Vaccination rate by locality as of March 10. Courtesy of Virginia Department of Health.

This weekend marks two years since the pandemic began.

On March 11, 20220, the World Health Organization declared the COVID-19 outbreak to be a pandemic.

On March 12, 2020, Gov. Ralph Northam declared a state of emergency in Virginia.

On March 13, 2020, President Donald Trump declared an emergency nationwide.

Or, if you want the anniversary of the date that the pandemic really hit home to many Americans, you can use March 12 – not because of what the governor of Virginia did then, but what the NCAA did. That’s the date that March Madness was canceled.

Whatever start date you choose, our lives haven’t been the same since.

Will things ever be back to normal? Or is this, as they say, the “new normal”? I’m not an epidemiologist so won’t dare speculate there. What I can do is offer some context about where Virginia – and, in particular Southwest and Southside Virginia – stand two years into this ordeal.

Infection rates

Remember the early days of the pandemic when we thought that our rural status might somehow protect us from the virus? Yeah, those were good days. Rural areas held out for a while – Bath County was the last county in the state to record an infection – but eventually COVID-19 reached everywhere. It’s a sobering reminder of how the whole world is connected, whether we want to be or not.

In the end, of course, communities in rural Virginia wound up with some of the highest infection rates in the state – and the nation – and, yes, the world. That was the case before vaccines were available, so the high infection rates in rural communities can’t be solely attributed to low vaccination rates. Rural areas also tend to be older, and therefore often sicker. They also tend to be poorer and have fewer doctors and hospitals, and more people who lack connections to the health care system. All those things play a role, long before we inject politics into the mix.

Virginia’s infection case rate has wound up being one of the lowest in the country (there’s an important caveat to come so don’t get too excited).

At the moment, our all-time rate is 19,335 per 100,000 population. Only six states – Washington, Vermont, Maine, Maryland, Oregon and Hawaii, in that order– have a lower rate. Hawaii comes in at 16,375. Rhode Island has the nation’s highest rate: 33,741. The national rate is 23,904.

This gives us some context by which to measure the rates of individual localities – although a lot more context is to come.

The highest infection rate in the state is in Galax – 40,359 per 100,000.

Galax is somewhat of an outlier, statistically speaking. Here are the 14 localities that show up in the Virginia Department of Health’s highest category:

  1. Galax 40,359
  2. Lexington 38,783
  3. Norton 32,497
  4. Franklin (city) 31,278
  5. Buena Vista 31,053
  6. Greensville County 29,211
  7. Richmond County 28,806
  8. Smyth County 28,787
  9. Bland County 28,033
  10. Colonial Heights 27,719
  11. Hopewell 27,236
  12. Danville 27,578
  13. Wise County 27,286
  14. Petersburg 27,133

None of these are Virginia’s major metros. They are either small cities or rural areas. And, contrary to popular belief, most of them aren’t in Southwest Virginia. The next tier down is definitely dominated by Southwest Virginia (you can see the shading on the VDH map) but the very highest are scattered across the state. Only five of the top 14 are in Southwest Virginia – an outsized number, given the state’s population, but still not a majority as some might think. (Recent trends are quite different, of course. In recent months, Southwest Virginia has dominated the top 10 but these figures reflect the totality of the pandemic.)

I promised more context so here it is. If these localities were countries, they’d have some of the highest infection rates in the world. Galax’s rate is almost three times the rate in Brazil; most of the others are twice as high as Brazil. The 14 localities above are all higher than Sweden, which famously resisted restrictions. Now, perhaps it’s unfair to compare our localities with those countries – different cultures, at the very least. So how about this comparison: Canada. Here’s our next-door neighbor, and a country that, except for its French-speaking province and an unnatural love for curling and poutine, is culturally quite like us. In Canada, the infection rate is 8,827 per 100,000. In Virginia, only one locality – Fairfax city, at 8,238 – is lower than Canada’s rate. The next lowest Virginia locality – Cumberland County – is at 12,363. Why is the overall American infection rate three times higher than Canada’s? This seems a question we should be asking over and over. I don’t have an answer to offer except – and this is based on having a lot of Canadian friends – that there’s a fundamental difference in the American character that has made us much more resistant to taking scientific advice, or, sometimes, just advice in general.

The difference becomes more stark when we look more closely at the data. In Canada, the infection rates are pulled up by its two most urban provinces – Ontario, home to Toronto, and Quebec, home to Montreal. In the United States, we usually see our highest infection rates in rural areas. In Canada, rural areas tend to have the lowest infection rates. The rates in Newfoundland and Labrador, New Brunswick and Nova Scotia – all mostly rural provinces – are especially low, about a quarter of Virginia’s rate. Newfoundland and Labrador is the highest of those three at 5,399, Nova Scotia the lowest at 4,747.There are a lot of cultural similarities between our Appalachia and their Atlantic provinces – early waves of Scots-Irish settlers, who helped give us old-time fiddling here and Cape Breton fiddling there – but those similarities run out when it gets to how both places have reacted to the virus and vaccines.

Death rates

The state with the highest death rate due to COVID-19 is Mississippi, with a rate of 411 per 100,000. The national rate is 290 per 100,000. Virginia comes in below the national rate at 224 per 100,000. Hawaii comes in lowest at 95.

Even Virginia’s lower-than-national rate has translated into at least 19,165 deaths due to COVID. For comparison purposes, that’s more Virginians than were killed in World War II – 11,444. It’s more Virginians than were killed in World War I, World War II, Korea, Vietnam, the Persian Gulf War, Afghanistan and Iraq put together. Many communities have memorials to the fallen in one or more of those conflicts. Will we see a move to put up memorials to those who have lost their lives in this pandemic? (Don’t count on it; just look around and see how many memorials there are to people who died during the great influenza pandemic of 1918-1920. You won’t find them.)

Now for more context. The highest death rate in Virginia is in Galax, with a rate of 1,207 per 100,000. Some like to discount that because Galax is a small place and it had a lot of deaths early on in nursing homes, so here are the localities with the 10 highest death rates:

  1. Galax 1,207
  2. Martinsville 915
  3. Danville 660
  4. Alleghany County 633
  5. Buena Vista 609
  6. Nottoway County 561
  7. Norton 552
  8. Smyth County 548
  9. Colonial Heights 535
  10. Lexington 522

All these are obviously higher than the state rate, the national rate, even the nation’s highest death rate in Mississippi. But now for the inevitable global comparisons. If these localities were countries, they’d have the highest death rates in the world. Bosnia is 475. Bulgaria is at 517. Peru is at 640. That’s the company we’re keeping. You’d think the world’s richest nation would do better but we haven’t. Why haven’t we? In recent years, we’ve seen people take to the streets for one cause or another. Some have demanded that Confederate statues come down; some went ahead and just tore them down. Some packed boards of supervisors a few years ago to demand meaningless resolutions declaring those localities to be a Second Amendment Sanctuary. Why is no one demanding to know why we have localities with COVID death rates that equal (or in a few cases exceed) Peru? No offense to Peru, but can we really do no better?

We can. Just not enough of us want to.

Once again, let’s look north. The death rate in Canada is a mere 98 per 100,000. In Virginia, only two localities – Loudoun County at 86 and Falls Church at 96 – are lower than that. Some are five, six, or even nine and 11 times worse than that. Is Canada really so foreign that those numbers are meaningless? Are we really so different from the rest of the world that we are numb to our grievously high death rates?

I hate to belabor this point, but it seems to need belaboring: While our death rates are generally higher in rural areas, Canada’s death rates are lower. In Nova Scotia, the death rate is 21 per 100,000. In Newfoundland and Labrador, 14. In Prince Edward Island, 10. Even Canada’s most death-prone province – Quebec – is at 164 per 100,000.

Why are our numbers so bad?


One reason – but not the only reason – is that Americans have politicized vaccinations.

It’s a popular belief that American vaccination rates break along rural and urban lines and left and right lines. There’s some truth to that, but enough exceptions to raise some perplexing questions. It’s only some rural and conservative localities where vaccination rates are low.

Virginia’s least vaccinated locality is Carroll County, where only 44.6% of the population has received at least one dose. But just across the border in North Carolina is Surry County, where 64.8% have received at least one dose. Are those counties really so different? Politically, no – both vote overwhelmingly Republican, but for some reason Carroll is much more resistant to vaccinations.

Next to Carroll on our side of the line is Grayson County, where 50.8% have had at least one jab. Across the border in North Carolina are Ashe County and Alleghany County, where the vaccination rates are 77.1% and 81.6%. Something is going on there – or not going on – and it can’t be political or cultural, because otherwise those counties are quite alike. For some reason, though, North Carolina’s Alleghany County is rural and conservative, yet getting vaccinated at a rate equivalent to Virginia’s suburban and generally liberal Loudoun County, and just slightly below the rate in definitely liberal Alexandria.

And yes, I’ll make yet another comparison to Canada. There, the national vaccination rate (for at least one dose) is 84.59%. And yes, once again, we see Canada’s most rural provinces posting the highest vaccination rates. In Nova Scotia, 90%. In Prince Edward Island, just under 91%. In Newfoundland and Labrador, 95.6%. Canada’s least vaccinated province is Alberta, an oil-and-ranching province that often gets compared to our Texas. This is Canada’s country music capital. (I personally recommend Corb Lund.) The vaccination rate there is 79.7% – and Canadians think of Alberta as a recalcitrant outlier. If Virginians were more like Albertans, every locality in the state, except a few in Northern Virginia, would have higher vaccination rates.

I shouldn’t have to point out – but will – that the most vaccinated places generally have the lowest infection rates and the lowest death rates.

Two years into the pandemic, we seem to have decided that we can live with sickness and death, so we’re not particularly inclined to help protect others, even if – maybe especially if – it involves some minor inconvenience like wearing a mask.

That’s just one of many things we’ve learned the past two years.

Yancey is editor of Cardinal News. His opinions are his own. You can reach him at