Once again, there’s a naive and unsubstantiated association between urbanism and the pandemic
Portland and Multnomah County have some of the lowest rates of Covid-19 cases of any large metro area
The big drivers of Covid-19 susceptibility are poverty, housing over-crowding and a lack of health care.
Like many states, Oregon is starting to re-open. Governor Kate Brown has approved re-opening of 34 of the state’s counties, but the two most populous (Multnomah and Washington) are still under stay-at-home orders. As the Oregonian’s Ted Sickinger reports, Multnomah County, home to the City of Portland, still hasn’t even submitted an application to re-open, and it may be weeks, rather than days before it does.
In his article, Sickinger likens Multnomah County to New York City:
Indeed, Multnomah County is Oregon’s New York City, uniquely important to its economic health, and uniquely vulnerable to a fast-spreading coronavirus outbreak, experts say. It has the most people. The most density. The most long-term care facilities. The most daycares and schools. The most vulnerable populations. The most people using shared spaces like offices and public transit.
The health care sector, where employees are perhaps most susceptible to infection, is the county’s No. 1 employer. And it is home to half the hospital beds in the state.
To be sure, Portland (and Multnomah County) are the state’s biggest city and biggest county, and consequently have more people, and more of just about everything else, than other cities and counties in Oregon. But that really begs the question of how serious the disease is. When you look at the data on the prevalence of Covid-19 in Oregon, and in other states, its apparent that Multnomah County is nothing like New York City.
We’ve been following the nationwide data on Covid very closely at City Observatory, (for example: here, and also looking at the county level data in Oregon.
While in a large and diverse county like Multnomah, scaling up to do contract tracing may be a challenge, but in many ways, this story creates or amplifies some misperceptions about the pandemic in Oregon, and more generally in cities.
First, Marion County (home to the capital, Salem), not Multnomah County, is the worst hit county in the state. Marion County has more than twice as many cases of Covid-19 per capita as Multnomah County. Multnomah is not “uniquely vulnerable”– it ranks third statewide in cases per capita (behind Marion and Umatilla), and has rates that are roughly comparable to Washington County (126 per 100,000 and 110 per 100,000.)
Second, Portland looks nothing like New York City when it comes to Covid. That’s true in absolute terms: the New York City metro area’s rate is 2,300 cases per 100,000 population, 15 times higher than Multnomah County. It’s also true in relative terms, the New York City metro rate is about 4.5 times higher than the US rate (less than 500 cases per 100,000 population). Multnomah County is not a wide outlier from the statewide average: the Multnomah County prevalence is less than 50 percent higher than the statewide rate (126 per 100K, vs. about 87 per 100K).
Third, there’s virtually no evidence to support the notion that density is a significant contributor to Covid risk. This is true globally (the densest cities like Tokyo, Taipei, Singapore and Hong Kong) have some of the lowest rates of infection (far lower than Portland). Its also true in North America (Vancouver, BC and San Francisco have very low rates of infection—Vancouver’s is lower than in any large US metro area). It’s also true within big metro areas like New York—Covid is worse in the suburbs (Westchester and Rockland Counties) and within the city limits, is higher in lower density neighborhoods.
What does explain Covid is not density, but poverty, inadequate access to medical care and housing over-crowding. Which is why the Navajo Nation, one of the least densely settled parts of the US has an even higher rate of infection that New York City.
Also, what the Oregonian article largely omits the much higher prevalence of Covid among the state’s Latino population, which is a big contributor to high rates in Marion, Polk, Washington, and Umatilla counties, as well as Multnomah. According to OHA data, Latinos account for at least 30 percent of all Covid cases in Oregon, and have a rate of infection that is more than double the statewide average. The Latino population is more vulnerable to the disease because they have lower incomes, are more likely to live in crowded housing, have less access to health care, and are more likely to be “essential workers” who have to work and who can’t telecommute.
Multnomah is the most populous county in the state, but the claim that it is “uniquely vulnerable” and the implication that density is a contributor isn’t correct.
And, for the record, when we look at large metro areas in the US (population 1 million or more, 53 of them) Portland has the second lowest rate of cases (behind only Sacramento) and the lowest rate of increase in new cases. If you zero-in on the largest urban county in each of these 53 metro areas, only 2 have lower rates than Multnomah County: Bexar (San Antonio) and Sacramento.
There are good reasons to be prudent in opening up after long weeks of Stay-at-home orders. While the logistics of implementing test and trace may be tougher in a big urban area, just because of the number of people who need to be hired and trained and the (somewhat) greater cultural and linguistic diversity of the city, that’s no reason to repeat baseless claims that the pandemic is driven by density, or that a large metro area is somehow “uniquely” susceptible to the virus.