Don’t Blame Cities For The Pandemic

If New York or other cities’ urban density is the “enemy,” how did more densely populated Asian cities—Hong Kong, Singapore, Seoul, Tokyo— slow the virus? 

With New York City as the current epicenter of America’s pandemic, and New Orleans, Detroit, Indianapolis, and other cities now showing rapidly increasing cases, urban density is getting blamed for the contagion.  President Trump considered quarantining the New York City metro area, as some urban residents fled to less populated areas, hoping to avoid infection or worse.  But, now as public health experts had predicted, the virus—and associated illness and deaths—is now appearing in rural areas.  

Inadequate public policy, not urban density, is our real enemy.  America’s outdated anti-urban policies have created a disconnect between our impressive scientific and economic resources and policy. We are much more prepared scientifically for pandemics than at any time in history, but our political system is failing us.  Cities and states are once again left to cope with a national problem, but having to rely on their own inadequate financial, tax, and budget resources 

The reality of the virus’ presence throughout the nation is finally dawning on policy makers.  After the administration speculated about quarantining the New York City metro area, Dr. Deborah Brix, the White House’s coronavirus response coordinator then warned that that “no state, no metro area” can avoid the virus. 

America’s population didn’t become more than 50 percent urban until 1920, but over 80 percent of us now live in urbanized areas.  Why have cities grown?  Because they are the engines of economic growth, democracy, equality, arts—and scientific and public health research and advancement.

Of course, unchecked urban density throughout history has harmed public health. London, Paris, Tokyo, Rome, and New York all suffered major waves of disease. But since we’ve only been a primarily urban species for 200 years, it took us time to get it right. As we learned about germs, sanitation, clean water, and public health, urban environments have grown and thrived. 

In 1928, Alexander Fleming famously discovered penicillin through a “mistake” when a stray fungus landed on his anti-influenza experiment. But the fungus isn’t the point—urban-based innovation is.  Fleming was one of many influenza researchers, and he was based at St. Mary’s Hospital in London.  Then as now, cities bring people and resources together, and innovation results.  Jonas Salk discovered the polio vaccine while heading the University of Pittsburgh’s Virus Research Laboratory.

While cities aren’t the cause, America does have a public health problem, caused in part by our fragmented federal system.  The federal government’s initial and continuing failures to act, mean that containing the virus in local hotspots is no longer possible—for New York City, for any state, or for the nation.  

Health experts say New York and other emerging hotspots are just further along the disease curve but much of the US will follow, further straining our public health system.  The problem is made worse by our federal system, empowering states to act—or fail to act—on their own without federal direction and resources, and by the government’s failure to adequately prepare and respond to the public health crisis. 

Although many governors and mayors are providing exemplary leadership, only the federal government can order and purchase enough testing and protective gear, get it equitably to states and cities, and coordinate the myriad steps required to contain a pandemic.  Instead, in 2018, the White House office that coordinated federal responses to pandemics was eliminated, leaving the government less prepared to act.  This has now contributed to states engaging in a bidding war for scarce medical supplies.  

Compare us with what’s been working in other countries – aggressive, coordinated public policies and resources. If New York or other cities’ urban density is the “enemy,” how did more densely populated Asian cities—Hong Kong, Singapore, Seoul, Tokyo— slow the virus?  They have denser populations and lower per capita incomes.

 But Singapore instituted border controls, conducted widespread testing and tracked exposed people, with clear and consistent public communication.  South Korea funded a massive increase in tests (they now produce 100,000 daily), allowing them to trace the pandemic and identify “hot spots” requiring quarantine.  And in Tokyo, people wear masks, practice social distancing, and generally obey government directives to avoid infection.

The misguided “cities are the enemy” argument has dangerous implications, especially if the virus and public health issues are politicized.  Although earlier polls found large partisan gaps concerning fears about the virus, those are now closing.  But eight states still do not have statewide shelter-in-place orders, all of them with Republican governors.  And President Trump routinely criticizes Democratic governors from affected states on Twitter and in press conferences.

President Trump and other politicians also continue calling coronavirus the “Chinese” or “Wuhan” virus,recalling anti-Asian prejudices of the late 19^th century and during World War II.  It also is a disturbing echo of how white nativists blamed the 1918 influenza epidemic on Jewish and Italian immigrants, just as Irish immigrants were blamed for earlier diseases.

Like other health problems, the virus’ impact will fall disproportionately on nonwhites, the poor, and the elderly.  Historically, black Americans have been blamed for their poor health outcomes, wrongly attributed to genetic differences or their alleged risky behaviors, rather than poverty, racism, and inadequate medical care.  Countering this narrative, several cities now identify racism as a major contributor to public health problems that affect not only blacks, but all Americans.  

There is no turning back from a diverse, urbanized nation or world, and there shouldn’t be.  We need cities, their innovation and diversity, and their economic output, and their potential for achieving greater democracy and equity.   What we need now is the political will to fully mobilize the federal government and deliver public health resources where they are needed, and in the long run, correct the tax, regulatory, and political imbalances that hurt cities.  But as the virus spreads across the country, don’t blame cities for larger policy failures beyond their control.