Building Resilience to COVID-19

The COVID-19 pandemic is still ongoing, with no end in sight. Prevention measures like hand washing, social distancing and wearing masks (particularly in enclosed public spaces) are essential, but not always easy to maintain in the long term. Transmission appears to be taking place more during private social events, such as dinners, weddings and birthday parties. The reopening of bars and nightclubs has also led to outbreaks and in some areas these public spaces are being closed again.

Many people are pinning their hopes on a vaccine to counter the virus, but even though many vaccines are being developed, it may take a long time before they actually reach the market and people get vaccinated. In the meantime, we need to focus more on prevention and building up resilience. In individuals, resilience is the ability to withstand adversity and bounce back from difficult life events. Community resilience is the sustained ability of a community to make use of the available resources (e.g. urban planning, transportation, food, etc.) to respond to, withstand and recover from adverse events.

How to Build Resilience?

Personal Resilience

Smoking, obesity and a lack of physical activity have all been linked with a higher risk of transmission and/or greater disease severity in COVID-19. Too many people still smoke or are overweight and/or physically inactive.

To improve your resilience, it is important to give up smoking, keep your weight within a healthy range (a body mass index between 18.5 and 24.9) and get enough exercise (at least 150 minutes of moderate or vigorous physical activity per week).

To improve your resilience, it is important to give up smoking, keep your weight within a healthy range and get enough exercise

We know that physical activity is an important factor in keeping the immune system functioning well and that a healthy immune system plays a crucial role in protecting us from infection and in the fight against COVID-19.

Visits to parks and exposure to nature and other green spaces can reduce stress and improve restoration of the brain, and thereby improve mental health and build resilience. Green space is essential for good physical and mental health. Moreover, the risk of COVID-19 transmission is much lower outdoors than indoors.

Finally, healthy eating habits —a diet with plenty of fruit and vegetables, for example—are important for maintaining general health and a strong immune system. The immune system is built on beneficial live bacteria that live in the gut. This colony of bacteria, which protects the human body from disease, is built from fibre-rich foods; plant-based foods improve the gut microbiome and therefore the immune system.

Community Resilience

A good, efficient and well-functioning health care system is the key to combatting the pandemic, in particular an efficient contact tracing system . Contact tracing is the process of identifying, assessing, and managing people who have been exposed to a disease to prevent onward transmission. When implemented systematically, contact tracing breaks the chains of transmission of an infectious disease, making it an essential public health tool for controlling infectious disease outbreaks.

One important prevention measure is physical distancing (approximately 1.5 meters). Therefore, we need sufficient public space in cities for people to be able to maintain this distance from others while walking or cycling. Much of the public space in cities is given over to motorised traffic, even though the car is often not the main mode of transport—walking is.

Photo: Clara Soler (Barcelona's City Council)

Therefore, we should create more space for walking and cycling, and increase physical activity. Many European cities are already doing this, but more efforts are needed. New urban design concepts, such as Superblocks (Barcelona), 15-minute city (Paris) and car-free cities (Hamburg), should be promoted and the motorised traffic speed on other urban roads reduced to 30 km/hr to create more and safer public space.

Air pollution increases the risk of COVID-19 infection and disease severity, possibly because it increases susceptibility. Cities are hotspots of air pollution, but levels can be reduced, as we have seen during the recent lockdowns. To curb the spread of COVID-19, more strenuous efforts should be made to reduce current air pollution levels, for example by drastically reducing and electrifying motorised traffic and by using cleaner household energy from renewable sources.

People spend as much as 90% of their time indoors, and the risk of transmission is much higher in enclosed spaces, including the home, than outdoors. Adequate ventilation can reduce the risk of transmission significantly and a well-engineered ventilation system and/or open windows are essential precautions.

The measures taken to increase our resilience may not eliminate COVID-19, but they could reduce the risk of transmission and disease severity

Comorbidity

Not smoking, a healthy weight, physical activity, visits to green spaces, a healthy diet and less air pollution are not only important factors in our ability to withstand the SARS-CoV-2 virus, they are also important in reducing our vulnerability to other diseases, such as cardiovascular and respiratory disorders, diabetes, cancer and Alzheimer’s disease, and the risk of premature mortality. Many people have died of COVID-19 because they had a pre-existing condition. Therefore reducing the prevalence of such conditions will also reduce mortality from COVID-19.

Cities, People and Health

The measures taken to increase our resilience may not eliminate COVID-19, but they could reduce the risk of transmission and disease severity. Personal and community resilience go hand in hand, and our communities determine how we behave. A more concerted effort is needed to build sustainable, liveable and resilient cities that will lead to more resilient and healthier people. These measures would have a long term impact on our cities and their inhabitants.