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Roger Keil

June 29th, 2020

Infectious disease in an urban society

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Estimated reading time: 10 minutes

Roger Keil

June 29th, 2020

Infectious disease in an urban society

0 comments

Estimated reading time: 10 minutes

“COVID-19 has caught many cities unprepared due to existing structural inequities and past institutional neglect”, writes Prof Roger Keil, Professor at the Faculty of Environmental Studies, York University in Toronto

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I live in Toronto, which shared the SARS experience in 2003 with Hong Kong and Singapore. S. Harris Ali and I did research at the time on the relationships of SARS and the global city which ultimately laid the foundation for the work we have been doing on cities and disease since. In 2003 we argued that SARS was a disease that revealed the connectivity of the global cities network in an uncanny and deadly way. The disease followed some of the pathways of global air traffic to the mobility nodes — the airports — that were considered crucial to that system of concentrated, coordinated finance capital accumulation and financialisation that those cities produce and represent. The virus, even then, did not stay in the airport lounges and luxury hotels but went to the capillary systems of each globalised city where it arrived, often along the lines traveled by diaspora communities and their families. What was also significant about SARS was the high degree of nosocomial infection, this means the infection in hospitals that often became the hotspots of contagion at the time. Patients were most infectious when they needed intensive care, a dangerous combination, especially for underequipped hospital workers. On the background of this research, let me make some observations on the present relationships of urbanisation and COVID-19.

The first point I would like to make here is that COVID-19, another coronavirus, much like SARS, revealed a different type of relationship with the urban world. It laid bare that we all now live in an “urban society” as French philosopher Henri Lefebvre has called it. The diseases we most likely encounter today are diseases in and of that urban society. Not confined to the elite spaces of global capital and the trajectories of finance, the current emerging infectious disease, COVID-19, enveloped the globe quickly in a deadly manner following the multiple interconnections that make up the urban fabric of the current world system. Barely any spot in that system has been spared. The original hearth of the pandemic, Wuhan, is all but forgotten now that the pandemic has spread so widely through the urban fabric. What we would add here is also that to a large degree, we can talk about a disease of the social, spatial and institutional periphery of this urban world. This needs nuance and explanation, but we can first let it stand as a typical characteristic of COVID-19 spread.

Our argument is basically that we need to see the spread of emerging infectious diseases — those that are new to humankind — in relation to the immense expansion of urban life around the globe. We are now a majority urban planet but even if we don’t technically live in cities, the tentacles of urban society reach to far flung mining camps, logging operations, agricultural regions and the like that make urban life possible elsewhere.

Large urban centres are mostly affected — at first — as they tend to be the mobility hubs of their countries. Economic travel, tourism, exchange students but also refugees are concentrated here. The large airports are in the metropolitan regions. Yet, how and whether the virus spreads through the city once it has arrived can have all kinds of reasons and pathways.

If we look at some of the most affected centres from Wuhan, to Milan, Madrid, New York and Montreal, there is no one pattern of transmission that would allow us to make simple connections to urban form and design. Still the phenomenon that my colleagues Murat Güney, Murat Üçoğlu and I have examined in the edited book Massive Suburbanization may play a role. It is true that this now dominant urban landscape with its extensive suburban settlements, many in towers, some in gated communities of houses, yet others in informal settlements, provides a generally more expanded set of points of attack for the virus. Often, we find a lower availability of public health infrastructures and medical establishments in those new peripheries. Sometimes, we find the poorest populations in the highrise neighbourhoods or informal settlements at the peripheries of the city. They are not well connected to the infrastructural fabric of the urban region and are hence vulnerable to all manner of service deserts from food to transportation to health. This is the dialectics of infection: We are getting exposed because we are too connected and then we are getting sick because we are not connected enough.

But there is no indication that in any of the affected cities there is a direct relationship of the spread of the virus to density of urban form per se. There is some evidence that in overcrowded and poor areas of cities like New York, Toronto and Chicago, where there is a concentration of marginalised, often racialised populations, that the virus has claimed a higher proportion of residents than in the more wealthy and whiter neighbourhoods in other parts of those cities. But there is scant relationship to built urban form and dense design. The virus has rather claimed most of its victims in institutional environments — care homes, prisons, camps, reserves, some work environments such as meatpacking plants and among migrant farm workers — where populations have been massed and sequestered under conditions of exploitation, austerity and underfunding.

What I mean to say, then, is that the virus arrives in the global city but it tends to do most damage to peripheral populations and institutions of our fundamentally urbanised society. This can be peripheral or smaller and poorer cities. In the UK, we can think of Wolverhampton but also of tourist regions such as the Lake District or other places that are in direct connection with cities elsewhere, and that are susceptible to contagion from casual visitors. But mainly, we need to have our eyes on the institutions that have been peripheralised socially in decades of “austerian realism” as Jonathan Davies has called it. This could be racialised neighbourhoods, Indigenous reserves, or care homes of all kind.

The second point I want to make is that the urban is not a collection of distinct towns and cities but a set of built, social and natural environments that are connected through urban lifestyles and related priorities. People have had their eyes on cruise ships and other mass tourism sites such as ski resorts as early points of contagion. Some have argued that this means COVID-19 was originally a disease of luxury affecting those who can afford to vacation and seek refuge in the prime spaces of elitist fun, and has since become a disease of misery killing those who are least mobile and most stuck in place, such as elderly people in long term care homes. This may be a fair reading, and I subscribe to the overall narrative that it was the most mobile and most privileged that were first spreading the virus around the world. But there is another lesson to be learned here and that is important to our topic: First we need to state that on most cruise ships and in most ski areas not all that glitters is gold. Those can be hideously overcrowded, cheap and miserable places themselves and let’s not forget about the workers that provide services under those conditions. But what is important about both those landscapes is that they are extensions of our urban world. They belong to the city. The Austrian scholar Wolfgang Andexlinger speaks about the valleys of Tyrol as “island-like” tourism landscapes linked to skiing as a mass event and tied into the urban fabric of the region and the continent through massive infrastructures, highways and entertainment establishments. So, in many ways, misery, that of the — urban — world of mass cruise ship travel and mass skiing, loved the company of the social, spatial and institutional peripheries where the virus was spread from there.

The third point I would like to highlight here is that in this urban world, local and regional jurisdictions remain important, perhaps more than ever, as bounded forms of territorial decision-making and governance areas that are also connected to other such areas regardless of their location in a particular nation state. This is a crucial point in effective pandemic preparedness, response and reopening as we are currently witnessing. Pathogens are not naturally contained by political borders. The borders are only as strong an obstacle to the spread of the disease as the health governance institutions and practices that govern the particular territory where it takes hold.

In an urban world, nation states have still shown to have a hard grip on global health governance. Realist international diplomacy and the role of the United Nations organisations, especially the World Health Organization, to deal only or mostly with national governments is behind this. That makes sense to some degree as the sovereignty of nation states still reigns supreme at the international scale. But the role of cities has, clearly grown nonetheless. This is true inside countries, as we could see from the self-confident politics of mayors in the United States, for example, vis-à-vis a federal government that had largely abdicated its responsibility throughout much of the pandemic; and it is true globally, as organisations such as the C40 organisation of mayors have rallied to join forces in their fight against the impact of the pandemic on their cities. Two areas will need our attention. First, can civil society and grassroots initiatives be made a stronger part of municipal governance strategies and, second, will municipalities be supported by higher level governments when they inevitably fall into a deep fiscal hole after the crisis is over? Both questions are important in Canada but I assume also elsewhere.

We shall see how municipalities will fare. There are some good initiatives under way. Renters have been protected in many cities. Low wage service workers have seen a boost and recognition of their dangerous work. But we have a long way to go until we can say that subnational governments have made a real difference here. Much will depend on whether specific urban social movements can turn on the heat on their municipal and regional governments. I think housing will be a battleground as the financialised real estate industry will have to be forced to change its evil ways that sees turning a profit as more important than providing affordable housing as an accessible use value to the majority. It is only if we tackle these larger, structural questions of urban inequities, many of which are the purview of municipal government, that we can develop a sound plan for reopening while looking ahead to a robust pandemic preparedness strategy for the future. COVID-19 has caught many cities unprepared due to existing structural inequities and past institutional neglect. We must do better on both fronts.

 


*This blog is based on Prof. Keil’s talk delivered at the LSE Saw Swee Hock Southeast Asia Centre’s online event on 3rd June 2020 entitled, “Post COVID-19 Futures of the Urbanising World”. Watch the recording of the event here.

*The views expressed in the blog are those of the authors alone. They do not reflect the position of the Saw Swee Hock Southeast Asia Centre, nor that of the London School of Economics and Political Science.

About the author

Roger Keil

Roger Keil is Professor at the Faculty of Environmental Studies at York University in Toronto. He researches global suburbanization, urban political ecology, cities and infectious disease, and regional governance. Keil is the author of Suburban Planet and editor of Suburban Constellations. A co-founder of the International Network for Urban Research and Action (INURA), he was the inaugural director of the CITY Institute at York University and former co-editor of the International Journal of Urban and Regional Research.

Posted In: COVID-19 and Southeast Asia

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