Arkansas' higher rate of poverty and relatively older population make much of the state more vulnerable to disasters, such as pandemics, according to the U.S. Centers for Disease Control and Prevention.
About 45.4% of Arkansans, or 1.4 million people, live in a census tract considered more at risk than most, CDC Social Vulnerability Index data analyzed by the Arkansas Democrat-Gazette shows.
Social distancing and covid-19 testing is difficult for many of those places, and some have already been hit by the virus while others are anticipating more positive tests.
Many of those regions neighbor areas with relatively high cases of covid-19, and officials say more testing and caution is needed.
Montgomery County, next door to 105-case Garland County, had no positive tests as Friday. It falls into the 61st percentile of vulnerability nationwide, largely from 26.6% of its population being 65 and older.
Montgomery County is home to retirees, a nursing home and an assisted living center, which makes its population, on average, older, County Judge Sammy Jones said.
"I think there's some [cases] here; it's just simply because we haven't had enough people tested," Jones said. "If every other county's had it, we're bound to have it."
Most of the state's Community Health Centers have drive-thru or tent screening, and more than 60 such sites exist statewide, Arkansas Health Department Office of Minority Health Director Michelle Smith noted in an email to the Arkansas Democrat-Gazette.
Jones said he hadn't heard complaints from people who couldn't get testing in Montgomery County. But, he said, he only gets about two calls a day from people right now. The county courthouse is closed to those who don't work there.
Most of the state's employment is related to recreation, which has declined precipitously as the federal government has closed sites. Still, many Montgomery County residents travel to Garland County for work.
As of Friday evening about 7.2% of tests in Arkansas came back positive, according to state data analyzed by the Arkansas Democrat-Gazette, but 13 counties had positive test rates more than double that. Those include 10 counties with populations considered more vulnerable than most: Lincoln (39% positive rate and 61 positives as of Friday, Lafayette, St. Francis, Chicot, Howard, Scott, Johnson, Poinsett, Miller and Crittenden (16% positive rate and 122 positives).
Health Department officials said they're working to make testing more widely available.
Health is determined by numerous social factors, such as income, education, neighborhood, physical environment, employment, social support networks and access to health care, Smith said.
"The root causes of these conditions did not originate from the coronavirus pandemic, but they have been exacerbated" by the effects of it, she said."Addressing these factors will be important for improving health and reducing longstanding disparities that are being highlighted by covid-19."
More than where a person lives in Arkansas, a person's socioeconomic status might determine risk, said Keyur Vyas, an infectious disease specialist and associate professor at the University of Arkansas for Medical Sciences.
Population density is a major reason why covid-19 has spread widely in places like New York City, he said.
But in Arkansas, people who can't work remotely or who must live in smaller quarters with more people may spread the disease more easily than someone who lives in a large house and who can work from home, he said.
Smith said social distancing may not be realistic for some families and added "we are working to identify measures that reduce spread if it cannot be eliminated."
Those with tighter finances also may find obtaining food more challenging than those who can stock up, negatively affecting their health, Vyas said. A person on the Supplemental Nutritional Assistance Program may go to the grocery store and find many basic items sold out, he said. They may have to buy other, pricier food items.
"That may mean their food budget doesn't stretch as far," he said. They may not have easier access to the Internet at home to order supplies online, either, he said.
The economic impact of the covid-19 pandemic may also play a bigger, more immediate role in the lives of lower wage workers at restaurants.
"With many of the businesses that have either temporarily or permanently closed, that's obviously disproportionately affecting persons who are either living paycheck to paycheck or living a lower socioeconomic status," he said.
Nearly 100,000 Arkansans work in more than 5,300 "food service and drinking place" establishments, according to U.S. Department of Labor Bureau of Labor Statistics data analyzed by The Associated Press.
Nearly 57,000 work in retail, which has laid off many workers, as well.
Another 20,000 more work at grocery and other food stores, which have been flooded with customers, putting workers at a greater risk than those who can stay home.
The Health Department, Smith said, is trying to teach employers "how to check temperatures on their workers and what do to when they report symptoms. We also want to ensure that workers do not feel that reporting symptoms could put them in jeopardy of losing their jobs."
WHAT'S TO COME
In Montgomery County, Jones has seen the closure of businesses begin to take a toll on the county's and individual's pocketbooks.
He and the county's other elected officials are still going into the office everyday. About 10 to 15 people are working at the courthouse on weekdays.
But people aren't going to church, at least not indoors, he said. Funerals are family members only.
Cabins aren't renting to people who live outside of Arkansas. Texas and Louisiana are usually major sources of tourism in the area.
The county's nursing home and assisted living center are screening everyone who tries to enter. Road workers aren't going to their usual station before going to job sites.
Sanitation workers are wearing masks.
Still, Jones said, the county's 9,500 people could line up across the county and "they'd have no problem staying six feet apart."
People might continue to fish or walk trails, but they don't do so in packs, he said.
People are taking the virus seriously, he said, adding that he doesn't think things will ever get "really bad" in the county because people are so spread out.
Still, he said, "I think the reason we don't have any positive cases, last time I checked we hadn't had but about 20 people tested."
Metro on 04/20/2020