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What Past Plagues Tell Us About the Post-Covid City

Disease changes urban life. But humans have to decide what shape that change takes.

People walk on the sidewalk in Manhattan while wearing facemasks.
Spencer Platt/Getty Images

Hundreds of thousands of obituaries have been written for the pandemic’s dead—including several prematurely drafted on behalf of American cities. “New York City is dead forever,” a viral blog post declared in August 2020. Tech workers allegedly abandoned San Francisco in droves. The pandemic “ended the boom of cities that started in the 1990s,” according to The Hill. And the urban expats were all in the market for a country estate.

Of course, some people really did move out, but others moved in. Two years into the pandemic, it’s clear that cities are doing just fine. Yet the urge to consign the metropolis to the ash heap runs deep, writes Sara Jensen Carr in her recently released book The Topography of Wellness: How Health and Disease Shaped the American Landscape. For all its obvious folly, it’s a trend that’s likely to continue through this pandemic—and the next one.

Urban landscapes have always been defined against the rural, Carr writes. In the early 1800s, cities were undeniably chaotic—a “ramshackle hybridity,” with animals, humans, industry, and their combined waste all crowded together. “It was not long before a reckoning came in the form of disease,” Carr continues, with cholera, typhoid, yellow fever, and diphtheria routinely decimating these populations. But instead of blaming obvious economic and social challenges facing poor, newly immigrated, and otherwise marginalized residents, anti-urbanists told a story about the supposed dangers of dense housing. The story stuck—and was reinforced by other quirks of medical thinking of the era.

At the time people believed in miasma, or the notion that illness spread by noxious vapors. One side effect of this, Carr argues, is that by equating dirty streets with disease and clean streets with wellness, health became increasingly a matter of aesthetics—and both became a matter of morality. That’s why architects and public health officials united to beautify and sanitize cities. Their success was undeniable: Epidemic disease was vanquished not only by vaccines and antibiotics, but by public health and sewer systems. Unfortunately, “the idea that disease disproportionately affected the poor because of insufficient hygiene habits or moral shortcomings persisted in popular opinion,” Carr writes. Those who continued to live in dirty, unhealthy, or otherwise ugly conditions were there, the thinking went, because they themselves were bad people.

Today, architects and designers still routinely claim to work in the name of wellness, though their specific interests have shifted. As epidemic diseases in urban America abated, designers worked to combat chronic disease, including heart disease, cancer, and obesity. They emphasized urban renewal, walkability, bike lanes, and other common features of today’s cityscapes. But an increasingly individualized narrative of health was already taking hold. While Carr writes that some still believe, as earlier urban designers did, that “the best strategy of controlling the spread of disease was controlling the urban environment and by proxy the behavior of people within it,” health is now traded as a “commodity”—standardized, certified, and inherently available only to a few.

Needless to say, “the past year been like watching the past 150 years of health narratives compressed into a few months, as Covid-19 somehow captures all the anxieties around disease spread discussed here,” Carr writes in the conclusion of her book, whose main chapters were completed before the pandemic. It’s hard to remember now, but in March 2020, public health officials were telling people to wash their hands and stop touching their face. That was good advice for a disease spread by heavy droplets, but over time, it became clear that Covid-19 was airborne—miasma-like, even—and mask mandates became widespread. But when the vaccine was deployed widely in early 2021, other precautions were all but abandoned—prematurely, it seems, as the virus continues to return, increasingly able to evade existing immunity.

Contemporary designers are already on the case, eagerly redesigning office spaces, retail outlets, and more for a post-Covid world. “In the future, protecting people from viruses will be one of the important functions of architecture,” architect Sun Dayong, founding partner of the firm Penda China, told the design magazine Dezeen in March 2021. Some of the “ad hoc changes” implemented, including distancing stickers and plexiglass dividers, are clearly subpar. But “given the politicization of individual choices such as masking and vaccines, I think environmental interventions and informed design are actually much more urgent than many people think they are,” Carr recently told Culture Study.

To date, pandemic design has coalesced around air purification, which harnesses tactics such as humidification, pressurization, filtration, and ultraviolet germicidal irradiation to kill viruses suspended in the air. Building back with antimicrobial surfaces like copper and UV light could help, too. While getting every American to wear a mask in indoor public spaces is seemingly impossible, few would register, let alone protest, copper door handles or air filtration. But larger, societal-scale efforts—some sort of twenty-first century equivalent to the sewer system—have barely been dreamed up. This kind of mass mobilization, however, is what’s needed to revive core urban functions, including public transportation, which suffers from a lack of investment, competition from rideshare companies, and persistent but largely unsupported fears of contamination.

We won’t know exactly how the coronavirus has changed our built environment for years to come, Carr writes. But future developments will likely accelerate preexisting trends. Although urban design has emphasized public health for centuries, our current conception of “wellness” has become increasingly corporatized, deprioritizing the body and its physical surroundings in favor of a neoliberal and individualistic understanding of the mind. “Mindfulness” and “meditation” are treated as personal panacea, and cognitive behavioral therapy can make any worker more productive. At Amazon, where warehouse workers struggle to secure adequate access to bathrooms, the company has deployed “AmaZen” booths where they can “recharge.” If the first century of the Industrial Revolution was defined by infectious disease, and the last few decades by chronic illness, then the future seems oriented toward designing for “mental health,” however poorly defined.

This isn’t always a bad thing. When applied at the level of the city, an increased sensitivity to mental well-being is long overdue—in part because it frequently intersects with issues of environmental health more broadly. In their new book, Restorative Cities: Urban Design for Mental Health and Wellbeing, Layla McCay, a psychiatrist and public health specialist, and Jenny Roe, an environmental psychologist, convincingly argue that the stress, anxiety, depression, and loneliness so common in city life can be partially alleviated by better design. In particular, they advocate for increased access to nature and water, two well-established stress-reducers, and the elimination of urban nuisances like noise and air pollution, which are associated with a host of physical and mental illnesses.

But there is a high likelihood that if post-Covid cities deploy these tactics, they will once again do so inequitably and, in the process, reinforce old ideas about not just where is healthy and “good,” but who. While cities must continue to evolve (because Americans aren’t actually abandoning them anytime soon), there is no “green pill, measured, packaged, and ready to be dosed at will,” Carr writes. “The effects of the landscape, both curative and harmful, are accrued over time and place until eventually it becomes embedded in our skin and bones.” Cities are already changing under the pressure of this pandemic. But it’s still up to their residents to decide how that change happens, and who benefits.