For weeks prior to the White House designating the coronavirus outbreak a national emergency, Donald Trump downplayed the severity of the pandemic, assuring his supporters it was “totally under control.” Just last month he insisted, without evidence, that warmer weather makes the virus “miraculously” disappear and wrote off media coverage as a “hoax” created to hurt his brand. With coronavirus now claiming 219 American lives, over 17,000 cases, and one collapsed economy, Trump is finally starting to treat coronavirus with the gravity it deserves. But for a huge segment of his supporters, the damage is already done.

The Axios-Ipsos Coronavirus Index, a national survey on the public’s reception of the pandemic, found that a majority of respondents who identified as Republicans or heartland residents are more inclined to treat the disease as a less serious matter than their Democratic and coastal counterparts. This is notable not only because it likely shows the lasting effects of Trump’s disinformation campaign, but also due to the age of Trump supporters, who, per 2016 exit polls, tend to belong to an older demographic more susceptible to the worst effects of COVID-19. Compared to the urban-dominant Democratic voting base, Trump supporters are more likely to live in rural or suburban areas, where COVID-19 patients could be more at risk. Citing the most recent Census Bureau data in an Axios report on Friday, William Frey of the Brookings Institution found a correlation between counties with the largest share of Americans in the latter half of their 60s, and the most heavily pro-Trump voting blocs.

Data shows that Trump voters are more inclined to trust the news sources the president himself favors. A Pew Research Center study found that the only news outlet a majority of Republicans and GOP-leaning independents trust is Fox News. Hosts like Sean Hannity initially played into the president’s “hoax” coronavirus claims, pushing a conspiracy theory about “deep state” actors and accusing the media of “scaring the living hell out of people” for no good reason. Trump’s supporters agree: 76% of GOP respondents in a new Pew survey believe the press overhyped the impact of the disease, while just one-third of Republicans polled view coronavirus as a serious health risk. They also followed through with Trump and Hannity’s early advice on coronavirus. Just 53% of Republican participants in a Kaiser Family Foundation survey said they were attempting to take precautionary measures to curb the outbreak, a number dwarfed by the 80% of Democrats who are heeding the advice of medical experts to either self-quarantine, practice social distancing, or avoid large crowds.

The case of the Frilots, a Republican family from a conservative Louisiana community, illustrates how the pandemic can be dismissed until it hits close to home. Heaven Frilot, a 43-year-old oil-and-gas analyst told the New York Times how she revealed on Facebook that her husband Mark tested positive as many in her social circle were scoffing at the deadly virus, making jokes with “eye-roll emojis, Fox News talking points, [and] Rush Limbaugh quotes.“ But as word of Frilot’s diagnosis proliferated locally, according to the Times, “it was a revelation for the conservative suburbs of New Orleans, where many had written off the pandemic as liberal fear-mongering.”

To gauge how many Americans could die from the pandemic, Nicholas Reich, an infectious disease expert on the White House Coronavirus Task Force, told the Washington Post he is studying regional death rates from the yearly flu, an indicator of which parts of the country could be hardest hit. (Reich added a disclaimer that this measurement is “probably not” perfect but is “a good place to start.”) Rural areas in states such as Iowa, Indiana, Missouri, North and South Dakota, Kansas, and Nebraska, as well as small cities in New England, have all faced deadlier impacts from the flu than metro areas, according to the Post’s analysis of Centers for Disease Control data. In the most extreme cases, the death rate from flu in rural areas is up to 60% higher than in urban areas.