Why Pandemics, Such as COVID-19, Require a Metropolitan Response

Abstract

We introduce evidence from the COVID-19 pandemic in the United States that lends support to future political efforts to include multi-county metropolitan areas as an additional and critical institutional layer—over and above municipalities, countries, states, or the federal government—for the effective management of present and future pandemics. Multi-county metropolitan statistical areas (MSAs) accommodated 73% of the U.S. population and, as of 27 September 2020, they were home to 78% of reported cases of COVID-19 and 82% of reported deaths. The rationale for a renewed focus on these spatial units is that they are found to be densely interconnected yet easily identifiable locales for the spread of pandemics and, therefore, for their proper management as well. The paper uses available data on cases and deaths in U.S. counties as of 27 September 2020 to lend statistical support to four hypotheses: (1) The Onset Hypothesis: The onset of COVID-19 cases and deaths commenced earlier in multi-county metropolitan areas than in small-city counties or rural counties; (2) The Peak Hypothesis: The current peak of COVID-19 cases and deaths occurred earlier in multi-county metropolitan areas; (3) The Scaling Hypothesis: Multi-county metropolitan areas had more than their shares of COVID-19 cases and deaths than their shares in the population; and (4) The Neighbor Hypothesis: Levels of COVID-19 cases and deaths in counties within multi-county metropolitan areas were more strongly related to respective levels in their neighboring counties than small-city counties or rural counties. The reported statistical results demonstrate the value of adopting a metropolitan perspective on pandemics and working to empower effective institutional arrangements at the metropolitan level for managing the present and future pandemics.