Whenever we need specialised medical attention, we head off to the large urban centres. Everywhere in the world, cities have the best hospitals, the most highly-trained professionals and the most developed healthcare infrastructure. And yet, in every work of fiction about epidemics, people flee their cities as quickly as possible because that is where the risk of contagion is greatest. This is the striking paradox of cities. The COVID-19 pandemic has highlighted the need to maintain and promote one of the good things about big cities—their healthcare resources—by reducing their role as centres of contagion. Is it possible to design cities that are safer against epidemics?
In the event of a pandemic, “the safest place to be is somewhere where no other humans are,” explained Abram Wagner from the University of Michigan (USA) to OpenMind, in the wake of a study from the University of Otago (New Zealand) that identified island countries, with their natural borders imposed by geography, as good places to take refuge from a major epidemic. Historically, urban agglomerations have played a harmful role in the transmission of infectious diseases. They have been plagued by scourges such as the Black Death and cholera when cities still lacked basic hygiene, which reached a peak with the great migrations from the countryside to the cities during the Industrial Revolution. Events such as the 1854 cholera epidemic in London brought about significant improvements in water quality, waste collection and sewerage.
Nowadays, cities are no longer the breeding grounds for germs that they once were before these advances, and it should be noted that where hygiene standards are met, further improvements do not involve excessive disinfection measures, which are not only unnecessary, but can even be harmful. COVID-19 has taught us the value of hand hygiene and cleanliness. But in light of the disinfection of streets practiced in many places, the World Health Organization (WHO) warns: “Spraying or fumigation of outdoor spaces, such as streets or marketplaces, is also not recommended to kill the COVID-19 virus or other pathogens.” Current science suggests that the risk of transmission by surfaces or objects is minimal and, as a recent article in The Lancet warns, excessive disinfection can lead to “a reduction in the diversity of the microbiome and an increase in the diversity of resistance genes.”
But of course, high standards of hygiene are in many cases a desirable goal. Public sanitation is still out of reach for 673 million people. Inequalities in urban areas mean that the disease is most prevalent in poorer districts; studies have shown that the COVID-19 pandemic is wreaking havoc in these communities, leading experts to warn that we are facing a syndemic, or synergistic epidemic, in which different factors come together in synergy, exacerbating the consequences for the poorest segment of the population.
Beyond public sanitation, the idea of making cities healthier spaces is not something that has only just emerged in the wake of the current pandemic. The proliferation of green spaces was originally intended to improve air quality and provide places to reduce population density and allow for healthy activities such as physical exercise; the role of green spaces in the mental health of citizens has also been noted. Therefore, the decision to close parks in many places during the pandemic has been questioned, even more so as these closures once again affect poorer neighbourhoods with smaller and more overcrowded housing.
In contrast to hygiene, air quality is an often neglected aspect of urban built-up environments, and in the current pandemic it is proving vital in controlling the spread of the virus. In buildings for office work and other uses, permanently-shut windows have become the norm, relying on the building’s own ventilation and air conditioning systems. But some experts have warned that not only do these systems tend to be kept to a minimum to reduce energy consumption, but at best they are not powerful enough to handle the necessary airflow with the right filters to remove viruses from the air. Even in hospitals, where high air quality is even more critical, the WHO has stressed the importance of natural ventilation. Perhaps in this respect the future of buildings will see a return to the past, to something as simple as being able to open the windows.
COVID-19 has fostered certain innovations which could become a regular part of urban management in the future. We have now learned the value of social distancing in containing epidemics, and Smart Cities technology can monitor the movements and flows of people and vehicles to assess their effect on the spread of viruses such as SARS-CoV-2. Newcastle University’s Urban Observatory, the largest in the UK, collects a wealth of data from sensors and devices to monitor not only climate, air quality or energy consumption, but also to track in real-time the dynamics of traffic and pedestrians, street parking occupancy or the position of buses.
During the pandemic, the observatory has analysed more than 1.8 billion pieces of data with automatic learning algorithms to monitor the impact of public measures taken against the virus. Using automatic visualisation and image processing systems, the researchers have developed algorithms that measure the physical distance between pedestrians, which helps to analyse the adherence to the measures and to identify places where it is not possible to maintain the appropriate distances.
In short, today there are many initiatives to make cities healthier and more resistant to disease, with a special emphasis on reducing and avoiding discrimination between areas or neighbourhoods. The WHO’s Healthy Cities movement or the ARCHIVE Global organisation are two examples on a large international scale, but there are a multitude of projects on a national or local level; competitions for ideas provide proposals for shielding cities against epidemics. More green and pedestrian spaces, more integrated transport, sensors that discourage physical contact, hand-washing stations, public spaces that can be converted into logistics or medical centres, or, of course, giving priority to teleworking. Perhaps, some experts point out, many of the changes will not be too obvious to notice. But they could make a big difference in the next pandemic.