Covid control a marathon, not a sprint

Historically, diseases such as tuberculosis and cholera prospered in cities, and with no understanding of the microbial world around them, inhabitants perished at astonishing rates. Life expectancy in some British cities did not pass 40 years until the early 1900s, for example.

Sanitation, improved housing, protected water supplies, waste disposal, hand washing with soap were some of the reforms that eventually came to the rescue and permitted cities to thrive in the 20th century. It was a mix of behavioural change and environmental design, but mostly the latter.

Now we have a new plague. Again it thrives in crowded cities. No one knows for sure, but it seems likely this virus will persist world-wide and local outbreaks will wax and wane, recur and recede. For how long? Without extraordinary interventions such as an effective vaccine, Stephen Kissler and colleagues from Harvard suggest the disease may still be a threat as late as 2024. This is a ‘marathon’ of infection control. We have to plan long-term, we have to set up systems that will run long-term. And along the way there will be ‘Covid sprints’, urgent but temporary responses to spiking numbers of people affected by the disease.

So what is required, once more, is effective urban hygiene. Masks, hand washing and staying home if you have symptoms all make a difference. But the intervention that has the biggest effect on spread of the virus is keeping people apart.
 

Physical distancing can be achieved by education, information, persuasion. But the fast route to protection, just as it was in the 19th century, is environmental. We need to arrange our cities so the healthy choice is the easy choice, so people can naturally and easily keep their distance and still experience the pleasure, comfort and sustenance a vibrant city provides.

Let’s start with streets. Why? Because this is the part of the public realm where large numbers of people mix and where big improvements can be made quickly. And here, on the streets, are opportunities for huge co-benefits, for win-win-win interventions.

Canadian urbanist Brent Toderian points out we have spent the last 30 years trying to redesign our public spaces to make them more ‘sticky’, that is, inviting places to linger and connect. But as anyone who witnessed the crowds at Mission Bay at the weekend will attest, stickiness may increasingly become a health hazard. So how to support physical distancing while also enabling us to get regular doses of nature and fresh air? Toderian and others argue for the ‘hyperlocal’: neighbourhood streets that provide opportunities for exercise and connection while being ‘unsexy’ enough to deter extended congregation.

Our research on the experience of neighbourhood during our first stay-at-home order showed that local streets were an important source of restoration and connection. Good neighbourhood design is critical for both the ‘sprints’ of lockdowns, as well as the ‘marathon’ of keeping up community resilience and community compliance during a pandemic. Being able to get out and exercise, to see people, and to access green and blue spaces are essential for maintaining our longer-term physical and mental health.

High-quality neighbourhoods, those that provide ‘space in density’, or ‘separation without isolation’, do more than keep apart potential hosts and willing viruses. Social trust is the secret ingredient of effective infection control. And neighbourhoods are a key place where social trust is forged and sustained.

The experience with SARS showed us that helping people maintain a sense of optimism, trust and feeling of ‘belonging’ is critical to the effectiveness of infection control. People who feel a stronger sense of trust in others have been shown to be more likely to follow directives to wash their hands and physically distance, for instance, during a pandemic. People who start to feel disconnected from their communities on the other hand are less likely to follow public health directives and more likely to believe conspiracy theories.

If we are to win the marathon against Covid in our cities we need to make it safer for people to move, rest and connect locally in their neighbourhoods. Toderian calls this the challenge of ‘social-bridging while physically distancing’. Our lockdown research showed traffic control will play a key role in helping to open up more space for safe neighbourhood interaction during the pandemic. The effect of traffic levels on levels of social trust is well-established. People in low-traffic neighbourhoods have more friends, higher levels of social trust, and they like their neighbourhoods more.

Reducing residential speed limits to 30km, widening footpaths to two metres, and making more safe space for higher interaction ‘open air’ modes such as walking, scooting and cycling will become essential features of the new urban hygiene.

Such environmental interventions will help to reduce the ‘mental load’ of living longer-term with a virus in our midst. Ultimately, interventions that encourage people to protect themselves, such as mask-masking and spending more time in our homes and cars, will likely be less effective and more damaging to social cohesion than creating more protective environments. Ashley Bloomfield has hinted there will be a new, long-term Level 1 with extras, Level ‘1.5’. If low level physical distancing truly is the new norm, let’s start by making our neighbourhoods safe to do so.