https://www.politico.com/news/magazine/2020/04/15/coronavirus-rural-america-covid-19-186031

In rural Washington, hospitals are faltering, stores can’t get supplies and people are staying closer to each other than you’d think.

Dr. Howard Leibrand has had two very different medical careers—29 years as an emergency room physician, then 12 as an addiction therapist. The challenge he’s facing now, as the novel coronavirus slams bucolic Skagit County, Washington, where he lives and works, is like both rolled into one. Covid-19 has struck fast and hard, like the car crashes and mishaps that send victims to the ER. And like opiate addiction, it has spread stealthily through the heartland, even as it was dismissed as a distant, urban problem.

“One of the negatives of living in a rural community is you think it protects you somehow,” says Leibrand, who for years has also been the health officer—a sort of local surgeon general—of the county, a sprawling expanse of rich alluvial farmland, exurban bedroom communities and steep Cascade peaks midway between Seattle and Vancouver, British Columbia. “We get a little bit cavalier, a little lazy about social distancing.” On April 1, Governor Kristi Noem of South Dakota—one of five states, all in the central heartland, without stay-at-home orders—defended her decision to leave South Dakotans “free to exercise their rights to work, to worship, and to play” by saying, “South Dakota is not New York City, and our sense of personal responsibility, our resiliency and our already sparse population density put us in a great position to manage this virus” without resorting to the “draconian” measures taken elsewhere.

Complacency is fast fading, however, as rural residents realize that, far from being immune, they may be uniquely vulnerable when the epidemic reaches them. Even as Noem spoke, Covid-19 was spreading at a Sioux Falls meatpacking plant that subsequently closed after more than 300 workers fell sick, and local officials across the state begged her to issue shutdown and shelter-in-place orders.

As of press time, all but one of Washington’s 39 counties, most of them rural, had reported Covid-19 cases. Nationwide, more than two-thirds of rural counties had confirmed cases as of April 6, a New York Times analysis found, and across rural America, the per capita infection rate “was more than double what it was six days earlier.” That’s as fast as or faster than recent increases in Chicago, Miami, Boston, Los Angeles and New York.The country’s highest Covid-19 rate is in Blaine County, Idaho, home to 22,277 residents and the Sun Mountain ski resort.

https://www.cnn.com/2020/04/17/business/small-grocery-stores-rural-america-coronavirus/index.html

New York (CNN Business)Small town grocery stores have been struggling, first against the rise of Walmart and then from the growth of Dollar General. But for many independent grocers across America, the coronavirus has provided an unexpected lift.

"All of a sudden, it's been an opportunity to address the challenges they have seen for years and years," said David Procter, director of the Rural Grocery Initiative at Kansas State University.

In rural Kansas, where more than 100 grocery stores have closed since 2008, a new store has not re-opened in 50% of those communities, according to the Rural Grocery Initiative. The situation is similar in other Farm Belt states. North Dakota has lost 20% of its rural grocery stores in the last five years, according to the North Dakota Association of Rural Electric Cooperatives.

Small town grocery stores have been bruised by several trends, experts say. The rise of such big box chains as Walmart (WMT) has pulled customers away. Wholesale distributors have consolidated, making it challenging to find vendors that are even interested in supplying small stores. And sales have dried up as the population has declined in many rural areas and some jobs have shifted outside small towns to larger suburbs and cities.

Additionally, Dollar General (DG) is opening 1,000 stores a year, mainly in small towns, chipping away at independent grocers. "Dollar General stores have had a significant impact on stores that are closing," Procter said. "That has been the event that has pushed them over them edge."

However, grocery owners and experts say the coronavirus crisis has led many customers to rediscover their local grocery stores. Some shoppers are turning to local grocers because items they are looking for are out of stock at big box chains. Others are shopping at their local stores to stay closer to home and avoid large crowds.

https://wjla.com/news/local/index-shows-best-social-distancing-arlington-dc-see-how-where-you-live-ranks

COLLEGE PARK, Md. — Social distancing numbers compiled at the University of Maryland indicate D.C. residents are doing better at it than almost any state in the country, and Maryland is not far behind.

The numbers were compiled by the Maryland Transportation Institute, which is based at the university. They can be viewed here.

Using privacy-protected data from cell phones along with information from the government and healthcare industry, researchers are giving a “social distancing index” score to every state and county in the U.S. Essentially, a score of zero represents no social distancing, 100 is perfect social distancing.

As of Tuesday, Hawaii and New York led the nation with scores of 73, followed by New Jersey with 72, and then D.C. with 71.

After Michigan with 67, Maryland was next with a score of 66. Meanwhile, Virginia was tied for 19th in the country with a score of 58, while West Virginia was tied for 34th with a score of 53.

The social distancing index is based on data such as the percentage of people who are staying at home, how many trips they are making, and the average distance a person travels.

https://www.ibtimes.com/coronavirus-update-first-case-covid-19-transmission-dead-body-human-confirmed-2957994

KEY POINTS
A medical examiner in Thailand has died after apparently being infected by COVID-19 from a dead patient
Buddhist temples refuse to perform funeral services on perons that died from COVID-19
Medical examiners, morgue technicians and people in funeral homes need to take extra care

Up until this week, the conventional medical knowledge was that bodies of people confirmed to have died from COVID-19 weren't infectious.

The World Health Organization (WHO) had said cadavers generally weren't infectious. The exceptions were persons who died from hemorrhagic fevers such as cholera, Ebola virus disease and Marburg virus disease. WHO, however, said workers who routinely handle corpses risk contracting tuberculosis, bloodborne viruses (hepatitis B and C and HIV) and gastrointestinal infections (cholera, E. coli, hepatitis A, rotavirus diarrhoea, salmonellosis, shigellosis and typhoid/paratyphoid fevers).

WHO also warned the lungs of patients with pandemic influenza -- if handled improperly during autopsies by medical examiners -- can be infectious. The latter reason seemed to be the cause of an alarming report from Thailand confirming the first death of a medical examiner anywhere in the world after contracting infection from a person who died from COVID-19, according to a story from BuzzFeed News.

A study published in the Journal of Forensic and Legal Medicine, issued Sunday, said this "is the first report on COVID-19 infection and death among medical personnel in a Forensic Medicine unit." The death was only the second case reported among medical personnel in Thailand, as of March 20. The journal was a peer-reviewed medical journal covering forensic and legal medicine published by Dutch firm, Elsevier.

Complicating any attempt to determine the extent of cadaver infection was why Thailand doesn't collect this data, which was also the case in many other countries.

https://www.theatlantic.com/ideas/archive/2020/04/biden-will-inherit-post-pandemic-world/609853/

His post-pandemic agenda will have to be a master class in redesign.

If Joe Biden wins the election in November, he will likely be sworn in—perhaps virtually—under the most challenging circumstances since Harry Truman became president in 1945. The country will probably be in the end stages of a brutal pandemic and faced with the worst economy since the Great Depression. The Treasury will be significantly depleted. Millions of people will have lost loved ones, their jobs, much of their net worth. Hopefully a vaccine or an effective treatment will be closer to reality, and our national attention can shift to what comes next.

We judge our great presidents by how they managed harrowing trials and wars: Abraham Lincoln and the Civil War; Franklin D. Roosevelt and the Depression, followed by World War II; Ronald Reagan and the Cold War. But many of the bigger and less historically rewarding challenges are what come immediately after—how to rebuild and remake the country and engage in the wider world. Think about Ulysses S. Grant and Reconstruction, Woodrow Wilson and the League of Nations, Truman and the architecture to wage the Cold War, George H. W. Bush and the collapse of the Soviet Union. Some failed; others succeeded. All faced enormous obstacles explaining what just happened, what had changed, and how we must adapt. This is the category of presidency that Biden, or Donald Trump if he is reelected, will find himself in.

If Trump wins, the country can expect more of what we have seen in the initial phase of dealing with COVID-19—shifting the economic and health burden to the states and Congress, a lack of interest in international cooperation, and a refusal to critically scrutinize the response.

But what about Biden? The beginning of his presidency will have a unique logic and character that sets it apart from the early stages of the crisis. His first year will be shaped in various measures by the public reaction to the horrors of 2020, the national Rorschach test of seeing Trump’s silhouette finally from a remove, and a dawning reality of exceedingly difficult choices across the board.

Biden’s first and toughest challenge will be to address the badly frayed governance compact, in which citizens expect and trust the government to deliver on essential services. For decades, Republicans and Democrats have believed that the government needs fixing, albeit for very different reasons. Republicans tend to view much of the state apparatus, including regulatory bodies and social services, as inherently inefficient and run by entrenched, unaccountable bureaucrats. Democrats see our federal workforce as under-resourced and frequently subjected to quixotic and unreasonable demands from political leaders. However, many Americans, particularly those with means, have been shielded from the consequences of a broken government. The economy has generally been good, and the wealthy purchase better education and health care from the private sector.