Commuters on the JR Rail Yamanote line in Tokyo, Japan, early March 2020.
Well, to begin, please stay home when and if you can and avoid close contact with people for a while. Preventing a huge outbreak that would overwhelm our healthcare system is critical right now.
But with that out of the way, here’s something I’ve been thinking about. This spring, I’ve been teaching a urban geography class at the University of Minnesota that, until recently, met twice a week.
The first book I had the students read was The Ghost Map, Steven Johnson’s wonderful narrative on the 1853 cholera epidemic in London. When we started reading the book in the class, Johnson’s descriptions of London’s Soho neighborhood during a deadly epidemic seemed surreal. Johnson writes about the aftermath of the outbreak, how the dense and bustling working-class neighborhood of Soho / Golden Square was devastated by an disease that killed hundreds of people within a few blocks in just a few days.
Here’s a description of the street scene from 1853 London:
By Sunday morning, a strange quiet had overtaken the streets of Soho. The usual chaos of the streetsellers had disappeared; most of the neighborhood’s residents had either evacuated or were suffering behind their doors. Seventy of them had perished over the preceding twenty-four hours, hundreds more were at the very edge of death. Out in front of 40 Broad [Street], the [water] pump attracted only a handful of stragglers. The most common sight on the streets were the priests and doctors making their frantic rounds.
Word of the outbreak had traveled through the wider city and beyond.
At the time, only six weeks ago, Johnson’s description was difficult to envision, a horrific disease outbreak where people did not know the precise causes. Now, it seems uncannily familiar.
The 1853 Cholera epidemic, which killed 10,000 Londoners, is rightly famous because of the investigation that followed it. The deaths became a key case study in debate within the English scientific community about what caused disease. The prevailing theory was that cholera was spread through miasma — or noxious odors — and that preventing its spread required people to have “clean air.” At the time, providing clean air meant dumping raw sewage into the river as quickly as possible, which ironically spread the disease even farther.
Of course, the actual cause of cholera was bacterial contamination in the water, and Johnson’s book details how a pair of researchers tried to use the outbreak to prove the existence of germ theory.
Detail from Dr. John Snow’s map of the cholera outbreak, trying to trace the causes to a local water source.
Public health aside, the larger point that Johnson makes in the book is that understanding the true origins of disease fostered urban life. Before people understood germ theory, most intellectuals assumed that cities were inherently deadly. They believed that density itself was the primary cause of epidemics, and cities were thus fundamentally flawed.
After Snow’s map appeared, and with increasing prevalence of germ theory, it became clear to most people that cities could indeed be healthy places for people to live. Without some mysterious miasma plaguing the population, it was clear that cities were not synonymous with death. Rather, with the right public health infrastructure in place, cities could be places for human society to thrive.
Coronavirus and Urban Life
Self-quarantined at home, and with the coronavirus pandemic affecting so many people and places around the world, I’ve been thinking about the lessons of these 19th c. London epidemics. It’s important to make sure that those of us who are anxious about American society these days correctly understand the real problem that’s facing us.
This is where I tell you that I recently spent two weeks in Japan on my honeymoon. From March 1st to March 15th, I was traveling through Japan, stopping in many different cities and eating out every day. (This is why I’m self-quarantined, you see, with another week to go.)
As you probably know, Japan has been dealing with a the COVID-19 outbreak for many months, but it’s one of the rare countries that has not seen huge increases or fatalities. It’s eye-opening to me that, as of Monday night, only 42 people have died in Japan, a country with one of the oldest populations in the world.
It’s sure hard to know what is driving the huge disparities in deaths and effects from the COVID-19 flu. Personally, I’ve spent hundreds of hours trying to understand it, and I don’t want to sound certain when there are so many things we don’t know about how this disease works. For example, why has Italy been so devastated by the COVID-19 outbreak but Germany has not? Why are people walking and talking and going out to eat in Tokyo, Osaka, and Seoul right this very moment?
[This is me, crossing the street in Shibuya, on March 15th.]
I don’t want to be blasé about vulnerable people’s lives, and certainly Americans need to be very cautious about preventing infection, but it’s hard for me personally to figure this out. During the first two weeks of March 2020, I witnessed Japanese cities that were full of people. Yes, most were wearing masks, but they were riding crowded trains, buying things in stores, walking on shopping streets, smoking a lot (well, at least the men were), and going to restaurants. Urban life has not ground to a halt there, nor has it in other places like Singapore, Taipei, Seoul, or Hong Kong, at least judging by reports that I’ve read.
For example, the Prime Minister of South Korea has only recently asked church services and athletic events to cease for two weeks due to infected tourists entering the country. In both South Korea and Japan, they’re planning on sending kids back to school in April. In Tokyo, one pressing issue in a major newspaper is that people are littering bars by leaving behind “four or five” masks per day as litter at a Tokyo each night. At least so far, it seems entirely possible to have dense urban life and reasonably deal with a pandemic flu.
[Both from the fabulous Our World in Data website. Note: log scale on the top chart.]
What’s the Fundamental Problem?
Witnessing the incongruity between everyday life in Japan and the USA during this outbreak, I keep thinking about how, contrary to some suggestions in the American media, cities are not synonymous with disease. Japan, Singapore, South Korea, and Hong Kong are some of the most densely populated countries/semi-autonomous regions, with some of the densest cities on the planet. Yet they are coping well, and the United States is not.
Contrary to some takes, it sure seems to me that the key problem here is not urban density. To my mind, the real difference is our different social safety nets, social practices, institutional health, and economic relationships.
I worry greatly for the USA because we have no comprehensive health care system, instead cobbling together a fractured, immoral hospital network predicated on profits for health care providers, drug companies, and the like. In this country, most people struggle to afford hospital visits and thus avoid them. Here, few people have reliable paid sick leave, most especially vulnerable groups, and thus work while we are sick. We have a whole class of the population that performs critical labor, like personal care for the elderly, but lacks basic rights and citizenship.
Hong Kong, Singapore, Japan are among the most densely built places in the world, and most globally connected. #flatteningthecurve pic.twitter.com/erzcw9CRk1
— Alexander Ståhle (@StockholmCyclo) March 21, 2020
Meanwhile, most American public institutions — all levels of government, transit agencies, public hospitals, the CDC etc. — have been ravished by years of underinvestment and/or been actively undermined by the right-wing. As a result, the difference in capacity between Japanese and American public institutions is extreme. To take but one example, read Henry Pan’s piece about how Metro Transit has to limit the number of disinfectant wipes its drivers use; meanwhile, the Japanese train stations I saw were uniformly well-staffed with people cleaning surfaces, escalators, and elevator buttons.
Finally, it should be obvious by now that our Federal preparations are beyond woeful, and the president of the country literally does more harm than good when he speaks. I shouldn’t have to say any more on that topic.
I fear that, like the miasma theorists of the 19th century, people will draw the wrong conclusions from the health crisis that is gripping our cities and towns right now. I hate to see the narrative emerge that cities themselves are a factor in this deadly American moment. I hate to think that COVID-19 will bankrupt transit systems or cause people to abandon institutions fundamental to urban life. So much of our society is already isolationist and privatized, with many Americans living in atomized homes, fenced inside yards along streets without sidewalks, unable to walk to stores or parks or schools.
It seems to me that the problem we’re facing is not urbanism or leading connected social lives. Rather, the real problem is our unequal and unjust economy and society, a society wrecked by decades of underfunding and undermining public institutions and handing over our everyday life to profit-seeking businesses.
I’m hopeful that once this terrible period passes, and we can resume our lives with a greater focus on our public infrastructure and government. I hope we reinvest in the social and material infrastructure we need, because I believe that quality transit, government support for fair housing, a generous and equitable health care system, and rich networks of public spaces are vital to our future. Even when we’re secluded in our homes, it’s critically important we remember what connects us. I hope we can soon safely return to our fulfilling cities and streets, and thrive together.
BRAVO! Great thorough analysis!
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It’s sure hard to know what is driving the huge disparities in deaths and effects from the COVID-19 flu.
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No. It’s not hard at all. It comes down to culture. Japanese culture values following the rules. Likewise it’s obsessed with cleanliness.
We’ve seen this culture lead to tremendously less cases of infection, hospitalization and deaths with other outbreaks in Japan, too.
The problem for most country’s like the US is that short of reproducing that culture, you can not get the same results.
Agreed. Many Asian cultures have dealt with pandemics recently, such as SARS, and still have procedures in place for how to deal with them. They value the collective, and they know that their indvidual choices will have a huge impact.
There are many underlying problems in the US, cultural, political, economic, etc…. that are helping drive up our risk, infections, and death. I don’t think it’s fair to completely rule out the impact density does play, but, IMO, the density only serves to exacerbate the underlying issues, it is by no means the primary driver.
I am curious what the total impact will be on large cities, and how long it will take to rebound to Feb 2020 numbers. Will developments in the pipeline be put on hold or cancelled? Will the Fed’s unlimited QE encourage banks to keep funding projects? Will 2+ months of lockdowns make people living in condos/apartments year for a small postage stamp of lawn? Will people return to mass transit or double down on SOVs?
Without effective leadership, it’s all but impossible to change people’s behavior.
Just wondering if it’s the attitudes in different countries that make a difference? The Asian culture is much more cooperative compared to the US. It does seem that the more densely populated the city, the greater the outbreak. NY numbers are growing so fast it’s hard to keep up.
I have noticed that in many US larger cities, people are going out anyway. Just wondering if it was like this in Japan.
We sure do need better health care, especially public health care departments all over this country.
It’s absolutely like that in Japan. Restaurants and streets are crowded.
Bill, changing culture is an onus beyond the capabilities of any leadership.
Japan has a long-standing tradition of people who have any kind of respiratory problem at all, including the common cold, wearing masks when they’re out in public. This probably minimizes the number of viruses landing on surfaces and being transmitted through the air.
This is true. Changing social behavior is a thing we can do in our country as well. In just the last week, there have been significant changes already!
Headline from NY Times today:
“Density Is New York City’s Big ‘Enemy’ in the Coronavirus Fight”
https://www.nytimes.com/2020/03/23/nyregion/coronavirus-nyc-crowds-density.html
More #FakeNews from NY Times. Thanks for exposing the lies.
Yes that was vexing, though the term “fake news” is extremely unhelpful for producing any kind of critical thinking.
I don’t think it’s any coincidence that New York City is the epicenter for the virus right now as opposed to Los Angeles or Peoria. . Yes, there might be other factors, but I’m not convinced having to sit next to someone on a bus instead of being behind glass in your car, or living literally on top of other people instead of density low enough you can easily avoid other people isn’t a huge factor.
Japan’s rate might be low due to wearing masks everywhere or whatever, but wouldn’t it likely be a lot lower if they had space to spread out and vehicles to separate themselves like suburban Americans?
This is the response, “living literally on top of other people”, that I fear and why Bill wrote this article.
Living in the Bay area of California in a very high density neighborhood. Not on the scale of New York or some cities in China and Japan but high density. This is a walking neighborhood, or biking, or people taking mass transit. Yes, a lot of people are driving their cars but so many people around here use mass transit. And people are out walking to the grocery, drug store, etc., keeping proper social distance , for the most part. I believe the rate of infection has stabilized a bit in the Bay area thanks to the immediate request to shelter in place by the 5 county bay area, then Gov Newsome’s request for the whole state to do the same.
I don’t think some cities have an option for people to spread out into separate vehicles. Some people don’t have a car. There is no room for any kind of urban sprawl due to the high density of buildings. This doesn’t even begin to cover the homeless population here-non drivers and very high density in the homeless camps.
Why is the rate so much lower here than in New York? The bay area is crowded!
I am very worried that “pandemic” will now be added to the NIMBY lexicon.
I had read the majority of the transmission of this novel coronavirus has been something like 80% within families. Not sure where density affects family transmission.
Also, it is not like low-density North America does not require people to concentrate with each other now and then, such as our big box stores, just to get necessities of life.
In China they have been removing people with symptoms from their families.
This density meme has been all over the Strib comments section the last 3-5 days, with many people calling for a quarantine of just Minneapolis, St. Paul, and/or Hennepin or Ramsey Counties.
I’m not convinced that what we call “urban” density in Minnesota is any more conducive to virus transmission than our suburbs. Near as I can tell, suburbanites and urbanites here go to bars, restaurants, workplaces, concerts, schools and grocery stores at similar patterns. No reason to believe a slightly lower rate of car usage is the primary driver.
I think we’re seeing cases concentrated on more urban areas, even more than population would suggest, simply because cases are generally starting in the more dense areas and spreading outward from there. It’s a time problem. Two months from now the pattern may look very different. By late summer we may be on the downward side of the curve in urban areas, while rural areas and small towns are just beginning to have their smaller hospitals overwhelmed. Then I don’t think people from the hinterlands will be complaining about density being the cause of this.
It is a difficult moment to be advocating for urbanism though, when everyone is trying to avoid being around other people and feeling cars are safer than public transit.
The more you drive, the less healthy you are. The more you walk & bike, the healthier you are. The healthier you are, the stronger your immune system.
I am curious as to the obesity rate in Asian countries you discussed, versus US and Italy. Obesity is a risk factor for death from Covid19. Not sure how this relates to Germany.
Obesity isn’t the factor, diabetes is the risk factor.
I’d like to know for certain. I’d read in this article on the spread in Detroit that BMI over 40 is a risk factor no matter what age. https://www.detroitnews.com/story/news/local/detroit-city/2020/03/26/detroiters-face-greater-risk-of-death-covid-19-coronavirus/2907235001/
both, actually. obesity produces a chronic inflammatory state, and increases risk of reactive airway disease/asthma.
Good point. Had not thought of that. Is obesity a big problem in Spain and Italy?
Bill, you make some great points, except around your main argument. Of course density is a factor. Numerous epidemiological studies demonstrate that density is a factor in the diffusion of diseases. Here’s but one example from 2018, but the conclusion is clear: https://www.lpthe.jussieu.fr/~roehner/epi.pdf
The other assessments you make are also true. All of those other systems are essential contributors, but the idea that density isn’t a factor is patently false. I don’t understand why so many armchair urbanists are making this argument right now. Cities can be wonderful places and also have problems. This is one of them. What I’d rather see is an essay that acknowledges those problems, makes an argument how to address the problem, and then argues for how resilient cities are because of all of the amazing features that make them cities. Covering our eyes and ears doesn’t help anyone.
I’m not sure that link is as strong an argument as you claim. From the link.
“We have shown that there is a weak but clearly defined relationship between population density and the death rate of epidemics providing sufficiently large density ranges are considered and background noise is kept under control. We have also shown that population density determines the time dependence of the death rate; thus, large densities (as in Philadelphia) lead to high narrow peaks whereas for small densities one observes low and broad humps.”
The problem being is that Philadelphia has been used as the poster child of how not to respond to an epidemic where the city opted to hold a massive gathering in the face of the outburst causing the death spike. That wasn’t a density problem except in the sense that the leaders were dense for thinking huge parades during epidemics were a fine idea.
That’s exactly my point. The link is not making a strong argument. It is making a nuanced argument that demonstrates how density is one factor. It doesn’t say that density is the only factor because literally no one says that. Even people who dislike density know that washing hands, government responses, etc. are important. It’s a non-argument. If you’d like more sources, I’m happy to post them, but this is exactly my point.
You should read the headline of the post again because it is possible you are attacking a straw man. Saying density isn’t driving America’s pandemic is not saying concentrations of population is a non factor.
I believe you are missing a large segment of the conversation happening in the comment sections and fever swamps out there where there really are people saying urban concentrations are their own pandemic doom by their nature. Opinions of people are being shaped that density is a threat to American civilization. Such as by Joel Kotkin, https://quillette.com/2020/03/25/the-coming-age-of-dispersion/
When we look at the spread of Covid-19 it suspiciously looks like a population density map. When you instead map it for cases per 1000 it amazingly looks like it is spreading about the same rate across rural and suburban as urban America. I’d post images but that doesn’t seem to work well in this comment system
It’s not density that has driven it to spread like a wildfire across the rural South as this map of cases per 1000 shows. (And warm and humid climate isn’t slowing it down) https://www.cnbc.com/2020/03/27/us-coronavirus-cases-top-100000-doubling-in-three-days.html
Eric, if I have to be clearer I will: I’m saying this headline and this article is a straw man. No one says density is “driving” the distribution. Not even the (garbage) article you link to really says it’s density. It spends tons of words referencing public transit and a lot of other factors that are sometimes associated with density but produce their own effects. (For what it’s worth, the research on public transit suggests it is way down the list on its contribution to the spread of non-airborne diseases.) And while a small child might look at a map and make the correlation between population size, density, and distribution, and say that’s all there is, that’s not a worry of mine. At best, this seems to be a fight between “urbanists” and “anti-urbanists” and their respective straw man arguments. I guess it’s Quillette, whatever that is, versus whoever wants to give their inconsistent and unsupported arguments attention.
And, Eric, you don’t have to convince me that there are other factors. That’s exactly what I’m saying. I’m not surprised that there are high mortality and morbidity rates related to COVID-19 in the rural South. Unrestricted diffusion in local social networks coupled with poor health infrastructure, high inequality as part of the legacy of slavery, and more are all operating there. Of course, that doesn’t mean that density isn’t a factor elsewhere.
I’m impressed with the confidence you are decreeing that’s “no one is saying” as if Bill hadn’t seen someone anywhere implying it. Or your confidence that adults (that but a small child might) do not regularly make the mistake of reading a map of a phenomena and not recognize it to be a basically a population density map. https://xkcd.com/1138/
Drop into the comment section sometime of a story about Covid-19 or coronavirus. You will regularly see gems like, “For all of human history, cities have been cesspools of disease and filth.”
Or, “cities are labs, but not labs of invention, creativity, innovation, and cultural exchange, rather labs of diseases, filthy, expensive, over-crowded cesspools of diseases where only the rich get to enjoy them.”
So I will not confidently say no one is saying these things because they are and they are part of driving the conversation about how we will respond to Covid-19. These voices are out there, they are numerous, and they get read and heard by others who are still making up their minds about this facet of the issue.
Saying “no one” is saying these things, when I’ve read them with my own eyes I feel is gaslighting.
Eric, really, I’m not trying to gaslight you. Ok, maybe someone, somewhere is making the argument, but you literally just made my second point. Neither of the ridiculous quotes you referenced even mention density. They reference cities, inequality, the lack of sanitary conditions, etc. They don’t say anything about density. I’d also say they don’t really deserve to be repeated here or anywhere.
So, look, I’m just reporting that density is part of the issue, but it’s certainly not all of the issue. It’s ok to say that cities are a place where diseases spread because of density, as long as we do that based on the facts and recognize it’s only part of the problem. (A relatively small part of the problem, at that.)
When people make unsupported arguments on either side of this issue, it doesn’t help our understanding of the problem and, thus, our understanding of solutions.
The links and perspectives that I was responding to are in my piece, but here are a few:
https://www.nytimes.com/2020/03/17/world/europe/coronavirus-city-life.html
“But the coronavirus undermines our most basic ideas about community and, in particular, urban life. Historians tell us that cities emerged thousands of years ago for economic and industrial reasons — technological leaps produced a surplus of agricultural goods, which meant not everyone had to keep working the land.”
https://www.nytimes.com/2020/03/23/nyregion/coronavirus-nyc-crowds-density.html
“New York is far more crowded than any other major city in the United States. It has 28,000 residents per square mile, while San Francisco, the next most jammed city, has 17,000, according to data from the U.S. Census Bureau.
All of those people, in such a small space, appear to have helped the virus spread rapidly through packed subway trains, busy playgrounds and hivelike apartment buildings, forming ever-widening circles of infections and making New York the nation’s epicenter of the outbreak.
Or see Joe Soucheray’s latest inane article.
The point I am trying to make here is that it’s entirely possible to have density and NOT have a rampant disease spreading through the population, and that the real problem is social and political, not simple demographics. I’m trying to better diagnose what the precise cause of this disaster, and to me anyway, it seems like we should focus on economic, political, and infrastructural failures rather than density per se.
The paper you reference uses data from the early 20th c., so it’s pretty good analogy for the metaphor I’m using here, about 19th c. London and misdiagnosing causes. It’s safe to say that in the 1918 flu, US cities did not have nearly as many public health and behavioral tools and technologies at their disposal. One hundred years later, we can and should be able to create cities where epidemics are not inherent by making social and political changes.
Bill, then that’s the argument you should be foregrounding, and the title of your piece should reflect it, rather than this density distraction. After all, there are dozens of books and hundreds (thousands?) of articles that demonstrate that cities are great for all sorts of reasons, and some of them even talk about health. The most popular is still probably Putnam’s Bowling Alone, which wades into this very issue by identifying how the physical and social infrastructure of cities can lead to positive health outcomes.
Furthermore, there’s nothing wrong with either of the quotes you reference. They’re accurate, but of course they’re not the whole story. They’re not even the full story in those pieces. It shouldn’t be controversial to say that one of the big takeaways from the current situation is that many of things we love about cities also make them places where disease can spread easily. We know that sites of major social interaction, large gatherings, people coming into contact with people from other parts of the region/world, and more contribute to the spread of disease. And those are all essential, valuable parts of the city. Terrible things about the city, including their massive inequality, their embodiment of racism, and more also contribute to the spread of viruses. We should fight those aspects of the city. It should go without saying that many of those good and bad things exist in suburban and rural areas too, but we know that they are present in cities and facilitate to the spread of viruses there. We also know that other factors like health infrastructure and policy responses are connected to cities but can vary independently too.
As I said above, a lot of what you share is well thought out and anchored in research. (Really, it should be a guide for other streets.mn contributors, who have a looser understanding of facts.) But I strongly encourage you to reconsider the framework of your argument. This denial of density is at best a straw man and at worst distracting us from having a comprehensive view of cities.
Streets.mn is currently taking submissions. I recommend you write the article you want!
Ha. I write elsewhere, but the point is this “debate” doesn’t need any more attention. I thought it was worth writing something in the comments here, because I agree with much of streets.mn’s advocacy and Bill seems like a thoughtful person.
Disease can spread easily, sure, but it doesn’t follow that that’s the main driver. Look at where and how the COVID spread in South Korea: the vast majority of cases came through a megachurch.
Just as miasma, noxious odors, correlated with some public health problems, it wasn’t the real issue and focusing on it was a distraction. So too density correlates with risk but is not the main factor that causes infection. Tokyo proves you can have a functioning, well-used subway system, and NOT spread COVID-19 if you change some of the other social and economic factors.
Istanbul ,KL ,Tokyo,Singapore and many Asian countries subways and stations are very clean unlike American where people are spitting and are lawless
It was difficult to find garbage cans in Tokyo and Istanbul .
Last year in Tokyo I had a bad cold couldn’t find garbage cans to toss my tissues when we were out .
LRT and buses here constantly spitting /urinating on the buses/train and stations .
.NYC and elsewhere in US the subways are disgusting.
Yeah it’s weird how there are no trash cans in much of Japan, but also no litter? Certainly institutions in the US should and must start prioritizing cleaning much more than we have in the past. This is part of the disinvestment in institutions (e.g. transit agencies) I was trying to describe.
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The point I am trying to make here is that it’s entirely possible to have density and NOT have a rampant disease spreading through the population,
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It takes a small miracle and everything has to be just right. Density by it’s nature creates a ginormous number of attack vetctors. Instead of grabbing that meal via the drive thru, you go inside, touching doors, sharing air, et al.
Instead of being alone in a car, you’re on the bus, sharing air with 20 other people.
We could go on and on. That you’re looking at residential density shows you’re not thinking this through. The issue is the density of those attack vectors. As we’ve seen with LA and NYC, it’s very difficult to overcome.
Arguing that it can be overcome is an argument that miracles can happen. They can. The Toledo Mudhens can win the World Series. But what it takes to get their is a mountain is too much for even the Japanese.
What was that? Japan has declared an emergency because of the spread of COVID19? It shouldn’t be surprising. They’ve been avoiding testing. Ignorance is bliss.
“Emergency” in Japan with fewer than 100 deaths nationally. You might call it luck, but I call it having a functioning government. I guess in the United States of America, that would be a miracle.
You think Soucheray’s article was bad, it was basically a warmup for the Katherine Kersten piece in the April 5 Strib.
Maybe the good thing about this Strib piece is that is so over the top that it highlights the ridiculous of the density-driving-disease argument.
It was vapid.