Growing evidence that physical activity-supportive neighbourhoods can mitigate infectious and non-communicable diseases

In the early stages of the COVID-19 pandemic, dubious assertions that population density increased spread of the virus led to premature and dangerous recommendations promoting suburban sprawl. In 2020, we published a commentary in Cities & Health to refute these recommendations. We hypothesized that features of activity-supportive environments, including high density, would be protective from severe COVID-19 outcomes. The goal of the present commentary is to examine evidence that has emerged during the pandemic to evaluate veracity of the predictions and recommendations we made in 2020. An updated analysis of cities from each continent supports our 2020 analysis that population density is not associated with COVID-19 mortality. Our earlier recommendations to promote activity-supportive environments to benefit both infectious and non-communicable diseases, and to ensure equity of access to such environments, are now supported by empirical studies. Evidence related to public transport shows mitigation of risk could be achieved by limiting riders, travelling during off-peak hours, enforcing physical distancing, requiring face coverings, and implementing strict cleaning protocols. There is substantial evidence that environmental features and interventions that support COVID-19 mitigation strategies also have additional health, environmental sustainability, and economic benefits.