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Two neighboring counties in rural northern Missouri are seeing big increases in COVID-19 cases, spikes blamed in part on new variants of the virus, and in part on the behavior of residents.

Health officials in Linn and Livingston counties are urging precautions to slow the spread of the virus, though they're not certain residents will follow that guidance — both counties lag well behind the state and national averages in vaccinations.

The COVID-19 hub for the Missouri Department of Health and Senior Services on Wednesday showed Livingston County with 348 cases per 100,000 residents over for the seven-day period ending Sunday, and Linn County with 243 cases per 100,000. The statewide average for the period was 27 cases.

The two counties combined have 27,000 residents. Both are a little more than 100 miles northwest of Kansas City.

Health officials in Livingston and Linn counties blame variants of the virus first identified in the U.K. and India. The World Health Organization said both variants are concerning because they appear to spread easily.

Sherry Weldon, administrator of the Livingston County Health Department in Chillicothe, said the outbreak's spread has come not from any single event but from several modest-sized gatherings.

"We're not seeing a specific hotspot," Weldon said. "We're seeing several from churches, a business might have a few, but we're also seeing a husband and wife and four of their kids."

Dr. Kendal Geno, Linn County's medical director, also has seen recent cases involving children, even infants. Re-infections also are common — Geno said people who first came down with COVID-19 last year are getting sick again.

The surge has not led to new deaths, but Geno said some people have had to be hospitalized.

Linn County Health Administrator Krista Neblock said the variants spread because people refuse to follow mitigation guidelines.

"We have a large portion of our community that never wanted to wear masks," she said.

Vaccination rates in both counties are low — 33.8 percent of residents in Livingston County and 33.9 percent in Linn County have initiated vaccination, compared to 41.8 percent statewide and 62.8 percent nationally.

The Livingston County Health Department is offering walk-in vaccinations two days a week, but typically, only 10-20 people show up, Weldon said.

"We can't make them," she said. 

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