Does the pandemic mean that urbanism is dead?

An empty Times Square.  Photo: Joshua Bright, New York Times.

There are many pieces making the point directly or indirectly that cities make a great platform for epidemics, such as the Counterpunch article, "Paradigm shift by pandemic."    Point 10 includes "moving to a more distributed population."

Looking at what's happening in Greater New York City, Detroit, Chicago, etc., or what happened in Wuhan, you can make that case.

It doesn't have to be.

Hong Kong, Taiwan (Taipei), Singapore, and South Korea (especially Seoul) demonstrate that the issue isn't cities per se but having robust public health and health care systems backed by strong surveillance and response systems ("Taiwan Saw The Coronavirus Coming," Foreign Policy; "Response to COVID-19 in Taiwan: Big Data Analytics, New Technology, and Proactive Testing," Journal of the American Medical Association).

Toronto Star photo.

Clear need to invest in public health infrastructure.  While before the covid19 pandemic the US was rated as the nation most able to respond to such an event, current events prove such a response is dependent on political leadership that cares about government and able public administration, which the Trump Administration does not.

Failures definitely occurred around surveillance--monitoring the globe for potential problems--although recent reporting indicates this wasn't the case ("Intelligence report warned of coronavirus crisis as early as November," ABC News), the issue was response.

A few days ago I thought I had a great original idea, of rebuilding the US public health "system" along the lines of the agriculture extension system, which links universities ("land grant colleges") and the US Department of Agriculture in an integrated system developing and disseminating research and best practice knowledge, delivered through a technical assistance program organized to reach farmers and stakeholders within regions and states, county by county.

After all, the federal government already has the building blocks for this within the Department of Health and Human Services, such as the US Public Health Service (headed by the "Surgeon General"), the CDC, and units of various agencies like the National Institutes of Health, the Food and Drug Administration, etc., alongside a robust set of public health graduate schools (+ medical schools) in most states.

Image: SPH Analytics.

Within states, counties and large cities have public health departments, which carry out a variety of responsibilities around what is called "population health."

Based on the disaster of response to covid19, obviously, the federal and state/local public health agencies need to be better integrated.

Unfortunately, there is a "natural experiment" underway, both within the US ("Did Ohio get it right? Early intervention, preparation for pandemic may pay off" and "The coronavirus was spreading. The parties went on. Now comes the pain," Washington Post) and globally ("Italy, Pandemic’s New Epicenter, Has Lessons for the World," New York Times; "Lessons from Italy's Response to Coronavirus," Harvard Business Review), demonstrating the difference between effective and ineffective responses and the number of deaths that could be avoided by early and fast response.

It turns out that the concept of creating a somewhat similar system is laid out in the Affordable Care Act, but it's never been funded or explored in any detail.

And the idea was more about supporting primary care rather than integration on the public health side of the health care system ("Cooperative Extension as a Framework for Health Extension: The Michigan State University Model," Academic Medicine. 2017 Oct; 92(10): 1416–1420).

The difference is crucial.  Traditional health and wellness care focuses on the health of individuals, while public health focuses more broadly on the population as a whole.  So maybe my idea is subtly different from the concept in the ACA.

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Differentiated response by states and cities/counties.  Another natural experiment is occurring within states and the difference in action between governors and local executives (mayors and county executives).  For example in New York State, the Governor has been quicker to act than the Mayor of New York City, and the City of New York now has the most deaths from the pandemic of anywhere in the US, irrespective of the fact that NYC is the nation's largest city.

One of the first major moves towards stay at home was the San Francisco Bay Area, where six counties (technically San Francisco is a city-county) made a joint declaration to shut down most services and for people to stay at home ("San Francisco Bay Area Nears Total Shutdown to Stop Virus," Bloomberg).  As a result, Northern California has a much lower rate of infection and death compared to other metropolitan areas.

(Ohio preceded this, but they aren't quite so visible, media-wise.  See "Did Ohio get it right? Early intervention, preparation for pandemic may pay off," Post).

San Francisco has 10 deaths from covid19.  Granted NYC is 10-11x bigger, but it has over 5,000.