Baltimore fared better than most similar places on COVID metrics, Johns Hopkins report finds

Baltimore fared better than most similar places during the coronavirus pandemic in avoiding sickness and death and in achieving high levels of vaccine coverage, a new study by public health researchers at the Johns Hopkins Bloomberg School of Public Health found.

The report, released Thursday, compared the city with more than 300 counties with similar sociodemographic makeup, reviewing data from January 2020 to June 2021.


The Hopkins report shows that Baltimore ranked in the 81st percentile in the COVID-19 incidence rate and in the 73rd percentile in the mortality rate. Its case-fatality ratio, or the number of infected people who died, ranked in the 56th percentile.

With vaccinations, Baltimore scored in the 97th percentile, with more than 60% of its population 12 and up at least partially immunized, according to the study.


“This analysis uses a method of grouping counties previously established to identify counties with similar population characteristics,” said Kyu Han Lee, an epidemiologist and research associate at the Hopkins Bloomberg School who is the report’s lead author, in a statement. “Compared to most other counties in its group, Baltimore City has experienced fewer COVID cases, less mortality, and more vaccination.”

Lee authored the report with assistant professor Melissa Marx, also an epidemiologist.

The researchers analyzed a total of 326 counties, focusing on jurisdictions deemed as “semi-urban” and having “mid/low socioeconomic status.” Counties were grouped together based on factors including health insurance status, educational attainment, age, marital status, employment status, and race and ethnicity.

In a locality mired with myriad public health challenges, the report highlights the city’s strong systems, said Dr. Letitia Dzirasa, Baltimore’s health commissioner, in a Thursday statement.

“The City’s COVID-19 response efforts have always been collective and collaborative, involving multiple partners and stakeholders across the City,” Dzirasa said. “This comparative analysis shows what we can do as a City when working together towards the common goal of protecting the health of all residents.”

Dzirasa’s department, operating at about half the size it should be, formed early partnerships with area hospitals, health systems and the state government to expand its reach. Using public-private collaborations with philanthropic entities including the Rockefeller Foundation and Pepsi, it also stood up its own contract tracing and community health workforce when staffing shortfalls threatened to cripple its progress.

After the coronavirus pandemic shut down schools, restaurants, many workplaces and other social gathering spots in March 2020, many assumed Baltimore would face mass mortality and infection given its density, said Dr. Joshua Sharfstein, a former city health commissioner and vice dean for public health practice and community engagement at the Bloomberg School.

But the worst did not happen, he said, due in large part to the city’s collaborative spirit and world-class medical and research institutions that helped keep the mitigation strategies in place as the demands on the health department increased.


“Baltimore did exceed expectations,” Sharfstein said in a recent interview. “There were so many risk factors for serious outbreaks. But the city responded at every level.”

The Hopkins study did not assess the success of specific mitigation strategies, and it notes that there are several limitations in the analysis given the problems in collecting timely data from more than 300 sources. It also did not evaluate the impact that widespread testing may have had on keeping case rates low.

“Further research could assess the importance of differences in policy, health system capacity, public health interventions, and other response efforts,” the study said.

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Other jurisdictions may have similar levels of collaboration among public, private and philanthropic institutions, but they may not communicate as frequently or as productively as they do in Baltimore, said Jeanne Hitchcock, a former deputy Baltimore mayor and cabinet-level executive in Gov. Martin O’Malley’s administration.

“Communication, communication, communication,” said Hitchcock, now an attorney and special adviser at Hopkins for local government, community and corporate affairs. “All those segments were talking to each other, wanting to minimize duplication of efforts and maximizing resources.”

On Thursday, city officials touted the study’s findings, especially as it pertained to vaccinations.


Early on in the vaccine rollout, city leaders sparred with Gov. Larry Hogan’s administration, arguing that the government was not allocating doses to jurisdictions in a proportional manner. The Republican governor later claimed that the city received more vaccines than it was “entitled” to, drawing the ire of the community.

Dzirasa and her department also drew criticism from at least one member of the City Council, who questioned the department’s decision to reallocate vaccines to hospitals in the initial months.

Baltimore Mayor Brandon Scott, a Democrat, said the report validates the city’s “equitable” approach in confronting the pandemic.

“Through a coordinated effort that embraces science and data, we have saved countless lives and protected many Baltimoreans from the worst of COVID-19,” he said in a statement.