An Uneven Curve Flattening, With Manhattan Ahead of the Bronx

(Bloomberg) --

The coronavirus-infection curve has been flattening out for weeks in New York City. That’s good news, though it’s probably better if you live in Manhattan than the Bronx.

Manhattan may be denser in terms of population, but it’s also wealthier, and new Covid-19 projection models suggest that socioeconomic conditions will continue to be major factors in the virus’s spread once the lockdown begins to loosen.

Based on trajectories to date, communities in outer boroughs could see faster and sharper upticks in infections compared to other parts of the city depending on when non-essential businesses reopen and people start to return to more normal movement, according to the models from the PolicyLab at the Children’s Hospital of Philadelphia. The Bronx and Queens have already been harder hit than Manhattan even though they are less than one-half and one-third as dense, respectively, as the city’s iconic core.

While New York’s overall extreme density -- more than 27,000 people per square mile -- is certainly a reason it became a coronavirus hotspot, hyper-local crowding, in dwellings or at worksites, may be a bigger culprit.

This is an issue in poorer neighborhoods, where “there are folks who can’t avoid the fact that they’re in public-facing jobs or living in crowded conditions,” said David Rubin, the director of PolicyLab and pediatrics professor at the University of Pennsylvania.

“Those areas are really sensitive to the amount of social distancing you can accomplish,” he said. Caution will be important as leaders reopen New York City on the whole, considering how interconnected the five boroughs are, Rubin said.

The models are windows into the complicated dynamics that played into New York’s outsized outbreak and the challenges in deciding how to restart the economy across the five boroughs. It’s a poverty and class-divide dynamic that’s apparent across the globe, in migrant dormitories in Singapore, the favelas where Brazil’s poorest reside, and working-class neighborhoods in Spain.

Governor Andrew Cuomo reiterated Saturday that the state, the center of the U.S. outbreak with almost 19,000 dead, wouldn’t immediately follow others in easing restrictions on business, schools or social life. He said he won’t begin reopening until at least May 15, and even then will move in phases starting in areas less hard-hit by the virus.

The virus has been as uneven in its attack statewide and across the country as it has been in New York City. But the evidence is clear that hyper-local crowding amplifies the risk, which is why the virus spread so swiftly in meat-processing plants as well as in prisons and nursing homes. The new coronavirus thrives when it can bounce from person to person without barriers.

Opportunities for clustering abound in Manhattan, which in normal times is crammed with residents and visitors often shoulder-to-shoulder in bars, restaurants, theaters and museums and on sidewalks. But its infection rate is the lowest of the boroughs. Once the island’s office towers emptied out in the lockdown -- with most white-collar employees of the businesses they house able to work from home -- the curve started to flatten.

In the Bronx, the infection rate is 2,590 per 100,000 people, more than twice as high as in Manhattan and higher than in any other borough, according to city data. The Bronx is the poorest borough and includes the poorest congressional district in the nation. Asthma, diabetes, hypertension and obesity, conditions linked to Covid-19 severity, occur at rates far exceeding the national average. Poverty and a lack of insurance coverage creates gaps in health-care access.

What’s more, the Bronx has some of the city’s most jam-packed apartment buildings. Residents are also more likely to have jobs that can’t be done remotely, many of them considered essential in the pandemic.

“Combined with other ways that social and economic disadvantage manifest themselves, that creates huge disparities,” said Michael Gusman, a professor of health policy at Rutgers University who studies health-care equity gaps.

The disparities fall along racial lines: According to Census data, roughly 44% of Bronx residents are black and 56% are Latino, groups that are dying at higher rates nationwide.

Why and Where?

Researchers are still working to sort out all the transmission triggers and reasons some parts of the U.S. have been more vulnerable than others to Covid-19. They know the New York metropolitan area was an easy target because it’s an international travel hub. Some 13,000 flights carrying more than 2.2 million people from Europe landed in New York and New Jersey between January and March, according to Cuomo. Waves of the virus had already struck European countries by then; researchers have learned that most early New York City cases of Covid-19 had European origins.

However it arrived, the virus was sure to be destructive in a such a bustling metropolis, particularly in the absence of strict lockdowns and social distancing measures, which weren’t in place until mid-March. Then the city’s stark economic inequality, which outstrips that of urban capitals in other Western countries, allowed the outbreak to rip with more intensity through some neighborhoods.

Anthony Vanky, a visiting assistant professor in urban planning at Columbia University, said the risk to the city is in what he called “a geography of inequity.” That is what “may be exacerbating the viciousness and voracity of this disease.”

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