The pandemic predominantly hits poor neighbourhoods? SARS-CoV-2 infections and COVID-19 fatalities in German districts

Background Reports from the UK and the USA suggest that coronavirus disease 2019 (COVID-19) predominantly affects poorer neighbourhoods. This article paints a more complex picture by distinguishing between a first and second phase of the pandemic. The initial spread of infections and its correlation with socio-economic factors depends on how the virus first entered a country. The second phase of the pandemic begins when individuals start taking precautionary measures and governments implement lockdowns. In this phase, the spread of the virus depends on the ability of individuals to socially distance themselves, which is to some extent socially stratified. Methods We analyze the geographical distribution of known cumulative cases and fatalities per capita in an ecological analysis across local districts in Germany distinguishing between the first and the second phase of the pandemic. Results In Germany, the virus first entered via individuals returning from skiing in the Alps and other international travel. In this first phase, we find a positive association between the wealth of a district and infection rates and a negative association with indicators of social deprivation. During the second phase and controlling for path dependency, districts with a higher share of university-educated employees record fewer new infections and deaths and richer districts record fewer deaths, districts with a higher unemployment rate record more deaths. Conclusions The social stratification of COVID-19 changes substantively across the two phases of the pandemic in Germany. Only in the second phase and controlling for temporal dependence does COVID-19 predominantly hit poorer districts.