FALL RIVER — Across the country and through much of Massachusetts, the coronavirus has hit immigrant and low-income communities especially hard.
But New Bedford and Fall River, two gateway cities south of Boston, are seemingly bucking that demographic trend, registering far lower rates of infections, hospitalizations, and deaths than comparable cities.
As of last week, there were 165 confirmed cases per 100,000 residents in New Bedford, and 167 cases per 100,000 in Fall River, one-third the statewide rate, according to the latest state data.
In New Bedford, whose population is 95,000, the epidemic is responsible for 10 deaths, a relatively low number for a city its size. Fall River, slightly smaller at 89,000, has recorded three deaths so far, all of them family members who worked together at a local grocery store.
By contrast, at least 25 people have died from COVID-19 in Newton and 38 people have died in Quincy, two similarly sized cities close to Boston.
The unexpected disparity has caught the notice of health officials and raised hopes that early preventive efforts in the two cities in Southeastern Massachusetts, coupled with their distance from the surge of infections in the Boston area, have paid off, at least for now. But local officials also admit they are puzzled, and worried that the worst is still to come.
“I don’t think we’ve figured it out, but we do notice it, and we do talk about it,” Cheryl Bartlett, CEO of the Greater New Bedford Health Center, said of the low-infection rates.
“It would be nice to think that emergency preparedness is effective," said Bartlett, the state’s public health commissioner from 2013 to 2014.
Both cities’ mayors attribute their low rates to early social distancing restrictions, compliant residents, and spread-out neighborhoods. But they are far from declaring victory, and remain wary that more cases will emerge in the coming days and weeks.
“Like everywhere else, we’re doing the best we can,” said New Bedford Mayor Jon Mitchell. But “we are not about to embark on a victory lap.”
Fall River and New Bedford are about an hour drive from Boston, which as of April 14 had recorded 663 cases per 100,000 residents. They are closer to Providence, which has logged slightly fewer cases — 587 per 100,000.
“It seems like a lot of stuff is working for us right now — everyone is following the public service announcements and wearing masks and just being diligent,” said Fall River Mayor Paul Coogan. “But they say the Providence surge might be another week away, and we’re only 15 miles from Providence, so our numbers might change.”
While the area’s geographic insulation may help explain some of the difference in rates, it’s likely that many cases are going uncounted, said epidemiologist Nadia Abuelezam, a professor at Boston College’s Connell School of Nursing.
Low-income and immigrant communities have been hit harder by the virus, she said, because of poorer access to health care, the types of jobs they work, more crowded living situations, and the inability to work from home or take sick days.
“It does seem weird that this area seems to be doing better — to me that indicates we’re not doing a good enough job collecting information on them,” Abuelezam said.
Fall River is a weathered city crowded with battered Victorian homes overlooking Mount Hope Bay. Old stone churches seem to outnumber gas stations. And there’s a genuine brick-building-lined Main Street with barbershops, a couple of pawn shops, more than one place to get a Coney Dog, and a market called Tu Bodega Latina.
Nearly 20 percent of residents live below the poverty line, and property crime is high.
Fifteen miles away is New Bedford, which has a similar poverty rate and also has a sizable Latino and immigrant community.
Mitchell attributed New Bedford’s low rate to two factors: his early actions to contain the virus, such as canceling public events and closing businesses, and the area’s relatively self-contained economy. Many people stick close to home, he said, and don’t often travel to Boston or Providence.
“It’s its own place,” Mitchell said.
Mike Gagnon, an administrator at Fall River Health Care, believes geography is a primary reason why the 155-patient nursing home has no confirmed case of COVID-19.
“Your true urban areas are where you’re getting the majority of the cases,” he said. “While Fall River is definitely not a farming community, we’re much smaller than say, Worcester, and our neighboring towns are farming communities.”
In downtown Fall River, far fewer people wear hospital masks or face coverings than are typically seen in many public places in the Boston area. On a recent afternoon in Fall River, dog walkers, bicyclists, pedestrians, and mail carriers walked without face coverings.
Breidy De Los Santos, 30, of Fall River, said that if she still lived in Boston she’d be wearing a mask. But she chose not to while shopping at Market Basket Monday evening.
“Maybe I feel a little bit safer than when we used to live in Boston,” she said. “It’s not as congested here.”
Another unmasked shopper, Yanylyz Navarro Nieves, said she has largely stayed indoors since January.
Most of her neighbors routinely do the same, she said, not just during a pandemic.
Perhaps the low infection rates reflected that, she said. “Honestly, I feel like people just stay home here.”
Mitchell said it’s unclear whether the New Bedford area is just behind the rest of the state on the epidemic curve or whether it’s on a lower curve altogether.
Bartlett, the health center CEO in New Bedford, said she is “wondering if we’re seeing some sort of a delay here."
“I’m cautious to think that we’re escaping this for some reason," she said.
The health care center where Bartlett works recently started to see more people from the area’s Portuguese, Guatemalan, Dominican, and Puerto Rican communities seeking testing, she said.
"I am a little concerned because we have such ethnic diversity and sometimes the language and cultural barriers make it take longer to penetrate into those communities,” she said. “We’re just starting to see a large Latino population coming forth for testing."
Those communities, she said, tend to seek out doctors only when they’re really sick. And because they’re largely hourly wage earners, they are more reluctant to take time off for health issues.
The available testing data is incomplete. The three testing sites in Fall River reported testing a total of 4,000 people so far, Coogan said. Southcoast Health said it had tested more than 3,500 people, 545 of them positive, largely in the greater New Bedford area, but there are another two testing sites in that city.
The state Department of Public Health said it can’t say whether that region of the state is testing more or less compared to other areas.
“We are still analyzing the data to better ascertain this,” said spokeswoman Ann Scales.
Coogan, the Fall River mayor, said he wished he could take credit for his city’s relatively low number of cases so far.
"But it does not work that way,” he said in an e-mail. “Any day the bottom could drop out — so luck can also help!”