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?:abstract
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Methods developed to analyze spread of the 1980–1990 AIDS syndemic within the New York Metropolitan Region (NYMR) are updated and applied to the rate of COVID-19 deaths in the early months of the pandemic, and to premature mortality, across that conurbation For COVID deaths, 21 of the 24 NYMR counties are strongly linked through diffusion mechanisms well indexed by standard journey-to-work statistics, as modulated by local poverty rates While the Bronx leads the COVID death rate, three highly affluent counties—Hunterdon, New Jersey;Putnam, New York;and Manhattan—are less well-integrated into the overall spread process at this early stage These areas, however, must ultimately be drawn into the system of the other 21 counties over the next few years There is, after all, no effective mechanism to impede the ultimate spread of the infection: concentration is not containment, but the central mechanism for the emergence of pathogens across both local and national urban structures Comparison of the COVID death pattern with that of general premature mortality shows a striking inverse commuting pattern, but similar dependence on poverty For both afflictions, the Bronx, focus of ‘planned shrinkage’ polices of the 1970s, is singularly marked by death © 2021, The Author(s), under exclusive license to Springer Nature Switzerland AG
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