Walkable, activity-friendly neighbourhoods are recommended for their benefits for non-communicable diseases, environmental sustainability, and economic performance. But how do activity-friendly neighbourhoods function during infectious disease pandemics like COVID-19? The spread of COVID-19 in some of the world’s dense cities has raised concerns about the risks of urban density and public transit. However, there are several pathways by which dense, mixed-use neighbourhoods with transit access and recreation facilities can reduce the risk of both infectious diseases and non-communicable diseases. Reducing health inequities is a core value for public health, and we comment on strategies for equitably creating activity-friendly communities.