How cities around the world are handling COVID-19 - and why we need to measure their preparedness :

More than half the world’s population lives in cities, hubs for transnational business and movement with the potential to amplify pandemic risk ;
Cities with a high concentration of urban poor and deep inequalities are potentially more vulnerable than those that are better resourced, less crowded and more equal ;
National and city governments could benefit from a pandemic preparedness index to better plan for and respond to epidemic outbreaks. There is currently no such map of city-preparedness around the world.
When it comes to infectious disease outbreaks, cities are dual-edged. To be sure, cities are a big part of the problem. They intensify the spread and transmission of infectious disease through increased human contact. Today, roughly 4 billion people live in cities, more than half of the world’s population. According to some analysts, around 600 cities generate two thirds of global GDP. Precisely because they are hubs for transnational commerce and mobility, densely populated and hyper-connected cities can amplify pandemic risk.

It is not just ‘global cities’ that are a risk of SARS, H1N1 or COVID-19, but also secondary cities and other urban hubs as well. Scholars have found that pandemics often emerge from the edge of cities. Viral outbreaks are frequently incubated and transmitted via peri-urban communities and transportation corridors at the outskirts of cities before they spread into the downtown core. It is not just cities, but also their local and global supply chains, travel networks, airports and specific neighborhoods that are sources of contagion.

Cities are part of the solution
Cities also play a central role in preparing for, mitigating and adapting to pandemics. In fact, many of the norms and rules for cities to manage infectious disease were first discussed at a global sanitary conference in 1851. Today, the preparedness of cities varies around the world. Their level of development and the socio-economic determinants of their populations play a big role. Cities with a high concentration of urban poor and deep inequalities are potentially more vulnerable than those that are better resourced, less crowded, and more inclusive. This is something that the Bill and Melinda Gates Foundation, Wellcome Trust and Skoll Foundation have all recognized and working to address.
Cities that are open, transparent, collaborative and adopt comprehensive responses are better equipped to manage pandemics than those that are not. While still too early to declare a success, the early response of Taiwan and Singapore to the COVID-19 outbreak stand out. Both Taipei and Singapore applied the lessons from past pandemics and had the investigative capacities, health systems and, importantly, the right kind of leadership in place to rapidly take decisive action. They were able to flatten the pandemic curve through early detection thus keeping their health systems from becoming rapidly overwhelmed.

Not surprisingly, cities that have robust governance and health infrastructure in place are in a better position to manage pandemics and lower case fatality rates (CFR) and excess mortality than those that do not. Adopting a combination of proactive surveillance, routine communication, rapid isolation and personal and community protection (e.g. social distancing) measures is critical. Many of these very same measures were adopted by the Chinese city of Hangzhou within days of the discovery of the virus. Likewise, the number, quality and accessibility (and surge capacity) of hospitals, internal care units, hospital beds and IV solution and respirators can determine whether a city effectively manages a pandemic, or not. City networks such as the US Conference of Mayors and the National League of Cities understand intuitively.
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