CITIES WERE A MISTAKE:

Dr. Ben Locwin of Portsmouth, an infectious disease expert, said it's population density, rather than raw population numbers, that drives the risk of the virus exploding in any community.

"Just because you have 10 times more people doesn't mean you get 10 times more virus. The population density is driving this inevitability," said Locwin, whose resume includes time as a senior consultant to the Centers for Disease Control. "It's all about so much high-rise living, people stacked up, all sharing volumes of air, touching the same doorknobs.

"There is, generally speaking, a lot more space and air volume in New Hampshire," said Locwin.

That's the first point Sununu and State Epidemiologist Dr. Benjamin Chan turn to when pressed why they think New Hampshire's incidence of disease has been lower.

"Areas like Boston, you have an apartment building, close confined coffee shops, everyday living and workplace environments that can be very dangerous, and that makes it very difficult to mitigate the spread," Sununu said.

But congestion alone doesn't tell the story.

Boston lies in Suffolk County, which doesn't have the state's most COVID-19 cases, according to its Department of Public Health.

The largest number is in Middlesex County, which includes most of the Merrimack Valley, just south of the New Hampshire border, to Cambridge, just north of Boston.

Essex County, from Lawrence to Gloucester on the coast and north to the state line, and Norfolk County, from Quincy south of Boston to the foot of Cape Cod, each have almost three times as many COVID-19 cases as all of New Hampshire.

State officials said contact by New Hampshire residents working or visiting south and then coming home is a major reason New Hampshire's southeastern border counties, Hillsborough and Rockingham, have 74% of New Hampshire's COVID-19 cases.

Two weeks ago the state installed signs on the interstates telling out-of-state residents who come to stay in New Hampshire that they must quarantine for 14 days before venturing out. "It's not complicated. If you're passing through, fine, but if you intend to stay for a while, we need you to self-quarantine," Sununu said.

It's also why cases from community spread have surpassed travel-related cases and contact with someone infected as the leading cause of COVID-19 in New Hampshire.

"I think we are still seeing a lot of community transmission taking place here in venues like liquor stores, grocery stores and other retail places. People who are asymptomatic, they are going to the liquor, grocery stores, not wearing masks and spreading the virus," said Dr. Rich DiPentima, a 30-year health executive with two stints at the New Hampshire Division of Public Health, including one as chief of communicable disease epidemiology.

Over his long career, DiPentima, 75, helped fight swine flu in the 1970s, AIDS in the 1980s and the SARS outbreak in 2002-04.

"The biggest risk factor for almost any untoward health event is poverty, and we are seeing that nationally as well," DiPentima said.

"If you are poor, you have fewer resources and access to what it takes to remain healthy during an outbreak. It's that simple."

According to 2019 U.S. Census department numbers, Massachusetts had the 25th-lowest poverty rate, at 10.4%.

That same year, New Hampshire's poverty rate was the nation's lowest at 7.7%.

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