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[22]Health
How do you build a city for a pandemic?
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By Harriet Constable 27th April 2020
The new coronavirus has spread rapidly in cities around the globe. How
might the virus make us think differently about urban design in the
future?
T

The pandemic has turned the world outside our doorsteps into a newly
formed wilderness. Public spaces are now areas to be ventured into
sparingly, except by essential workers, so for most of us our worlds
have shrunk to the size of our homes.

Modern cities weren’t designed to cope with life during a pandemic, and
this upside-down way of living has turned them into “a disorganised
array of disconnected bedrooms and studios”, says Lydia Kallipoliti,
assistant professor of architecture at The Cooper Union in New York.
This layout might have made sense when cities were internationally
connected hubs filled with millions of people working, commuting,
sightseeing, drinking, dancing and hugging one another without a second
thought. But that world seems a long way off now.

The 21st Century has so far seen Sars, Mers, Ebola, bird flu, swine flu
and now Covid-19. If we have indeed entered an [26]era of pandemics,
how might we design the cities of tomorrow so that the outdoors doesn’t
become a no-go zone, but remains a safe and habitable space?

You might also like:

• [27]Why we can never go back to “normal”
• [28]How global outbreaks are contained
• [29]Should we use phones to track Covid-19

Cities have already come a very long way when it comes to disease
prevention. “It used to be that that living in a city would reduce your
life expectancy… they were death traps,” says science journalist and
author of The Fever and Pandemic, Sonia Shah. The rapid growth of
cities during the Industrial Revolution led to polluted streets that
were a hotbed for infection, especially in places like London and New
York. As these cities grew, outbreaks of typhoid and cholera became
such major public health issues that they led to the construction of
entire new sanitation systems: sewers.
[p08bdzr8.jpg]

The measures put in place to prevent the spread of Covid-19 have meant
many people are isolated in their homes (Credit: EPA)

“To store the filth of a city within the city is simply to invite
disease and death,” wrote the authors of the 1840 book The Separate
System of Sewerage, its Theory and Construction, which called for
sewers to be built in New York. It went on to note that, “by sewering
certain towns in England, the death rate from pulmonary diseases alone
was reduced by 50%”.

Over time, cities also started implementing basic building standards
including “apartments to have light and ventilation and, you know, only
a certain number of people in each one,” says Shah, who explains that
gradually things began to change.

In recent years, calls for cities to focus on health in their planning
have been growing. “For the resilient, sustainable cities we all want
and need, urban plans need to be designed, evaluated and approved using
a health lens,” says Layla McCay, director for the Centre for Urban
Design and Mental Health.

There are many examples of this: since 2016, the National Parks Board
of Singapore has been building [30]therapeutic gardens in public parks
to boost the mental and emotional well-being of citizens. In Tokyo,
[31]citizens are working with urban designers to greenify their
neighbourhoods to improve their health.

As the world’s cities have grown, urban design has actually made many of them
healthy alternatives to suburban or rural living

Over the past century more and more of us have flocked to cities for
work opportunities, and to be close to the sources of all our daily
needs, from food to healthcare. As the world’s cities have grown, urban
design has actually made many of them healthy alternatives to suburban
or rural living. A 2017 study found that [32]city living was linked to
lower levels of obesity in the UK than life in the suburbs, and the
story is [33]similar in the United States. (Read more about [34]the
world’s healthiest places to live.)

But that’s not to say that city life is best when it comes to
infectious diseases. In a pandemic, busy urban centres are a big part
of the problem. Without speedy and efficient public health measures to
counter the infection’s spread, the bigger and more well-connected a
city, the faster it will travel.

“Precisely because they are hubs for transnational commerce
and mobility, densely populated and hyper-connected cities can amplify
pandemic risk,” wrote Rebecca Katz, co-director of the Centre for
Global Health Science and Security and Robert Muggah, director at the
Igarapé Institute, a Brazilian-based think tank in [35]a piece for the
World Economic Forum. With estimates that 68% of the world’s population
will live in cities by 2050, the need to design cities well for
pandemics will only get more pressing.

Urban hotspots

Not all cities are equally vulnerable to disease. Wealthy cities like
Copenhagen, with lots of green space and provisions for cycling, are
world-famous for their health benefits. But it’s a very different story
for those living in the informal settlements of less economically
developed cities like Nairobi, Kenya or Dhaka, Bangladesh.

Without proper sanitation or access to clean water to wash “this is
where epidemics have the most potential to start and spread”, says
Elvis Garcia, an expert in public health and a lecturer at the Harvard
Graduate School of Design. “In 10 years, an [36]estimated 20% of the
world’s population will live in urban environments with a limited
access to appropriate water, health, and sanitation infrastructures,”
he says.
[p08bdzj4.jpg]

Making more space for people to get around and exercise could help to
reduce the risk of infections spreading in cities (Credit: Getty
Images)

Were a virus like Covid-19, which can go undetected for many days
before symptoms show, to emerge among these vulnerable communities it
would be disastrous, as was the case with the 2014-2016 Ebola outbreak
in West Africa. The countries affected have some of the worst water,
sanitation and hygiene (WASH) coverage in the world, which exacerbated
the spread and reach of the Ebola outbreak, with fatal consequences,
according to [37]Oxfam International. Tackling basic sanitation is the
first step in building a healthier city. “That means appropriate water
and sanitation systems and good quality houses,” says Garcia. (Read
more about [38]how hand hygiene effects the spread of a virus.)

Population density is another factor that can have a big influence on
the spread of infectious disease. This is because it can lead to
overcrowding, which can increase the frequency of transmission. In 2002
and 2003, a housing estate in Hong Kong was at the centre of the Sars
outbreak. The city and special administrative region is one of the most
densely packed and [39]unequal places in the world, and the virus
eventually killed nearly 800 people.

Even with big green spaces like Central Park in Manhattan residents have
struggled to stay far enough away from one another to curb the spread of the
disease

Wuhan, the Chinese city where the Covid-19 outbreak began, is the most
densely populated in central China, home to 11 million people.
Likewise, New York, which has had the worst of the outbreak in the US,
is [40]the most densely populated city in the country. Even with big
green spaces like Central Park in Manhattan and Prospect Park in
Brooklyn, residents have struggled to stay far enough away from one
another to curb the spread of the disease.

We can see hints of what the pandemic-resilient cities of tomorrow
might look like in the way that urban spaces are being repurposed right
now.

One solution to address the overcrowding issue was proposed by New York
City councillor Corey Johnson in an [41]interview with Politico: close
off parts of the city to traffic and open them up for exercise. “You
may be able to deliver more social distancing if you pick certain
streets that could be shut down,” he said.

At a daily press conference, the Governor of New York Andrew Cuomo
supported the idea of opening streets to reduce density. Their street
closures lasted just 11 days, but across the globe, from Calgary to
Cologne, cities have been closing off streets to give people more
space. Oakland has gone as far as shutting down 74 miles of city
streets for walkers and cyclists. In future cities, planning for
pedestrians may even go a step further by building much wider
pavements, according to the Centre for Urban Design and Mental Health’s
McCay.

Access to lots of green space is also important for the mental and
physical health of city residents during a pandemic. Marianthi Tatari,
an architect at UNStudio Amsterdam, says, “20 minutes of ‘green time’ a
day helps to give us a healthy and humane approach to our present
situation”. In the UK, [42]private green spaces were opened and
subsequently closed amid fears they were helping spread the disease,
but in Portland instead of closing their parks, they [43]shut them to
traffic to make more space for people to get outside. These moves are
temporary for now, but as the need to social distance continues we may
see more spaces pedestrianised.
[p08bf0qf.jpg]

Providing handwashing facilities in public places could help to reduce
the risk of passing on infections (Credit: Getty Images)

But with sanitation being such a crucial part of stemming disease,
being in a park with no way to keep your hands clean could be a
concern. McCay suggests the ramping up the building of hand washing
stations in all cities. “If everyone was washing their hands diligently
we would see a reduction in all types of infection,” she says. “Perhaps
one of the reasons we’re not is because there aren’t these facilities
in place.”

Jo da Silva, global sustainable development director at engineering
firm ARUP suggests we might need to change the way we build our indoor
environments too. In shared buildings “we might think about having more
than one lift, and multiple communal staircases,” she says. Doing this
avoids “pinch points”, a term for when lots of people are trying to use
the same space and getting too close to each other in the process.

If pandemics are to be a regular part of our lives, our cities will
need to be more adaptable, according to Johan Woltjer from University
of Westminster’s School of Architecture and Cities. “During a crisis
like we’re in at the moment, it would mean creating temporary housing
and [having] health centres be built more flexibly and have space
available in cities for those,” he says. One example of this is the
temporary Nightingale Hospital in London, converted in just nine days
and able to accommodate 4,000 patients and a 1,000-bed hospital in
Wuhan, China, that was [44]built from the ground up in just 10 days.
Having both the space and capability to create these rapid, temporary
structures will be a fundamental part of a city built for a pandemic.

In shared buildings we might think about having more than one lift, and
multiple communal staircases

But cities might go beyond this “to be able to change rapidly, [from
the delivery of] essential supplies, shopping and goods, to evacuation
routes,” says Woltjer. Materials would need to be sourced which enabled
rapid building, like timber and wood, the usage of [45]which is already
appealing to many as they are more sustainable. We may see more
buildings made from shipping containers too. “There are ready-made
houses and smaller buildings that can be put together like a package,”
adds Woltjer.

So making different use of our current spaces, implementing further
sanitation and transitioning toward more room for pedestrians are all
going to be key features in a pandemic-resilient city of the future.

But one of the biggest changes to our cities won’t be so visible as a
fancy new building or a big new park, according to Davina Jackson,
author of Data cities: How satellites are transforming architecture and
design. “Cities of the future are going to have to be designed to deal
with completely invisible flows [like a global virus], and that’s where
the data mapping comes in.”

She gives an example which brings us back to the urban gut of a city:
researchers at the [46]Senseable City Lab at MIT placed sensors into
sewers to detect concentrations of illegal drugs and harmful bacteria
in specific areas. A city built for a pandemic would likely be filled
with hidden sensors to help map the spread of disease.

Self-sufficiency

Another important aspect in building a city resilient to pandemics is
thinking about how to source food.

In our globalised world, resources from all corners of the world can
end up in the heart of our urban centres within a matter of hours or
days, and viruses hitch a ride with them. “Our cities are not
citadels,” says Shah. [47]Scientists say coronavirus likely came from
bats, which passed through an intermediary species before reaching
humans in Wuhan, with its large train station connecting the city to
the rest of China and its busy international airport. “[48]Five million
people left Wuhan before they locked down that city, because we’re all
connected,” says Shah.
[p08bf0m6.jpg]

The Chinese authorities were able to build a 1,000-bed hospital in
Wuhan from the ground up in just 10 days (Credit: Getty Images)

She suggests that to reduce risk, our cities may need to become more
localised and self-sufficient in the future. “If you had a city, for
example, that could feed itself,” Shah suggests. “It’s not like each
place has to be an island, but that there’s some kind of sense of
balance and sustainability that you can see within your own
settlement.”

There are already examples of urban farming feeding millions when there
is little other choice. During World War Two Americans planted 20
million household vegetable plots, producing nine million lbs of
produce each year and [49]amounting to 44% of the US harvest, but the
challenge of building a self-sufficient city is still a huge one.

Garcia agrees that the city of the future needs to be more localised,
not just in food but in access to day-to-day amenities. “Maybe in the
mega-cities, you have to create small nuclear entities,” he says. “And
each nuclear entity has all the resources inside.” One example of this
is the 20-minute city, something that was being trialled in Melbourne,
Australia before the coronavirus outbreak. In a 20-minute city, almost
everything a citizen needs, from shopping to healthcare to exercise, is
within a 20-minute walk or bike ride.

Localisation can also help with another sticking point in the fight
against contagion – mass public transport. While hailed as an
environmental solution to the pollution caused by individual car usage,
public transport is not ideal in a pandemic situation. So cities would
need to make more provisions for cycling, and cities may need to “offer
more paths and small roads so there are alternative ways to get around:
so we’re not all collectively on the same road or in the same public
transport”, says Woltjer.
[p08bf54k.jpg]

Therapeutic parks in Singapore are designed to boost the mental and
emotional well-being of citizens (Credit: Getty Images)

Our homes will need to change too. In an effort to make them more
energy and heat efficient, many workspaces, flats and apartment blocks
don’t have operable windows. But if we are to going to be spending more
time indoors, our houses will need to be better ventilated and offer
more light, according to the Irwin S. Chanin School of Architecture’s
Kallipoliti. She describes the need to avoid something called “sick
building syndrome”, which is what happens “when buildings [are]
entirely sealed and start recirculating pathogens through their
systems”. Perhaps our homes will even be built to feature
“decontamination airlocks like in a Martian environment”, she suggests.

But as the world grapples with the harsh reality of our current
situation, we cannot simply build our way out of the problem. A shift
in thinking is needed for any city of tomorrow, according to architect
Roberto Palomba, who is currently quarantining in his home in Milan.

As a judge on a newly launched [50]Pandemic Architecture competition,
which calls for creatives to submit ideas on city design in the face of
globalised health threats, he wants to focus not just on design, but on
our broader relationship with nature.

“We have abused nature, and [generated] epidemics,” Palomba says.
Before thinking about new cities, the focus should be on preventing new
diseases from emerging in the first place. “I believe that cities
against pandemics will be just that, places where each species will
find respect in coexistence.”

So perhaps we shouldn’t be picturing shiny new city-centre plans when
envisioning a pandemic-resilient city. The changes will be quite
practical, like pop up hand washing stations, and often invisible, like
tracking devices built into our sewers. If we do pandemic preparedness
right, our cities might look much as they do today – just a little less
crowded, with a little more local open space, and with more of the
resources they need to support themselves on the doorstep.

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