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Social distancing amid the coronavirus pandemic is a mantra now in America’s urban centers, where the outbreak is spreading exponentially -- but what about wide-open places in rural America where neighbors live miles apart?

Tiny towns tucked into Oregon’s windswept plains, and cattle ranches miles from anywhere in South Dakota might not have had a single case of the new coronavirus, but their main streets are also empty and their medical clinics overwhelmed by the worried.

Residents from rural Alabama to the woods of Vermont, to the frozen reaches of Alaska fear the spread of the disease from outsiders, the social isolation that comes when the town’s only diner closes and economic collapse in places where jobs were already scarce.

“Nobody knows what to do and they’re just running in circles, so stay away from me is what I’m saying,” said Mike Filbin, a 70-year-old cattle rancher in Wasco County, Ore., one of the few parts of the state that has yet to see a case of COVID-19.

“Right now, we’re pretty clean over here, but we’re not immune to nothin’ -- and if they start bringing it over, it’ll explode here.”

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Worldwide, the death toll climbed past 20,000, according to a running count kept by Johns Hopkins University. The number of dead in the U.S. topped 800, with more than 60,000 infections.

New York State alone accounted for more than 30,000 cases and close to 300 deaths, most of them in New York City.

Gov. Andrew Cuomo, again pleading for help in dealing with the coming onslaught, attributed the cluster to the city’s role as a gateway to international travelers and the sheer density of its population, with 8.6 million people sharing subways, elevators, apartment buildings and offices.

“Our closeness makes us vulnerable,” he said. “But it’s true that your greatest weakness is also your greatest strength. And our closeness is what makes us who we are. That is what New York is.”

The case is different in the heartland, a region less about anonymity and invisibility and more about a life of hospitality: welcome and invitation.

“Rural people are reliant on their neighbors and have more confidence and trust in their neighbors,” said Ken Johnson, a senior demographer at the Carsey School of Public Policy and professor of sociology at the University of New Hampshire. “Now you have people who are supposed to self-isolate themselves. What does that mean when people you depend on, in order to help you, are going to put themselves and their families at risk? I don’t know what that will do in rural America.”

Some communities have pushed back on shutdowns that have brought daily life to a standstill. Leaders from seven Utah counties, for example, sent a letter earlier this week to Gov. Gary Herbert urging a “return to normalcy,” and said the closure of schools and business was causing panic and hurting the economy.

“As of [Monday], the total deaths attributed to the virus in the United States stands at ninety,” the letter states. “Not nine hundred, not nine thousand, not ninety thousand. Ninety. This number is sure to rise in the near future but we need to keep our wits about us.”

Others worry about outsiders bringing the disease to truly remote areas that aren’t equipped to deal with it. Across the nation, there are over 51,000 general intensive care beds in urban counties, compared with just 5,600 in rural counties, according to data compiled by The Associated Press.

Those beds serve a smaller population than in urban areas, but it would still take fewer people in rural areas to overwhelm a typical hospital. In fiscal year 2018, the average rural hospital had eight ICU beds, compared with 20 for a typical hospital in an urban area.

In Georgiana, a small town in southern Alabama, the only hospital closed last year, so residents flocked to the health clinic instead when a person in a town 5 miles away was diagnosed with COVID-19. More than 30 percent of Georgiana’s 1,600 residents are over age 60, putting them at higher risk with limited medical facilities to serve them, said Mayor Jerome Antone.

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Neil Bradshaw, the mayor of Ketchum, Idaho, is starting to see answers in his own community.

The rural resort town has struggled since the arrival of COVID-19, and he fears if the virus lingers too long, it could devastate it. The town is nestled next door to the tiny skiing destination Sun Valley Resort and is known as the second-home haven for dozens of celebrities.

It’s also become the epicenter of Idaho’s caseload, with at least 35 cases and known community spread of the virus. At least 14 of the cases are among health care workers, forcing the town’s small medical workers to bring in replacement staffers from nearby cities.

The town’s coffers rely on a local option tax, and if that drops by half the city will have lost $700,000 in revenue, he said.

“Our town thrives on people coming to town, and for the first time in our history we are discouraging visitors,” said Bradshaw, of the town of 2,700 people. “Initially people had different levels of adoption, but there’s tremendous community pressure that we’re all in this together. We’ve gone from being a vibrant town to a ghost town.”

The Associated Press contributed to this report.​​​​​​