The COVID-19 pandemic in the US had started mostly in metropolitan areas such as New York and Seattle. However, as the pandemic played out and vaccines become available, the trend has reversed so that the death rate in rural America is twice that of metropolitan America, a new report shows.

Data from the Rural Policy Research Institute (RUPRI) indicated that from the beginning of the pandemic until Sept 15, roughly 1 in 434 rural Americans have died from COVID-19, compared with about 1 death in 513 urban Americans.

The rural mortality has been steadily climbing since mid-July, with the rate accelerating quickly in the last month, the data showed

The seven-day average mortality rate for rural Americans was 1 per million people on July 1, compared with 0.7 person per million for metropolitan Americans. However, as of Sept 15, the mortality rate for rural Americans has grown to 8.5 per million while for metropolitan America it was 4.1 per million.

An analysis by the Daily Yonder website, which covers rural America, showed that as of Sept 23, the rural rate of completed vaccinations was 41.4 percent while the vaccination rate for metropolitan counties was at 53.3 percent.

On Thursday, the site noted that "new infections fell by 14% last week in rural (nonmetropolitan) counties, from about 210,000 new cases two weeks ago to 181,000 new cases last week", the largest single-week drop since winter.

The Wall Street Journal reported that the coronavirus is infecting clusters of unvaccinated people even in some of the most-vaccinated parts of the country, such as Maine.

Roughly 69 percent of Maine's population is fully vaccinated, compared with the national average of 56 percent.

At Portland's Maine Medical Center, part of MaineHealth, nearly all the COVID-19 patients on ventilators in the recent surge were unvaccinated, the Journal reported.

"The Delta variant is so much more contagious that it doesn't need much kindling to continue to burn," Dora Anne Mills, chief health improvement officer at nonprofit health system MaineHealth, told the Journal.

The discrepancy in vaccination rates don't fully explain why mortality rates are so much higher in rural areas than metropolitan areas, experts said. They pointed out that other factors are also at work: rural Americans have poorer health and inferior medical care options compared to their metropolitan counterparts.

According to COVID-19 data from The New York Times, on Sept 29, the total number of COVID-19 related deaths was 1,984, bring the toll to more than 695,000. More than 43 million confirmed infections had been recorded.

The Centers for Disease Control and Prevention forecast that the number of newly reported COVID-19 deaths will likely decrease over the next four weeks, with 5,300 to 18,500 new deaths projected in the week ending Oct 23. The CDC also predicted that the overall US COVID-19 death rate will be 724,000 to 753,000 by that date.