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Cities and Pandemics Have a Long History

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Cities and Pandemics Have a Long History

Contagious disease has always been the enemy of urban life; we should persevere and bolster our defenses against future outbreaks. Spring 2020
Covid-19
Cities
Economy, finance, and budgets

The Covid-19 pandemic creates such uncertainty because it strikes at the heart of our urban world. Over the past five centuries, humanity has become connected with ever closer ties across continents and within cities. Those ties enable commerce, build friendships—and ease the spread of contagion. If we don’t invest enough in preventing future pandemics, the downsides of density may become too severe and our world will start to splinter. A more fragmented world will mean less innovation, less growth, and far more suffering for the disadvantaged.

Classical Athens is the North Star of urbanism—the city whose legacy still shapes the West. After the defeat of Persia at Salamis and Platea, Athenian power and wealth attracted talent from across the Mediterranean world. The city’s close quarters enabled the face-to-face interactions that practically invented philosophy, drama, history, and democracy: Socrates and Plato; Aeschylus and Euripides; Herodotus and Thucydides; Pericles and Themistocles.

But density and connection to the outside world— the defining characteristics of great cities—can also turn deadly. Plague struck Athens in 430 BC, when its citizens were packed more closely together than usual because they were avoiding the Spartan army. Thucydides, who caught the disease and recovered, claimed that it originated in Ethiopia and passed through Egypt. The plague killed tens of thousands, including Pericles, and probably led to Athens’s defeat in the Peloponnesian War and eclipse as a great metropolis.

One millennium later, another plague struck Constantinople and ended the emperor Justinian’s attempt to rebuild the glory of Rome. Justinian’s plague was the first recorded mass appearance of Yersinia pestis, the flea-borne illness known as the Black Death, which would slaughter Europeans by the millions. Cities were, as always, particularly vulnerable because they were ports of entry for diseased fleas and because urban proximity enabled the spread of illness.

Only in the past century have cities ceased to be killing fields. A boy born in Shakespeare’s London or Edith Wharton’s New York City could expect to live six years less than a boy born in the countryside. Water-borne illnesses, like cholera and typhoid, killed thousands until cities spent massively on water systems. Mosquitoes carried yellow fever and malaria. Diseases that travel by droplet, including smallpox and influenza—and now Covid-19—prove particularly hard to disrupt, without a vaccine.

Sky-high urban mortality rates make the speedy growth of nineteenth-century cities somewhat astounding. Yet urban incomes were much higher—and life could be cheap in rural areas as well. For an Irish refugee fleeing the potato famine, the risk of cholera in New York surely seemed like the lesser of two evils. Moreover, cities were becoming safer because of medical breakthroughs, engineering achievements, and decent urban sanitation.

The work of a pantheon of nineteenth-century urban heroes led to healthier cities. John Snow observed the pattern of London’s cholera deaths in 1854 and concluded that the disease was coming from a well. (See “Germs and the City,” Spring 2007.) The increasing medical consensus that cholera was water-borne led Stephen Smith, the first leader of New York’s Metropolitan Board of Health, to force tenement owners to connect to the city’s water and sewerage system. Colonel George Waring designed sewerage systems and led the fight to clean up New York’s streets. Louis Pasteur improved the safety of urban food that always had to travel from farm to city.

Their work guided massive urban investments in sanitary infrastructure that created a century of healthier cities. Starting in the 1980s, AIDS proved terrifying—but, once understood, sexually transmitted diseases can never endanger an entire city. By then, most of us had forgotten that urban proximity created health risks as well as benefits.

In the first decades of the twentieth century, American cities enabled economic growth and upward mobility by housing industrial expansion. In the middle decades of the century, cities stalled as factories and residents moved to lower-density locales, like the car-based suburbs that grew rapidly after World War II. Former manufacturing hubs, like New York’s once-giant garment district, withered away. Social problems, including crime, along with fiscal distress, accompanied the economic dislocation.

But remarkably, in the decades since 1980, many of America’s cities, including New York, revived themselves. They have come back as centers of service industries, which still benefit greatly from proximity. Ninety-five percent of New York City’s nongovernmental workers provide services of some kind.

Professional and business services provide the high-wage export industries for the most successful cities. Financial services have been New York’s economic powerhouse for decades. When an industry provides enormously high returns to information, it creates strong incentives for people to cluster together in knowledge-rich environments, like trading floors.

“We must not treat Covid-19 as a one-time shock; instead, we should bolster our defenses against future outbreaks.”

But the social importance of the lower-wage service industries is also enormous. One-fifth of America’s workers, and one-fifth of New York City’s workers, labor in retail trade, leisure, and hospitality. As I think about the future of work for less skilled Americans, these face-to-face service industries seem like the most plausible options for future job creation. An espresso machine still can’t provide friendly banter. Yet such service jobs become far less plausible in a world of pandemics.

The other massive employer of the less skilled is health care and social assistance. These jobs exist even in the poorest parts of the U.S. because the federal government provides payment through Medicare and Medicaid. Some 220,000 home health-care workers labor in New York City.

In the wake of the pandemic, most of us are experiencing a reduction in our effective density level. We’re not crowding in line at a Starbucks or looking at a screen on a coworker’s desk. If we’re not connecting with other people or sharing common urban infrastructure, like parks and museums, then cities offer little but cramped living space—and overcrowded hospitals.

We will get through this pandemic, and we will get through the economic dislocation that has come with it. But if the threat of future plague is going to be a permanent part of our existence, cities will be far less appealing. Remote working is rarely a close substitute for being there, especially in knowledge-intensive occupations. My teaching and advising over Zoom is much less ideal than when I can work face-to-face. The move to electronic co-working will mean less productivity, fewer innovations, and less joy in personal connection. (For an optimistic assessment of remote work’s potential, see “Remote Work’s Time Has Come.”)

We have long had options that reduced face-to-face contact, including living in lower-density areas, eating at home, shopping online, and working remotely. Some of those options caught on, but mostly we have continued to operate face-to-face. Even e-commerce, which can feel so ubiquitous, accounted for only 11 percent of U.S. retail sales in 2019. Today’s pandemic is a short-run disaster for the 32 million workers in retail trade, leisure, and hospitality. If fear of pandemic dominates the future, the shock will turn into permanent cataclysm for those industries and their workers. If demand for less educated workers drops in these huge sectors, wages will fall for similar workers, and American joblessness will become more severe.

How can we reduce the threat of future pandemic and bring the world’s cities back to those halcyon days of November 2019? Almost assuredly, this is worth a massive increase in public-health-related spending. America’s nineteenth-century cities became healthier only because they spent as much on clean water as the federal government spent on everything else, but for the post office and the military. Covid-19 has destroyed trillions of dollars of shareholder value and generated a $2 trillion bailout. It makes sense to spend billions to avoid future losses of trillions.

We can produce vast stockpiles of protective equipment at low cost, so we never again force health-care workers to operate without N95 masks. We can ensure that the Centers for Disease Control has the capacity to monitor fully all disease outbreaks throughout the world and make recommendations about screening and travel restrictions. We can massively increase funding for research on vaccines and cures, even for diseases that have not yet had a major footprint in the U.S., like Ebola.

As an economist, I almost always emphasize the waste inherent in exuberant public spending—but sometimes waste is the price of preparedness. We must not treat Covid-19 as a one-time shock; instead, we should bolster our defenses against future disease outbreaks. We have built our modern world around proximity, and Covid-19 has made the costs of that closeness painfully obvious. We can either reorient ourselves around distance or recommit ourselves to waging war against density’s greatest enemy: contagious disease.

Photo: Flemish artist Michael Sweerts’s seventeenth-century depiction of the plague that struck ancient Athens (BRIDGEMAN IMAGES)

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