The glory of cities is to serve as places of interaction between people and economies. Yet throughout history—from Roman times to the present—this advantage has also entailed exposure to deadly contagions. As Marc Riedl, a specialist in respiratory disease at UCLA, puts it: “Megacity life is an unprecedented insult to the immune system.” Today’s coronavirus pandemic reflects these patterns, concentrating, at least initially, in densely populated regions, such as Wuhan, Madrid, and around Milan. In the United States, the vast majority of cases to date are occurring in the densest, most globalized regions, such as Seattle, San Francisco, and, in particular, greater New York. Cases have been far less prevalent, so far, in the vast middle of the country—except for New Orleans and Detroit—and in rural areas, where people have less daily contact.
Yet density is not a death sentence. Taiwan and South Korea—which have denser cities—and Singapore, roughly the density of New York City, have largely avoided the worst of the outbreaks. In all three countries, health officials took decisive and early steps to control travel and identify those who might be susceptible to the disease. Some of this was based on experience from earlier contagions, such as SARS, and from a far more disciplined population and more effective, authoritative governance. From the beginning, notes MIT Technology Review, Singapore authorities worked to piece together the complex chain of transmission from one person to another. As of February, anyone entering a government or corporate building in Singapore had to provide contact details. South Korea also began aggressive testing early on and has administered at least a quarter-million tests.
By contrast, the U.S. and Europe have been slower to address the crisis, posing a significant threat to their cities. Europe’s fast-growing infection rate is, to some extent, the product of its weak border controls, one of the EU’s proudest accomplishments. Canada was also slow to act. It did not ban overseas travelers until mid-March; flights from China to Vancouver continued as late as March 15, reportedly without screening or testing.
As a result, we’re seeing in Europe and North America a shutdown of many urban essentials, including in dense and transit-dominated New York. To tell New Yorkers to avoid crowded subways—a legitimate concern—is also to take away one way that dense cities work. Mass-transit ridership, struggling throughout the country, has taken a huge hit during the crisis, leaving systems in perilous financial shape. In New York, despite efforts to keep the subway cars clean, ridership is down as much as 50 percent, as the lockdown has many commuters working from home. The massive transit subsidies in the federal stimulus could end up largely plugging holes from devastated budgets.
The pandemic raises issues that should have been confronted after earlier scares such as SARS, Ebola, and swine flu. Cities, historian William McNeill noted in his revealing Plagues and Peoples, have always struggled from being “unhealthy places.” To avoid the high rates of infectious disease in the tropics, the earliest cities generally were built in the dry areas of Mesopotamia, Egypt, northern India, and China, as well as in the Mediterranean basin. Even so, the great classical cities—Athens, Rome, and Alexandria—all suffered from periodic plagues that, in some cases, wiped out as much as half their population.
Trade, an essential element of cities, often triggered what McNeill described as “fateful encounters” with foreign pestilence. The rat-borne bubonic plague came to Europe on ships from the East, where the disease originated. It affected the cosmopolitan centers of Renaissance Italy—with their often crowded and filthy marketplaces—far more than the rural, backward reaches of Poland or other parts of central Europe. Those who could—like some contemporary wealthy New Yorkers fleeing to country homes—tried to avoid the contagion by holing up in rural redoubts, where the chances of infection, though not negligible, were generally less. Boccaccio’s Decameron relates 100 stories told by a coterie of elite Florentine youths who fled the 1348 outbreak of the Black Death.
Modernity brought its own health crises. Friedrich Engels speaks powerfully in The Condition of the Working Class in England of the squalid conditions endured by Britain’s mid-nineteenth-century urban poor. Mortality rates in London were three times higher than in the surrounding countryside, making the city dependent on constant demographic infusions from the hinterlands and Ireland. The urban proletariat suffered stunted lives, not only in terms of economics but also regarding their physical stature and longevity. Epidemics of infectious diseases such as cholera, typhoid, typhus, smallpox, and tuberculosis were widespread, and crowded conditions, alcoholism, and mass prostitution contributed to a public-health nightmare.
Such maladies also became commonplace in America. Pollution of air and water was rampant—observers speak of the Ohio River in Cincinnati turning red with “rivers of blood” from slaughtered pigs. Residents of industrial cities like Pittsburgh suffered high rates of lung infection. Smog in southern California in the past created an environment so toxic that young children often had to be warned not to play outside.
Today, we see these conditions most commonly in the fast-growing cities of the developing world. The massive slums of Dhaka, Cairo, Kinshasa, Karachi, and New Delhi are extraordinarily unhealthful places. Coronary diseases, according to one study, have grown as Asian populations have urbanized, often in stressful conditions. The average Mumbaikar lives to 55—seven years less than the general population, which is still largely rural.
The epicenter for the new urban pandemics remains China, a country transformed by mass urbanization but with conditions that recall some of the worst aspects of nineteenth-century cities. Unsanitary conditions in the congested urban centers have been linked to the 2003 SARS outbreak. China’s authoritarian rulers, determined to avoid blame, made the current pandemic far worse by initially downplaying the threat—indeed, ignoring it for months. Now they are even trying to blame their American enemy for creating the virus. Not many people, outside the media, are fooled. Beijing’s handling of coronavirus, notes the South China Morning Post, severely threatens the regime’s credibility, while two other predominantly Chinese nations, Taiwan and Singapore, have had much greater success in limiting the outbreak.
One possible key to China’s pandemics may lie with its hundreds of millions of migrant laborers, many lacking access to regular health care and often living in overcrowded areas with poor sanitation and drinking water. Amid shining trains, superhighways, and high-rise towers, the folkways of the Chinese village clash with urban realities. Anyone who has spent time in that country’s “wet markets,” as I have, cannot be surprised that these places—with streets coated with spit and blood from exotic animals herded into cages—have been identified as likely breeding grounds for respiratory ailments like SARS and the new coronavirus.
Markets may be magnificent at spurring growth and innovation, but the business of hygiene and sanitation tends largely to be a government project. European and American cities coped with urban-centric disease in the past by building sewers and water systems, carving out space for parks, and limiting the most egregious pollution from industrial facilities.
In the United States, these policies were fostered largely by progressives, including some open socialists. Often referred to as “sewer socialists,” they shared Marxist dreams of controlling the means of production but, failing that, worked studiously to create a more healthful environment for the urban masses. This included the provision of more open space, which has been widely linked to better mental health and extended longevity.
In New York, Fiorello La Guardia, who ran variously as a Republican, as a socialist, and on the American Labor Party and Fusion tickets, pursued a similar agenda. Earlier reformers had created Central Park and improved sanitation, but La Guardia’s administration, fueled by New Deal largesse, directed massive investments in sanitation, health, and transportation, powering the city’s rise to global predominance. Even today, many cities in the West—New York, London, and Paris—still enjoy slightly longer life spans than their national averages, partly because of these improvements.
Public hygiene and efficient governance seem less of a concern for today’s “woke” progressives. Many cities dominated by progressives—San Francisco, Los Angeles, and Seattle—have allowed the growth of homeless encampments, where such insalubrious activities as shooting up in public or defecating in the streets are tolerated. These encampments are breeding grounds for diseases, some distinctly medieval and arguably far more dangerous than coronavirus. Los Angeles city workers have been infected with typhus, and some now demand elaborate protective gear when asked to hose down putrid streets. Cases of leprosy are on the rise in Los Angeles; some predict, with the resurgence of rats, that the return of bubonic plague may be imminent.
It’s difficult to imagine that such policies would be tolerated by earlier progressives like La Guardia. Certainly, the Fabian socialists who founded modern Singapore—some of whom I worked with for years—would never allow such pestilential breeding grounds to fester, particularly given the problems associated with building cities in the tropics. Successful cities like Singapore avoid virtue-signaling about tolerance, focusing instead on “concrete gains” for the working class and protecting the general public from diseases and crime. By its nature, a city requires rules that protect citizens and encourage them to stay; large homeless encampments endanger the public and may lead some to depart for safer climes.
City leaders must confront the reality that forces such as digital technology could weaken their hold on companies and talent. Telecommuting, already experiencing enormous growth, represents an alternative to the jostling, crowded, and often dirty experience of city life. The response to the coronavirus seems likely to accelerate this trend, particularly if cities don’t act effectively to control the outbreak. In the end, the virus threatens to be a crisis not just of public health but of governance around the world. Only by making urbanity safer and cleaner, as well as addressing the health concerns of the many as opposed to appeasing the political concerns of the disorderly few, can cities continue to thrive.