Which Localities Are at Most Respiratory Risk?

COVID-19 is a respiratory disease, meaning it attacks the lungs. According to public health authorities, patients most at risk of severe illness or death from contracting the virus are those who have preexisting respiratory conditions.

The American Lung Association publishes estimates, compiled from multiple data sources dating to 2017 and 2018, of the prevalence and incidence of lung disease for each county and state, including those for Virginia. The conditions include pediatric and adult asthma, COPD (chronic obstructive pulmonary disease), adult chronic lung disease, and lung cancer.

I have compiled a risk factor based on these data — adding up the number of patients in each disease classification for each of Virginia’s localities and dividing by the locality’s estimated 2020 population. A risk factor of 0.289 for Highland County, the most vulnerable locality in Virginia, does not mean that 28.9% of the population has lung disease. Some people may fall into multiple categories. Rather the risk factor provides a quick-and-dirty indicator of prevalence and intensity of respiratory issues in a single metric. For details, consult the Virginia data, which appears here.

In the table above, I have listed the 10 localities with the lowest risk factors and the ten with the highest. By this measure, localities most at risk tend to be from rural counties; presumably they have older populations. Localities whose populations are least at risk skew toward Northern Virginia and urban areas. Click to “continue reading” to see the risk factors for every locality in the state. Presumably, Virginia’s public health authorities are taking data like this into account when preparing their response to the virus.


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10 responses to “Which Localities Are at Most Respiratory Risk?”

  1. vaconsumeradvocate Avatar

    As I look at the list of communities that have the greatest risk for COVID-19, I can’t help but note that starting with Highland most of the counties through which the Atlantic Coast Pipeline intends to cross are in the bottom half of the list. We’ve been told repeatedly that our counties can “afford” the pollution and related respiratory challenges. Certainly doesn’t appear that we can!

    Based on this list, of all the localities crossed by the ACP or MVP (listed below), only Suffolk and Chesapeake have less risk than the state average. Most of the affected counties are in the lower portion of the list since they have high risk. Respiratory disease isn’t the only factor in the listing, but I bet it highly influences it.

    Citizens living along pipeline routes are already concerned about the spring return of pipeline crews and the viruses workers may bring. FERC has been asked to make all work stop until the pandemic is behind us but it has not responded.

    ACP: Highland, Augusta, Nelson, Buckingham, Cumberland, Prince Edward, Nottoway, Dinwiddie, Brunswick, Greensville, Southampton, Suffolk, and Chesapeake

    MVP: Giles, Montgomery, Craig, Roanoke, Franklin, Pittsylvania

  2. Lung cancer caused by radon in homes or smoking, that would have to subtracted out. Not sure we can do much with the Am Lung Assoc numbers where they are trying to argue funding by lumping everything.

  3. Posted on behalf of Carol Bova:

    Yes, the percentage of over 65 correlates with lower or higher incidence.


  4. LarrytheG Avatar

    That was good Carol! Thanks!

    I think what you did, in general, would benefit quite a bit of single variable data we see.

    The other thing I might add would be the population and density. Highland, for instance, has a population of 2212. Fairfax County is 1.1 million.

    Density is 5.59 per square mile in highland, about 3000
    per square mile for Fairfax.

    Density plays a role in contagion as well as age.

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  6. Larry, in general, higher population density is probably more a reflection of younger, more urban, residents vs older rural residents. Loudoun has the lowest density of the top five with the lowest incidence, but its density is still 7 times that of Mathews, the highest of the five with the worst incidence of respiratory disease.

    Harrisonburg’s population density is 3,117.5/sq mi
    Loudoun 747/sq mi
    Manassas 4,195/sq mi
    Prince William 1,358/sq mi
    Manassas Park 6,448/sq mi

    Middlesex 82/sq mi
    Mathews 102/sq mi
    Lancaster 81/sq mi
    Northumberland 64/sq mi
    Highland 5/sq mi

  7. LarrytheG Avatar

    Carol – we agree.

    re: ” COVID-19 is a respiratory disease, meaning it attacks the lungs. According to public health authorities, patients most at risk of severe illness or death from contracting the virus are those who have preexisting respiratory conditions.”

    and this is true but it also depends on how much interaction you have with others and someone who lives on a farm in Highland even though they have lung disease is a lot less likely to run into other people as much as someone who lives in an apartment complex in Loudoun , etc, etc.

    that was my point – that assessing by one factor alone probably is not as accurate a predictor as including the other factors also.

    i.e. two people with lung disease are not at equal risk if one lives alone on a farm and the other lives in closer proximity to many others in an apartment in a densely populated area.

    The more daily contacts that occur likely increase risk.. though I will totally admit I have no expertise at all in this… just thinking out loud a bit.

    some of my thinking came from this WaPo article… go down to where they have a box with a bunch of moving dots inside it that change color as folks get infected:


    then skip down further to where they isolate groups…

    the most isolate folks are a lot less likely to interact with an infected person.

    That’s essentially what he authorities are now saying – i.e. do not interact with large numbers of others…

    what say you?

  8. Two distinct questions here:

    (1) What is a given population’s risk of contracting COVID-19.

    (2) What is a given population’s risk, once people have contracted the disease, of suffering elevated harm from preexisting conditions.

    Both questions are important. The data I presented addresses only the second.

    1. LarrytheG Avatar

      there are a lot of variables to both.

      take for instance:

      two people with exactly the same preexisting conditions but
      one of them gets food from a country store with 5 people in it

      and someone living in Fairfax that goes to a Walmart with hundreds of people in it.

      same pre-conditions – but who has the greater risk ?

      then complicate – greater pre-conditions for rural – how to trade that off between greater risk of moving around in greater density and more human contacts?

      it’s not simple at all.. it’s the stuff of data modelling where the factors and estimated weight of the factors can have significant effects on the results.

      Just off the top of my head – I’d reason that less human contact is a much greater factor… than the others… and that also seems to be the advice about not being around others if you can help it. The problem is, in a dense region, it’s much harder to do that , than, for instance, you’re in a farmhouse that is far away from neighbors.

      If you lived in a very remote cabin and only came into town every few months – your “risk” would probably be quite low.

      If you lived in an urban area and had to go out every day – much higher.

  9. LarrytheG Avatar

    We have friends who left Virginia and moved to Mora, NM… and they checked in yesterday and wanted to ask how things were going.

    Out there , there nearest neighbor is a mile away… and the “town” of Mora some 20 miles distant where the only ranch/grocery store is getting twice as much business as new customers are saying that the store in Mora is a lot safer to shop at that the Walmart 30 miles away.

    here’s Mora for the curious:


    Our friends sad events was the lost their horse that they had in Virginia and took with them to NM – symbolically putting Virginia further in their rear-view mirror.

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