SALEM, Ore. – Heather Griggs presses a phone to her ear in a makeshift office in the small brick courthouse that once served as a jail in rural Pendleton, a place best known for its annual rodeo.
Her assured tone masks her exhaustion when she tells the person on the other end that they may have been exposed to COVID-19. It’s a call she has made thousands of times since March, but lately there has been a heightened sense of urgency.
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The coronavirus has torn through the small Oregon community where farmers grow crops such as potatoes, onions and grains. In Umatilla County, where Pendleton is located, the rate of people testing positive for COVID-19 is about 16%. That's a measure of how widespread the disease is in the community, and the World Health Organization recommends it stay below 5%.
In the county with a population of 77,000, the virus has infected more than a thousand people and killed nine, overwhelming its limited resources and employees.
“I’m tired,” said Griggs, who's working as a contact tracer.
The pandemic sweeping through major U.S. cities is now wreaking havoc on rural communities, with some recording the nation's most new confirmed cases per capita in the past two weeks. The virus is infecting thousands of often impoverished rural residents every day, swamping struggling health care systems and piling responsibility on government workers who often perform multiple jobs they never signed up for.
Officials attribute much of the spread in rural America to outbreaks in workplaces, living facilities and social gatherings. Food processing plants and farms, where people typically work in cramped quarters, have proven to be hot spots.
Umatilla County has Oregon’s highest number of confirmed infections per capita, sometimes reporting a figure this month above that of Multnomah County, which is 10 times larger and includes Portland. The surge in Umatilla and most of Oregon's rural counties is driving the state's rise in confirmed cases.
In response to the pandemic, Umatilla County divided virus-related tasks among the 30-person public health department.
For Griggs, that meant her role supervising the agency's maternal-child section turned into contact tracing and investigating. She spends her days asking people with positive test results about those they interacted with and then calling to warn those people.
“We are a small county, so I don’t think there is a single person here at public health who hasn’t been involved in some way,” said Griggs, who works with eight other contact tracers.
Other rural counties also are seeing virus cases soar.
Forested Hot Spring County in Arkansas leads the nation in the number of confirmed new cases per capita in the past two weeks, according to data compiled by The Associated Press.
Also near the top of the list are even more remote places, such as Scurry and Crockett counties in Texas.
The Scurry County judge announced last week that 169 inmates and 11 employees at the prison there had tested positive for COVID-19. In Crockett County, whose population density is less than two people per square mile, 71 people have tested positive. The number of infections is thought to be far higher because many people have not been tested, and studies suggest people can be infected with the virus without feeling sick.
Officials recognize that rural case numbers are low compared with city totals, but even a slight increase can push a small community over the edge.
“We’ve discovered we are getting really overwhelmed by the rapid numbers in the rise we are seeing now,” Umatilla County Commissioner George Murdock said. “We really need help.”
The county has received guidance, contact tracers, case investigators and equipment from the state, but Murdock says more help might be necessary. Officials need housing alternatives for people who have COVID-19 or are living with multiple families and field teams to serve at-risk residents and distribute federal aid to poor families, he said.
The fact that many rural jobs can not be done from home has exacerbated the virus's impact, Murdock said. Officials have noted cases where people continued to work despite having minor coronavirus symptoms, which led to outbreaks.
“They are forced to go to work in order to survive. They don’t have benefits. You can’t telecommute on a production line,” he said.
Of Oregon’s 23 rural counties, 12 have reported workplace outbreaks at farms or meat and seafood processing plants. Umatilla County has reported six workplace outbreaks since mid-June.
For most people, the new coronavirus causes mild or moderate symptoms, such as fever and cough that clear up in two to three weeks. For some — especially older adults and people with existing health problems — it can cause more severe illness, including pneumonia, and death.
To confront the surge in cases, rural governments are rearranging and shuffling responsibilities for workers already juggling multiple roles.
Lt. Melissa Ross updates journalists about drug busts and fatal crashes as the public information officer for the Morrow County sheriff in eastern Oregon. She also oversees the records and civil department. Adding to her duties, she's now the spokeswoman for the county's Emergency Management Team, which gives updates on case numbers and other virus-related information.
“That’s what happens when you live in small rural America I guess,” Ross said.
Those communities are relying on already limited medical systems.
Lake County, where southern Oregon meets California and Nevada, has just one hospital. The next one is 90 miles (145 kilometers) away.
To serve its 7,000 residents, the county took the unusual step of asking the Lake Health District to not only run the hospital but also oversee its health department during the pandemic.
“We think that works better on coordinating care for our entire population," district CEO Charles Tveit said. “That’s why we got involved.”
Murdock of Umatilla County said that while rural areas have fewer resources than major cities, they have the same responsibility to keep people safe.
“Out here, we are kind of used to being on our own,” he said. “But this is bigger than us.”
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Sara Cline is a corps member for the Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.