The urban side of pandemics

Cities are known to be places of multimodal transport connectivity, social interaction and gathering, agglomeration economies and public life. In the last weeks, as cities all around the world turned into desert spaces due to quarantine measures, they have become the most evident and symbolic example of the health crisis that our world is facing. Now we can hardly recognize them.

Pandemics do shape cities, leaving a visible trace in the way they are planned. The Romans built numerous aqueducts to bring water from distant springs to their cities, supplying thermal baths, latrines, fountains and private homes. The wastewater was eliminated with complex sewage systems and discharged into nearby watercourses, keeping cities clean and free of effluents. They made cities healthier places for their residents and helped preventing collective diseases, bringing clean and drinkable water within their borders.

More recently, the London Metropolitan Board and the first urban sanitation systems developed during the 19th century in response to a cholera outbreak. These urban reactions to epidemics were the result of experimentation. Part of the history of urbanization is no more than a series of trials to face the spread of infectious diseases within cities.

A series of images from cities under quarantine (Source: The Guardian)

However, as Michele Acuto, professor of global urban politics at the University of Melbourne and director of Connected Cities Lab, explained during his recent interview for CityLab, Covid-19 is the result of “peri-urban and rural-to-urban” interactions (Klaus 2020). Globalization definitely plays a central role, but global cities do not represent the scenario where everything started (Klaus 2020). Most probably this is the story of a person who travelled from the peri-urban region of Wuhan to a rural-to-urban city in Bavaria (Klaus 2020).

If global supply chains might explain part of the story, global cities are those which experience the outbreak of the pandemic more seriously and violently. Public health is definitely an urban issue and now more than ever the overwhelming burden on hospitals is affecting cities more than smaller urban and rural areas. Thus, cities tend to represent a multiplier of opportunities and problems at the same time. Indeed, proximity as a result of built-environment densification in cities can be a problem when trying to contrast pandemics with a high rate of transmission such as Covid-19. One of the first lessons, suggests Prof. Acuto, may be rethinking density management to survive in a pandemic world, by decentralizing some essential services and imagining new forms of health care delivery such as door-to-door testing. In fact, compared to rural areas, urban centers provide stronger chains of viral transmission, with higher contact rates and more people prone to infection.

The increasing danger generally associated with living in cities during the age of pandemic disease seems to have induced some people to quarantine themselves in the suburbs, considered as safer places. A new line of business is growing in the US, where there are cases of people renting their rural houses and branding them as Covid-19 safe houses (Bliss and Capps 2020). These social reactions easily remind of The Decameron, a well-known story written by Giovanni Boccaccio about a group of young and rich Florentines who escaped the Black Death, which was slaughtering Florence in the 14th century, to find shelter in a cottage in the countryside.

However, there is no place which is inherently safe and, as aforementioned, Covid-19 initially spread in the urban periphery. Indeed, if rural populations have less means to contract Covid-19, they also have less means to treat it, as Kassens-Noor explained, professor of urban planning at Michigan State University specialized in the study of the relations between pandemics and urban densities (Bliss and Capps 2020). Thus, there are specific challenges that peri-urban and rural areas need to cope with. Firstly, there is the issue of access to health care facilities. Secondly, vaccination rates are usually higher in cities. Therefore, the so-called phenomenon of the heard immunity tends to occur more easily in large urban agglomerations (Bliss and Capps 2020).

Finally, a paper published in 2018 on Science explained how middle-size urban centers tend to experience “shorter and more intense outbreaks of influenza” when compared to big cities (Bliss and Capps 2020). This still depends on the heard immunity mechanism which reaches higher degrees in bigger cities.

Moreover, and especially in the global south, risks associated with pandemics in cities result to be higher for people living in slums and informal settings, where common hygiene standards and self-isolation are not really feasible. Therefore, as anthropologist and health systems researcher Annie Wilkinson pointed out, it is necessary to consider how to mitigate the impact of Covid-19 on people living in densely populated and unsanitary environments (2020). She highlighted how the difficulty in the collection of data on slums represents an additional constraint when policies need to be implemented. In these areas, many diseases and health issues go unresolved and people live in chronic untreated conditions (Wilkinson 2020). Most vulnerable groups tend to be more exposed to any kind of epidemic disease and urban planning across the world cannot avoid considering this trend. Thus, specific policies must be implemented to guarantee an additional support especially in term of food and health care access for city dwellers who are socially and economically excluded but more exposed to urban risks.

Finally, there is a lesson that every city around the world must learn, which is that crises can be productive when established ways of thinking are jeopardized by non-predictable circumstances, such as global epidemics. The magnitude and direction of transformation depend on how cities can learn from each other, from their successes and mistakes in interpreting and handling epidemics. Again, as Prof. Acuto stressed, there is a terrific opportunity offered by digital transformation (Klaus 2020). In particular, digital infrastructure may determine one most revolutionary change in health care management and sanitation across the globe. Therefore, cities with their higher levels of connectivity can lead the way towards revolutionary changes. Hence, understanding the urban planning dimension of pandemics starts from improving data management, digital infrastructure and connectivity in cities. We have now the opportunity to rethink, especially in dense urban settings, the way to test and contain pandemics. Acuto reported how platforms such as Tencent and Alibaba can provide detailed information on how many people are sick in a given neighborhood, which may be a relevant tool for decision-making and urban planning during this trying time (2020). These experimentations, however, inevitably raise questions on privacy, state control and policing.

How can we use digital innovation tools for the improvement of our health care management and risk prevention strategies without transforming them into mass controlling instruments?

Sources

Bliss, L. and K. Capps (2020), Are Suburbs Safer From Coronavirus? Probably Not, available from https://www.citylab.com/life/2020/03/coronavirus-data-cities-rural-areas-pandemic-health-risks/607783/

Klaus, I. (2020), Pandemics are also an Urban Planning Problem, available from https://www.citylab.com/design/2020/03/coronavirus-urban-planning-global-cities-infectious-disease/607603/

Wilkinson, A. (2020), What is the impact of Covid-19 in informal settlements?, https://blogs.lse.ac.uk/africaatlse/2020/03/13/what-is-the-impact-of-covid-19-coronavirus-informal-settlements-africa/