City size and the spreading of COVID-19 in Brazil

Ribeiro, Haroldo V.; Sunahara, Andre S.; Sutton, Jack; Perc, Matjaz; Hanley, Quentin S.

The current outbreak of the coronavirus disease 2019 (COVID-19) is an unprecedented example of how fast an infectious disease can spread around the globe (especially in urban areas) and the enormous impact it causes on public health and socio-economic activities. Despite the recent surge of investigations about different aspects of the COVID-19 pandemic, we still know little about the effects of city size on the propagation of this disease in urban areas. Here we investigate how the number of cases and deaths by COVID-19 scale with the population of Brazilian cities. Our results indicate that large cities are proportionally more affected by COVID-19, such that every 1% rise in population is associated with 0.57% increase in the number of cases per capita and 0.25% in the number of deaths per capita. The difference between the scaling of cases and deaths indicates the case fatality rate decreases with city size. The latest estimates show that a 1% increase in population associates with a 0.14% reduction in the case fatality rate of COVID-19; however, this urban advantage has decreased over time. We interpret this to be due to the existence of proportionally more health infrastructure in the largest cities and a lower proportion of older adults in large urban areas. We also find the initial growth rate of cases and deaths to be higher in large cities; however, these growth rates tend to decrease in large cities and to increase in small ones during the long-term course of the pandemic.