Internet access has been crucial during the pandemic. It’s allowed some of us to work or go to school remotely or order all manner of things for delivery.

But there’s not much research so far on the connection between internet access and health.

A new paper in the Journal of the American Medical Association looks at how COVID mortality rates varied based on factors like race, socioeconomic status — and internet access. 

Researchers found that counties with less access could expect more COVID deaths; for every extra percentage point of homes with no internet, another 2 to 6 people per 100,000 would die.

Qinyun Lin, a postdoctoral researcher at the University of Chicago’s Center for Spatial Data Science, was the paper’s lead author. The following is an edited transcript of our conversation.

Qinyun Lin: Internet access is actually the only predictor that has shown significant association with COVID-19 mortality across all communities, meaning that the association is not only significant in rural areas, but also in suburban and urban areas.

Kimberly Adams: But at the same time, not having access to internet could reflect other factors, other social determinants of health, like maybe not being able to afford health insurance. How did you account for that in your research?

Lin: It’s important to highlight that in our study, we account for other factors that are related to the internet access. For example, if you think about two counties, and they have the same level of socioeconomic disadvantage, the same level of uninsurance rate, all the other factors that internet access could be approximator for, if a county has more households with no internet access, then this county still has higher COVID-19 mortality. At the same time, from like [an] academic perspective or a research perspective, we are not supposed to say this in a causal way, but we do believe that the statistical association we identified between internet access and mortality is pretty robust, and important.

Adams: Right. People always say, “Correlation is not causation.” But were you surprised when this data started coming in?

Lin: I think surprised, but also not surprised. Especially, there was one study that looks at COVID-19 [in the] Chicago area. They already identify this association in their study. I’m saying, “I’m surprised,” because the association does not only hold in rural areas, as I mentioned before, but also in suburban and urban areas. So it’s not only about the infrastructure or whether the homes can be wired to [the] internet, but also it’s about whether households can or whether they do connect to internet in the end.

Adams: What are some of the possible reasons why a lack of internet access might have contributed to higher COVID deaths and COVID mortality rates?

Lin: There could be that the lack of internet access means a lack of technological access to reliable information, telehealth services, ordering groceries or other resources online. Indirectly, there could also be reasons like without access to internet, they cannot work virtually, they cannot do schooling online, they cannot apply for public assistance online and they cannot access social support like some broader social support.

Adams: What are some of the policy implications from your research, particularly in regards to issues of internet access among different communities in times of emergencies like the COVID pandemic?

Lin: With regards to internet access, the association between denied access and health is definitely underresearched right now and deserves more attention. And we guess that this is probably not the last pandemic we will experience in the future. And probably telehealth and online learning for children, for adults, are likely to stay and definitely would help people get through a pandemic like this one.

Related links: More insight from Kimberly Adams

Here’s that Chicago study Lin mentioned, which listed broadband internet access at home as one of several “neighborhood characteristics” that factored into COVID-19 infection risk. A few others were dense housing, crowded living conditions and the ability to work from home.

Vox unpacked Lin’s study in a piece that also lays out the scale of internet inequality in this country, as well as how new funds to expand broadband that were included in last year’s infrastructure law might address that gap. But as the article notes, much of that funding is designated for rural areas. And, as Lin noted, expanding internet access in urban areas could also play a role in reducing COVID deaths.

We have a whole series of stories on this topic on our website called “The Internet Is Everything.” Former “Marketplace Tech” host Molly Wood followed just how the deep divides in internet access played out from the early days of the pandemic. And we’re still covering it today.