COVID-19 and the city: Did urbanized countries suffer more fatalities?

In this paper we derive a theoretical model of the spread of a viral infection which we use as basis for an estimation strategy to test four interrelated hypotheses on the relationship between country-level COVID-19 mortality rates and the extent of urban development. Using data covering 81 countries we find evidence that countries with a higher population density, a higher share of the urban population living in the largest city, and countries with a higher urbanization rate had on average the same or fewer COVID-19 fatalities compared to less urbanized countries in 2020. Even though COVID-19 spreads faster in cities, fatalities may be lower, conditional on economic development, trust in government, and a well-functioning health care system. Generally, urbanization and city development are associated with economic development: with the resources urbanized countries have, it is easier for them to manage and maintain stricter lockdowns, and to roll out effective pharmaceutical interventions. •Based on a literature survey, we derive a theoretical model of the spread of a viral infection.•We use this to empirical test whether COVID-19 mortality rates were higher in more urbanized countries during 2020.•The evidence indicates that countries with a higher urbanization rate had on average the same or fewer COVID-19 fatalities.•COVID-19 fatalities may be lower conditional on economic development, trust in government, and a well-functioning health care system.•Accelerated investments and inclusive urban planning will improve cities' resilience against infectious diseases.