Why did COVID-19 affect some cities more than others? Insights from Brazil before vaccination

Abstract

This paper examines the local impact of COVID-19 in 2,500 cities in Brazil, contrasting findings with existing international estimates. It shows that pre-pandemic city characteristics have time-varying correlations with COVID-19 deaths per capita in Brazil and that the evolution of these correlations can differ significantly from other countries. Some patterns, such as the association between population density and mortality, are consistent across international experiences. However, in contrast to the U.S. but consistent with studies in China, Italy, and other European countries, the pandemic in Brazil took a greater toll on cities with higher income levels. This is consistent with the fact that higher incomes correlate with greater mobility in Brazil. Other city characteristics, such as the presence of slums and high residential crowding, also correlate with higher death rates per capita in Brazil. Nonetheless, these vulnerabilities do not appear to be driven by mobility differences, as people in cities with these characteristics had a greater propensity to stay home.