Epidemics More Likely in Rural Places

surgical-mask-studiomillerBy Miryam Ehrlich Williamson

Photo: studio.miller / flickr

Anyone with a shred of common sense would know that the risk of picking up a flu virus would be greater in the city than in a rural area. Cities are more crowded. You stand on lines, get packed into buses and elevators, and stand with dozens of others at the corner, waiting for the light to change. Everything you touch is laden with germs from the hands of thousands of strangers. And we all know by now that flu bugs are transferred from hand to hand, or from hand to object to another hand. We put the germs on our lips, in our mouths, our noses, even our eyes. Stay out of cities and you’ll be safer, right?


A research team at Kansas State University in Manhattan, Kansas, is using computer models to forecast and control the spread of disease in rural places. The group ran a simulation of a hypothetical disease outbreak in a small town in which everyone is healthy on Day One. By Day 20, they found that everyone would have contracted the disease. The news release that reports this dire finding doesn’t provide the fictional town’s population.

Nonetheless, the model is based on the understanding that people in cities are less likely to visit and interact with sick neighbors, in contrast to the tendency of rural folks to look out for each other. City people brush past each other on the streets; rural people take meals to sick neighbors and stay to do the dishes.

Compounding the likelihood of increased contagion in rural places are two basic facts of our existence: It’s harder to get medical attention, and the lack of cell phone and fast Internet service makes communication at a distance more difficult. So we visit, rather than use the phone or e-mail. And we care for each other, rather than expecting our sick neighbors to find a doctor or go to the ER.

In spreading disease, person-to-person contact is more important than the strength of the virus itself,said Todd Easton, an associate professor at KSU.

Having a population with two times as many interpersonal contacts is more dangerous than a disease that is twice as virulent.

The research shows that rural people are more likely than city dwellers to maintain social contacts during a severe epidemic. This suggests that, in case of scarcity, vaccines should be administered to those with the most connections to neighbors, family, co-workers, and friends. Less-connected people who serve as go-betweens to two or more closely linked social groups should also be considered potential carriers and vaccinated.

You’ve heard this before, but I’ll say it again: The best way to avoid catching or transmitting the flu is to wear a surgical mask if you feel a cold coming on, and wash your hands frequently and vigorously. Soap and warm water are important, but it’s friction under running water, more than anything else, that reduces hand contamination.

People in America, unlike those in Japan, among other societies, often feel self-conscious wearing a face mask, so I want to tell you about my experience doing it. Late last winter I woke up with what I thought was a wicked cold – a rarity for me. I can’t tell you when my last cold was. I had promised to take a friend to a doctor’s appointment sixty miles away. There was no option but to follow through. I stopped by the drug store, bought a box of surgical masks, and put one on. I was thinking cold, not flu, but it seemed unkind to trap a friend in the car with me for hours while I sneezed and coughed almost constantly.

The doctor’s receptionist thanked me enthusiastically for covering my mouth and nose. When the doctor saw me he asked if I had the flu. No, I said, just a cold. He praised me warmly for protecting others.

Flu was going around then, and during the night the aches and fever set in and I realized that I had it, but bad. Yes, I had my flu shot last fall. But each year the Centers for Disease Control have to predict which flu strains would be the most prevalent and order up the vaccine for them. I guess I got the one that didn’t make the cut. And I’m glad I didn’t pass it on. Not even my husband got it from me.

We can’t know if predictions for the flu epidemic next fall are accurate or simply a CYA maneuver, but there’s no harm in equipping ourselves to keep from being carriers if they’re right. We can, and we should. Taking protective action (how hard is it to buy a box of surgical masks next time you’re at the drug store?) is a good way to keep from being scared.

Spread the word, not the germs.

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One Response to “Epidemics More Likely in Rural Places”

  1. Masks all around. And pocket hand sanitizer. All of it helps.

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