Cities – Emerging Hotspots for Infectious Diseases

Divya Mehra

Cities and pandemics have shared a long history and over the decades it has been witnessed that cities have emerged to be the epicentre for infectious diseases. This is often attributed to its very nature – the population densities and inter/intra connections have turned out to be the important factors.  Cities act as nodal points, trade hubs, economic and cultural centres, service providers, etc. which result in immigration and emigration of large numbers of people resulting in overcrowding, and over the past few centuries, this movement has only increased due to globalization. The limited spatial extent of an urban centre results in people living in close proximity to each other providing contagion to breed and spread rapidly among the urbanites.  

The history of infectious diseases also suggests that cities have always been the worst affected by them. In 1793, a yellow fever outbreak killed 5,000 people (about 10% of the total city population) in Philadelphia, the then national capital and largest city of the United States of America. The Cholera epidemic of 1832 hit New York hard with three thousand people dying within the first few weeks of the epidemic, and around one-third of the population left the city in fear of the disease. In 1896,  Bombay (now Mumbai) became the epicentre of the Bubonic Plague epidemic which killed an estimated 10 million people in India. The death toll in Bombay was estimated to be 1,900 people per week through the rest of the year. In November 2002, the Severe Acute Respiratory Syndrome (SARS) began spreading across the world, which is believed to have first emerged in the city of Foshan in Guangdong province of China affected global cities like Beijing, Hong Kong, Toronto, and Singapore, and the virus spread across 29 countries in Europe, North America, South America, and Asia. The 2014-2016 Ebola outbreak in West Africa emerged in rural areas of Guinea, spread to urban areas and across borders within weeks, and became a global epidemic within months. The urban slums became the hotbeds for the outbreak in the urban centres of West Africa and inadequate access to safe water, sanitation, and other infrastructure in the area provided the perfect breeding ground for the Ebola virus.

The new coronavirus pandemic which we are facing currently also emerged in a major city. It is believed that the virus originated at a wet market in Wuhan which is one of the largest Chinese cities and a major transportation node with national and international connections. According to a recent online article by Observer Research Foundation, the global trends suggest that this pandemic is highly urban-centric. It has affected some of the largest cities in the world such as Wuhan, New York, London, etc. In India as well, the top 15 urban agglomerations account for nearly half of all COVID-19 cases in the country. As of 8th July 2020, Delhi is the most affected city which has recorded 102,831 cases so far, and Mumbai, the largest city in the country, has recorded 85,724 cases so far. Both the cities account for approximately 25% of the total COVID-19 cases in the country.  The most important reason for this trend is credited to high population density in cities and their global nature. Cities are no longer local but are connected to the world outside, which exposes them even further to these infectious diseases. It is believed that by 2030, about 60 per cent of the world population will be living in urban areas, and the occurrence and spread of infectious diseases are only going to increase. This emphasises the importance of preparing our cities to deal with such outbreaks. 

Pandemics have changed and reshaped our cities before as well. The cholera outbreak in New York forced the authorities to create wastewater management systems and development of open/green spaces such as Central Park and tree-lined boulevards to purify the toxic air in the city. The 1793 yellow fever outbreak in Philadelphia made the city adopt the costly project of garbage removal and create the sanitation department. In 1896, the bubonic plague outbreak in Bombay resulted in the creation of Bombay City Improvement Trust, a city planning body and emphasis was given on providing better housing facilities to mill workers. The 1911 plague, resulted in the formation of modern Hyderabad when Nizam VII, Mir Osman Ali ordered the creation of an urban development authority known as the Hyderabad City Improvement board. The plague also led to the removal of slums from the city and 10,000 houses were built to avoid evacuation during the epidemic.

Many experts around the globe are suggesting that the Coronavirus pandemic has already started reshaping cities and is bringing behavioural changes in its residents, including practices such as maintaining personal hygiene and social distancing. Further, people are relying more and more on technology to carry out day to day activities. Corporates, businesses, Universities, schools, etc. are adapting to online mediums to avoid direct physical interactions. The pandemic is also forcing the city development authorities to prioritise the strengthening of health infrastructures, rethink their approach to deal with urban poverty and focus more on public housing, homelessness, food security, public distribution systems, sanitation, etc.

As the world is rapidly urbanizing and more and more modern cities are emerging, there is a need to plan these cities responsibly and sustainably. The coronavirus pandemic has made us realize the importance of preparedness and planning. If we need to recover from such a crisis in the future we need to strengthen our planning systems. The utmost priority should be given to health infrastructure and the sanitation departments who are currently at the front-line in fighting this highly contagious disease. The informal settlements and slums in urban areas are often considered to be the breeding grounds for infectious diseases and providing better sanitation and health care facilities to people living in these areas need urgent attention. Planning and development of affordable and adequate housing are important steps to provide a better standard of living to urban poor. The development of open spaces and green belts should be encouraged as it facilitates the mental and physical well being of its citizens and helps in rejuvenating the natural resources. These are some of the basic interventions that are necessary to prepare our cities to face these outbreaks with minimum impacts. To build a sustainable and resilient city, urban plans need to be designed and implemented keeping such outbreaks in mind.

Featured Image by Silviu Costin Iancu from Pixabay

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