Rural residents’ closer contact with livestock and wild game that can carry bird flu make them more vulnerable to infection from the potentially fatal disease, at the same time that they may have less access to healthcare facilities to treat the condition.
Rural communities could face greater risk from the spread of avian flu than their urban counterparts because of these factors, according to an infectious disease expert.
“Our rural communities may not have the same kind of healthcare resilience [as cities], so if you have more than a couple of cases, my concern would be that we want to ensure that we can quickly make testing available,” said Dr. Nahid Bhadelia, an infectious diseases physician and founding director of the Boston University Center on Emerging Infectious Diseases. Bhadelia also served as the senior policy advisor for the Covid-19 White House response team in 2022 and 2023.
Although avian influenza originates in wild birds, the virus can pass between different animal species, including nonhuman to human species. As of January 16, 2025, there have been 66 confirmed human cases of bird flu in the U.S., and one death. Of the humans that have been infected, the majority were people working on commercial farming operations, according to U.S. Department of Agriculture data.
People who have been exposed to avian influenza can be treated with an antiviral medication called Tamiflu. Bhadelia warned that testing people for bird flu and treating them could be more difficult in rural communities where the nearest hospital is on average more than double the distance than in a city. Since 2005, nearly 200 rural hospitals across the country have either closed or decreased the number of services they provide, making it even more difficult for rural people to easily access healthcare.
People who are in direct contact with livestock or wildlife like farm workers and hunters face the greatest risk from avian influenza. In the U.S., poultry and dairy cows have been particularly affected by the outbreak. In the last quarter of 2024, bird flu killed 20 million egg-laying hens. The egg industry has attributed the rising cost of egg prices to this loss.
For dairy cows, the flu’s effect has been less deadly but similarly widespread. As of January 15, 2025, 16 states and 927 dairy herds have been affected. The U.S. Food and Drug Administration found that the virus can be contracted by humans through the consumption of raw milk, but it is made inactive through pasteurization.
In response, the USDA implemented a five-stage national milk testing strategy to track the flu rates and inform how state agencies address outbreaks. So far, 28 states have enrolled in the program, accounting for nearly 65% of the country’s total milk supply.
For people working with these animals, wearing personal protective equipment (PPE) like face shields, gloves, and respirators is the best way to decrease the risk. But at commercial farms, its use is spotty at best, according to an Investigate Midwest reporting. Their investigation found that one-third of states with active bird flu outbreaks in dairy herds were not tracking the distribution of PPE, leaving it up to the farmers to protect themselves and their workers.
This inconsistent use of PPE is because there’s no single directive for how to address bird flu outbreaks. “Most people might not know this, but the implementation of public health activities at the local or state level is actually left to state and local public health departments and USDAs,” Bhadelia said. The most successful state responses to bird flu are ones that involve different stakeholders, she said.
While the current public health risk of bird flu is still low, Bhadelia called the chance of it mutating to become transmissible between humans a game of “Russian roulette.”
“Will it happen for sure? No.” Bhadelia said. “But the more chances we give this virus to potentially infect humans and to evolve within humans, it is possible that it might grow into something that’s a greater threat to humans.”
This article first appeared on The Daily Yonder and is republished here under a Creative Commons license.