Spread thinly: COVID 19 and lessons for Indian cities

Amitabh Kant& Richa Rashmi
India houses some of the densest cities in the world where people live cheek-to-jowl and cram themselves into packed metros and buses every day. With novel coronavirus (COVID 19) cases on the rise—it has so far affected more than 100 countries—it is important to understand the urban dimensions of pandemic planning and ensure preventive and curative measures for mitigation. With a robust city management, India could become a forerunner in tackling the disease.
History underscores the connect between maladies and urban planning. Many of the modern city systems and engineering were born out of the mid-19th century development of water and sanitation infrastructure in response to the spread of malaria and cholera in cities. Similarly, in the 20th century, the Spanish flu, which wiped out nearly 50 million people across the world, led to the establishment of several city-level governance structures and institutional frameworks to combat such pandemics.
The difference in today’s world is the exponential growth of medical science and digital infrastructure, which can be leveraged to successfully fight the COVID 19 spread. Today, the world’s population has expanded four times, with more than half living in urban areas, and national economies are heavily intertwined thanks to globalization.
City governments play a crucial role in developing efficient and innovative methods of confronting emerging infectious diseases, from ensuring efficacy of physical and social infrastructure (water and sanitation, and hospitals and healthcare systems) to safeguarding the ecosystem through more connected networks of digital and economic infrastructure.
Water and sanitation authorities must ensure hygienic systems in the city. Environmental hygiene is an absolute necessity in effectively combating the spread of the virus. All public and community toilets must be sanitized at regular intervals and equipped with hand-wash and hand tissues. Public spaces such as parks, markets and institutions should have waste management and safe disposal systems working at consistent frequencies. The initiatives under Swachh Bharat Mission and AMRUT scheme have already prepared many Indian cities to effectively handle this situation.
Digital infrastructure needs to be strengthened and monitored regularly by the district administration. Kerala is leading the way in successfully tracking and combating coronavirus cases in the state.It is making effective use of its digital health infrastructure to isolate and diagnose the positive cases. As part of an intensive drive, the Pathanamthitta district administration has come up with a system supported with GPS to track those quarantined in the district in order to restrict stray movement. NITI Aayog report Health System for a New India (2019) also advocates that digital initiatives are crucial in effectively managing health facilities clinically, administratively and financially.
Data can play an important part in enhancing preparedness, curbing incidences and containing the spread of identified cases. Local authorities must regularly monitor the spatial and temporal distribution of affected cases and geographical proximity to affected regions. In the aftermath, such data can be analyzed to develop a comprehensive and robust response system.
Given that smart infrastructure is in place in hundred Smart Cities of India, data collection and management can be explored and extended regionally.
The origin of Geographic Information Systems is frequently associated with the work of John Snow in 1854 who mapped the spread of Cholera cases in London by merging physical maps and infographics while adding additional layers such as water sources. This led to the discovery that the Cholera virus was spreading via the water sources instead of the air as previously assumed. Insights such as these can tremendously speed up corrective actions.
Non-pharmaceutical interventions (NPIs) help contain communicable diseases. In the 1918 Spanish influenza pandemic, US cities that implemented efforts to reduce infectious contact between people early had significantly lower peak death rates than cities that were late to adopt disease containment policies. Philadelphia allowed public gatherings while St Louis chose to ban all public gatherings. As a result, there were dramatic differences in the mortality rate per day between the cities: St Louis had a peak weekly death rate of 31 per 100,000 persons, while Philadelphia’s was 257 per 100,000 persons. Thus, NPIs like work-from-home, school closures, restricting public gatherings, etc., which eliminates high-risk chances for mass-infection and enforces social distancing, prevent disease spread. This in turn reduces the chance of burdening the healthcare system and saves precious resources.
Ensuring strong lines of communication with the community can go a long way in being the first line of defense. Certain NPI actions may draw public attention and can have negative psychosocial and economic consequences especially to high-risk and vulnerable populations. Public messages should address fear, stigmatization and discrimination. The Ministry of Health and Family Welfare recently released a comic book Kids, Vaayu and Corona: Who Wins the Fight? for generating awareness among kids about coronavirus. Using such early warning systems create a line of informed and cautious citizenry.
Rationing of healthcare system and temporary expansion of facilities may be required on critical care beds. Respiratory diseases such as COVID 19 necessitate specialist hospital treatment for a sizable proportion of those who become symptomatic in the form of ventilation and the need for antibiotics to fight secondary infections.Quarantine centres and provisional hospitals with isolation facilities will be required to deal with established cases of COVID 19 infections. Buildings and facilities that can be used for the purpose should be identified and necessary sterilization must be carried out in advance as part of preparedness strategy.
Maintainingand regulating the supply of essential drugs and precautionary items such as masks, medical textiles, hand wash and alcohol-based sanitizers is necessary.On 13 March, the government declared hand sanitisers and masks as ‘essential commodities’ under the Essential Commodities Act up till 30 June 2020. It was important to do this to avoid a situation of demand–supply mismatch, rent-seeking, hoarding and exorbitant pricing. Each district must maintain inventories of these items and ensure that pharmacies do not indulge in coercive practices.
Public transit agencies should ramp up regular scheduled cleanings and consistently announce to staff and riders about best practices to protect themselves and others.The Delhi Metro trains and Mumbai local trains arebeing disinfected and sanitized, during operational and non-operational hours, along with stations. Such practices should also penetrate other services like shared non-motorized vehicles, buses, railways, ships etc.Detection of a travel-related or unrelated suspect case of COVID-19 should be followed up by rapid isolation in designated health facilities and line-listing of all contacts of such cases.
Finally, the urban economy is likely to take a toll and this cannot be disregarded as cities contribute significantly to GDP. It is important that local economic impacts are minimised and district authorities can play important role in achieving this. Individuals in precarious employment deserve targeted attention. Precautionary measures when practiced in full swing will definitely help to keep the business as usual and early response can abate any long-term impacts.
A well-managed and planned urban system can reduce the risks of pandemics and endemics. India’s urban system will have to champion the change for a more organized and formal development. Even though there is little or no population immunity to the virus, with proactive planning and implementation, the impact of this pandemic can be mitigated to avoid the worst-case scenario effectively.
Amitabh Kant is CEO, NITI Aayog, and Richa Rashmi is Young Professional, NITI Aayog. Views expressed are personal.