According to three public health policy experts writing for the Washington Post, rural communities that are strongholds of Donald Trump voters are about to feel the brunt of the coronavirus pandemic that has shut down the country’s major metropolitan areas and it will likely will be worse.

In their column for the Post, Michelle A. Williams, a dean at the Harvard T.H. Chan School of Public Health, Bizu Gelaye from Massachusetts General Hospital and Emily M. Broad Leib, deputy director of the Harvard Law School Center for Health Law and Policy Innovation claim it is only a matter of time before COVID-19 ravages small communities — and that the effects will likely be worse for a multitude of reasons.

Writing, “Covid-19 is infiltrating more of the country with each passing day. Colorado, Utah and Idaho are grappling with sudden clusters in counties popular with out-of-state tourists. Cases are also skyrocketing in Southern states such as Georgia, Florida and Louisiana,” they add, “So far, sparsely populated communities have been better insulated from the spread. But since no place in the United States is truly isolated, there’s simply no outrunning this virus. Every community is at imminent risk.”

Noting that people living in rural communities tend to be older — and thus more susceptible to the coronavirus — the trio of experts explain they already “…suffer from a rural mortality penalty, with a disparity in mortality rates between urban and rural areas that has been climbing since the 1980s. Chronic financial strain and the erosion of opportunity have contributed to “deaths of despair” as well as a rise in conditions such as heart disease, Type 2 diabetes and stroke. Add in prolonged social distancing and the economic downturn, and these trends will surely worsen.”

More importantly, those communities lack the health facility infrastructure to handle heavy critical care caseloads.

“Rural counties have just 5,600 intensive care beds total, compared with more than 50,000 in urban counties. In fact, half of U.S. counties do not have any ICU beds at all. And even if these counties are somehow able to scale up their infrastructure, experts are afraid there will not be enough health-care workers to staff them,” they wrote. “Long before the novel coronavirus emerged as a threat, America’s rural hospitals were already in dire financial straits. About 1 in 4 are vulnerable to being shuttered, with 120 having closed in the past decade. With the pandemic looming, many of these health systems have been forced to cancel elective procedures and non-urgent services such as physical therapy and lab tests, which in some cases account for half of their revenue. As cash flow wanes, the American Hospital Association warns that even more hospitals could be forced to shut their doors exactly when patients need them most.”

“It is clear the battle against covid-19 will look vastly different in the heartland than in our cities. The U.S. Navy won’t be docking a floating hospital in Nuckolls County, Neb,” they added. “But if what’s happened in America’s coastal cities can teach us anything, it’s that the coming weeks will determine the trajectory of this virus. And we don’t have a moment to waste.”

You can read more here.