Unequal impact and spatial aggregation distort COVID-19 growth rates

The COVID-19 pandemic has emerged as a global public health crisis. To make decisions about mitigation strategies and to understand the disease dynamics, policy makers and epidemiologists must know how the disease is spreading in their communities. We analyze confirmed infections and deaths over multiple geographic scales to show that COVID-19's impact is highly unequal: many subregions have nearly zero infections, and others are hot spots. We attribute the effect to a Reed-Hughes-like mechanism in which disease arrives at different times and grows exponentially. Hot spots, however, appear to grow faster than neighboring subregions and dominate spatially aggregated statistics, thereby amplifying growth rates. The staggered spread of COVID-19 can also make aggregated growth rates appear higher even when subregions grow at the same rate. Public policy, economic analysis and epidemic modeling need to account for potential distortions introduced by spatial aggregation.