Urbanism Pays the Price for High COVID Death Toll in New York and New Jersey

Opponents of dense housing and public transit have seized on the disproportionate death toll originating from the epicenter of the nation's coronavirus outbreak. Is it time for the leaders of New York and New Jersey to admit they acted late?

6 minute read

April 30, 2020, 7:00 AM PDT

By Irvin Dawid

East Harlem

By Joakim Lloyd Raboff / Shutterstock

Urbanist Kate Wagner opines in Curbed on April 22 that after her "property manager emailed the building’s residents to inform us that there was a confirmed case of COVID-19 in the building," life in the District of Columbia became much worse.

Suddenly, what had been a bastion of sociality and the pinnacle of good urban living became unrecognizable. I can’t deny that the pandemic has affected my everyday life and challenged my urbanist beliefs.

Yet she continues to praise the principles of "density, walkability, and good, equitable transit, recognizing that "[t]he spread of the coronavirus, both in cities around the world and in my apartment building specifically, is not the fault of architecture or public transportation. Coronavirus spread like wildfire in places like New York City because of delayed action from city officials who allowed bars, clubs, restaurants, stores, and schools to stay open far later than they should have."

Her thoughtful post appears to have been inspired by reading attacks on urbanism in the media inspired by the pandemic.

One anti-density op-ed blamed close apartment-building living quarters for the spread of the coronavirus in Minneapolis. Writer Katherine Kersten [a founding member of the Minnesota-based conservative think tank, Center of the American Experiment], warns that if the 'New Urbanist' plan to densify and diversify downtown Minneapolis succeeds, the next pandemic will be even worse.

Density blamed

With nearly 40 percent of the more than one million COVID-19 cases and nearly half of all deaths originating in New York and New Jersey as of April 29, it's become commonplace to associate density with death in the era of this highly contagious pathogen. Yet, as Wagner suggests, density isn't responsible for infection – behavior is. Hong Kong, a city comparable to New York in population and density with a highly successful subway, suffered four deaths and just over 1,000 infections to-date, despite its proximity to the origin of the virus in Wuhan, China.

However, the comparison is not a fair one due to the role played by the Trump administration's response to the pandemic. A better comparison is with America's second densest large city, San Francisco, which also has a high transit ridership. The city of 883,000 suffered 23 deaths or 2.6 per 100,000 people, compared to almost 18,000 deaths or 209 per 100,000 people in New York City.

Timing, not density

As Dr. Thomas R. Frieden, the former head of the Centers for Disease Control and Prevention and former commissioner of the city’s Health Department, told The New York Times on April 8:

"[COVID-19] was spreading widely in New York City before anyone knew it...You have to move really fast. Hours and days. Not weeks. Once it gets a head of steam, there is no way to stop it."

"Dr. Frieden said that if the state and city had adopted widespread social-distancing measures a week or two earlier, including closing schools, stores and restaurants, then the estimated death toll from the outbreak might have been reduced by 50 to 80 percent," wrote 

But New York mandated those measures after localities in states including California and Washington had done so.

San Francisco, for example, ordered schools closed on March 12 when that city had 18 confirmed cases; Ohio also ordered its schools closed on the same day, with five confirmed cases. [Mayor] de Blasio ordered schools [and restaurants and bars] in New York to close three days later when the city had 329 cases.

On March 16, public health officers of six of the nine counties in the Bay Area announced the nation's first "shelter-in-place" orders to take effect at 12:01 a.m on March 17. [See post.] Two days later, Gov. Gavin Newsom (D-Calif.) issued the nation's first stay-at-home order [pdf] that took effect immediately, closing all non-essential businesses (posted here).

Closer to New York, Hoboken, N.J. became the first city in the U.S. to enact a curfew and close restaurants and bars on March 14.

By contrast, after several days of "tightening the valve", Gov. Andrew Cuomo (D-N.Y.) announced the nation's second stay-at-home order on March 20, a Friday, but rather than taking effect immediately, it took effect 5 p.m. on Sunday (posted here). Why the wait? In fact, Illinois' and Ohio's orders took effect earlier.

"Whatever the final death toll is in the United States, the cost of waiting will be enormous, a tragic consequence of the exponential spread of the virus early in the epidemic," wrote father and daughter epidemiologists Nicholas and Britta Jewell in a New York Times opinion on April 14.

To a large extent, the growth in U.S. deaths from Covid-19 has been fueled by the devastating events in New York...Our assessment echoes that of Dr. Tom Frieden... He has estimated that deaths might have been reduced by 50 percent to 80 percent in the city if social distancing had been widely adopted a week or two earlier.

The point here is not to cast blame on mayors or governors for the timing of what were difficult decisions for both public health and the economy, but rather, to alert cities and states where full social distancing measures are not in place that hesitation can come at a very high cost.

Looking forward

"Like any misdiagnosis, this one [referring to New York's high density and transit usage] will make it harder to find the cure," writes Henry Grabar on April 17 in the source article in Slate.

Those factors will surely prove to have hastened the spread. But they don’t explain New York’s divergence from other world cities. Tragically, what seems to have put New York on such a different trajectory from San Francisco was that its leaders were so late to shut down public life.

“History will be pretty critical of Cuomo and de Blasio for not taking the same decisive decisions that Mayor [London] Breed took in San Francisco,” said Dr. Michael Reid, an infectious disease specialist in San Francisco who is running that city’s contact tracing program.

However, like the Jewells, Grabar makes clear that he is not assigning blame.

This recognition is not about doling out blame to New York pols for what happened in March. Washington was worse than useless, from the president to the CDC. Cuomo and Mayor Bill de Blasio had to make difficult decisions that inflicted their own type of suffering—particularly closing the city’s public schools.

It’s about what happens next. The sooner New York can be honest about why its outbreak was so severe, the sooner leaders can figure out how to move forward. In fact, it’s a precursor to moving forward. Who will want to reopen a restaurant when political leaders still believe contagion is in the city’s DNA? And why should Washington help prop up a subway system that’s perceived to be an outsize disease vector?

Grabar is looking at the future of the Big Apple if its density is perceived to be the main reason for the almost 160,000 COVID infections and nearly 18,000 deaths as of April 29. But as Kate Wagner pointed out earlier with the op-ed in the Minnesota Star Tribune, it's not just about New York City – it applies to anywhere in urban America where public policy is supportive of investing in denser multi-family housing and public transit. 

The next challenge

The Jewells, who wrote about the need to act quickly, get the last word as the 50 states turn to the reopening of their economies.

Decisions about the timing of imposing social distancing are now largely behind us. The next critical decisions will center on when we begin easing stay-at-home policies.

Getting that wrong will lead to second wave of infections and a return to lockdowns. We can’t afford to repeat the same mistakes.

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