVID-19 after being hospitalized with the virus.

Of the total deaths in the region, 103 have occurred in Hamilton County — which has a population of 367,804 — compared to 379 deaths in the surrounding counties, which about 894,628 people call home.

As of Thursday, 44 of the 67 total hospitalizations reported by the Hamilton County Health Department were people from surrounding counties. Bradley, Grundy and Marion counties in Tennessee are considered in the "Red Zone" for the virus based on the number of new cases and positivity rates, according to the White House's COVID-19 task force.

Drawing meaningful conclusions using data from small counties can be difficult because a dozen new cases or a few deaths can result in large data swings. However, several rural counties surrounding Chattanooga stand out for their surges of new cases and overall high number of deaths relative to their population size.

In the early part of September, Grundy County reported only one new COVID-19 case in a week's time. The county reported 56 new cases in the past seven days and is averaging 5.99 new cases a day per 10,000 residents in the past week. Hamilton County, for comparison, is averaging 2.24 new cases a day per 10,000 residents.

Twenty-six people in Chattooga County, Georgia — home to about 25,000 people — have died due to the coronavirus so far, for a rate of 10.5 deaths per 10,000 people — higher than any other county in the region. For comparison, the virus has killed 2.8 per 10,000 Hamilton County residents.

Chattooga County is "currently highlighted as having high transmission indicators," according to Logan Boss, spokesperson for the Northwest Georgia Health District, which encompasses Bartow, Catoosa, Chattooga, Dade, Floyd, Gordon, Haralson, Paulding, Polk and Walker counties.

Hamilton County health officials have credited the public mask mandate with helping slow the spread of COVID-19 from Chattanooga's late July peak, saying much of the current spread is continuing at parties and large gatherings when people let their guard down.

Still, DeKalb County's case increase comes in spite of Alabama's statewide mask mandate instituted by Gov. Kay Ivey on July 16.

Across the nation, COVID-19 is surging in rural areas, including Midwestern states like Wisconsin, Minnesota and the Dakotas, which until now were largely spared from the coronavirus.

Even when New York City was the early epicenter of the pandemic in the U.S., it became apparent that rural communities were not immune to the devastating effects of COVID-19. Albany, Georgia, in Dougherty County became one of the worst early hotspots in the country. The county's population is nearly 88,000, yet the coronavirus has killed 188 residents, according to the New York Times.

Georgia made significant strides in controlling the epidemic since its July peak. The state's seven-day average of new cases is down 66% from the state's peak on July 24, according to data from the Georgia Department of Public Health. However, the state's seven-day average of new cases reported increased by 4.3% last week, and daily coronavirus hospitalizations increased 4.2%.

Boss said in an email that "we are still seeing widespread community transmission in all our Northwest Georgia counties." Nursing homes and other long-term care facilities continue to be the main source of outbreaks, he said, followed by jails and schools.

A poll in July and August conducted by NPR, The Robert Wood Johnson Foundation and the Harvard T.H. Chan School of Public Health found 53% of rural households include someone living with a chronic illness and 42% of households reported experiencing financial problems from the virus, including loss of jobs or using all of the household's savings.

A quarter of rural households surveyed said they faced difficulty accessing health care during the pandemic, such as not being able to find a doctor who would see them or not being able to afford coverage. Bledsoe and Grundy counties in Tennessee are among the poorest counties in the state.

Rae Bond, chair of the COVID-19 Joint Task Force, said Tuesday that the areas surrounding Hamilton County, which do not have mask mandates, are affecting residents locally. Many people in outlying areas commute to work in Chattanooga or visit for leisure.

"We're all impacted by what happens in the counties around us," Bond said. "And unfortunately, most of those areas don't have mask mandates."

Contact Elizabeth Fite at or follow her on Twitter @ecfite.

Contact Wyatt Massey at or 423-757-6249. Follow him on Twitter @news4mass.