Health, illness and death

Health, illness and death: How illness spreads, hospitals and beds, outbreaks, flu shots, old age, every cause of death, hearses and cemeteries.

Residents fall ill now and then, and under the standard rules illness is catching. Clinics and hospitals get people better faster and save lives, but they cannot stop illness altogether.

How people fall ill

Anyone can fall ill out of nowhere: the chance is 0.9% a day, roughly one person in 111. Most illness, though, is passed on. Each resident meets about 2.2 people a day closely enough to catch something, and how likely each meeting is to pass it on depends on how they live:

Illness spreads 1.6 times as fast in winter (December to February). People who walk to work or school while snow is on the ground are a little more likely to fall ill, more so in a blizzard. Medical research nearby makes it less likely.

Outbreaks

Once the city has 20,000 residents, an outbreak can start on any day (about one chance in 60). It lasts 7 days and adds 2% a day to everyone's chance of falling ill. The news feed reports it, and the advisor tells you how many are ill.

Being ill

Someone who falls ill spends a day ill and passing it on before a doctor sees them. What happens next depends on whether a clinic or hospital reaches their home and has a bed free:

• With care, an ambulance takes them in and they are better in about 2.5 days. Higher health funding shortens that. Patients in care still pass it on, at 55% of the usual rate.
• Without care (no clinic or hospital in reach, or every bed taken) they stay ill at home for 5 days.

Once better, a resident cannot catch it again for 45 days.

Hospital beds

When every bed in reach is full, new patients are sent home, so they stay ill longer and spread it further.

Sick days

Sick days are unpaid. The lost pay comes out of the resident's savings, and the city collects no income tax on it, so an epidemic hits the budget as well.

Flu shots

Flu shots is a district policy (City Hall, Rules, Districts) that costs $0.02 per resident a day. Residents of the district who live in reach of a clinic or hospital get a shot over the weeks after you turn it on: 75 in every 100 are willing, and about 5% of those still without one get it each day. A shot lasts about 90 days. With a shot, a resident is half as likely to fall ill and passes it on half as much.

The advisor suggests flu shots in winter, or during an outbreak, once the city has 2,000 residents and no district has the policy.

Keeping track

The Health page in City Hall has a Flu shots tile: how many residents have a shot that still protects, how many are ill and how many of those are in care, how many are immune, and whether there is an outbreak. Click any resident to see their own Health line, for example "Ill since Jan 4, in care", "Ill since Jan 4, at home with no care", "Well · immune for 12 more days" or "Well · flu shot (60 days left)".

Healthcare and happiness

Homes in reach of a clinic or hospital get +3 for a hospital nearby and another +2 for good healthcare. When the hospitals are full the second one turns into a penalty instead. With no hospital in reach, the penalty grows with the size of the city (see Happiness).

In Easy mode illness is not catching: about 0.2% of people fall ill a day, and they are better in half a day with care or 3 days without. Flu shots still cost the same there but make no difference.

Death

Old age

From 65, every resident has a small chance each day of dying of old age, under the standard rules and in Easy mode alike. It starts at 0.4% a day and grows by 0.25% for every year past 65, up to 10% a day.

Causes of death

• Old age, as above.
• Illness: see the table under Being ill. In Easy mode nobody in care dies of illness, and someone with no clinic or hospital in reach has a 5% chance of dying.
• Fire: people can die in a burning building, more often when it burns down (see Fires).
• Homeless camps: people sleeping rough can fall ill from exposure, far more often in winter, and some of them die.
• Disasters, with the Force of Nature pack: buildings that collapse in a tornado, an earthquake or another disaster, and people caught outside by a tornado (see Weather and disasters).

Crime and road accidents do not kill anyone: a crash can injure people, who are taken to hospital, and a break-in costs a household its happiness, not a life.

When someone dies

The news feed reports the death, and a skull and crossbones appears over the lot. The body stays where the person died until a hearse collects it. If they were the last of their household, the home goes up for sale. While a body waits, the street suffers:

• After about an hour, the neighbors get -8 ("A neighbor died and no undertaker has come").
• After about three hours, the household itself gets -15 ("Someone who died here has waited hours for a hearse").
• Land value drops on that lot and the lots beside it until the body is gone (see Land value).

A death in a public building opens an inquiry. With an intelligence agency in reach it is investigated, and the finding appears in the news.

Hearses

A funeral home sends its hearses to collect the dead from anywhere in its reach, day and night. A funeral home has two hearses, and you can buy up to 6 more from its info panel for $900 each. The large funeral home has 24. Hearses take the dead to a cemetery with graves free, or to a crematorium. With no cemetery or crematorium, or every grave taken, the dead are left waiting, and the advisor and City Hall warn you.

Funeral homes, cemeteries and crematoriums

Prices are under the standard rules, with Easy mode beside them. A cemetery fills up: once its graves are taken it accepts nobody else. A crematorium never fills.

Keeping track of deaths

City Hall, Health, then the Death tab, opens with the coroner's report. Its tiles show how many are waiting for a hearse, deaths in all, graves free and hearses out. Below them are what the city needs, a map of each funeral home's reach, every funeral building, the dead still waiting to be collected and the latest deaths with their causes. Each death also appears in the news feed.

See also

• Growth and move-ins – How people move in, what keeps them away, and when denser buildings arrive.
• Fires – Fire engines, how fires spread, casualties, and fires from homeless camps.
• All reference categories
• How the City Works

The reference pages are made from the game's own data, version 1.10.11. Numbers can change between versions.