COVID-19 and the City: How is the Pandemic Affecting Urban Health?

Over the last weeks, confirmed cases and deaths from COVID-19 have soared globally, with these figures expected to continue increasing for some time to come. The pandemic has overwhelmed health care systems and led to dramatic preventive measures in many countries. The response and the actions taken appear to have been particularly successful in China, Singapore and Japan.

Prevention through home confinement programmes, hygiene measures and social distancing is currently the key that has led to a considerable reduction in the number of potential cases that otherwise would have overwhelmed health care systems.

Reduction in Air Pollution Levels

In addition to this health benefits, the drastic prevention measures have also caused a dramatic reduction in road traffic and industrial activity -70-80% or more-, which may in turn have resulted in significant reductions in CO ₂ emissions and air pollution, up to 20-30% in the case of China. A similar reduction has been observed in Italy, larger in Barcelona and other places.

It is important to highlight that every year an estimated 8.8 million people worldwide die prematurely of air pollution (giving rise to an average reduction of 2.9 years in average global life expectancy), 3.2 million die prematurely due to insufficient physical activity and 1.35 million are killed in traffic accidents. The climate crisis has further increased the number of premature deaths.

Some SARS research has suggested that lower air pollution levels may also reduce the transmission and fatality rate of COVID-19.

In China, where the COVID-19 epidemic is now beyond its peak and data is now available, a quick back-of-the-envelope calculation shows that a 25% reduction in air pollution levels for one month may have prevented more than 9,000 premature deaths*, a figure higher than the number of deaths caused by the virus (nearly 4,000). And some sources have suggested that this figure may be as high as 77,000. However, increased indoor air pollution from smoking may have increased the number of premature deaths.

Even so, keeping in mind that air pollution levels are much lower in countries like Italy and Spain than in China, fewer premature deaths will probably be prevented by lowering these levels. The number of deaths caused by the COVID-19 is likely to be higher than the number prevented by the improvement in air quality. However, some SARS research has suggested that lower air pollution levels may also reduce the transmission and fatality rate of COVID-19 .

Physical Activity

On the other hand, social distancing measures may cause a significant reduction in physical activity during the period of confinement and lead to an increase in premature mortality. In fact, some studies suggest that populations have reduced their levels of physical exercise in 20-30%. Physical activity is very important for physical and mental health, including the immune system. The development of home exercise can mitigate some of these effects.

With the aim of promoting physical exercise, there have been calls to allow walking and cycling as part of home confinement programmes. Although reasonable, the question is how to build this into the programme in a way that it is accepted without increasing the risk of contagion. Certainly, in the first few weeks, it is advisable not to go outdoors, but in the medium-to-longer term physical activities outdoors should be allowed as part of any restrictions.

Car Accidents

Another consequence of confinement is traffic reduction. In China, this has led to a dramatic decrease in accidents. In 2016, 256,180 people were killed by car accidents in China. This works out to more than 20,000 fatal accidents per month, which could have been avoided. Reduction in car accidents are likely in other countries, where the stay at home programmes are implemented.

Outcomes of the Economic Downturn

But the greatest impact on public health may come from the economic downturn, including job losses, although the evidence from the 2007 crisis was quite mixed and outcomes may depend on the measures taken to mitigate the recession. However, the current crisis appears to be much more severe and may lead to the total collapse of certain sectors, such as aviation, entertainment and tourism, and therefore have much more profound consequences for the economy and health. A strong health system needs a strong economy; and what we now know is that a strong economy needs a strong health system.

How Should Cities Respond?

The high population density, close contact between people, high level of mobility and shared means of transport, among other features, tend to turn cities into the hotspots of outbreaks and gateways for the disease. In this case, however, rural areas have also been hit hard. In any case, the advantage of urban outbreaks is that cities often have better more accessible health care systems in place.

Furthermore, cities are also part of the solution because they are centres of innovation and can be the drivers improvements in public health , for example through better urban and transport planning, by moving away from a car-centred model and favouring active forms of transport, such as walking and cycling. Walking and cycling have the advantage that they involve a lower risk of contagion and at the same time strengthen the lungs and immune system.

Social distancing programmes are likely to remain in place for the foreseeable future and we need to prepare our cities for this, for example by rapidly putting in place an adequate and safe infrastructure for walking and cycling to work as well as providing opportunities for daily physical activity without causing high air pollution levels and sufficient safe public spaces (parks, beaches and other outdoor spaces) where people can meet and exercise without running a high risk of contagion.

Social distancing programmes are likely to remain in place for the foreseeable future and we need to prepare our cities for this.

Loneliness and poor mental health, which are already an issue in cities, can also increase due to social distancing and home confinement. How can cities use public space and their services to reduce the impacts? In a city like Barcelona, 60% of public space is used by cars. Clearly, when people require a lot of space due to social distancing, this is not the best and most effective way to use it. Innovative approaches on the use of public space are urgently needed. Furthermore, for many of these issues there is an unequal distribution in society with for example the less well-off and elderly left behind, and it is important to take measures to mitigate the impacts for these groups.

The COVID-19 pandemic has put public health at the centre of policy making and shows that radical actions taken to reduce potential deaths are possible. Could we apply this logic to the other major problems we are facing today, such as air pollution, traffic accidents and the climate crisis, which together cause millions of premature deaths every year? Can we place prevention rather than treatment at the centre of our approaches?

Can we place prevention rather than treatment at the centre of our approaches?

A Wake-up Call

The COVID-19 pandemic is a wake-up call and maybe also an opportunity to build better and more sustainable societies and cities. Currently it may give us time to reflect and think about long-term solutions while tackling the short-term problem. Can we effect a permanent paradigm shift? Is it possible to prevent a return to the bad old habits?

In the short term we need to focus on the health of our colleagues, friends and family and the effectiveness of our health care systems. For the medium-to-long term, we should analyse the data that become available, take a more holistic view of the pandemic, and evaluate, build and implement policies to address health care system requirements, including surveillance, environmental and climate impacts, and governance—policies designed to prevent premature death in both the short and the long term.