Outbreaks like coronavirus start in and spread from the edges of cities
Emerging infectious disease has much to do with how and where we live. The ongoing coronavirus is an example of the close relationships between urban development and new or re-emerging infectious diseases.
Like the SARS pandemic of 2003, the connections between accelerated urbanization, more far-reaching and faster means of transportation, and less distance between urban life and non-human nature due to continued growth at the city’s outskirts — and subsequent trans-species infection — became immediately apparent.
The new coronavirus, SARS-CoV-2, first crossed the animal-human divide at a market in Wuhan, one of the largest Chinese cities and a major transportation node with national and international connections. The sprawling megacity has since been the stage for the largest quarantine in human history, and its periphery has seen the pop-up construction of two hospitals to deal with infected patients.
When the outbreak is halted and travel bans lifted, we still need to understand the conditions under which new infectious diseases emerge and spread through urbanization.
No longer local
Infectious disease outbreaks are global events. Increasingly, health and disease tend to be urban as they coincide with prolific urban growth and urban ways of life. The increased emergence of infectious diseases is to be expected.
SARS (severe acute respiratory syndrome) hit global cities like Beijing, Hong Kong, Toronto and Singapore hard in 2003. COVID-19, the disease caused by SARS-CoV-2, goes beyond select global financial centres and lays bare a global production and consumption network that sprawls across urban regions on several continents.
To study the spread of disease today, we have to look beyond airports to the European automobile and parts industry that has taken root in central China; Chinese financed belt-and-road infrastructure across Asia, Europe and Africa; and in regional transportation hubs like Wuhan.
While the current COVID-19 outbreak exposes China’s multiple economic connectivities, this phenomenon is not unique to that country. The recent outbreak of Ebola in the Democratic Republic of the Congo, for example, shone a light on the myriad strategic, economic and demographic relations of that country.
New trade connections
In January 2020, four workers were infected with SARS-CoV-2 during a training session at car parts company Webasto headquartered near Munich, revealing a connection with the company’s Chinese production site in Wuhan.
The training was provided by a colleague from the Chinese branch of the firm who didn’t know she was infected. At the time of the training session in Bavaria, she did not feel sick and only fell ill on her flight back to Wuhan.
First one, then three more colleagues who had participated in the training event in Germany, showed symptoms and soon were confirmed to have contracted the virus and infected other colleagues and family members.
Eventually, Webasto and other German producers stopped fabrication in China temporarily, the German airline Lufthansa, like other airlines, cancelled all flights to that country and 110 individuals who had been contact traced to have been in touch with the four infected patients in Bavaria were advised by health officials to observe “domestic isolation” or “home quarantine.”
This outbreak will likely be stopped. Until then, it will continue to cause human suffering and even death, and economic damage. The disease may further contribute to the unravelling of civility as the disease has been pinned to certain places or people. But when it’s over, the next such outbreak is waiting in the wings.
We need to understand the landscapes of emerging extended urbanization better if we want to predict, avoid and react to emerging disease outbreaks more efficiently.
First, we need to grasp where disease outbreaks occur and how they relate to the physical, spatial, economic, social and ecological changes brought on by urbanization. Second, we need to learn more about how the newly emerging urban landscapes can themselves play a role in stemming potential outbreaks.
Rapid urbanization enables the spread of infectious disease, with peripheral sites being particularly susceptible to disease vectors like mosquitoes or ticks and diseases that jump the animal-to-human species boundary.
Our research identifies three dimensions of the relationships between extended urbanization and infectious disease that need better understanding: population change and mobility, infrastructure and governance.
Travel and transport
Population change and mobility are immediately connected. The coronavirus travelled from the periphery of Wuhan — where 1.6 million cars were produced last year — to a distant Bavarian suburb specializing in certain auto parts.
Quarantined megacities and cruise ships demonstrate what happens when our globalized urban lives come grinding to a halt.
Infrastructure is central: diseases can spread rapidly between cities through infrastructures of globalization such as global air travel networks. Airports are often located at the edges of urban areas, raising complex governance and jurisdictional issues with regards to who has responsibility to control disease outbreaks in large urban regions.
We can also assume that disease outbreaks reinforce existing inequalities in access to and benefits from mobility infrastructures. These imbalances also influence the reactions to an outbreak. Disconnections that are revealed as rapid urban growth is not accompanied by the appropriate development of social and technical infrastructures add to the picture.
Lastly, SARS-CoV-2 has exposed both the shortcomings and potential opportunities of governance at different levels. While it is awe-inspiring to see entire megacities quarantined, it is unlikely that such drastic measures would be accepted in countries not governed by centralized authoritarian leadership. But even in China, multilevel governance proved to be breaking down as local, regional and central government (and party) units were not sufficiently co-ordinated at the beginning of the crisis.
This mirrored the intergovernmental confusion in Canada during SARS. As we enter another wave of megaurbanization, urban regions will need to develop efficient and innovative methods of confronting emerging infectious disease without relying on drastic top-down state measures that can be globally disruptive and often counter-productive. This may be especially relevant in fighting racism and intercultural conflict.
The massive increase of the global urban population over the past few decades has increased exposure to diseases and posed new challenges to the control of outbreaks. Urban researchers need to explore these new relationships between urbanization and infectious disease. This will require an interdisciplinary approach that includes geographers, public health scientists, sociologists and others to develop possible solutions to prevent and mitigate future disease outbreaks.
The Urbanization of COVID-19
Three prominent urban researchers with a focus on infectious diseases explain why political responses to the current coronavirus outbreak require an understanding of urban dynamics. Looking back at the last coronavirus pandemic, the SARS outbreak in 2002/3, they highlight what affected cities have learned from that experience for handling the ongoing crisis. Exploring the political challenges of the current state of exception in Canada, Germany, Singapore and elsewhere, Creighton Connolly, Harris Ali and Roger Keil shed light on the practices of urban solidarity as the key to overcoming the public health threat.
Creighton Connolly is a Senior Lecturer in Development Studies and the Global South in the School of Geography, University of Lincoln, UK. He researches urban political ecology, urban-environmental governance and processes of urbanization and urban redevelopment in Southeast Asia, with a focus on Malaysia and Singapore. He is editor of ‘Post-Politics and Civil Society in Asian Cities’ (Routledge 2019), and has published in a range of leading urban studies and geography journals. Previously, he worked as a researcher in the Asian Urbanisms research cluster at the Asia Research Institute, National University of Singapore.
Harris Ali is a Professor of Sociology, York University in Toronto. He researches issues in environmental sociology, environmental health and disasters including the social and political dimensions of infectious disease outbreaks. He is currently conducting research on the role of community-based initiatives in the Ebola response in Africa.
Roger Keil is a Professor at the Faculty of Environmental Studies, 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” (Polity 2018) and editor of “Suburban Constellations” (Jovis 2013). 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.
Ali, S. Harris, and Roger Keil, eds. 2011. Networked disease: emerging infections in the global city. Vol. 44. John Wiley & Sons.
Keil, Roger, Creighton Connolly, and Harris S. Ali. 2020. “Outbreaks like coronavirus start in and spread from the edges of cities.” The Conversation, February 17. Available online here: ►https://theconversation.com/outbreaks-like-coronavirus-start-in-and-spread-from-the-edges-of-ci
Extended urbanisation and the spatialities of infectious disease: Demographic change, infrastructure and governance
Emerging infectious disease has much to do with how and where we live. The recent COVID-19 coronavirus outbreak is an example of the close relationships between urban development and new or re-emerging infectious diseases. Like the SARS pandemic of 2003, the connections between accelerated urbanisation, more expansive and faster means of transportation, and increasing proximity between urban life and non-human nature — and subsequent trans-species infections — became immediately apparent.
Our Urban Studies paper contributes to this emerging conversation. Infectious disease outbreaks are now global events. Increasingly, health and disease tend to be urban as they coincide with the proliferation of planetary urbanisation and urban ways of life. The increased emergence of infectious diseases is to be expected in an era of extended urbanisation.
We posit that we need to understand the landscapes of emerging extended urbanisation better if we want to predict, avoid and react to emerging disease outbreaks more efficiently. First, we need to grasp where disease outbreaks occur and how they relate to the physical, spatial, economic, social and ecological changes brought on by urbanisation. Second, we need to learn more about how the newly emerging urban landscapes can themselves play a role in stemming potential outbreaks. Rapid urbanisation enables the spread of infectious disease, with peripheral sites being particularly susceptible to disease vectors like mosquitoes or ticks and diseases that jump the animal-to-human species boundary.
Our research identifies three dimensions of the relationships between extended urbanisation and infectious disease that need better understanding: population change and mobility, infrastructure and governance. Population change and mobility are immediately connected. Population growth in cities - driven primarily by rural-urban migration - is a major factor influencing the spread of disease. This is seen most clearly in rapidly urbanising regions such as Africa and Asia, which have experienced recent outbreaks of Ebola and SARS, respectively.
Infrastructure is also central: diseases can spread rapidly between cities through infrastructures of globalisation such as global air travel networks. Airports are often located at the edges of urban areas, raising complex governance and jurisdictional issues with regards to who has responsibility to control disease outbreaks in large urban regions. We can also assume that disease outbreaks reinforce existing inequalities in access to and benefits from mobility infrastructures. We therefore need to consider the disconnections that become apparent as rapid demographic and peri-urban growth is not accompanied by appropriate infrastructure development.
Lastly, the COVID-19 outbreak has exposed both the shortcomings and potential opportunities of governance at different levels. While it is awe-inspiring to see entire megacities quarantined, it is unlikely that such drastic measures would be accepted in countries not governed by centralised authoritarian leadership. But even in China, multilevel governance proved to be breaking down as local, regional and central government (and party) units were not sufficiently co-ordinated at the beginning of the crisis. This mirrored the intergovernmental confusion in Canada during SARS.
As we enter another wave of megaurbanisation, urban regions will need to develop efficient and innovative methods of confronting emerging infectious disease without relying on drastic top-down state measures that can be globally disruptive and often ineffective. This urges upon urban researchers to seek new and better explanations for the relationships of extended urbanisation and the spatialities of infectious disease - an effort that will require an interdisciplinary approach including geographers, health scientists, sociologists.
Cities after coronavirus: how Covid-19 could radically alter urban life
Pandemics have always shaped cities – and from increased surveillance to ‘de-densification’ to new community activism, Covid-19 is doing it already.
Victoria Embankment, which runs for a mile and a quarter along the River Thames, is many people’s idea of quintessential London. Some of the earliest postcards sent in Britain depicted its broad promenades and resplendent gardens. The Metropolitan Board of Works, which oversaw its construction, hailed it as an “appropriate, and appropriately civilised, cityscape for a prosperous commercial society”.
But the embankment, now hardwired into our urban consciousness, is entirely the product of pandemic. Without a series of devastating global cholera outbreaks in the 19th century – including one in London in the early 1850s that claimed more than 10,000 lives – the need for a new, modern sewerage system may never have been identified. Joseph Bazalgette’s remarkable feat of civil engineering, which was designed to carry waste water safely downriver and away from drinking supplies, would never have materialised.
From the Athens plague in 430BC, which drove profound changes in the city’s laws and identity, to the Black Death in the Middle Ages, which transformed the balance of class power in European societies, to the recent spate of Ebola epidemics across sub-Saharan Africa that illuminated the growing interconnectedness of today’s hyper-globalised cities, public health crises rarely fail to leave their mark on a metropolis.
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As the world continues to fight the rapid spread of coronavirus, confining many people to their homes and radically altering the way we move through, work in and think about our cities, some are wondering which of these adjustments will endure beyond the end of the pandemic, and what life might look like on the other side.
One of the most pressing questions that urban planners will face is the apparent tension between densification – the push towards cities becoming more concentrated, which is seen as essential to improving environmental sustainability – and disaggregation, the separating out of populations, which is one of the key tools currently being used to hold back infection transmission.
“At the moment we are reducing density everywhere we can, and for good reason,” observes Richard Sennett, a professor of urban studies at MIT and senior adviser to the UN on its climate change and cities programme. “But on the whole density is a good thing: denser cities are more energy efficient. So I think in the long term there is going to be a conflict between the competing demands of public health and the climate.”
Sennett believes that in the future there will be a renewed focus on finding design solutions for individual buildings and wider neighbourhoods that enable people to socialise without being packed “sardine-like” into compressed restaurants, bars and clubs – although, given the incredibly high cost of land in big cities like New York and Hong Kong, success here may depend on significant economic reforms as well.
In recent years, although cities in the global south are continuing to grow as a result of inward rural migration, northern cities are trending in the opposite direction, with more affluent residents taking advantage of remote working capabilities and moving to smaller towns and countryside settlements offering cheaper property and a higher quality of life.
The “declining cost of distance”, as Karen Harris, the managing director of Bain consultancy’s Macro Trends Group, calls it, is likely to accelerate as a result of the coronavirus crisis. More companies are establishing systems that enable staff to work from home, and more workers are getting accustomed to it. “These are habits that are likely to persist,” Harris says.
The implications for big cities are immense. If proximity to one’s job is no longer a significant factor in deciding where to live, for example, then the appeal of the suburbs wanes; we could be heading towards a world in which existing city centres and far-flung “new villages” rise in prominence, while traditional commuter belts fade away.
Another potential impact of coronavirus may be an intensification of digital infrastructure in our cities. South Korea, one of the countries worst-affected by the disease, has also posted some of the lowest mortality rates, an achievement that can be traced in part to a series of technological innovations – including, controversially, the mapping and publication of infected patients’ movements.
In China, authorities have enlisted the help of tech firms such as Alibaba and Tencent to track the spread of Covid-19 and are using “big data” analysis to anticipate where transmission clusters will emerge next. If one of the government takeaways from coronavirus is that “smart cities” including Songdo or Shenzhen are safer cities from a public health perspective, then we can expect greater efforts to digitally capture and record our behaviour in urban areas – and fiercer debates over the power such surveillance hands to corporations and states.
Indeed, the spectre of creeping authoritarianism – as emergency disaster measures become normalised, or even permanent – should be at the forefront of our minds, says Sennett. “If you go back through history and look at the regulations brought in to control cities at times of crisis, from the French revolution to 9/11 in the US, many of them took years or even centuries to unravel,” he says.
At a time of heightened ethnonationalism on the global stage, in which rightwing populists have assumed elected office in many countries from Brazil to the US, Hungary and India, one consequence of coronavirus could be an entrenchment of exclusionary political narratives, calling for new borders to be placed around urban communities – overseen by leaders who have the legal and technological capacity, and the political will, to build them.
In the past, after a widespread medical emergency, Jewish communities and other socially stigmatised groups such as those affected by leprosy have borne the brunt of public anger. References to the “China virus” by Donald Trump suggest such grim scapegoating is likely to be a feature of this pandemic’s aftermath as well.
On the ground, however, the story of coronavirus in many global cities has so far been very different. After decades of increasing atomisation, particularly among younger urban residents for whom the impossible cost of housing has made life both precarious and transient, the sudden proliferation of mutual aid groups – designed to provide community support for the most vulnerable during isolation – has brought neighbours together across age groups and demographic divides. Social distancing has, ironically, drawn some of us closer than ever before. Whether such groups survive beyond the end of coronavirus to have a meaningful impact on our urban future depends, in part, on what sort of political lessons we learn from the crisis.
The vulnerability of many fellow city dwellers – not just because of a temporary medical emergency but as an ongoing lived reality – has been thrown into sharp relief, from elderly people lacking sufficient social care to the low-paid and self-employed who have no financial buffer to fall back on, but upon whose work we all rely.
A stronger sense of society as a collective whole, rather than an agglomeration of fragmented individuals, could lead to a long-term increase in public demands for more interventionist measures to protect citizens – a development that governments may find harder to resist given their readiness in the midst of coronavirus to override the primacy of markets.
Private hospitals are already facing pressure to open up their beds without extra charge for those in need; in Los Angeles, homeless citizens have seized vacant homes, drawing support from some lawmakers. Will these kinds of sentiments dwindle with the passing of coronavirus, or will political support for urban policies that put community interests ahead of corporate ones – like a greater imposition of rent controls – endure?
We don’t yet know the answer, but in the new and unpredictable connections swiftly being forged within our cities as a result of the pandemic, there is perhaps some cause for optimism. “You can’t ‘unknow’ people,” observes Harris, “and usually that’s a good thing.” Sennett thinks we are potentially seeing a fundamental shift in urban social relations. “City residents are becoming aware of desires that they didn’t realise they had before,” he says, “which is for more human contact, for links to people who are unlike themselves.” Whether that change in the nature of city living proves to be as lasting as Bazalgette’s sewer-pipe embankment remains, for now, to be seen.
Listening to the city in a global pandemic
What’s the role of ‘academic experts’ in the debate about COVID-19 and cites, and how can we separate our expert role from our personal experience of being locked down in our cities and homes?
This is a question we’ve certainly been struggling with at City Road, and we think it’s a question that a lot of academics are struggling with at the moment. Perhaps it’s a good time to listen to the experiences of academics as their cities change around them, rather than ask them to speak at us about their urban expertise. With this in mind, we asked academics from all over the world to open up the voice recorder on their phones and record a two minute report from the field about their city.
Over 25 academics from all over the world responded. As you will hear, some of their recordings are not great quality, but their stories certainly are. Many of those who responded to our call are struggling , just like us, to make sense of their experience in the COVID-19 city.
Ce que les épidémies nous disent sur la #mondialisation
Bien que la première épidémie connue par une trace écrite n’ait eu lieu qu’en 430 avant J.-C. à Athènes, on dit souvent que les microbes, et les épidémies auxquels ils donnent lieu, sont aussi vieux que le monde. Mais le Monde est-il aussi vieux qu’on veutbien le dire ? Voici une des questions auxquelles l’étude des épidémies avec les sciences sociales permet d’apporter des éléments de réponse. Les épidémies ne sont pas réservées aux épidémiologistes et autres immunologistes. De grands géographes comme Peter Haggett ou Andrew Cliff ont déjà investi ce domaine, dans une optique focalisée sur les processus de diffusion spatiale. Il est possible d’aller au-delà de cette approche mécanique et d’appréhender les épidémies dans leurs interactions sociales. On verra ici qu’elles nous apprennent aussi beaucoup sur le Monde, sur l’organisation de l’espace mondial et sur la dimension sociétale du processus de mondialisation.
Città ai tempi del Covid
Lo spazio pubblico urbano è uno spazio di relazioni, segnato dai corpi, dagli incontri, dalla casualità, da un ordine spontaneo che non può, se lo spazio è pubblico veramente, accettare altro che regole di buon senso e non di imposizione. È un palcoscenico per le vite di tutti noi, che le vogliamo in mostra o in disparte, protagonisti o comparse della commedia urbana e, come nella commedia, con un fondo di finzione ed un ombra di verità.
Ma cosa accade se gli attori abbandonano la scena, se i corpi sono negati allo spazio? Come percepiamo quel che rimane a noi frequentabile di strade e piazze che normalmente percorriamo?
Ho invitato gli studenti che negli anni hanno frequentato il seminario “Fotografia come strumento di indagine urbana”, ma non solo loro, ad inviarmi qualche immagine che documenta (e riflette su) spazio pubblico, città e loro stessi in questi giorni. Come qualcuno mi ha scritto sono immagini spesso letteralmente ‘rubate’, quasi sentendosi in colpa. Eppure documentare e riflettere è un’attività tanto più essenziale quanto la criticità si prolunga e tocca la vita di tutti noi.
Appunti di viaggio – Iacopo Zetti Ho avuto modo, per una serie di evenienze, di attraversare Firenze di mattina e di sera. Aspettavo il silenzio ed infatti l’ho ascoltato. Il silenzio non è quello dei luoghi extraurbani. ...
Inferriata – Eni Nurihana L’inferriata de balcone ricorda sempre di più le sbarre carcerarie 23 marzo 2020, 15:11
Situazioni di necessità – Chiara Zavattaro Le strade della zona di Sant’Ambrogio a Firenze
Ora d’aria – Antonella Zola Ho avuto la possibilità di scattare queste foto dopo 10 giorni di quarantena completa, in cui ho rinunciato a qualunque contatto con il mondo esterno. Alla fine sono dovuta uscire ...
Firenze – Agnese Turchi Firenze - Agnese Turchi
Nostalgia di Silenzi – Gabriele Pierini
Il recinto – Laura Panichi In un libro che ho letto in questo periodo di “reclusione”, Haruki Murakami dice che quando si prova ad uscire da una gabbia alla fine si finisce sempre per trovarci ...
Spazio solidale – Jacopo Lorenzini
Castagneto Carducci – Cristian Farina Chissà se dall’alto qualcuno si è accorto che ci siamo fermati solo per un attimo Da lontano si scorgano i monumenti fermi nel tempo, quasi come noi, fermi nello spazio
Firenze, mercoledì 18/03/20 ore 15.30 circa – Leonardo Ceccarelli Firenze, mercoledì 18/03/20 ore 15.30 circa - Leonardo Ceccarelli
Firenze, marzo 2020 – Giulia D’Ercole Firenze, marzo 2020 - Giulia D’Ercole
Feriale d’altri tempi – Dario Albamonte La mia fortuna è quella di vivere in campagna e di potermi muovere liberamente e avere molto spazio a disposizione senza varcare i confini di casa mia. Quello che mi ...
L’architettura è fatta di mattoni e PERSONE – Laura Pagnotelli L’architettura è fatta di mattoni e PERSONE. Esse sono il fine ultimo del costruire, del dare vita a spazi sempre nuovi. Senza la loro presenza, dell’architettura non resta che una scatola vuota, priva ...
Il traffico di Firenze – Veronica Capecchi Il Traffico di Firenze, oggi è scomparso, e lascia intravedere la città, profondamente diversa e silenziosa. Una città che è sempre viva, oggi priva della sua vitalità, dei suoi rumori, una ...
Dalla finestra – Lucio Fiorentino Ho sentito dei rumori nella strada sotto la mia finestra e ho immaginato l’atmosfera scura di un film di Bergman, (goffamente) ho cercato di riprodurla Nel palazzo di fronte alla mia ...
Livorno, 28 marzo – Giulia Bandini Luoghi affollati di ricordi vie trafficate di emozioni ormai vinte dal tempo ma vive nella mente di chi sa sperare forte
Sesto Fiorentino: la piana senza smog – Alice Giordano Sesto Fiorentino: la piana senza smog - Alice Giordano
Lari e Pontedera – Silvia Princi Ritorno alle origini – Perignano di Lari (Pi), 23 marzo 2020 La semina del trattore, rappresenta uno dei pochi segni di vitalità umana e meccanica,in questo periodo di quarantena e di ...
A distanza sociale nel parco: Zurigo – Philipp Klaus A distanza sociale nel parco: Zurigo - Philipp Klaus
Galleggiare in un mondo irreale – Alessio Prandin
Coronavirus Was Slow to Spread to Rural America. Not Anymore.
Grace Rhodes was getting worried last month as she watched the coronavirus tear through New York and Chicago. But her 8,000-person hometown in Southern Illinois still had no reported cases, and her boss at her pharmacy job assured her: “It’ll never get here.”
Now it has. A new wave of coronavirus cases is spreading deep into rural corners of the country where people once hoped their communities might be shielded because of their isolation from hard-hit urban centers and the natural social distancing of life in the countryside.
The coronavirus has officially reached more than two-thirds of the country’s rural counties, with one in 10 reporting at least one death. Doctors and elected officials are warning that a late-arriving wave of illness could overwhelm rural communities that are older, poorer and sicker than much of the country, and already dangerously short on medical help.
“Everybody never really thought it would get to us,” said Ms. Rhodes, 18, who is studying to become a nurse. “A lot of people are in denial.”
With 42 states now urging people to stay at home, the last holdouts are the Republican governors of North Dakota, South Dakota, Nebraska, Iowa and Arkansas. Gov. Kristi Noem of South Dakota has suggested that the stricter measures violated personal liberties, and she said her state’s rural character made it better positioned to handle the outbreak.
“South Dakota is not New York City,” Ms. Noem said at a news conference last week.
But many rural doctors, leaders and health experts worry that is exactly where their communities are heading, and that they will have fewer hospital beds, ventilators and nurses to handle the onslaught.
“We’re behind the curve in rural America,” said Senator Jon Tester, Democrat of Montana, who said his state needs hundreds of thousands of masks, visors and gowns. “If they don’t have the protective equipment and somebody goes down and gets sick, that could close the hospital.”
Rural nurses and doctors, scarce in normal times, are already calling out sick and being quarantined. Clinics are scrambling to find couriers who can speed their coronavirus tests to labs hundreds of miles away. The loss of 120 rural hospitals over the past decade has left many towns defenseless, and more hospitals are closing even as the pandemic spreads.
Coronavirus illnesses and deaths are still overwhelmingly concentrated in cities and suburbs, and new rural cases have not exploded at the same rate as in some cities. But they are growing fast. This week, the case rate in rural areas was more than double what it was six days earlier.
Deaths are being reported in small farming and manufacturing towns that barely had a confirmed case a week ago. Fourteen infections have been reported in the county encompassing Ms. Rhodes’s southern Illinois hometown of Murphysboro, and she recently quarantined with her parents, who are nurses, as a precaution after they got sick.
Rich ski towns like Sun Valley, Idaho, and Vail, Colo., have some of the highest infection rates in the country, and are discouraging visitors and second homeowners from seeking refuge in the mountains. Indian reservations, which grapple daily with high poverty and inadequate medical services, are now confronting soaring numbers of cases.
In some places, the virus has rushed in so suddenly that even leaders are falling ill. In the tiny county of Early in southwest Georgia, five people have died. And the mayor and the police chief of the county seat, Blakely, are among the county’s 92 confirmed cases. It has been a shock for the rural county of fewer than 11,000 people.
“Being from a small town, you think it’s not going to touch us,” Blakely’s assistant police chief, Tonya Tinsley, said. “We are so small and tucked away. You have a perception that it’s in bigger cities.”
That is all gone now.
“You say, wait a minute, I know them!” she said. “It’s, like, oh my God, I knew them. I used to talk to them. I knew their family. Their kids. It’s a blow to the community each time.”
Even a single local case has been enough to jolt some people out of the complacency of the earliest days of the virus, when President Trump spent weeks playing down the threat and many conservative leaders brushed it aside as politically driven hysteria.
In Letcher County, Ky., which got its first case on Sunday, waiting for the disease to arrive has been unnerving. Brian Bowan, 48, likes the daily briefings by Gov. Andy Beshear, a Democrat, and he is glad for the governor’s relatively early actions to close nonessential businesses. Without them, Mr. Bowan said, “we could have a really bad pandemic. We could be like California or New York.”
In Mississippi, a mostly rural state, the virus had spread to nearly every county by April, with more than 1,000 cases and nearly two dozen deaths reported, causing health care workers to wonder, nervously, when the governor would issue a stay-at-home order. Last week, he finally did, and doctors at the University of Mississippi Medical Center in Jackson breathed a sigh of relief.
“There was this chatter today at the medical center, people saying ‘Oh thank goodness — we need this to get people to realize how serious this is,’ ” said Dr. LouAnn Woodward, the hospital’s top executive.
While Americans are still divided on whether they approve of how Mr. Trump has handled the crisis, the virus is uniting nearly everyone in the country with worry — urban and rural, liberal and conservative. More than 90 percent of Americans said the virus posed a threat to the country’s economy and public health, according to a Pew Research Center poll conducted from March 19 to March 24.
“Some of the petty things that would be in the news and on social media before have sort of fallen away,” said David Graybeal, a Methodist pastor in Athens, Tenn. “There’s a sense that we are really in this together. Now it’s, ‘How can we pull through this and support one another in this social distancing?’ ”
In Mangum, Okla., a town of 6,000 in the western part of the state, it all started with a visit. A pastor from Tulsa appeared at a local church, but got sick shortly thereafter and became the state’s first Covid-19 fatality.
Then somebody at the local church started to feel unwell — a person who eventually tested positive for coronavirus.
“Then it was just a matter of time,” said Mangum’s mayor, Mary Jane Scott. Before realizing they were infected, several people who eventually tested positive for the virus had moved about widely through the city, including to the local nursing home, which now has a cluster of cases.
Over all in the town, there are now three deaths and 26 residents who have tested positive for the coronavirus — one of the highest infection rates in rural America.
“You’d think in rural Oklahoma, that we all live so far apart, but there’s one place where people congregate, and that’s at the nursing home,” she said. “I thought I was safe here in Southwest Oklahoma, I didn’t think there would be a big issue with it, and all of a sudden, bam.”
Mangum now has an emergency shelter-in-place order and a curfew — just like larger towns and cities around the United States.
Just as New Yorkers have gotten accustomed to Gov. Andrew Cuomo’s daily televised briefings, residents of Mangum have turned to the mayor’s Facebook page, where she livecasts status updates and advisories. On Monday night, it was the recommendation that residents use curbside pickup when going to Walmart, a broadcast that garnered more than 1,000 views in the hour after she posted it.
“Since we have no newspaper, it’s the only way I know to get the word out,” she told viewers, after inviting them to contact her personally with any questions or concerns.
She also has encouraged residents to step out onto their lawns each night at 7 p.m. where she leads them in a chorus of “God Bless America.”
The virus has complicated huge swaths of rural life. Darvin Bentlage, a Missouri rancher, says he is having trouble selling his cattle because auctions have been canceled. In areas without reliable internet access, adults are struggling to work remotely and children are having to get assignments and school updates delivered to their door.
Rural health providers are also challenged. A clinic in Stockton, Kan., turned to a local veterinarian for a supply of masks and gowns. One rural hospital in Lexington, Neb., was recently down to its last 500 swabs. Another in Batesville, Ind., was having its staff members store their used masks in plastic baggies in case they had to sterilize and reuse them. In Georgia, a peanut manufacturer in Blakely donated a washer and dryer to the local hospital for its handmade masks and gowns.
The financial strain of gearing up to fight the coronavirus has put much pressure on cash-strapped rural hospitals. Many have canceled all non-emergency care like the colonoscopies, minor surgeries and physical therapy sessions that are a critical source of income.
Last month, one hospital in West Virginia and another in Kansas shut their doors altogether.
“It’s just absolutely crazy,” said Michael Caputo, a state delegate in Fairmont, W.Va., where the Fairmont Regional Medical Center, the only hospital in the county, closed in mid-March. “Across the country, they’re turning hotels and sports complexes into temporary hospitals. And here we’ve got a hospital where the doors are shut.”
For now, there is an ambulance posted outside the emergency room, in case sick people show up looking for help.
Michael Angelucci, a state delegate and the administrator of the Marion County Rescue Squad, said the hospital’s closure during the pandemic is already being felt.
On March 23, emergency medics were called to take an 88-year-old woman with the coronavirus to the hospital, Mr. Angelucci said. Instead of making a quick drive to Fairmont Regional, about two minutes away, Mr. Angelucci said that the medics had to drive to the next-nearest hospital, about 25 minutes away. A few days later, she became West Virginia’s first reported coronavirus death.
Coronavirus in the city: A Q&A on the catastrophe confronting the urban poor
‘While all populations are affected by the COVID-19 pandemic, not all populations are affected equally.’
Health systems in the world’s megacities and crowded urban settlements are about to be put under enormous strain as the new coronavirus takes hold, with the estimated 1.2 billion people who live in informal slums and shanty-towns at particular risk.
To understand more about the crisis confronting the urban poor, The New Humanitarian interviewed Robert Muggah, principal of The SecDev Group and co-founder of the Igarapé Institute, a think tank focused on urban innovation that has worked with the World Health Organisation to map pandemic threats and is supporting governments, businesses, and civil society groups to improve COVID-19 detection, response, and recovery.
What has so far been a public healthcare crisis in mostly wealthier cities in East Asia, Europe, and the United States appears likely to become an even graver disaster for countries with far less resources in Latin America, Africa, and South Asia.
Cities from Lagos to Mumbai to Rio de Janeiro have started locking down, but for residents of crowded slums the unenviable choice is often between a greater risk of catching and spreading disease or the certainty of hunger. Social distancing, self-isolation – handwashing even – are impossible luxuries.
This interview, conducted by email on 29-30 March, has been edited for length and clarity.
TNH: A lot has been made about the risks of coronavirus in crowded refugee and displacement camps – from Greece to Idlib. Do you feel the urban poor have been a little neglected?
Robert Muggah: While all populations are affected by the COVID-19 pandemic, not all populations are affected equally. Lower-income households and elderly individuals with underlying health conditions are particularly at-risk. Among the most vulnerable categories are the homeless, migrants, refugees, and displaced people. In some US cities, for example, undocumented migrants are fearful of being tested or going to the hospital for fear of forcible detainment, separation from their families, and deportation. In densely populated informal settlements and displaced person camps, there is a higher likelihood of infection because of the difficulties of social distancing. The limited testing, detection, isolation, and hospitalisation capacities in these settings mean we can expect a much higher rate of direct and excess mortality. The implications are deeply worrying.
The COVID-19 pandemic is a totalising event – affecting virtually every country, city and neighbourhood on the planet. It is also laying open the social and economic fault lines in our urban spaces. Predictably, many governments, businesses, and societies are looking inward, seeking to shore up their own health capacities and provide for their populations through aid and assistance. Yet the virus is revealing the extent of economic and social inequalities within many countries, including among OECD members. In the process, it is exposing the deficiencies of the social contract and the ways in which certain people – especially the elderly, poor, homeless, displaced – are systematically at-risk. While media attention is growing, there is comparatively limited investment in protecting refugees and displaced people facing infectious disease outbreaks. As public awareness of the sheer scale of infection, hospitalisation, and case fatalities becomes clearer in lower- and middle-income settings, we can expect this to change; at which point it may be too late.
TNH: Can you give us a sense of the scale of the problem in the world’s megacities and slums, where social distancing and self-isolation are a fantasy for many?
Muggah: According to the UN, there are about 33 megacities with 10 million or more people. There are another 48 cities with between five and 10 million. Compare this to the 1950s when there were just three megacities. Most of these massive cities are located in Africa, Asia, and Latin America. Many of them are characterised by a concentrated metropolitan core and a sprawling periphery of informal settlements, including shanty-towns, slums, and favelas. Roughly 1.2 billion people live in densely packed informal settlements characterised by poor quality housing, limited basic services, and poor sanitation. While suffering from stigmas, these settlements tend to be a critical supply of labour for cities, an unsatisfactory answer to the crisis in housing availability and affordability. A challenge now facing large cities is that, owing to years of neglect, informal settlements are essentially “off the grid”, and as such, difficult to monitor and service.
There are many reasons why large densely populated slums are hotbeds for the COVID-19 pandemic and other infectious disease outbreaks. In many cases, there are multiple households crammed into tiny tenements making social distancing virtually impossible. In Dharavi, Mumbai’s largest slum, there are 850,000 people per square mile. Most inhabitants of informal settlements lack access to medical and health services, making it difficult to track cases and isolate people who are infected. A majority of the people living in these areas depend on the services and informal economies, including jobs, that are most vulnerable to termination when cities are shut down and the economy begins to slow. Strictly enforced isolation won’t just lead to diminished quality of life, it will result in starvation. A large proportion of residents also frequently suffer from chronic illnesses – including respiratory infections, cancer, diabetes, and obesity – increasing susceptibility to COVID-19. These comorbidities will contribute to soaring excess deaths.
All of these challenges are compounded by the systemic neglect and stigmatisation of these communities by the political and economic elite. Violence has already erupted in Ethiopia, Kenya, India, Liberia, and South Africa as police enforce quarantines. In Brazil, drug trafficking organisations and militia groups are enforcing social distancing and self isolation in lieu of the state authorities. In Australia, Europe, and the United States, racist and xenophobic incidents spiked against people of Asian descent. There is a real risk that governments ramp up hardline tactics and repression against marginalised populations, especially those living in lower-income communities, shanty-towns, and refugee and displaced person camps.
TNH: How seriously were international aid agencies and other humanitarian actors taking calls to scale up urban preparedness and response before this pandemic, and to what extent is COVID-19 a wake-up call?
Muggah: The global humanitarian aid sector was aware of the threat of a global pandemic. For more than a decade the WHO, several university and research centres, and organisations such as the CDC, the Wellcome Trust, and the Bill and Melinda Gates Foundation have publicly warned about the catastrophic risks of pandemic outbreaks. The international community experienced a series of jolting wake-up calls with SARS, H1N1, Ebola, and other major epidemics over the past 20 years, though these were typically confined to specific regions and were generally rapidly contained. Although fears of potential outbreaks emerging from China were widely acknowledged, the sheer speed and scale of COVID-19 seems to have caught most governments, and the aid community, by surprise.
With notable exceptions such as Singapore or Taiwan, there has not been major investment in preparing cities for dealing with pandemics, however. Most attention has been focused on national capacities, and less on the specific capabilities of urban governments, health and social safety-net services. Together with Georgetown University’s Center for Health Sciences and Security, the Igarape Institute highlighted the importance of networks of mayors to share information and strategies in 2018. This call was highlighted by the Global Parliament of Mayors in 2018 and 2019. Starting in March 2020, the Bloomberg Foundation established a mayors network focusing on pandemic preparedness in the US. The Mayors Migration Council, World Economic Forum, and UN-Habitat are also looking to ramp up assistance to cities. What is also needed are systems to support mayors, city managers, and health providers in lower- and middle-income countries.
TNH: Part of the problem is that cities are unfamiliar territory for humanitarian responders, with many new actors to deal with, from local governments to gangs. What relationships and skill sets do they need to cultivate?
Muggah: Well before the COVID-19 pandemic, many humanitarian agencies were already refocusing some of their operations toward urban settings. International organisations such as the International Committee of the Red Cross, Médecins Sans Frontières, and Oxfam set up policies and procedures for engaging in cities. There is a growing recognition across the relief and development sectors of the influence and impacts of urbanisation on their operations and beneficiary populations. This is more radical than it sounds. For at least half a century, most aid work was predominantly rural-focused. This was not surprising since most people in developing countries lived in rural or semi-rural areas. This has changed dramatically, however, with more than half of the world’s population now living in cities. Over the next 30 years, roughly 90 percent of all urbanisation will be occurring in lower- and middle-income countries – predominantly in Africa and Asia. The aid community only started to recognise these trends relatively recently.
Working in urban settings requires changes in how many international and national aid agencies operate. For one, it often depends less on direct than indirect delivery, working in partnership with municipal service providers. It also requires less visible branding and marketing strategies, shoring up the legitimacy of public and non-governmental providers with less focus on the contribution of relief agencies. In some cases, aid agencies are also required to work with, or alongside, non-state providers, including armed groups. For example, in some Brazilian, Colombian, and Mexican cities organised crime and self-defence groups are engaged in social service provision, raising complex questions for aid providers about whether and how to support vulnerable communities. Similar challenges confronted aid agencies working to provide relief in Ebola-stricken villages in eastern DRC.
A diverse range of skill sets is required to navigate support to cities affected by epidemics, including COVID-19. Some cities may need accounting assistance and expertise in budgeting to help them rapidly procure essential services. Other cities may require epidemiological and engineering capabilities to help develop rapid detection and surveillance, as well as “surge” capacity including emergency hospitals, clinics, and treatment centres. A robust communications and public outreach strategy is essential, particularly since uncertainty can contribute to social unease and even disorder. Moreover, rapid resource injections to help cities provide safety nets to the most vulnerable populations are critical, particularly as existing resources will be redirected to shoring up critical infrastructure and recurrent expenses will be difficult to cover owing to reduced tax revenue.
TNH: Name three things aid agencies need to do quickly to get to grips with this?
Muggah: There are a vast array of priorities for aid agencies in the context of pandemics. At a minimum, they must rapidly coordinate with public, private, and non-governmental partners to ensure they are effectively contributing rather than creating redundancy or unintentionally undermining local responses. Humanitarian organisations must also act rapidly, especially in the face of an exponential crisis such as the COVID-19 pandemic. Agencies cannot let perfection be the enemy of the good, and focus on delivering with speed and efficiency, albeit while being mindful of the coordination challenges above. Aid agencies must also be attentive to the health, safety, and wellbeing of their own personnel and partners – they must avoid at all costs becoming a burden to hospital systems that are already overwhelmed by the crisis.
The first thing aid agencies can do is reach out to frontline cities and assess basic needs and their organizational potential to contribute. A range of priorities are likely, including the importance of ensuring there are adequate tests kits and testing capacities, sufficient trained health professionals, medical supplies (including ICU and ventilation capacities), and related equipment for frontline workers. Providing supplementary capacity as needed is essential. Consider that in South Sudan there are believed to be just two ventilators, and in Liberia there are reportedly only three. Other critical priorities are ensuring the integrity of the local food supply and attention to critical infrastructure. This may involve deploying a surveillance system for monitoring critical supplies, providing supplementary cash and food assistance without disrupting local prices, and ensuring a capability to rapidly address distribution disruption as they arise. Aid agencies can also help leverage resources to settings that are neglected, helping mobilise funds and/or in-kind support for over-taxed public services.
TNH: Cities like Singapore and Taipei, Hangzhou in China – to an extent Seoul – have had some success in containing COVID-19. What can other cities learn from their approaches?
Muggah: Cities that are open, transparent, collaborative, and adopt comprehensive responses tend to be better equipped to manage infectious disease outbreaks than those that are not. While still too early to declare a success, the early response of South Korea, Singapore, and Taiwan to the COVID-19 pandemic stands out. Both Taipei and Singapore applied the lessons from past pandemics and had the investigative capacities, testing and detection services, health systems and, importantly, the right kind of leadership in place to rapidly take decisive action. They were able to flatten the pandemic curve through early detection thus keeping their health systems from becoming rapidly overwhelmed.
Not surprisingly, cities that have robust governance and health infrastructure in place are in a better position to manage pandemics and lower case fatality rates (CFR) and excess mortality than those that do not. Adopting a combination of proactive surveillance, routine communication, rapid isolation, and personal and community protection (e.g. social distancing) measures is critical. Many of these very same measures were adopted by the Chinese city of Hangzhou within days of the discovery of the virus. Likewise, the number, quality, and accessibility (and surge capacity) of hospitals, internal care units, hospital beds, IV solution and respirators can determine whether a city effectively manages a pandemic, or not. The SecDev Group is exploring the development of an urban pandemic preparedness index to help assess health capacities as well as social and economic determinants of health. A digital tool that provides rapid insights on vulnerabilities will be key not just to planning for the current pandemic, but also the next one.
TNH: You’ve spoken in the past about the need to develop a pandemic preparedness index. INFORM has one and Georgetown Uni has a health security assessment tool. Are these useful? What is missing?
Muggah: The extent of a city’s preparedness depends on its capacity to prevent, detect, respond, and care for patients. This means having action plans, staff, and budgets in place for rapid response. It also requires having access to laboratories to test for infectious disease and real-time monitoring and reporting of infectious clusters as they occur. The ability to communicate and implement emergency response plans is also essential, as is the availability, quality and accessibility of hospitals, clinics, care facilities, and essential equipment.
To this end, the Center for Global Health Science and Security at Georgetown University has created an evaluation tool – the Rapid Urban Health Security Assessment (RUHSA) – as a resource for assessing local-level public health preparedness and response capacities. The RUHSA draws from multiple guidance and evaluation tools. It was designed precisely to help city decision-makers prioritise, strengthen, and deploy strategies that promote urban health security. These kinds of platforms need to be scaled, and quickly.
There is widespread recognition that a preparedness index would be useful. In November of 2019, the Global Parliament of Mayors issued a call for such a platform. It called for funding from national governments to develop crucial public health capacities and to develop networks to disseminate trusted information. The mayors also committed to achieving at least 80 percent vaccination coverage, reducing the spread of misinformation, improving health literacy, and sharing information on how to prevent and reduce the spread of infectious disease. A recent article published with Rebecca Katz provides some insights into what this might look like.
TNH: All cities are not equal in this. Without a global rundown, do you have particular concerns for certain places – because they are transmission hubs that might be hit worse, or due to existing insecurity and instability?
Cities are vulnerable both to the direct and indirect effects of COVID-19. For example, cities with a higher proportion of elderly and inter-generational mingling are especially at risk of higher infection, hospitalisation, and case fatality rates. This explains why the pandemic has been so destructive in certain Italian, Spanish, and certain US cities in Florida and New York where there is a higher proportion of elderly and frequent travel and interaction between older and younger populations. By contrast, early detection, prevention, and containment measures such as those undertaken in Japanese, South Korean, and Taiwanese cities helped flatten the curve. Yet even when health services have been overwhelmed in wealthier cities, they tend to have more capable governments and more extensive safety nets and supply chains to lessen the secondary effects on the economy and market.
Many cities in Africa, South and Southeast Asia, and Latin America are facing much greater direct and indirect threats from the COVID-19 pandemic than their counterparts in North America, Western Europe, or East Asia. Among the most at-risk are large and secondary cities in fragile and conflict-affected countries such as Afghanistan, Colombia, DRC, Iraq, Myanmar, Nigeria, Somalia, South Sudan, Syria, and Venezuela. There, health surveillance and treatment capacities are already overburdened and under-resourced. While the populations tend to be younger, many are facing households that are already under- or malnourished and the danger of comorbidity is significant. Consider the case of Uganda, which has one ICU bed for every one million people (compared to the United States, which has one ICU bed for every 2,800 people). Specific categories of people – especially those living in protracted refugee or internal displacement camps – are among the most vulnerable. There are also major risks in large densely populated cities and slums such as Lagos, Dhaka, Jakarta, Karachi, Kolkata, Manila, Nairobi, or Rio de Janeiro where the secondary effects, including price shocks and repressive police responses, as well as explosive protests from jails, could lead to social and political unrest.
TNH: The coronavirus itself is the immediate risk, but what greater risks do you see coming down the track for poorer people in urban settings?
Muggah: The most significant threat of the COVID-19 pandemic may not be from the mortality and morbidity from infections, but the political and economic fallout from the crisis. While not as infectious or lethal as other diseases, the virus is obviously devastating for population health. It is not just people dying from respiratory illnesses and organ failures linked to the virus, but also the excess deaths from people who are unable to access treatment and care for existing diseases. We can expect several times more excess deaths than the actual caseload of people killed by the coronavirus itself. The lost economic productivity from these premature deaths and the associated toll on health systems and care-givers will be immense.
“The most significant threat of the COVID-19 pandemic may not be from the mortality and morbidity from infections, but the political and economic fallout from the crisis.”
COVID-19 is affecting urban populations in different ways and at different speeds. The most hard-hit groups are the urban poor, undocumented migrants, and displaced people who lack basic protections such as regular income or healthcare. Many of these people are already living in public or informal housing in under-serviced neighbourhoods experiencing concentrated disadvantage. The middle class will also experience severe impacts as the service economy grinds to a halt, schools and other services are shuttered, and mobility is constrained. Wealthier residents can more easily self-isolate either in cities or outside of them, and usually have greater access to private health alternatives. But all populations will face vulnerabilities if critical infrastructure – including health, electricity, water, and sanitation services – start to fail. Cut-backs in service provision will generate first discomfort and then outright protest.
Most dangerous of all is the impact of COVID-19 on political and economic stability. The pandemic is generating both supply and demand shocks that are devastating for producers, retailers, and consumers. Wealthier governments will step in to enact quantitative easing and basic income where they can, but many will lack the resources to do so. As income declines and supply chains dry up, panic, unrest, and instability are real possibilities. The extent of these risks depend on how long the pandemic endures and when vaccinations or effective antivirals are developed and distributed. Governments are reluctant to tell their populations about the likely duration, not just because of uncertainties, but because the truth could provoke civil disturbance. These risks are compounded by the fact that many societies already exhibit a low level of trust and confidence in their governments.
Les enjeux économiques de la #résilience_urbaine
La notion de #résilience pour qualifier la capacité d’une ville à affronter un #choc, y compris économique, n’est pas nouvelle, mais elle revêt, en pleine crise du coronavirus, une dimension toute particulière.
Les villes, en tant que #systèmes_urbains, ont toujours été au cœur des bouleversements que les sociétés ont connus. Pour autant, les fondements du paradigme économique qui gouverne les villes sont restés les mêmes. L’essor des capacités productives exportatrices et l’accroissement des valeurs ajoutées guident encore l’action locale en matière d’#économie.
Corollaire d’un monde globalisé qui atteint ses limites, la crise sanitaire ébranle ces fondamentaux et en demande une révision profonde. Ainsi, au cœur de la crise, les ambitions de #relocalisation_industrielle, de #souveraineté_économique, d’#autonomie_alimentaire semblent avoir remplacé (au moins temporairement) celles liées à la #croissance et à la #compétitivité.
#Eurasian_Geography_and_Economics is publishing a series of critical commentaries on the covid-19 pandemic, with some urban dimensions.
These will be collated in issue 61(4) of the journal but will appear online first.
The first two are currently OA on the journal webpage at: ▻https://www.tandfonline.com/toc/rege20/current?nav=tocList
Xiaoling Chen (2020) Spaces of care and resistance in China: public engagement during the COVID-19 outbreak, Eurasian Geography and Economics, DOI: 10.1080/15387216.2020.1762690
As the COVID-19 pandemic continues to unfold, the approach of the Chinese government remains under the spotlight, obscuring the complex landscape of responses to the outbreak within the country. Drawing upon the author’s social media experiences as well as textual analysis of a wide range of sources, this paper explores how the Chinese public responded to the outbreak in complex and nuanced ways through social media. The findings challenge conventional views of Chinese social media as simply sites of self-censorship and surveillance. On the contrary, during the COVID-19 outbreak, social media became spaces of active public engagement, in which Chinese citizens expressed care and solidarity, engaged in claim-making and resistance, and negotiated with authorities. This paper situates this public engagement within a broader context of China’s health-care reforms, calling attention to persistent structural and political issues, as well as the precarious positionalities of health-care workers within the health system.
Xuefei Ren (2020) Pandemic and lockdown: a territorial approach to COVID-19 in China, Italy and the United States, Eurasian Geography and Economics, DOI: 10.1080/15387216.2020.1762103
Three months into the Covid-19 crisis, lockdown has become a global response to the pandemic. Why have so many countries resorted to lockdown? How is it being implemented in different places? Why have some places had more success with lockdowns and others not? What does the effectiveness of lockdowns tell us about the local institutions entrusted with enforcing them? This paper compares how lockdown orders have been implemented in China, Italy, and the U.S. The analysis points to two major factors that have shaped the enforcement: tensions between national and local governments, and the strength of local territorial institutions.
Pourquoi Bergame ? Le virus au bout du territoire
La région de #Bergame en Italie a été l’un des foyers les plus actifs du coronavirus en Europe. Marco Cremaschi remet en cause les lectures opposant de manière dualiste villes et campagnes et souligne la nécessité de repenser la gouvernance de ces territoires d’entre-deux.
L’urbanisme a de longue date et durablement été influencé par les épidémies. Depuis le Moyen Âge, la peste et le choléra ont contribué à sédimenter un ensemble de critiques dirigées contre la densité et la promiscuité caractéristiques du mode de vie urbain. Particulièrement prégnante aux débuts de la recherche urbaine au XIXe siècle, sous l’influence du mouvement hygiéniste (Barles 1999), cette hypothèse anti-urbaine a régulièrement refait surface au gré des crises sanitaires. C’est ainsi presque naturellement qu’elle a été réactivée en lien avec la diffusion mondiale du Covid-19, y compris au cœur des sciences sociales.
Selon certains géographes, la cause de la pandémie serait ainsi à chercher dans la « métropolisation du monde » (Faburel 2020), concept catch-all qui désigne à la fois la densification, le surpeuplement, la promiscuité des modes de vie uniformisés et la surmodernité ; en somme, tout ce qui nous aurait éloignés de la « nature ». Pourtant, si l’on exclut les situations de surpeuplement extrême de quelques mégapoles des pays en développement, rien n’indique que la densité de population soit un bon indicateur des relations humaines et en dernière analyse de la propagation des maladies. En effet, comme l’a déjà amplement montré la critique faite à la thèse « écologique » (Offner 2020), les caractéristiques de l’environnement physique ne reflètent que marginalement la culture et les modes de vie. Ce n’est qu’au niveau de la coprésence physique, telle qu’on la trouve dans les transports en commun, que la densité de la population conduit directement à une intensification des contacts humains.
Cet article ne prétend pas avancer d’hypothèses épidémiologiques relatives aux modes socio-spatiaux de transmission du Covid-19 : en la matière, la prudence est de mise en raison de la modestie des éléments empiriques disponibles. Son objet est plutôt de proposer une description du territoire bergamasque à l’aune des grilles de lecture contemporaines de l’urbain et des grands modèles interprétatifs mobilisés actuellement dans le débat public – et d’en souligner ainsi les limites. Ni métropole, ni campagne, la région de Bergame en Italie a en effet été l’un des foyers les plus actifs du virus en Europe, et les conséquences de l’épidémie y ont été dramatiques.
Cette description montre les limites des modèles interprétatifs binaires et suggère d’analyser, au-delà des causes de la pandémie, l’influence indirecte de la « formation socio-territoriale » (Bagnasco 1994), c’est-à-dire de la manière dont une société évolue et change dans les structures de la longue durée, bien plus probante que la densité ou la présumée uniformisation métropolitaine.
Un entre-deux territorial
La crise a commencé officiellement le dimanche 23 février à l’hôpital d’Alzano, à six kilomètres de Bergame : deux cas de Covid-19 sont identifiés. En dix jours, la situation s’est dégradée au-delà des prévisions les plus alarmistes. Au mois de mars, 5 400 décès ont été répertoriés dans la province, contre 900 en moyenne les trois années précédentes (Invernizzi 2020). La mortalité a donc été multipliée par six ; dans certaines municipalités, comme Alzano et Nembro, elle est même dix fois supérieure à la moyenne.
Située au cœur de la Lombardie, région la plus riche et la plus urbanisée d’Italie (et l’une des plus riches d’Europe), à cinquante kilomètres au nord-est de Milan, la province de Bergame rassemble en 2020 un peu plus d’un million d’habitants (dont 120 000 seulement dans la ville-centre). Elle est marquée par une situation d’entre-deux territorial : ce n’est ni une métropole ni une simple ville moyenne environnée d’un pays rural ; ce n’est ni une centralité ni une périphérie marginale ; son économie prospère est fortement industrielle, à la fois ancrée localement et insérée dans les réseaux économiques mondiaux.
Le modèle de développement bergamasque résiste aux grilles de lecture opposant de manière dualiste villes et campagnes, métropoles mondialisées et ancrage local, densité et dispersion. Il ne peut être qualifié de « périurbain », en raison de la vitalité de ses centres secondaires ; il est sensiblement plus dense que la città diffusa du nord-est de l’Italie, vaste région sans centre dominant parsemée de maisons individuelles et de petites entreprises (Indovina 1990) ; et son industrialisation est bien plus ancienne et ses entreprises plus grandes et plus robustes que ceux des « districts industriels » de l’Italie centrale (Rivière et Weber 2006).
La population, en faible croissance depuis trois décennies, est moins âgée que la moyenne de la région. Un fort attachement territorial s’adosse à une faible mobilité géographique : environ trois quarts des habitants sont nés dans des municipalités voisines ou dans la région. Mais depuis l’après-guerre, le développement économique fulgurant a suscité une immigration de main-d’œuvre, notamment depuis l’étranger (environ 7 % de la population est d’origine étrangère en 2016). L’émergence de nouveaux besoins, liés notamment au vieillissement de la population (aides à domicile, soignants), a entraîné plus récemment une diversification des origines nationales des habitants.
Une urbanisation par bandes linéaires
Dans les communes de Alzano et Nembro, et en général dans la vallée Seriana, le bâti est dense , à peu près cinquante habitants par hectare (Lameri et al. 2016), mais entrecoupé de nombreux espaces ouverts, souvent des jardins avec des potagers, tandis que les champs interstitiels encore cultivés au début des années 2000 ont presque complètement disparu. Sur la bande d’en haut, les flancs des collines, les anciens pâturages, cèdent la place aux bois en expansion. À l’exception des centres-villes anciens, où les maisons sont adossées les unes aux autres tout au long d’une rue principale, les bâtiments sont presque toujours érigés sur des parcelles individuelles et organisées selon des bandes parallèles au fond de la vallée, dans un espace particulièrement étroit.
L’urbanisation du territoire bergamasque témoigne d’un mélange de connaissances anciennes et de techniques récentes qui permettent de mettre en valeur chaque centimètre carré. Chaque maison exploite ainsi les plis des règles de construction et la pente de la vallée, sur la base d’un savoir local difficile à standardiser : un garage accessible depuis la rue du bas, la cour depuis celle située au-dessus, un étage supplémentaire sous les combles.
Après la Seconde Guerre mondiale, de nombreuses personnes ont restauré la cabane de leurs grands-parents dans la bande urbanisée près des pâturages et ont construit la maison de leurs enfants dans la bande inférieure, en investissant les fruits du travail industriel : c’est la génération qui était jeune pendant les trente glorieuses qui est aujourd’hui décimée par le virus, avec les conséquences dramatiques en matière de mémoire et de perte culturelle que l’on peut imaginer (Barcella 2020).
Il ne s’agit donc pas d’une ville linéaire, mais d’une organisation urbaine par bandes linéaires. Les rues sont les repères de ce ruban urbain, qui fait l’effet d’un code-barres vu d’en haut : si vous le « coupez » perpendiculairement, vous y rencontrez en premier la zone habitée la plus ancienne, disposée tout le long de ce qui était autrefois la route romaine puis vénitienne ; en parallèle, se trouvent l’ancienne et la nouvelle route départementales, en alternance avec les fossés industriels du XIXe siècle.
De la première mondialisation à la métropole régionale
L’industrialisation commence au milieu du XIXe siècle : des protestants suisses et des industriels milanais trouvent dans la vallée des ressources en eau bon marché et s’approprient et complètent le réseau médiéval de canaux (Honegger fit l’histoire du textile, l’Italcementi celle du béton ; les usines de papier de Pigna, aujourd’hui propriété du groupe Buffetti, y ont déménagé en 1919 en provenance de Milan). Ces industries s’installent dans le lit majeur du fleuve et occupent l’autre rive, souvent inondée jusqu’au milieu du XXe siècle. Le coût environnemental de ce développement est considérable : destruction de terres agricoles, pollution croissante, exploitation de la nappe phréatique.
Entre Nembro et Albino, on peut observer le cœur du système productif bergamasque : des centaines de petites et moyennes entreprises se juxtaposent et font travailler près de 4 000 employés. C’est un système totalement intégré dans les réseaux de production mondiaux : l’entreprise Acerbis, par exemple, transforme la matière plastique en réservoirs et composants pour motos ; Persico produit les coques des bateaux de la Coupe de l’America ; Polini Motori est spécialisée dans les kits de mise à niveau pour les cycles et les motos.
Ces entreprises génèrent un trafic incessant de voitures et de camions qui encombrent l’ancienne route nationale de Val Seriana, l’autoroute qui relie Cene à Nembro et atteint Seriate, et l’autoroute qui relie Venise à Milan. Depuis 2009, un tramway relie la vallée à la gare de Bergame et transporte environ 13 000 passagers par jour.
Le mode de vie y dépend donc autant du réseau familial organisé dans le voisinage, autour du palier ou de l’autre côté de la rue, que de l’enchevêtrement des autoroutes et des lignes aériennes qui traversent la région et mènent presque partout en quelques heures : Bergamo Orio al Serio est en effet le siège du hub italien de Ryanair et le troisième aéroport du pays, 17 millions de passagers par an et des liaisons avec le monde entier.
Le système territorial bergamasque face au Covid-19
L’hypermobilité (Verdeil 2020) est une des clés pour comprendre l’effet de la pandémie sur ces municipalités qui sont en même temps villageoises et métropolitaines : un exemple tragique est l’itinéraire de vacances d’un couple, elle d’Alzano, lui de Nembro, parti en vacances à La Havane le 29 février et terrassé par la maladie à Madrid le 19 mars (Nava 2020).
Mais les contacts humains dépendent de nombreux autres facteurs, comme l’interdépendance (Baratier 2020) liée aux formes sociales et culturelles. En effet, la forme des établissements humains (la sociabilité, l’organisation spatiale, les institutions) a une influence importante, et la densité n’est plus la bonne mesure. Il semble que la sociabilité augmente les contacts sociaux qui répandent le virus, tandis que les nœuds infrastructuraux les démultiplient sur des échelles territoriales variées. Toutefois, les institutions de ces territoires n’ont aucune capacité de gouverner les effets croisés de ces différents facteurs. Du point de vue territorial, cette pandémie est une nouvelle manifestation de la discontinuité entre le politique et le territoire, qui s’était déjà manifestée bien avant le coronavirus.
On pourrait même émettre l’hypothèse contraire, selon laquelle le modèle métropolitain est plus efficace dans la gestion de distances sociales et sa gouvernance plus résiliente face au risque de propagation liée à la sociabilité de province : les distances physiques sont mieux respectées, les institutions ont un accès privilégié aux réseaux mondiaux, et si les nœuds de transports y sont plus fréquentés, la mobilité des habitants des campagnes s’étale sur des échelles bien plus vastes.
Comme nous ne disposons pas de données stabilisées, nous ne savons pas si la crise du virus s’ajoute à la déconnexion entre la sociabilité individualiste, les réseaux technologiques indifférents à l’environnement et les institutions, ou si elle est générée par cette déconnexion. Ce qui est certain, c’est que la région de Bergame additionne et multiplie les risques et les limites qui sont propres à la sociabilité paysanne, aux nœuds infrastructuraux urbains et aux institutions métropolitaines.
Une fois l’urgence passée, cette crise devrait conduire à ouvrir une réflexion critique sur la gouvernance de ces territoires intermédiaires. L’examen des éléments proposés ci-dessus montre que la densité, la concentration, la promiscuité ne sont pas des indicateurs suffisants de l’uniformité du modèle de développement ; il indique également le rôle à multiples facettes des formations socio-territoriales.
Si on doit reconnaître que le monde est urbain, comme l’a montré Henri Lefebvre, on peut sans doute questionner la métropole sans ignorer la variété de projets de métropolisation ou de rapprochement de la nature dans les différentes régions du monde. On n’a pas encore une explication exhaustive des causes de l’origine du virus, et encore moins de sa propagation : les hypothèses sous examen considèrent les déséquilibres environnementaux, les maladies pulmonaires, la capacité de réponse, les modèles de santé autant que la proximité et la distance physique. Tout résumer sous l’étiquette de métropolisation risque de ressusciter la mythologie des grandes explications, quand les spécificités des territoires réclament l’accompagnement des sociétés locales par l’étude et la compréhension de leur diversité.
Angel, S., Parent, J., Civco D. L. et Blei, A. M. 2012. Atlas of Urban Expansion, Cambridge : Lincoln Institute of Land Policy.
Bagnasco, A. 1994. Fatti sociali formati nello spazio : cinque lezioni di sociologia urbana e regionale, Milan : Franco Angeli.
Baratier, J. 2020. « Pandémie, résilience, villes : deux ou trois choses que nous savons d’elles », Linkedin [en ligne], 29 mars.
Barcella, P. 2020. « Cartolina da Bergamo. Perché proprio qui ? », La Rivista del Mulino, 2 mars.
Barles, S. 1999. La Ville délétère, Ceyzérieu : Champ Vallon.
Faburel, G. 2020. « La métropolisation du monde est une cause de la pandémie », Reporterre [en ligne], 28 mars.
Indovina, F. 1990. La città diffusa, Venise : Quaderno Iuav-DAEST.
Invernizzi, I. 2020. « Coronavirus, il numero reale dei decessi : in Bergamasca 4.500 in un mese », L’Eco di Bergamo, 1er avril.
Lameri, M. et al. 2016. Trampiù : studio delle esternalita’ territoriali generate dall’ipotesi di prolungamento della linea tranviaria T1 da Albino a Vertova, Bergame : TEB.
Nava, F. 2020. « Mancata zona rossa nella bergamasca : storia di un contagio intercontinentale, da Alzano Lombardo a Cuba, passando per Madrid », TPI, The Post International, 31 mars.
Offner, J.-M. 2020. Anachronismes urbains, Paris : Presses de Sciences Po.
Rivière, D. et Weber, S. 2006. « Le modèle du district italien en question : bilan et perspectives à l’heure de l’Europe élargie », Méditerranée, n° 106, p. 57-64.
Verdeil, E. 2020. « La métropolisation, coupable idéale de la pandémie ? », The Conversation [en ligne], 9 avril.
Rethinking the city: urban experience and the Covid-19 pandemic
Whilst the full effects of the Covid-19 pandemic are yet to be seen, the near-global lockdown of urban centres has been a jarring experience for city-dwellers. But how does the rapid spreading of the virus change our perception of the city? Here, Ravi Ghosh argues that these conditions prompts us to see the city differently, and sets us the urgent task of extending the right to the city to all its inhabitants.https://cdn-ed.versobooks.com/blog_posts/000004/648/coronavirus-covid19-newyork-kentucky-derby_wide-0d2ae9fd2f87970c4a116bf71df49a2b6ad66fd7-.jpg
Whilst the full effects of the Covid-19 pandemic are yet to be seen, the near-global lockdown of urban centres has been a jarring experience for city-dwellers. The optimisation narrative has been stopped in its tracks. The speed, number, and efficiency of available urban experiences are now fixed somewhere close to zero. And even the things we do to escape this logic of urban gratification — to calm the pace of everyday life — are now increasingly unavailable; without culture, community, and recreation, people are beginning to wonder what they’re actually doing here, squashed into crowded cities across the world. But, as the peak of the pandemic approaches in many countries, there are more profound forces at play beyond just the individual’s loss of activity and communication.
To be isolating in the city is to embody an agonising contemporary paradox: that, although the coronavirus is now moving rapidly through regions like New York State and London, the connectivity, medical resources, and infrastructure in these centres means that local health prospects may actually be higher than in less infected areas. Having already spread along the avenues of globalisation — holidaying, business travel, and international supply chains — the virus is now recreating a familiar Western narrative: that of the city under siege. Whether via cabinet-war-room style depictions of central government, or makeshift hospitals in the triangle of London, Birmingham, and Manchester, cities will inevitably emerge as defiant symbols of human endeavour and resilience, irrespective of the harm their cramped organisation may also have caused.
But what of this desire for an active city? In Urban Revolution (1970), Henri Lefebvre uses a rough axis (marked from 0 to 100% urbanisation) to imagine the city space. It starts with the political city — marked by bureaucratic power — before progressing through mercantile and industrial phases. Postindustrial society is termed ‘urban’, at which point the city undergoes a process of ‘implosion-explosion’ as it approaches the end of the axis. This rampant expansion of the ‘urban fabric’ which Lefebvre describes will evoke nostalgia to anyone living in a major hub, but unable to enjoy it:
the tremendous concentration (of people, activities, wealth, goods, objects, instruments, means, and thought) of urban reality and the immense explosion, the projection of numerous disjunct fragments (peripheries, suburbs, vacation homes, satellite towns) into space.
For Lefebvre, these ideas were both a loose historical commentary and a starting point for his own socialist reimagining of ‘complete urbanisation’. This is apt given the current lockdown; the current pandemic may well be an acid test for society’s infrastructure and economic model. Watching from behind closed doors as they mobilise in tandem offers an historically unique, often painful perspective. Flaws are revealed gradually, and with great cost to human life. However painful these may be now, in time they could offer a unique opportunity to remake society with the lessons learned.
Perhaps most relevant to our current situation is Lefebvre’s broad understanding of the urban fabric; he includes vacation homes, motorways, suburbs, and even countryside supermarkets in his definition. In normal circumstances, these structures are self-sustaining and peripheral, but what we see in the current crisis is the power of individuals to balloon the city by flocking to its fringes — often at the expense of fellow citizens. When movement is coded with infection, urbanisation suddenly becomes a form of domination. Under this kind of siege, it’s better to sit tight than to flee.
It’s interesting to see this being acknowledged by some sections of the media, even if the socio-cultural consequences remain largely unexplored. The New York Times states that to make meaningful per capita comparisons for Covid-19 cases, its data focuses upon ‘metropolitan areas’ rather than cities or countries, as they more accurately account for ‘the regions where the virus might spread quickly among families, co-workers or commuters’. The statistics for the New York area therefore include nearby suburbs in Westchester, Long Island, and northern New Jersey. And although there’s no immediate way of determining whether people are moving out of necessity or choice, a fairly obvious distinction can be made between displaced workers moving from Delhi, for example, and those in prosperous Western centres — where movement is contingent on financial stability. The pushback against needless migration is mostly anecdotal, seen through viral images of angry placards in British seaside towns, and local news stories of overwhelmed health services. The pandemic has caused a retreat into the familiarity of nation states: not just in the literal sense of repatriation, but also as a means of civic organisation, internal governance, and statistical monitoring. What some call ‘de-globalisation’ reveals what we already know: that not all nations, governments, or health services are created equal — and that this applies to sub-national groupings too. Spatial inequality will play a huge role in determining the eventual death map of the pandemic.
In such strangely out-of-time situations, what constitutes the normal is thrown into sharp relief. Activities normally taken for granted are judged by how easily they can be replicated while upholding their essential values — which in our current time usually means a relocation to the internet. What emerges is a familiar gulf between the professional and the social. Whereas for most office-based employees, work can continue with the assistance of specialised software, communications, and adaptable management structures, the integrity of social relationships suffers far more when human contact is removed.
We feel an acute yearning for companionship, not just because we miss our friends more than we miss our bosses, but because for the most part, the means of reproducing social intimacy online are far inferior to those which ensure the fulfilment of economic roles. That video calling is the go-to for both spheres demonstrates this; it’s somehow the optimal social medium, but exists alongside far more complex tools within the work of work, especially in highly adapted corporate industries. The overlap is somewhat inevitable given that work needs a social element to function, but it’s still grimly remarkable that to evoke all the tenderness and multiplicity of friendships, the best we’ve come up with is drinking a beer while watching someone else do the same on our phones.
It’s tempting to read the digitalisation of work as a direct transposition of the relations of production. This may be roughly the case, but in reality, there are obvious (and often welcome) differences between urban work culture and the current isolation, which speak to Lefebvre’s earlier ideas on ‘everyday life’ (not to mention that work has been at least partially online for decades). By theorising new forms of alienation within modernity — the unpaid labour of the daily commute, for example — Lefebvre in many ways anticipated common qualms about 21st century work life. These are familiar to us, now mostly expressed in the pithy, resigned idiom of being ‘chained to the desk’, ‘meetings that could be an email’, and the general exhaustion of 24/7 communications. The lockdown has stripped back many of these rituals, revealing that much of face-to-face professional life is made up of parade, gesture, formality, and convention — even if there is enjoyment to be found in the structure and atmosphere of the office. Doing more online, and crucially, from not-the-office may be a lasting result from the current changes.
As William Davies has recently suggested, rather than viewing the pandemic as a crisis of capitalism, ‘it might better be understood as the sort of work-making event that allows for new economic and intellectual beginnings’. While this is not the dawning of Lefebvre’s ‘urban utopia’, conceiving of digitalisation as a form of urban progression does point to potential improvements in everyday life, even if the existing internet hierarchy hardly favours citizens. As Joe Shaw and Mark Graham from Oxford Internet Institute argue in a 2017 paper, in order to democratise the city space, we need to understand contemporary urbanisation “as a period where the city is increasingly reproduced through digital information’. They focus on Google’s ability to control the reproduction of urban space through features like maps and email: ‘this is a power to choose how a city is reduced to information, and to control the manner in which it is translated into knowledge and reintroduced to material everyday reality’. Companies are utterly dominant in this area, though the relocation of work and social relations to the digital space — coupled with an overdue revaluation of critical work, a recognition of the service industry’s precarity, and an increase in corporate responsibility — could provide a turning point for some urban hierarchies. The case for universal low-cost internet will be made with renewed urgency after the pandemic; access to accurate information has suddenly become a matter of life and death. If the oft-mentioned global solidarity outlasts the pandemic, then meaningful progress could be made against tech monopolies, resource inequality, and climate breakdown.
For all the difficulties of the lockdown, it does refine our appreciation of what came before. Social existence is naturally incidental and unpredictable — there’s a kind of randomised joy borne of living amongst others. In the city, this effect is amplified. As Lefebvre says of the city’s streets, they are ‘a place to play and learn….a form of spontaneous theatre, I become spectacle and spectator, and sometimes an actor’. There’s certainly a romantic optimism here, but as isolation brings longing, the words feel ever sincerer. A recent Financial Times article contained an amusing vignette on an empty London:
The bankers have disappeared and new tribes with different uniforms have taken over: builders in black trousers and dusty boots; security guards in high-vis jackets pacing outside empty lobbies; and trim young men and women in lycra running or cycling through the empty streets.
The reality, of course, is that these people were always there; it’s just that not everyone notices them. The task beyond the pandemic will be extending this right to the city to all: remaking the structures of everyday life so that they empower all citizens, and harnessing digital urbanisation rather than existing at its mercy. Extending our current social contract — which shows we are prepared to live differently to protect the vulnerable — will be a powerful first step.
In Dense Cities Like Boston, Coronavirus Epidemics Last Longer, Northeastern Study Finds
An analysis by Northeastern University researchers and colleagues finds that in crowded cities — like Boston — coronavirus epidemics not only grow bigger, they also tend to last longer.
The paper, based on data from Italy and China, looks at how quickly an epidemic peaks depending on how crowded a location is.
“In urban areas, we tend to see long, broad epidemics — for example, Boston,” says lead co-author Samuel Scarpino from the Network Science Institute at Northeastern. “And in comparatively more suburban or rural areas we tend to see sharp, quick, burst-y epidemics.”
Scarpino says it’s key for Massachusetts to have uniform rules across the state, because movement from one area to another — say, from a town where restaurants are closed to one where they’re open — can help spread the virus. Here are some edited excerpts of our conversation, beginning with how he sums up the research just out in the journal Nature Medicine:
Scarpino: What we report in the paper is that the structure of communities affects both the height and the duration of COVID-19 epidemics.
Carey Goldberg: So more dense areas will have not just more cases, but a more prolonged course?
Right. In urban areas, we’re likely to have larger outbreaks — in terms of total number, even in terms of percentage of the population — and they will be much longer, lasting weeks and weeks or months, as we’ve seen in Boston, New York City, London and many places around the world.
However, in rural areas, or areas that have population structures that are much more tightly knit — as opposed to a looser collection of households in neighborhoods, as we have spread out across Boston — you get sharp, intense outbreaks. They can be overwhelming in terms of the resources available for caring for patients, and quite dramatic in terms of their effects on the population.
Think about the outbreak in rural Maine that was sparked by a super-spreading event at a wedding, and how it quickly swept through the population.
Why do these insights about community structure and its effect on transmission matter?
In many rural areas that are at risk of these intense outbreaks, there’s much lower health care coverage and often, especially in the United States, a lot more complacency around mask-wearing and physical distancing. These areas are largely protected because they’re isolated. However, if cases show up — as we’ve seen in places like rural Maine — the outbreaks can be quite severe and rapid.
Also, in the more dense areas, you’re going to have cases that move around throughout the population, throughout the different neighborhoods of the city. You’re going to have outbreaks go quiet in some areas, and then become louder in other areas.
And this process can be very, very prolonged, and can make the types of intervention measures that you need to deploy either quite severe or quite complicated, because they have to be very specifically tailored to what’s happening at the really local level within the larger cities.
So what does this mean for policy?
Well, in related work we show that having policies that are different across a city can lead people to move out of their neighborhoods, to go to parks or to go to restaurants with different dining restrictions, or to go to venues with different limits on capacity. And that interacts with the structure of the city to spread the outbreak much more rapidly, kind of accelerating the pace and tempo of cases.
So that really suggests that because the outbreak is going to be so long-lasting, you really either need to focus on driving it completely out or you need to have policies that will protect all of the places with lower rates of cases while intervening in a targeted way in the places with much higher rates of cases.
So what you don’t want to do is put in tougher measures in hot-spots, because then you’re just going to drive people out to other places where they’re going to spread it even more.
Exactly. In the state of Massachusetts, where we have the governor relaxing measures in a fairly extreme fashion in some areas and not in other areas, you are likely to have a situation where you’re just moving the infection around and putting other communities at risk.
So having a more intermediate level of control that’s more uniformly distributed across space is much better epidemiologically.
But that’s not what the state is doing.
The state in many ways is really doing almost the opposite of what our paper suggests in terms of the ways in which you need to focus on controlling COVID-19, and also related work that shows this sort of patchwork of different policies really creates quite a bit of risk.
It seems incredibly important to have hyper-local information, because in the structure you describe, the spread happens at the level of households or neighborhoods, and then you have just a bit of crossover to other places, and that’s how it just keeps going.
That is the implication of our work and many other studies that show that COVID-19, from an epidemiological perspective, is an amalgamation of local transmission that’s happening in households, in restaurants, in occasional longer-distance transmission that moves it into new areas. So you need to have really hyper-localized information around where the cases are occurring and to find out where the cases are coming from.
And that, unfortunately, is one of the things that we’re still not getting clear guidance on from the state: Where are the cases coming from? So that we can understand how we need to intervene.
Without that data, we really aren’t armed with the right kinds of information to both stop the spread and to try and implement measures that will maximally control COVID-19 while having the least possible effects on our economic health, mental health and societal health.
Eichelhäher auf Zweig / Jay on branch
am Rumelner Bach in Bergheim (Rheinhausen), März 2018
Eichelhäher putzt sich / Jay cleaning themselves
#Eurasian_Union nightmare for US and Europe
Pro-Kremlin activists march during a rally in support of ethnic Russians in #Ukraine in central Moscow, March 2, 2014. (Photo:AFP/Dmitry Serebryakov) Pro-Kremlin activists march during a rally in support of ethnic Russians in Ukraine in central Moscow, March 2, 2014. (Photo:AFP/Dmitry Serebryakov)
#Vladimir_Putin's political resilience in the Middle East bolstered by the creation of the Eurasian Union, similar to the European Union, is a nightmare for the Americans and Europeans. And through Ukraine’s revolutionary coup, America and the #EU have decided to intervene in the emergence of a union made up of former Soviet republics under #Russia's leadership.
Sabah Ayoub (...)
The #obama Doctrine and a New Equilibrium
US President Barack Obama with French President Francois Hollande (R) during a greeting ceremony on the South Lawn of the White House in Washington, DC, on February 11, 2014. (Photo: AFP- Alain Jocard) #US President Barack Obama with French President Francois Hollande (R) during a greeting ceremony on the South Lawn of the White House in Washington, DC, on February 11, 2014. (Photo: AFP- Alain Jocard)
In David Remnick’s recent interview with President Obama in the New Yorker, Remnick quotes Ben Rhodes, Obama’s deputy national-security adviser for strategic communications, saying that Obama’s “long game” on foreign policy calls for traditional categories of American power and ideology to be reordered – insisting that (...)
The #obama Doctrine and a New Equilibrium
US President Barack Obama with French President Francois Hollande (R) during a greeting ceremony on the South Lawn of the White House in Washington, DC, on February 11, 2014. (Photo: AFP- Alain Jocard) #US President Barack Obama with French President Francois Hollande (R) during a greeting ceremony on the South Lawn of the White House in Washington, DC, on February 11, 2014. (Photo: AFP- Alain Jocard)
In David Remnick’s recent interview with President Obama in the New Yorker, Remnick quotes Ben Rhodes, Obama’s deputy national-security adviser for strategic communications, saying that Obama’s “long game” on foreign policy calls for traditional categories of American power and ideology to be reordered – insisting that (...)