It was January 2021 in McKinley County, New Mexico, and George Munoz was despondent. Ten months into the coronavirus pandemic, the devastating impact on his community weighed him down.

"We live in a small town, so everybody kind of knows everybody right?" Munoz, a representative elected to the state’s legislature, told Yahoo Finance. "For seven days straight, I knew somebody who had died.”

McKinley County has one of the highest COVID-related mortality rates in the U.S., according to a new analysis by Yahoo Finance and Economic Innovation Group (EIG), and represents a subset of America for which the coronavirus pandemic has been particularly devastating.

The pandemic has had a 'disproportionate impact on these counties'

McKinley’s fight with COVID-19 isn’t unique: For some parts of the country, pain from worsening job prospects and deaths of despair was felt long before the pandemic made life unimaginably worse.

EIG's Distressed Communities Index (DCI) is a running study of counties that are under the most economic distress. The analysis includes 99% of the U.S. population and all 25,400-plus zip codes with at least 500 residents.

Roughly 50 million Americans live in counties considered "distressed," a category of counties with DCI scores over 80.0. On average, 25% of the population in a distressed county lives below the poverty line, 35% of the prime working age adult population is unemployed, and more than 20% of adults do not have a high school diploma.

“There are many factors, and usually a combination of factors, that can lead to economic distress,” August Benzow, a research and policy analyst at EIG, told Yahoo Finance. "The persistence of that distress is often the result of structural disinvestment, some of it unintentional, as in shrinking tax bases, and some of it more willful, as in a lack of government investment in struggling places.”

Distressed counties generally face a vicious mix of aging demographics, chronic underfunding of its public health institutions, and poverty. These factors converge with local circumstances: The opioid crisis in Pennsylvania and Ohio exacerbated distress, Benzow noted, and the collapse of coal mining jobs exacerbated distress in Appalachia.

Underlying issues are often long-running: In 2000, McKinley had a distressed score of 87.1, according to EIG's analysis, and that number had risen to 94.4 by early 2021.

Adding the number of deaths due to COVID-19 cases per 100,000 residents in the country, EIG found the mortality rate for distressed counties to be higher than non-distressed counties. (Estimates for counties smaller than 100,000 residents were adjusted accordingly.)

The resulting analysis reflects "the disproportionate impact on these counties,” Benzow noted.

The lack of coronavirus testing in distressed areas — leading to fewer confirmed COVID-19 cases —could skew the data toward higher death rates, though poorer areas are also more likely to undercount the total death toll. Furthermore, distressed counties are more likely to experience more residents with underlying conditions, less prepared hospital systems, less effective governance, and ultimately a higher number of preventable deaths.

'All these little riddles to try and figure out'

Hancock County in Georgia and its slowly dwindling population of roughly 8,500 is poorly suited for a pandemic.

The county's poverty rate is 24% and median household income is less than $32,000. In 2012, the Atlanta-Journal Constitution noted that Hancock County was “so impoverished that 80 percent of its public school students are eligible for a free-lunch program." As of December 2020, the unemployment rate stood at 8.5%.

Hancock County's DCI score was 99.8 as of February 2021, making it one of the most distressed U.S. counties.

Rural areas in general don’t have quick and easy access to hospitals — rural zip codes lost one in five hospital beds between 2006 and 2017 — and Hancock Memorial Hospital closed in 2001 amid unsustainable debt.

EIG calculated the cumulative death rate in the Hancock County to be 644 per 100,000 — one of the highest across all counties and nearly six times the death rate of Maricopa County in Arizona, a prosperous county with a death rate of 110 per 100,000 people.

Union County, Florida, has seen better fortune than Hancock amid the pandemic but still faces immense difficulties.

A small county with a population of roughly 15,000 has a poverty rate of 22% and a median household income of less than $42,000. Union County's DCI score was 95.5 as of February 2021.

EIG calculated the cumulative death rate in the county to be 459 (per 100,000) — one of the highest across all counties — and travel played a big role in spreading the coronavirus there.

“The fascinating thing about COVID and geography is there's just all these little riddles to try and figure out,” Ray Oldakowski, geography professor at Jacksonville University, told Yahoo Finance. “A lot of the people that live in that North Central Florida area, they are going to go back and forth across county boundaries for health care for work and that sort of thing."

'You’re thinking about who’s going to be next'

Munoz, the New Mexico state legislator, said that McKinley County county didn’t really suffer a major setback after he was elected during the 2008 recession until the coronavirus pandemic brought profound devastation.

Roughly 1 in 6 of the county's 72,000 residents — the population is overwhelmingly Native American, with the Navajo and Pueblo Pintado tribes most prevalent — have tested positive for COVID-19.

“I know five people who passed away this past week due to COVID,” Dr. Crystal Lee, an assistant professor at the University of New Mexico’s College of Public Health and member of Navajo Nation, told Yahoo Finance. “A lot of my friends and family members, parents have passed, grandparents, and it’s on a weekly basis. Just on my Facebook feed, I’ve personally known at least 60 people who have passed from COVID since March.”

There are currently average of 14 cases per day in McKinley County, according to The New York Times, which considers McKinley County “very high risk” based on coronavirus trends.

“Seeing it around my community at a constant rate, it’s disheartening for a lot of us and we’re experiencing a lot of grief, a lot of mental and emotional trauma," Lee added, "because you’re thinking about who’s going to be next or hoping it’s not someone that’s close to you."

Ultimately, a healthy recovery from the coronavirus pandemic looks elusive for U.S. counties like McKinley unless there is enough support to address the underlying issues that made them so vulnerable in the first place.

“Sustained investment in these distressed places to help them rebuild their economies is needed," Benzow stressed, "and the goal should be to make their economies more resilient than they were before the pandemic."

— Aarthi Swaminathan is a reporter for Yahoo Finance. She can be reached at [email protected]. Follow her on Twitter @aarthiswami.

— Adriana Belmonte is a reporter and editor covering politics and health care policy for Yahoo Finance. She can be reached at [email protected]. You can follow her on Twitter @adrianambells.

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