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Multiple small- to middle-scale cities, mostly located in northern China,became epidemic hotspots during the second wave of the spread of COVID-19 inearly 2021. Despite qualitative discussions of potential social-economiccauses, it remains unclear how this pattern could be accounted for from aquantitative approach. Through the development of an urban epidemic hazardindex (EpiRank), we came up with a mathematical explanation for thisphenomenon. The index is constructed from epidemic simulations on a multi-layertransportation network model on top of local SEIR transmission dynamics, whichcharacterizes intra- and inter-city compartment population flow with a detailedmathematical description. Essentially, we argue that these highlighted citiespossess greater epidemic hazards due to the combined effect of large regionalpopulation and small inter-city transportation. The proposed index, dynamic andapplicable to different epidemic settings, could be a useful indicator for therisk assessment and response planning of urban epidemic hazards in China; themodel framework is modularized and can be adapted for other nations withoutmuch difficulty.

Urban Epidemic Hazard Index for Chinese Cities: Why Did Small Cities Become Epidemic Hotspots?