It is folly to respond to COVID by focusing only on the coronavirus that causes it, because the virus alone did not dictate the catastrophic impact. For instance, in the U.S., the illness initially hit urban populations hard. But the virus has traveled to more rural areas over time, and recently the impact has shifted to Southern states. In those areas, people younger than 70 years old have been dying more frequently from COVID than they have elsewhere. These same states have had fewer people getting vaccinated and protected. The mortality trends are strongly tied to the increased burden of cardiovascular and metabolic illnesses in the American South, which existed before the virus hit but have made its impact worse. Poorer access to health care has also been a factor in these sad Southern numbers because many of these same states refused to expand Medicaid under the Affordable Care Act. Even before the pandemic, states that…

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