Lincoln – Federal officials need to figure out better ways to track the coronavirus in rural, sparsely populated areas where fewer people are getting tested, a top White House coronavirus official said Friday in an appearance in Nebraska.

Dr. Deborah Birx, the coordinator of the White House’s coronavirus task force, said health officials are struggling at times to get a sense of how the virus is spreading outside metro areas.

People in rural areas are often more self-reliant and reluctant to get tested, and in some remote counties, one positive case can lead people to conclude that the virus is more widespread than it actually is, Birx said after meeting with Gov. Pete Ricketts. Her comments echoed Ricketts’ recent remark that some Nebraska counties are so remote that even one confirmed case would result in an abnormally high rate of positive cases.

“What this trip has taught us is we really need to create rural indicators, particularly for rural areas with very low populations,” Birx said at the Capitol.

Her Midwestern tour included stops in Iowa, Missouri, Kansas, Oklahoma and Arkansas.

Birx said Nebraska’s virus outlook has improved over the last 10 days after a sharp rise in cases last month that prompted federal officials to put it in a “red zone” of high-risk states.

The red zone indicator means a state has seen more than 100 new cases per 100,000 within the last week. Birx said federal officials have since placed Nebraska in a lower-risk yellow category because of a drop in the percentage of positive cases.

Ricketts raised a similar issue as he criticized the White House’s decision to designate Nebraska as a red zone state. Ricketts, a Republican and vocal supporter of President Donald Trump, said the federal government has been counting multiple tests on the same person as different cases. For example, he said nursing home residents who are hospitalized with the virus are tested numerous times before they’re allowed to return home.

“The White House putting us on that list in my opinion was a mistake,” Ricketts said last week at an unrelated press briefing.

Statewide, Nebraska officials have confirmed at least 29,660 coronavirus cases and 360 deaths, although the actual number is likely higher because some people haven’t been tested.

Rural residents may have a false sense of security because the virus didn’t strike those areas right away, said Brian Depew, executive director of the Center for Rural Affairs, a rural advocacy group based in Nebraska.

It’s more difficult to get tested in rural areas because many drive-thru testing sites are set up in larger and mid-sized towns, and rural residents often aren’t as willing to wear masks as city dwellers, Depew said.

“I think in a lot of ways, rural areas in the Midwest were lucky early on, and we’ve seen a lag in adopting some of the safety measures because of that,” he said.