Neighbourhood income and physical distancing during the COVID-19 pandemic in the United States

Abstract

hysical distancing has been the primary strategy to limit the spread of COVID-19 in the United States. Physical distancing (also called 'social distancing') entails reducing contacts between non-household members to reduce opportunities for transmission from infected to susceptible individuals. To promote physical distancing, most US states closed schools, mandated business closures, and issued 'stay-at-home' orders directing residents to avoid unnecessary trips. These measures have been essential to prevent worst-case scenarios involving millions of deaths 1-3. Although there is evidence that new cases of COVID-19 declined as people stayed home 2 , evidence suggests unequal declines in the burden of COVID-19. While case data disaggregated by income are not available, COVID-19 case and death rates have risen fastest in low-income communities 4,5. An association between lower neighbourhood income and COVID-19 risk is also consistent with data showing higher COVID-19 mortality among racial and ethnic minorities 6 , whose socioeconomic position is systematically lower, on average, than that of white Americans and who disproportionately reside in low-income neighbourhoods due to a long history of discriminatory housing policy 7,8. Financial constraints to physical distancing may have been an important factor contributing to higher COVID-19 burden among economically marginalized populations 4. At businesses that have remained open during the pandemic, low-income workers have reported less ability to work from home relative to higher wage earners 9. At these workplaces, most workers were not eligible for unemployment insurance unless they could document a COVID-19 diagnosis or exposure 10. Although many states began closing businesses and ordering residents to stay home in the second half of March, businesses deemed essential remained open, and staffed predominantly by low-wage workers 11,12. It was not until mid-April that some states began requiring people to wear masks in public spaces to reduce COVID-19 transmission, and some states still have not done so 10. In this context, low-income workers have had to choose between staying home and losing their income or going to work and risking exposure to COVID-19 for themselves and their households and neighbours. Given that those in low-income households typically have little savings 13 , losing income could bring other health and safety risks, including homelessness and food insecurity. Previous work 14 has found that residents of low-income neighbourhoods were less likely than residents of higher-income neighbourhoods to stay home in response to COVID-19. In this article, we test two main hypotheses. First, we proposed that this gap in physical distancing was explained by work-related demands (hypothesis 1a) and not by visits to places other than work (hypothesis 1b). Second, we proposed that state policies that ordered non-essential businesses to close, and for residents to stay at home, increased the gap in physical distancing between low-and high-income neighbourhoo...

Exposure density and neighborhood disparities in COVID-19 infection risk

“…The COVID-19 pandemic is considered the most severe public health crisis since the 1918 flu pandemic due to its transmission and infection characteristics (2)(3)(4)(5). Social distancing (also referred to as physical distancing) has been shown to be an effective behavioral nonpharmaceutical intervention to reduce the transmission rate of COVID-19 (3)(4)(5)(6)(7). Social distancing reduces the probability of contacts between individuals who might be infected, resulting in reduced exposure risk (7,8).…”

“…Social distancing (also referred to as physical distancing) has been shown to be an effective behavioral nonpharmaceutical intervention to reduce the transmission rate of COVID-19 (3)(4)(5)(6)(7). Social distancing reduces the probability of contacts between individuals who might be infected, resulting in reduced exposure risk (7,8). Governments have implemented a range of social-distancing policies, including travel bans, restrictions on gatherings, school closures, nonessential business closures, and restaurant restrictions.…”

“…Governments have implemented a range of social-distancing policies, including travel bans, restrictions on gatherings, school closures, nonessential business closures, and restaurant restrictions. In particularly hard-hit locations, mandatory "stay-at-home" orders have been issued to limit or avoid unnecessary close contacts outside of the home (7)(8)(9).…”

Invited commentary: The Covid-19 pandemic in the United States

“…In April, 38% of people living in neighborhoods in the lowest income quintile spent the entire day at home, compared to 47.1% living in the highest quintile. Conversely, 12.6% in the lowest quintile worked outside the home compared to 10.2% in the highest quintile [ 28 ].…”

The effect of state-level social distancing policy stringency on mobility in the states of Brazil

“…Building on Oxford COVID-19 Government Response Tracker (OxCGRT) (Hale et al, 2020), we show how the stringency of government policy responses to COVID-19 can be used to better understand how state governments deterred COVID-19 in the context of federalism in a middle-income country. In this sense, our study contributes to a series of recent studies that have aimed to examine how sub-national policies affect mobility (Jay et al, 2020), cases and hospitalizations (Courtemanche, Garuccio, Le, Pinkston & Yelowitz, 2020;Hsiang et al, 2020), and how sub-national political dynamics impact policy adoption distinctly in federations (Adolph, Amano, Bang-Jensen, Fullman & Wilkerson, 2020). Unlike these studies, which mainly focus on developed economies in North America and Europe, we explore dynamics in Latin America's largest federation.…”