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Rebecca Harrington/Business Insider
- As big cities like San Francisco and New York watch coronavirus cases climb, residents continue to flee to their smaller hometowns or neighboring communities in an attempt to stay safe, spread out, or be closer to family.
- A psychologist told Insider the impulse to return to the familiar or a less-densely populated area is a natural response to the unknown, but can be driven by anxiety rather than logic.
- In reality, fleeing cities could mean carrying the virus into new parts of the country and burdening already ill-equipped healthcare systems, some of which only have a single ventilator.
- But in some cases, like traveling to assist older relatives, leaving town could be worth the tradeoff.
- Visit Business Insider's homepage for more stories.
Molly Mitchell was running an errand in New York City on March 12th when she got a text from a friend: The mayor was going to shut down the subway system and only allow emergency vehicles on the road in order to help prevent the spread of the novel coronavirus.
While that didn't end up happening, "I went into complete panic mode," said Mitchell, a 32-year-old who works in advertising. She worried about being trapped for months in the 780-square-foot apartment she shares with her partner and their dog, and worse, being in the city if things escalated to the point of looting and riots.
Less than five hours later, the couple was on the road from their apartment in Brooklyn to their house with about 2,000 more square feet in Damascus, Pennsylvania, a township with less than 4,000 people.
Across the country, people are fleeing big cities for nearby rural communities or their smaller hometowns in an effort to protect themselves from the virus, save their mental health by relocating somewhere with more space, be closer to or take care of family, or all of the above.
But while experts say the impulse is understandable and sometimes necessary, the trend could lead to unintended consequences like spreading the disease or burdening small healthcare systems that are low on resources.
Going home is a natural response for some when faced with a threat
Rebecca Harrington, a New York City-based Business Insider editor, decided to leave for her family's Wisconsin farm when the office announced a mandatory work-from-home policy March 11. "The thought of spending weeks on end alone in my Manhattan apartment became unbearable," she wrote.
Ashley Ridgway, a law student in Los Angeles, booked a flight from the city of 4 million to Richmond, Virginia, where she grew up, even though it meant cancelling her plans for an internship in San Francisco over the summer.
"My family made it clear they were worried about me riding out the storm in a big city like LA, so far from all my family and friends" she told Business Insider.
According to Natalie Dattilo, director of psychology in Brigham & Women's Hospital's department of psychiatry, wanting to go home is understandable in the face of danger.
"During times of great uncertainty and unpredictability, people long for a feeling of familiarity and safety, and home is a place that often feels that way," she told Business Insider.
Getting out of town can also be thought of as one of three options humans feel they have when faced with a threat, either physical or psychological: fight, flight, or freeze. "This is our biologically pre-programmed 'better to be safe than sorry' reaction, and the goal is to prepare us to fight or run away - in this case, run away," Dattilo said.
Plus, in the current situation, where closeness breeds contagion, wanting to go somewhere less dense makes sense, she said.
Finally, it's human nature to want to do something, however rational, whether that's leaving town or buying excessive rolls of toilet paper.
"When we are afraid, we often feel we need to act, to do something, that by staying in place we become 'sitting ducks,'" Dattilo said. "I don't believe that to be the case here. In this case, staying in place may very well be the safest action to take."
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Many small communities aren't welcoming visitors, and sometimes are outright hostile to them
Susan McVea, a business sales strategist on Canada's west coast, already had a spring break trip planned to Ucluelet, an area of British Columbia with less than 2,000 residents, when coronavirus cases started building in Washington State and neighboring Vancouver.
"We decided to go because it was an isolated cabin right on the beach," she told Business Insider.
While there, locals tried to barricade the highway to prevent tourists from entering. Even when she and her family went to the grocery store, they felt uncomfortable because residents knew they were tourists.
They chose not to extend their stay. "We are now self isolated at home," McVea said.
Small communities around the US are also urging, if not demanding, outsiders stay home. In Florida, Hawaii, and Alaska, governors are specifically telling New Yorkers to stay out, the New York Times reported.
In California, where many park systems have closed, the North Lake Tahoe visitor bureau website tells would-be tourists that now is not the time.
"Our locals have welcomed visitors from around the globe for generations but right now our community needs the time and space to protect our loved ones and health resources," it says.
In another California ski resort community, Mammoth Lakes, the dialogue hasn't been so gentle toward outsiders, the Sacramento Bee reported on March 24.
"I'm really concerned about the level of vitriol and xenophobia," Stacy Corless, a Mono County Supervisor, told the publication. "I'm worried someone is going to get shot."
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Many small hospitals only have a single ventilator
More people in small towns means more responsibility for those healthcare systems, which are overburdened and underfunded as is, Alan Morgan, the CEO of the National Rural Health Association, told Business Insider.
A lot of small hospitals in rural areas have 25 or fewer inpatient beds, and most have only one ventilator. Many don't have intensive-care units at all, Nora Super, senior director at the Milken Institute Center for the Future of Aging, told Business Insider.
"People have to think about, if they do get sick, what that would do to an already really strained system?" Super said.
There's also the financial strain to consider. This year alone, six rural hospitals have closed because they couldn't afford to keep their doors open, and almost half of those that remain in the red, Morgan said. What money they could bring in from elective procedures and regular office visits is now off the table as they prepare for an influx of COVID-19 patients.
"They're postponing all elective procedures, they're trying to clear their hospitals out, so they're foregoing revenue right now," Morgan said. Doctor's offices and small clinics are doing the same thing. "And so now you have the potential of upper-income individuals who are in these small communities and decide, 'Oh, I should just check in with the doctor.' This is not a good time for that."
The worst-case scenario, he said, is what he hears is happening in Colorado and has already happened in the San Francisco Bay Area: visitors unknowingly importing the virus. "Not only are you taxing the local community by being there, you're bringing the problem in with you."
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In some cases, making the move may actually benefit the healthcare system
While fleeing a city for the countryside can come with its own set of public-health consequences, staying in place doesn't always make sense either.
After all, it's not just small and rural healthcare systems that are overburdened: In New York City, hospitals are overloaded with patients they can't manage, and cities including Las Vegas and Nashville have fewer than 20 intensive-care unit beds for every 100,000 residents, NPR reported.
Sometimes, uprooting from city life to ride out the pandemic with older relatives is actually the responsible thing to do, both for your family and the healthcare system, Super said. Younger people can help their relatives get groceries and medications, for instance, and help triage potential symptoms in a way that actually keeps them out of the hospital when a visit isn't necessary.
Plus, staying with parents or grandparents can help head off another looming, and serious, consequence of this pandemic: loneliness. "It's s a risk for [older adults] to be out and be around people, but there's also a great risk from them being socially isolated," Super said.
Ultimately, experts say a decision to leave town should be made when you're calm, not anxious, and with a respect for the community you're entering.
"Know and appreciate the community you're coming into, know the strengths and weaknesses," Morgan said. "I think that's key - really just being culturally competent when it comes to small town communities."
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