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.