Too many have felt the pain of the COVID-19 pandemic. Yet, the burden of COVID-19, like other challenges in our state's past and present, is not shared equally. Minnesotans who are Black, Indigenous and people of color (BIPOC), and those living in rural communities, are substantially more likely to experience the devastation of COVID-19.

The pandemic's worst consequences lie at the intersection of geography and race among rural BIPOC Minnesotans. We requested data from the Minnesota Department of Health (MDH) and used it alongside census data to calculate COVID-19 case and death rates for Asian, Black, Indigenous, Latinx and white Minnesotans in rural and urban counties.

County-level COVID-19 case rates are higher for all BIPOC Minnesotans, compared with white Minnesotans. And case and death rates are higher for rural residents in every racial or ethnic group, compared with their urban counterparts. For Indigenous and Asian Minnesotans, death rates were more than twice as high in rural counties than in urban.

These statistics highlight the confluence of two pernicious forces: structural racism and urban bias. Baked into Minnesota's history, and compounded over time by policies that disproportionately advantage white over BIPOC people and urban over rural areas, the highest COVID-19 risks are inequitably distributed by race and place.

Early in the pandemic, case surges were driven by outbreaks in rural meatpacking plants, where low-wage employees work in close proximity to one another and lack basic protections like paid sick time. Latinx individuals comprise a disproportionate share of meatpacking employees, and experience the majority of COVID-19 cases in such facilities.

In Nobles County, COVID-19 cases spiked in mid-April, with an outbreak at JBS, a pork processing facility. At that time, more than 16% of all residents of Nobles County had contracted COVID, the highest cumulative per capita case rate in Minnesota. As of February 2021, 28% of all Latinx residents of Nobles County had contracted COVID-19, compared with 11% of white residents.

Nationwide, nearly two-thirds of meatpacking plant workers are people of color, and roughly half are immigrants; these figures extend to Minnesota, too. It is no coincidence that COVID-19 rates spiked among low-wage, predominantly BIPOC workers at these facilities. Indeed, these COVID-19 infection patterns were driven by structural factors that affect access to resources and opportunities by race and geography: health insurance and access to care, economic security, immigration status, language barriers, and workplace benefits and protections.

The COVID-19 pandemic has revealed the depth of inequities built into our health care and economic systems. To ensure Minnesotans most vulnerable to COVID-19 are prioritized in vaccination, treatment, and prevention efforts, and to begin to dismantle the entrenched harms of racism and urbanism on the health of Minnesotans, the following steps should be taken:

First, Minnesota needs better COVID-19 data on race and place. We were only able to provide the above statistics after a data request and analysis; these data must be more readily available.

MDH is releasing information regularly, and data by both race and geography ought to be reported in order to inform effective targeting of COVID-19 resources. MDH needs to be appropriately resourced to do this work.

Second, rural BIPOC voices must be centered in decisionmaking. Rural BIPOC Minnesotans are the most deeply affected by COVID-19 deaths; they are also underrepresented politically. It is essential for decisions on prevention, treatment, and resource allocation to be directed by those most affected, and for policies to reflect disproportionate risk.

We are disappointed, for example, to see that the recently released vaccination plan for Minnesota did not prioritize BIPOC individuals for COVID-19 vaccination. This is a missed opportunity, and could still be corrected using data and input from rural BIPOC Minnesotans.

The tumult of the past year, including an ongoing pandemic, the death of George Floyd, a historically divisive presidential election, and an assault on our democracy, has forced Minnesotans to reckon with the deadly consequences of inequitable policies. We have a chance to rebuild our systems on a foundation of justice, and that starts with data and decisions that center rural Minnesotans who are Black, Indigenous and people of color.

Katy Backes Kozhimannil, is professor at the University of Minnesota School of Public Health and director of the Rural Health Program. Mariana Tuttle is a researcher and communications manager at the Rural Health Research Center. Carrie Henning-Smith is associate professor at the University of Minnesota School of Public Health and deputy director of the Rural Health Program. Follow them on Twitter @katybkoz, @story_tuttle and @Carrie_H_S