One of the scariest parts of the coronavirus pandemic is the idea that anyone could get infected at any time. With the virus circulating as widely as it is, anyone could be unlucky.
But while we are all at risk of COVID-19 infection, we are not all at equal risk. You’re clearly more likely to get sick if you live in an area currently experiencing a surge in cases, like Florida, Arizona and Texas. But even within the same city, your risk of getting infected is deeply tied to where you live.
New data from the City Health Dashboard, a project run by New York University Langone Health, shows how drastically the risk of COVID-19 infection can vary from neighborhood to neighborhood within the same city—a reflection of how strongly socioeconomic factors affect who gets sick and who stays healthy.
Race, for example, has been a powerful predictor of COVID-19 infections, hospitalizations and deaths across the country, with people of color bearing a disproportionate burden in all three categories. Black and Latino Americans are three times more likely than white Americans to get infected with COVID-19, according to a New York Times analysis of U.S. Centers for Disease Control and Prevention data. People of American Indian/Native Alaskan descent have the nation’s highest rates of COVID-19 hospitalization, followed by Black, Hispanic, Asian and white Americans, in that order.
This isn’t because people of color are inherently susceptible to COVID-19, but rather because the trickle-down effects of systemic racism have left them uniquely vulnerable. For example, people of color in the U.S. are more likely to work or live in environments where the virus can spread readily; have underlying conditions that complicate the disease’s course; and lack the financial resources to secure private housing and transportation, adequate medical care, insurance and so many other things that help people stay healthy.
To better understand how these social and environmental risk factors are geographically distributed, the City Health Dashboard calculated neighborhood-level COVID-19 infection risk (on a 1-10 scale) based on 23 metrics, including racial breakdown, the number of residents who live in poverty or overcrowded housing, local rates of chronic conditions and more. Almost 200 cities included in the dashboard, which tracks the nation’s 500 largest urban areas, have at least one neighborhood with the lowest possible risk of COVID-19 infection, as well at least one with the highest possible risk—a stark indication of the wealth and health gaps that persist in metropolitan areas across the U.S.
To illustrate these trends, TIME mapped Boston and its neighbor, Cambridge; Miami and nearby Miami Gardens; and Los Angeles and the enclave of Burbank. These city pairs illustrate how significantly socioeconomic profiles can affect risk of disease. Each of the larger cities has at least one neighborhood with a risk profile of one and at least one with a ranking of 10, while the smaller cities generally have less variation in risk—for better or for worse. In some places, that means risk is low across the board; in others, the opposite.
Take Boston. The city has long struggled with racial and income inequity, and that’s clearly reflected in its COVID-19 risk spectrum. Residents of wealthy neighborhoods, like Beacon Hill and the Back Bay, can leave their homes each day with relative confidence they won’t get sick, while people in poorer, predominantly Black and Hispanic neighborhoods, like Roxbury, Dorchester and Mattapan, are at much higher risk. The Boston Public Health Commission’s latest map of COVID-19 incidence tracks closely with the dashboard’s estimate for neighborhood-level risk in Boston.
Across the Charles River in Cambridge, risk of infection is lower across the board. The highest-risk area, in the western part of the city, topped out at a four on the dashboard’s 1-10 scale. While Cambridge has its own struggles with segregation and income inequality, the gentrifying city has a significantly higher median household income than Boston ($95,000 vs. $66,000) and fewer residents living in poverty (13% vs. 20%), according to the U.S. Census Bureau.
Huge swaths of Miami, one of the hardest-hit cities in what is currently one of the U.S.’s hardest-hit states, fall on the upper end of the dashboard’s risk spectrum. Little Haiti, a haven for Haitian immigrants that’s now grappling with gentrification, is one example. It’s still home to a heavily Black population, many of whom work in the service industry for relatively low wages, contributing to its high COVID-19 risk rating. But there are a handful of extremely low-risk neighborhoods as well—concentrated around the Greater Downtown Miami area near the waterfront, as well as wealthy nearby islands. Residents of this area tend to be younger and wealthier than those in other parts of the city, with smaller households and more disposable income, according to the Miami Downtown Development Authority. Some of the Downtown area’s neighborhoods have infection risks of just one or two, according to the dashboard, while many of Miami’s poorer areas max out at 10.
Miami Gardens, a predominantly Black city about 15 miles north of Miami, also falls on the high end of the risk scale. Every neighborhood has a COVID-19 risk rating of at least seven, reflecting the city’s relatively large average household size (3.67 people, compared to the U.S. average of 2.63) and low household income ($42,000), according to the Census Bureau.
In sprawling Los Angeles, there’s huge variation in neighborhood-level COVID-19 risk. Predictably, in heavily white, wealthy areas like Pacific Palisades, Brentwood and Bel-Air, risk is negligible. As of July 20, there had been only about 330 cases in these three neighborhoods combined, according to Los Angeles County data. Travel east to Boyle Heights, however, and the picture looks different. About a third of the 87,000 residents in the heavily Hispanic area live below the poverty line, and many residents are unemployed. Boyle Heights has the most confirmed cases of any single Los Angeles neighborhood, according to county statistics: more than 2,700, including some cases from a correctional facility in the community
Black and Latino residents have been disproportionately affected by COVID-19 throughout Los Angeles County, with the Latinx community accounting for about 60% of the area’s deaths outside nursing homes. (Census Bureau data show about 48% of the county’s residents identify as Hispanic or Latino.) The COVID-19 death rate among Latinx residents of Los Angeles County is 54 people per 100,000, compared to 46 for Black residents, 29 for Asian residents and 23 for white residents.
Finally, there’s nearby Burbank, Calif. In many ways, it’s similar to L.A. Both have median household sizes of between two and three people and both are fairly diverse, according to the Census Bureau. But Burbank has a higher median household income than L.A. ($73,000 vs. $58,000), more of its residents have health insurance (92% vs. 86%) and fewer of its residents live in poverty (about 10% vs. 20%). All of this adds up to a slightly lower risk profile, spanning only 2-6 instead of 1-10 in Los Angeles.
These three areas are far from the only examples. Indeed, similar trends are playing out across the country, in cities from coast to coast. As the virus continues to surge in many regions, the tragedy will be national—but the toll will not be evenly shared.
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Contributor: Jamie Ducharme