Did the rural health infrastructure breakdown during the pandemic? Evidence from the 2020 meatpacking plant COVID-19 outbreaks

This study examines the impact of COVID-19 outbreaks in large meatpacking plants on rural healthcare systems, which have limited resources to manage the virus spread. Using individual death certificate data from Minnesota and South Dakota, we find that COVID-19-related deaths among meatpacking workers were relatively low despite the outbreaks. However, innovative spatial analysis reveals that excess mortality in surrounding communities far exceeded recorded COVID-19 deaths. This suggests that disruptions in care overwhelmed rural healthcare systems, contributing to increased non-COVID mortality. To further understand these patterns, we propose a conceptual framework based on the elasticity of substitution in healthcare production. We argue that rural hospitals had limited capacity to reallocate labour and equipment due to financial constraints, pre-existing workforce shortages and the specialized skills required for certain roles. Our analysis shows that excess mortality in rural counties was statistically significant only during peak COVID-19 case periods, consistent with a healthcare infrastructure operating beyond capacity. The inability to substitute healthcare inputs likely led to increased triaging and delayed treatments. These results underscore the public health consequences of pandemic-related disruptions in rural communities, highlighting the need to strengthen rural healthcare capacity, improve workforce flexibility, and implement sustainable staffing strategies for future crises.