Background Rural U.S. communities are at risk from COVID-19 due to advanced age and limited access to acute care. Recognizing this, the Vashon Medical Reserve Corps (VMRC) in King County, Washington, implemented an all-volunteer, community-based COVID-19 response program. This program integrated public engagement, SARS-CoV-2 testing, contact tracing, vaccination, and material community support, and was associated with the lowest cumulative COVID-19 case rate in King County. This study aimed to investigate the contributions of demographics, geography and public health interventions to Vashon’s low COVID-19 rates. Methods This observational cross-sectional study compares cumulative COVID-19 rates and success of public health interventions from February 2020 through November 2021 for Vashon Island with King County (including metropolitan Seattle) and Whidbey Island, located ~50 km north of Vashon. To evaluate the role of demography, we developed multiple linear regression models of COVID-19 rates using metrics of age, race/ethnicity, wealth and educational attainment across 77 King County zip codes. To investigate the role of remote geography we expanded the regression models to include North, Central and South Whidbey, similarly remote island communities with varying demographic features. To evaluate the effectiveness of VMRC’s community-based public health measures, we directly compared Vashon’s success of vaccination and contact tracing with that of King County and South Whidbey, the Whidbey community most similar to Vashon. Results Vashon’s cumulative COVID-19 case rate was 29% that of King County overall (22.2 vs 76.8 cases/K). A multiple linear regression model based on King County demographics found educational attainment to be a major correlate of COVID-19 rates, and Vashon’s cumulative case rate was just 38% of predicted (p<.05), so demographics alone do not explain Vashon’s low COVID-19 case rate. Inclusion of Whidbey communities in the model identified a major effect of remote geography (-49 cases/K, p<.001), such that observed COVID-19 rates for all remote communities fell within the model’s 95% prediction interval. VMRC’s vaccination effort was highly effective, reaching a vaccination rate of 1500 doses/K four months before South Whidbey and King County and maintaining a cumulative vaccination rate 200 doses/K higher throughout the latter half of 2021 (p<.001). Including vaccination rates in the model reduced the effect of remote geography to -41 cases/K (p<.001). VMRC case investigation was also highly effective, interviewing 96% of referred cases in an average of 1.7 days compared with 69% in 3.7 days for Washington Department of Health investigating South Whidbey cases and 80% in 3.4 days for Public Health–Seattle & King County (both p<0.001). VMRC’s public health interventions were associated with a 30% lower case rate (p<0.001) and 55% lower hospitalization rate (p=0.056) than South Whidbey. Conclusion While the overall magnitude of the pre-Omicron COVID-19 pandemic in rural and urban U.S. communities was similar, we show that island communities in the Puget Sound region were substantially protected from COVID-19 by their geography. We further show that a volunteer community-based COVID-19 response program was highly effective in the Vashon community, augmenting the protective effect of geography. We suggest that Medical Reserve Corps should be an important element of future pandemic planning. Methods The study period extended from the pandemic onset in February 2020 through November 2021. Daily COVID-19 cases, hospitalizations, deaths and test numbers for King County as a whole and by zip code were downloaded from the King County COVID-19 dashboard (Feb 22, 2022 update). Population data for King County and Vashon are from the April 2020 US Census. Zip code level population data are the average of two zip code tabulation area estimates from the WA Office of Financial Management and Cubit (a commercial data vendor providing access to US Census information). The Asset Limited, Income Constrained, and Employed (ALICE) metric, a measure of the working poor, was obtained from United Way.

The COVID Tracking Project collects information from 50 US states, the District of Columbia, and 5 other US territories to provide the most comprehensive testing data we can collect for the novel coronavirus, SARS-CoV-2. We attempt to include positive and negative results, pending tests, and total people tested for each state or district currently reporting that data.

Testing is a crucial part of any public health response, and sharing test data is essential to understanding this outbreak. The CDC is currently not publishing complete testing data, so we’re doing our best to collect it from each state and provide it to the public. The information is patchy and inconsistent, so we’re being transparent about what we find and how we handle it—the spreadsheet includes our live comments about changing data and how we’re working with incomplete information.

From here, you can also learn about our methodology, see who makes this, and find out what information states provide and how we handle it.

The seven-day average number of COVID-19 deaths in the U.S. decreased significantly from April to July 2020, but it remained higher than in other countries. Seven-day rolling averages are used to adjust for administrative delays in the reporting of deaths by authorities, commonly over weekends.

The challenges of tracking and reporting the disease The U.S. confirmed its first coronavirus case in mid-January 2020 – the virus was detected in a passenger who arrived in Seattle from China. Since that first case, around 945 people have died every day from COVID-19 in the United States as of August 23, 2020. In total, the U.S. has recorded more coronavirus deaths than any other country worldwide. Accurately tracking the number of COVID-19 deaths has proved complicated, with countries having different rules for what deaths to include in their official figures. Some nations have even changed which deaths they can attribute to the disease during the pandemic.

Young people urged to act responsibly Between January and May 2020, case fatality rates among COVID-19 patients in the United States increased with age, highlighting the particular risks faced by the elderly. However, COVID-19 is not only a disease that affects older adults. Surges in the number of new cases throughout July 2020 were blamed on young people. The World Health Organization has urged young people not to become complacent, reminding them to maintain social distancing guidelines and take precautions to protect themselves and others.

Case investigation and contact tracing on Vashon, South Whidbey and in King County.