DALLAS (NewsNation Now) — Rural Americans are dying from COVID-19 at more than twice the rate of their urban counterparts, the Rural Policy Research Institute said.

There is a host of possible reasons. The populations are often poorer, sicker and heavier than people in large cities. And many lack the access to quality health care offered in large metropolitan cities. In addition, many rural hospitals are simply overrun and understaffed.

“We are seeing unfortunately, this kind of fourth wave affecting our rural hospitals to the point where we’re being stretched very, very thin,” said Cara Veale, CEO of the Indiana Rural Health Association.

As hospitals nationwide fill up, there’s less availability for the sickest patients in small communities to find care. It’s the same story from Texas to Mississippi.

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“The challenge that we face is most of all of the higher-level facilities that we transfer patients to, they’re maxed out,” Dr. Desmar Walkes of Austin-Travis County Health Authority said.

According to data from the Rural Policy Research Institute, when COVID-19 first burst on the scene, it was an overwhelmingly urban problem. The next two waves affected both cities and small towns, but in August, COVID-19 death rates skyrocketed outside major metropolitan areas. And now rural Americans are dying at twice the rate of urban residents. It’s a problem rural hospital officials say won’t improve anytime soon.

“How much longer can we keep doing this, because it’s taking a very heavy toll on the people that have to do the work on the frontline of taking care of people,” University of Iowa Hospitals & Clinics CEO Suresh Gunasekaran said.

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