A record 19 rural hospitals closed in 2020, according to research from the University of North Carolina at Chapel Hill — more than in any other year. … Covid-19 death rates in counties where hospitals closed were 37% higher than in their states overall. Looking at the most rural counties — those with fewer than 50,000 residents and at least 50 miles from a major city — the death rates were 66% higher than in their states. Seven of the eight hospital closures in counties where the fatality rate was at least 80% higher than their state’s were in such rural counties.