Remote rural towns are a good place to be early in a pandemic, as they tend to be more spread out, which potentially means fewer chances to catch a bug. Remote rural areas are also, by definition, way removed from major seaports, airports and often even big highways. So it generally takes longer for new viruses to show up in tiny towns, like Fredonia, Kan.
"I always say it's a hundred miles from anywhere," says Cassie Edson, with the Wilson County Health Department. "It's a hundred miles from Wichita, a hundred miles to Joplin, a hundred miles to Tulsa."
Health Department Director Destany Wheeler says all the miles of farm fields between Fredonia and the next big town are a plus, for now.
"It gives us a little bit more time to prepare and to, to educate people on, especially social distancing," she says.
Epidemiologists recommend social distancing or staying a few feet away from anyone who might have the coronavirus. That's easier in spacious little towns with no mass transit, long lines or dense crowds.
"I think it's accurate that where you have more individuals, you increase the likelihood of transmission of infections," says Allison Aiello, a professor of social epidemiology at the University of North Carolina.
That said, rural communities are not permanently shielded from the spread of the coronavirus.
"I think it's just a matter of time," says Andy Pekosz, a professor of molecular microbiology and immunology at Johns Hopkins University's Bloomberg School of Public Health.
Most remote rural towns don't get many outside visitors, but the people who live in them drive to larger cities all the time. They go for everything from medical treatment, to work, to a night on the town. And Pekosz says that unless containment efforts succeed beyond his expectations, those people are going to be increasingly likely to be exposed to the coronavirus on those trips.
"As case numbers increase, then, there's more of a likelihood of people moving from those urban areas to all sorts of other parts of the country," Pekosz says. "And so therefore the rest is really going to increase exponentially."
It's a scenario that has played out before. Alex Navarro, a medical historian at the University of Michigan, says Spanish flu swept the entire U.S. in 1918, except for a few notable exceptions, including Gunnison, Colo.
"You have the story of a town that literally barricaded the roads and forced everyone who did come into town into quarantine," Navarro says.
In fact, all of Gunnison County sealed itself off from the outside world for four months. And it worked. At the height of the Spanish flu pandemic, Gunnison recorded just two cases, both in isolation.
Navarro says people keep asking him if a remote little town could pull off the same trick today.
"It's a very highly qualified maybe. I mean, I think there's probably no doubt that it can work if it's done properly," Navarro says. "You have to do it really early. You have to do it as strictly as possible, and it has to be, it has to last long enough for community transmission outside of that area to, to end."
It turned out that even the four-month shutdown in Gunnison wasn't long enough. More than 100 people got sick and several died when the city finally lifted its barricades.
In Fredonia, Kan., Wheeler has masks and other supplies stockpiled. She has plans at the ready, and she fears that when the coronavirus does come to town, the local outbreak may be devastating.
Like most rural communities, the population of Wilson County skews older than the national average. Wheeler says folks here are also more inclined to smoking and more likely to have chronic health issues, putting a higher percentage of the community at risk for life-threatening cases of COVID-19, the disease caused by the new coronavirus.
Fredonia is fortunate enough to have a hospital in town, but it's small, with only 25 beds, though it has one ventilator.
Edson says a serious outbreak could quickly overwhelm the local health system.
"If enough people need more hospitalization, well they'll have to go elsewhere and [that's] a fact. It'll be challenging to everybody," Edson says.
Because that treatment could be hours away, in a busy, crowded city.
RACHEL MARTIN, HOST:
All right, so we have heard about some of the measures being taken in big cities to combat the coronavirus. What about rural communities, though? History shows that these towns where the population is sparse could be at an advantage. But as Frank Morris of member station KCUR reports, they also face big challenges.
FRANK MORRIS, BYLINE: Fredonia, Kan., doesn't have a single stoplight, but like a lot of rural towns, it does have wide open spaces.
CASSANDRA EDSON: I always say it's 100 miles from anywhere. It's a hundred miles from Wichita, hundred miles to Joplin, hundred miles to Tulsa.
MORRIS: Cassie Edson is with the Wilson County Health Department here in Fredonia's town square. It's a four-person agency serving an area almost twice as large as New York City but with fewer than 9,000 residents. Director Destany Wheeler says all the miles of farm fields between Fredonia and the next big town are a plus, for now.
DESTANY WHEELER: I think we will have more time. It gives us a little bit more time to prepare and to educate people on, especially social distancing.
MORRIS: Social distancing - you probably heard the term recently. Epidemiologists recommend staying a few feet from anyone who might have the coronavirus. That's second nature in spacious little towns with no mass transit, long lines or dense crowds. But Sidney Simon, who lives outside Fredonia, says it's harder elsewhere.
SIDNEY SIMON: Places like Wichita, there's just people everywhere, and everybody's touching everything. And same place as everywhere, but it's worse where there's more people.
MORRIS: Science supports that notion. Mark Holmes is a health policy professor at the University of North Carolina.
MARK HOLMES: Because rural communities tend to be a little more spread out and often more distant from transportation hubs, such as airports, rural communities will typically see a novel agent later than urban communities.
MORRIS: Of course, rural residents drive to larger cities all the time. They go for everything from medical treatment to work to a night on the town. So health experts say that unless containment efforts work really well, it's likely just a matter of time before the coronavirus spreads deep into rural areas. It's a scenario that's played out before. Alex Navarro, historian at Michigan University, says Spanish flu swept the entire country in 1918, with a notable exception.
J ALEXANDER NAVARRO: You have the story of a town that literally barricaded the roads and forced everyone who had come into town into quarantine.
MORRIS: He's talking about Gunnison, Colo. The whole county sealed itself off from the outside world for four months, and it worked. At the height of the Spanish flu pandemic, Gunnison recorded just two cases. Navarro says people keep asking him if a remote little town could pull off the same trick today.
NAVARRO: It's a very highly qualified maybe. I mean, I think there's probably no doubt that it can work if it's done properly.
MORRIS: But doing it properly would be exceedingly difficult. Even the four-month shutdown in Gunnison wasn't long enough; a hundred people got sick, and several died when the city finally lifted its barricades.
Back at the health department in Fredonia, Kan., they've got masks and other supplies stockpiled and plans at the ready. But Cassie Edson says if the coronavirus strikes here, it may hit especially hard. Rural residents tend to skew older and sicker than the national average, making them more susceptible to the coronavirus. The two hospitals nearby are small, and each has only one ventilator.
EDSON: If enough people need more hospitalization, well, they'll have to go elsewhere, and that's just a fact. It'll be challenging to everybody.
MORRIS: Because that treatment could be hours away in a busy, crowded city. For NPR News, I'm Frank Morris in Fredonia, Kan.
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