In the spring, as thousands of people were sickened by the coronavirus, the bodies began to pile up in one of the country’s densest urban centers: New York City.
News headlines rolled like a steady drumbeat of doom. The region became known as the epicenter of the pandemic. Economists predicted that the city’s recovery would take years. Some New Yorkers started moving out, “fleeing” to the suburbs.
Government leaders, including Gov. Andrew M. Cuomo, blamed the city’s population density for fueling the spread of the virus. And soon it seemed as though big cities, especially those that relied heavily on crowded public transportation, were inherently some of the most dangerous places to live during a pandemic.
“Those outbreaks started and spread in those cities because, as major international travel hubs, those were the places that cases were coming into this country,” said Janet Baseman, an epidemiologist at the University of Washington School of Public Health in Seattle.
But now, coronavirus cases are rising across much of the United States. In recent months the pandemic has surged in some of the least densely populated states, like Alaska, the Dakotas, Nebraska and Wyoming. Suburbs such as Westchester County, N.Y., and small towns like Dewey, S.D., now have more cases per capita than New York City.
“During a pandemic, there really are no safe places,” said Kim Weeden, a sociology professor and director of the Center for the Study of Inequality at Cornell University in Ithaca, N.Y.
So is it still right to assume that it’s riskier to live in a city when faced with a highly contagious respiratory virus? We asked seven public health experts.
More space, but fewer resources.
During a pandemic, regions with fewer people and more space, like suburbs and rural areas, can offer more room to isolate from others, which can help you avoid getting sick. A more spacious home can also help preserve your mental health during lockdown — especially if you’re quarantining with family, said Sandra Albrecht, an assistant professor of epidemiology at the Columbia University Mailman School of Public Health in New York City and the chief epidemiologist behind “Dear Pandemic,” a scientific communication initiative on social media.
But while less populous areas may have more space, they may also be lacking in critical resources.
“It’s not hard to find rural areas where the closest hospital that has testing capacity is over 100 miles away,” said Tracy H. Loh, a fellow at the Brookings Institution and an expert in city and regional planning.
In editorials published in the spring on the Brookings website and in NextCity, a nonprofit news organization, Dr. Loh and her co-authors have argued that some of the very traits that can make cities more dangerous during a pandemic, like population density, can also make them more advantageous should a pandemic take hold.
Populous urban areas and cities may offer larger safety nets than rural regions, Dr. Loh said. New York City, for example, has plentiful hospitals, specialists, equipment and resources for coronavirus testing.
Cities also tend to offer a larger variety of social support services, said Jenifer E. Allsworth, an epidemiologist at the University of Missouri-Kansas City, including various child care and public transportation options. (So far, mass transit does not seem to significantly contribute to the spread of the coronavirus, provided there is adequate ventilation and riders wear masks.) And cities tend to have more delivery options for of all kinds of items including food, medicine and household supplies.
It’s also easier for small businesses like restaurants to use delivery services to stay afloat when there are more potential customers per square mile, a boon to city residents who either own those businesses or depend on them. And cities tend to have more employment opportunities than do rural areas, Dr. Loh said.
“Urban areas are more resilient because they have more diversified economies,” she added.
How you (and your community) behave is more important than where you live.
In the end, every expert agreed that when it comes to reducing the risk of getting sick, behavior is more important than location.
“This virus is relentless and it will hunt down anyone who ignores social distancing practices,” said Dr. Lee W. Riley, a professor of infectious disease at the School of Public Health at the University of California, Berkeley. “So it’s not necessarily the type of space where people live, but the type of behavior that people engage in their spaces that ultimately determines who gets infected.”
New York City was able to beat back the virus in the late spring and summer months by enforcing critical public health measures like shutting down nonessential businesses, adopting mask wearing and encouraging social distancing. Other areas that took no such precautions, like parts of the South and Upper Midwest, saw big surges.
Generally speaking, people in cities might have more incentive to follow public health guidelines because they are often surrounded by strangers who may or may not be taking the proper precautions, said Dr. Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health.
Dr. Mina, who lives on a quiet road in Boston, said that right now his city “is as safe or safer than any place in the rural United States,” though he added that this has the potential to change if the community does not take steps to suppress the virus.
He’s thankful that his home has a small backyard. But, like many of us, he often craves even more freedom to move around without a mask.
“I think if I had the chance, it would be really nice to live somewhere where there’s much more space,” he said.
The best possible environment to ride out a pandemic may vary for each person, the experts said. Ideally it’s a place where you can protect yourself and others from the coronavirus while maintaining your income and preserving your mental and emotional health.
Being able to choose where you live or how you quarantine, however, is an enormous privilege.
Many residents in parts of Queens, where thousands fell ill earlier this year, had service jobs that didn’t allow for them to work remotely, and lived in cramped, close quarters with family, friends or roommates.
Those with more money, autonomy and job flexibility can more easily reduce their risk of infection and live more comfortably in isolation, Dr. Allsworth said, regardless of whether they are in a rural, suburban or city setting.
After we get through the long, dark winter and cases eventually start to decline, those who left cities may find that living in a suburban or rural environment has lost much of its earlier appeal.
“Many will move back into cities or stay in cities once they feel protected by the vaccine, because of all the convenience and social activities cities have to offer,” Dr. Riley said.
As for Dr. Albrecht, she is staying put in New York City.
“While I understand why people left during lockdown, much of what keeps me here is the idea that once this is all over, the city, with all its energy and vibrancy, is where I’d want to be,” she said.
All personal preferences aside, the experts said the best course of action right now is simply to hunker down, wherever you happen to be.
“Covid is so widespread across so much of the U.S. now, the safest place to be is at home with your household members,” Dr. Baseman said, “whether that home be in the city or in the mountains.”