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New York City has been the epicenter of the coronavirus pandemic, the daily accounting of hundreds of fatalities has reinforced the idea it's an urban contagion, but its spillover area has faced deep impact.

Many of the city’s suburbs have been hit just as hard. In some, there have been more fatalities per capita than in super-dense Manhattan.


The virus’ rampage through the New York metro region, from the well-to-do towns along Connecticut’s coastline to the bedroom communities of northern New Jersey and Long Island, offers a counterweight to the notion of the suburbs, with their plentiful open spaces, as safe havens.

“You expect to see it spread more rapidly in densely populated areas like cities, but it does that anywhere the virus is introduced and where people are in contact with other people,” said Dr. Stephen Morse, professor of epidemiology at Columbia University Mailman School of Public Health in New York. “All it needs is fertile soil because it spreads quite well, unfortunately.”

The first sustained outbreak to be detected in the New York metropolitan area occurred in the suburb of New Rochelle, where an attorney who had attended large gatherings at a local synagogue was the first to test positive.

Another cluster sprang up 5 miles west of the city in Teaneck, New Jersey. The first New Jersey resident to die, 69-year-old horse racing veteran John Brennan, lived in northern New Jersey and worked at a racetrack in Yonkers, a New York suburb.

According to data compiled by Johns Hopkins University, Rockland County, New York, has reported roughly 3,500 positive cases per 100,000 residents, nearly triple the rate in Manhattan and more than double the rate in Brooklyn. Westchester County, which includes New Rochelle, has a rate of nearly 2,900 cases per 100,000 residents.

If the five New Jersey counties closest to New York were a country, they would have recorded the 12th most cases in the world, more than 59,000 through Tuesday.

At Hudson Regional Hospital in Secaucus, New Jersey, just west of Manhattan, the volume of patients had quadrupled by early April, forcing the emergency room to divert patients several times, hospital CEO Dr. Nizar Kifaieh said, though the numbers have decreased recently.

Dr. Tanaya Bhowmick, an infectious disease physician and assistant professor at Rutgers Robert Wood Johnson Medical School in New Jersey, said her patients who have underlying immune issues have been taking precautions. But she recently saw a group of youths playing basketball in her suburban neighborhood.

“There might be the perception that they’re a little more safe here, which obviously isn’t true,” she said.

The virus remains a long-term foe. In the shorter term, globally, it will be up to individuals as much as policymakers to make decisions that will help chart the virus’ course.

“I think everyone still needs to use their judgment. I’m not having a book club in my house. I’m going to my doctor for an allergy shot because that’s safe to do,” Dr. Emily Landon, who leads infection control at the University of Chicago Medical Center, told The Associated Press. “You can try and make it political, make it about freedom, but it’s a virus. It’s biology. Biology doesn’t negotiate.”

Tracking the virus’ path can yield some surprises. The first several people to test positive for the coronavirus in Connecticut actually had a strain that was linked to the outbreak in Washington state, said Nathan Grubaugh, an assistant professor of epidemiology at the Yale School of Public Health. He is leading a study with other researchers that is using genomic testing to chart the spread of the virus across the U.S. and into Connecticut.

After those first cases, data showed Connecticut residents were testing positive for a virus similar to the strains in New York, which have been linked to those in Europe, Grubaugh said.

It wasn’t surprising to Stamford Mayor David Martin that his city of about 130,000 people would be one of the hardest hit in the state.

Downtown Stamford is less than 10 miles from the New York state line and less than an hour from Manhattan by train. Nearly 1,800 Stamford residents have tested positive for the coronavirus, by far the highest total among the state’s 169 cities and towns.

“The reality is that ... in normal times we have 30,000 people get on or get off the train at the Stamford train station and a big chunk of those people are traveling to or from New York City,” Martin said. “With a wide diversity of socioeconomic status that are basically right here next to the New York epicenter, it has been a struggle for us.”

Commuting patterns can partly explain the virus’s spread in the New York region. Subway ridership in the city tops 5 million on an average weekday, and according to a recent study by the city’s planning commission, about 1 million people travel into New York each day from the surrounding counties — and a quarter-million go in the opposite direction — many on public transportation that is routinely overcrowded.


The picture is more complicated, though. An Associated Press study of COVID-19 cases by zip code in New York City has found, for example, more cases per capita in Staten Island, the least congested of the five boroughs and the one not served by the city’s subway system, than in some of the more densely populated areas of Manhattan, Brooklyn and Queens.

Bergen County Executive James Tedesco, whose county has the highest number of cases in New Jersey, said officials were initially able to track the virus’ spread along the most heavily used bus and train lines. As other outbreaks followed, he has waged an ongoing campaign, mostly successful, to stress the importance of social distancing to the county’s approximately 932,000 residents.

“Some people have a behavior that says, ‘I don’t care;’ that’s the small minority still, and I’m happy about that,” Tedesco said. “I get it, it’s not easy. But I have lost an uncle, my cousin lost her father and her husband in the last three weeks, and a friend of mine lost his wife. This isn’t the flu.”

The Associated Press contributed to this report.