Disease shapes cities. Some of the most iconic developments in urban planning and management, such as London’s Metropolitan Board of Works and mid-19th century sanitation systems, developed in response to public health crises such as cholera outbreaks. Now COVID-19 is joining a long list of infectious diseases, like the Spanish flu of 1918 in New York and Mexico City or the Ebola Virus Disease in West Africa in 2014, likely to leave enduring marks on urban spaces.
For Michele Acuto, professor of global urban politics in the School of Design at the University of Melbourne, the intersection of urban design and public health is an increasingly critical territory. He’s the director of the Connected Cities Lab, a leading center for advancing urban policy development; he’s worked on urban health in a number of capacities, including with the European Commission and the World Health Organization’s Western Pacific Regional Office. While the University of Melbourne scrambles to accelerate a COVID-19 vaccine, the Lab is working to understand the urban planning dimensions of pandemic preparedness.
CityLab spoke to Acuto about why COVID-19 could change how we study cities — and how we live in them.
Much of the coverage of the new coronavirus feels unprecedented, as if this is the first time urban spaces and global movement of goods and people have given rise to the threat of pandemic. But the stories of cities have always also been those of infectious disease.
Anyone you talk to on the urban or medical side would tell you this is not new. You can do parallels between COVID-19 and many other epi- and pandemics, from the plague to SARS and Ebola. The line of caution we need here is not to draw too many parallels or rushed conclusions without evidence. COVID-19 is not as deadly as Ebola, which had a mortality rate of 60%, or SARS and MERS at 30%.
But if the risk of death is lower, transmission is much higher, and that makes it challenging globally. Quarantines only work insofar as you can identify all dangerous cases, and with COVID-19’s symptoms and delayed onset, you can’t spot it that easily. In that way this is much more similar to the 1918 Spanish flu epidemic, which inflected 500 million and killed up to 50 million.* The question is whether we are prepared to avoid that.
Looking back, did we miss something in the way we were thinking about the intersection of urbanization and infectious disease? Were we looking in the wrong places?
Yes, to a degree. We have perhaps been a bit too biased toward global cities. COVID-19 is really a story of peri-urban and rural-to-urban connections, in places that are often not on the global map. Roger Keil, Creighton Connolly and Harris Ali recently argued for this suburban view. They tell the story of how the spread to Germany starts with a car [parts] factory in the outskirts in Wuhan. A person travels from Wuhan to Germany to help with training. This is a story of peri-urban Wuhan to semi-suburban, tertiary-city Bavaria. So sure, you have some of the global connections at airports, but it’s a much more complex urban system.
This is a rich point. It’s easy to look at these major cities and global supply chains, and say of course we have an epidemic — this is how globalization plays itself out. But you’re telling a different story — one about non-global cities, tertiary cities and peri-urban areas.
Yes, it’s actually about a much wider set of urban areas. This is the story in Washington state [where COVID-19 first emerged in Snohomish County], or the Italian story, which is still largely suburban.
Part of the history of urbanization is building and managing your way out of infectious diseases, such as cholera outbreaks in the middle of the 19th century. Here’s Richard Sennett on how Joseph Bazalgette and his colleagues went about developing London’s response: “They were not practising an exact science. They did not apply established principles in particular cases, there were no general policies that dictated best practices.” They experimented and learned as they went along, he argues. How do you conceive of the design approach to managing outbreaks in everything from global to tertiary cities?
It’s a bit early to take on lessons learned from COVID-19, but you’d probably have a big conversation about the value versus the risks of densification. Clearly densification is and has been the problem with some of this. COVID-19 puts a fundamental challenge to how we manage urbanization. Hong Kong has 17,311 people per square mile. Rethinking density management is a key for long-term survival in a pandemic world, really.
Part of this means thinking about decentralization of essential services. Singapore had to shut down its main hospitals during SARS. Many countries such as Italy are considering door-to-door testing. But we need to also rethink the ways, perhaps digital ones, we test and contain. How would we manage to do door-to-door testing even just in Melbourne alone, with 5 million residents, and in giants like Shanghai and London with upwards of 10 million dwellers? Bubbling up are some core questions about what we’ve been told is desirable urbanization versus what makes sense from an infectious disease perspective.
Here’s a difficult question. Even Le Corbusier, who prized efficiency and movement, understood the value of people bumping into each other. It gives cities their energy and cosmopolitanism its effect. I wonder if you think this decentralized city — a London of villages, Mayor Hidalgo’s 15-minute Paris — will be part of our response in urban form?
Here’s a way to think about it. SARS got some people to think about cities and their connectivity as a fundamental factor. Fast-forward to Ebola and that got people to think about the coexistence of cities in the Global North and South, and the ferocity of the city itself — the impossibility of just cordoning it off. The city is not a thing: it’s an amorphous blob.
Fast forward to now, and we’ve moved beyond Global North-Global South thinking. It’s one very large system, given it’s really about that connection between, for example, [the Italian village of] Codogno and the outskirts of Wuhan. Hopefully this gets us to think about some fundamental principles.
We need to begin with a new imagination of the urban data we rely on. The best thing a professional probably looks at in this moment is Johns Hopkins’s CSSE aggregator of information. It splashes together data sources from WHO, NHS, and so on. Many national governments’ “official” numbers lag, so there’s better information by aggregating different sources of information.
But this also brings into play the current digital revolution and the challenges of evidence that has different levels of legitimacy. Had this happened not, say, in China but in some place like India with very strong informal settlements, you’d potentially be arguing that something like Slum Dwellers International, which uses local mapping and communities to source data, would probably be the best-suited entity to support the collection of information. You’ve gotten something there about the legitimacy of different types of urban knowledge and the need to rethink who are the right sources of it.
Moving from that information to changes within the built environment again, we know the management of water and waste helped remake cities. Can you predict the area where we might see a radical transformation coming out of this?
We must remember you will be weighing such changes in the context of climate change and sustainability as well. If you spread the city rather than densify, that would have to go with much better connectivity of public transport. What should change — the decentralization of services, better managing of supplies, nets of smaller entities in food delivery, for instance — is different from will. Will market forces sway the things we do towards what’s marketable and economically profitable versus saying this clearly is a call for redundancy in public health and public transport?
One thing I’ve barely heard talked about is the digital response here, which didn’t exist at all at the time of most of our historic parallels. It existed a bit during Ebola, but not in the same size as this. Major services like Tencent and AliBaba can tell you who is sick in your neighborhood, and people are making daily decisions based on the whole digital infrastructure. I come from an hour from the “red zone” in Italy, and family and friends make a lot of decisions based on digital connectivity information.
Modern planning and civil engineering were born out of the mid-19th century development of sanitation in response to the spread of malaria and cholera in cities. Digital infrastructure might be the sanitation of our time.
*CORRECTION: An earlier version of this story used an inaccurate figure for the 1918 influenza epidemic.