It’s a longstanding problem for the counties that make up Alabama’s Black Belt — named for the black, fertile soil used to grow cotton but also home to a large share of the state’s Black population. The counties suffer high rates or poverty and poor health, and the COVID-19 pandemic has brought out the worst of both issues.

While the counties that are home to the state’s largest metro areas have seen large raw numbers of positive tests since the outbreak began in March, the Black Belt counties and a handful of counties in the northern part of the state have seen numbers that show their residents are proportionally more hard-hit than those in the Big 4 counties.

BirminghamWatch has analyzed the share of the population in each county that has contracted COVID-19, using a standard statistical method of measuring the number of cases per 100,000 residents.

Since all but 11 counties in Alabama have fewer than 100,000 people, the numbers in those counties have been extrapolated.

July 2019 county population estimates from the U.S. Census, the most recent available, were compared to the number of cases reported by the Alabama Department of Public Health on July 9.

The results show that in many counties, the portion of their residents who have had COVID-19 are larger than the portion of residents in larger counties who have had the disease, in some cases, several times larger. Nearly all of those smaller counties with disproportionately high cases of COVID-19 are concentrated in the Black Belt region.

Lowndes County, just west of Montgomery, has the most cases per capita. With 480 of its 9,974 residents reported as testing positive for the virus, that would give the county a rate of 4,812.5 cases per 100,000 people.

Just on the other side of Montgomery sits Bullock County, which ranks second in the per capita list, with a rate of 3,649.6 cases per 100,000. Among its 10,138 residents, 370 have tested positive for the coronavirus.

The top 10 counties in the per capita analysis are adjacent to each other in the Black Belt, except for Franklin County in northeast Alabama. The rankings are:

1. Lowndes: 4,812.5
2. Bullock: 3,649.6
3. Butler: 3,267.3
4. Franklin: 2,939.8
5. Wilcox: 2,785.4
6. Dallas: 2,513.7
7. Greene: 2,332.1
8. Hale: 2,288.5
9. Perry: 2,286.7
10. Sumter: 2,245.7

All of these counties are rural areas and have long been plagued with insufficient medical care, due in part to a lack of hospitals and other acute-care facilities as well as historically persistent poverty. Many of the COVID-19 patients with symptoms have had to travel to Montgomery for proper care, which has stressed the capital’s hospital capacity.

Montgomery County itself has 1,921.9 cases per 100,000 people. That number ranks it 13th in cases per capita, largest among the major metro areas.

In contrast, Jefferson County, which has the most cases in the state, has 914.6 cases per 100,000 people. It’s ranked in 38th place.

Tuscaloosa County, which has seen a marked upswing in cases in recent weeks, is ranked 25th with 1,217.7 cases per 100,000. Mobile County is right at the midpoint of the 67 counties with 1,067.8 cases per 100,000.

Madison County, which has fared better than most parts of the state, reports 520.3 cases per 100,000, 58th in the list. Just below that on the list is Baldwin County, with 511 cases per 100,000 people.

Statewide, Alabama has 961.4 cases per 100,000 people. Put another way, just less than 1% of the population has tested positive for COVID-19. As of 10 a.m. Friday, that total number of cases was 49,892.

A disproportionate number of those cases represent Blacks, whether in the Black Belt or the big city. The ADPH COVID-19 online dashboard shows that Blacks have been diagnosed with 44.3% of all of the state’s cases, despite composing just 26.58% of the overall population. That percentage has been fairly consistent since the outbreak began.

Alabama ranks 33rd in the country for cases per capita. The neighboring states of Mississippi, Georgia and Florida have similar numbers, while Tennessee is slightly lower.