“Even in wealthy cities like Singapore, the poorest sectors of the population often have an inability to self-isolate due to dense living conditions and are thus at higher risk of contracting and spreading diseases”, writes Dr Creighton Connolly, Senior Lecturer in Development Studies and the Global South in the School of Geography at the University of Lincoln
Most of the recent pandemics and major epidemics in the world, from SARS to H1N1, to Ebola, Zika and now COVID-19 emerged in cities, and were largely transmitted in cities. Previous research has shown that dramatic changes in demographic and social conditions, including an exponential increase in global transport, are responsible for much of the global emerging infectious disease problem. Diseases like SARS were associated with the rise of globalisation, as inter-connected global cities like Toronto and Hong Kong were severely affected. Decreasing travel times allowed for the quicker spread of microbes/viruses, before governance and healthcare systems could identify and control them. But COVID-19 is really a story of peri-urban and rural-to-urban connections, in places that are often not on the global map. We are now seeing more peri-urban and regional connections between a larger network of cities that makes it much more difficult to contain disease outbreaks.
For example, as is well-known now, the emergence of SARS-COV-2 was connected to a seafood market in Wuhan, a city of 11 million people. The coincidence with the emergence immediately before the Chinese new year holiday, and Wuhan’s role as a major travel hub or ‘thoroughfare’ in China, led to the rapid spread of the disease. In general, cities are inherently connected with their peripheries through flows of people and goods on a daily basis. People commute into and out of the city each day for work; food and other essentials are often produced in peri-urban or rural areas and transported into the city. There are thus plenty of opportunities for the spread of microbes, bacteria and different forms of natures through these activities and networks.
Recent trends suggest that the emergence of pathogenetic zoonoses in rapidly developing and urbanising regions appears to have become a paradigmatic component of urbanisation and globalisation processes in the 21st Century. This is happening with expansion of urban areas into the previously uninhabited/urbanised peripheries, where there is more contact/interaction between humans and other animal and plant species. Recent research indicates that rapidly expanding infrastructure networks and urban landscapes can themselves play a role in the emergence of potential outbreaks. Examples include deforestation on the edges of cities and new agro-industrial transformation of hinterlands, producing new pathways of emergent infectious disease transmission.
The fact that the global aviation industry has confounded the ability to contain disease outbreaks has been well established since the SARS crisis of 2003. But we also need to look beyond airports to transnational manufacturing networks; Chinese financed Belt and Road infrastructure across Asia and Africa; and in global and regional transportation hubs like Wuhan. However, the lack of infrastructures in rapidly urbanising regions, including Southeast Asia, can also have severe consequences for the rise of epidemics, as this rapid growth in cities and urban populations is not accompanied by the appropriate development of social and technical infrastructures. This includes access to clean water supplies which are essential for combating the spread of infectious disease, but are often lacking in rapidly growing informal settlements. Even in wealthy cities like Singapore, the poorest sectors of the population often have an inability to self-isolate due to dense living conditions and are thus at higher risk of contracting and spreading diseases.
As some may recall, Singapore was initially praised for its handling of COVID-19, and even managed avoiding imposing lock-down conditions until mid-April. However, a sharp increase in COVID-19 cases among Singapore’s migrant worker population then emerged. Nine dormitories, housing more than 50,000 men, mostly from Bangladesh, India and China, had been declared “isolation areas.” and were effectively on lockdown, meaning that about 300,000 workers had restrictions on their movements within their complexes. This accords with our research on the peri-urban aspects of infectious disease, as most worker dormitories are located on the peripheries of Singapore and can have 12–20 workers sharing a single room. They were also essentially ‘out of sight’ of politicians, until the issue exploded.
This brings me on to another topic, which is how cities have responded to the COVID pandemic, particularly the role of civil society. Hong Kong is an interesting case in this regard, as the organisational capacity and the civic infrastructure built by the recent protest movements played a central role in the city’s response, and ultimate success in containing the virus’ spread. One group set up a website to track cases of COVID-19, monitor hot spots, warn people of places selling fake PPE, and report hospital wait times and other relevant information. Civilians also spontaneously adopted the wearing masks in public, defying the government’s ban on masks (in place due to the protests). Large groups of volunteers also distributed masks to the poor and elderly, and installed hand sanitiser dispensers in crowded (low income) tenement buildings. When the government at first refused to close the border with mainland China, more than 7000 medical workers went on strike, demanding border closures and PPE for hospital workers.
My final point is about how urban design strategies can be reformulated to cope with increasing densities and deepening inequalities in the age of global pandemics. Urban density has been widely accused in popular media for the severity of the current pandemic in places like New York City. But in fact, Asian cities like Hong Kong, Seoul and Taipei are far denser than and they have had far fewer cases of COVID-19 per capita. This is why Roger Keil, Harris Ali and I have argued that governance is a more important factor than density in determining the severity of outbreaks. We are thus likely to see dramatically different responses in the next pandemic, as politicians will have learned some important lessons from this one. Politics in municipalities, between cities and other jurisdictions, and between municipalities and civil society actors and local communities will thus be crucial to understanding the role urban health governance plays in an increasingly urbanised and globalised society.
There has also been a lot of discussion about how cities and the world is going to change after COVID-19, much of which also relates to density and how we get around (mobilities). Some urban designers are now arguing for a so called ‘Goldilocks density’ which refers to density that is high enough, but not so high that people are living in 30 storey apartment blocks which rely on extensive use of public spaces like elevators. There is also a widely recognised need to plan cities better to support bike and pedestrian infrastructure, so that people can get around without relying on crowded public transit like subways if needed. This also needs to be constructed evenly, rather than just serving wealthier, middle class communities, which has been the case in some cities in recent decades.
In terms of global and regional transport, research on past pandemics has shown — and as we’re seeing with COVID-19 — that travel bans aren’t really useful in containing diseases, because there will inevitably be some spread of the disease before these are enforced. At best they can delay the spread of disease. In contrast, cities that have worked the quickest and most diligently to control local transmission through contact tracing, identifying sources of infections, quarantining affected individuals, and so on, have been most effective. It’s also essential to avoid total inaction at early stages (e.g., UK & US) and total lockdowns, which as we’re also seeing can have severe economic effects. As such, we will need to have much more research along truly interdisciplinary lines, including social scientists, urban planners, and epidemiologists in order to effectively respond to future pandemics and understand the inter-connected dimensions, which is something that we are actually now starting to see with COVID-19.
*This blog is based on Dr Connolly’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.