How We’ll Build Pandemic Immunity Into Our Future Cities
by Smart City Expo Atlanta
March 31, 2020
The coronavirus outbreak started the same way most infectious diseases do: through contact with wildlife. But the reason it has spread to, at the time of writing, near-pandemic levels isn’t because of anything inherent to the disease—instead, it’s because the virus occurred in a city.
“Pandemics are much more than a health problem,” says Dr. William Karesh, pandemic expert and executive vice president for health and policy at the EcoHealth Alliance. “They’re a societal issue. Human behavior is what drives them.”
In cities in particular, the two behaviors that facilitate the spread of pandemics are at their zenith: travel and trade. In 2020, Wuhan, China’s population is nearly 30% larger than New York City’s and is a hub for travel and trade in the region. And despite the relatively early detection of the disease, a response wasn’t coordinated until the spread was too large to contain. Today’s advisories around things like hand-washing, along with the growing number of shelter-in-place advisories, are changes that will help slow the coronavirus. But immunizing our cities to future pandemics will require a much more concerted effort to alter human behavior—not only around travel and trade but also in our overall approach to their management.
“And they’re changes that need to begin sooner than later, since the number of human emerging infectious diseases has been increasing over the last 50 years,” says Dr. Karesh.
Rather than responding to an outbreak, we need to focus on detection and prevention of infectious diseases in cities—and technology can help. Doing so will not only help slow the coronavirus, but also stop the next virus (and the next, and the next) from becoming a pandemic.
“The COVID-19 pandemic has revealed the need to implement systems that proactively manage infectious disease risks which, in our rapidly changing world, are increasing in frequency, scale and impact.”
Real-Time Monitoring Stems Pathogens at the Source
The first report of the coronavirus came not from health officials or organizations, but from artificial intelligence. A risk software provider called BlueDot uses natural language processing and machine learning to scan for disease in news reports, animal and plant disease networks, and official proclamations. It alerted its customers to the coronavirus more than one week before the World Health Organization announced the disease’s appearance.
“The COVID-19 pandemic has revealed the need to implement systems that proactively manage infectious disease risks which, in our rapidly changing world, are increasing in frequency, scale and impact,” Dr. Kamran Khan, Founder and CEO of BlueDot and infectious disease physician said in a statement. “And it is with enhanced preparedness that we can get ahead of these threats to create a healthier, safer, and more prosperous world.”
Real-time monitoring technologies like these are key to preventing the spread of infectious diseases, agrees Dr. Karesh, whose firm works with similar technologies.
“Every day you save in catching it, the less amplified this thing becomes,” says Dr. Karesh. “A week is a huge amount of time in a city when millions of people are at risk.”
This kind of continuous monitoring could be improved in cities, says Dr. Karesh, by leveraging data. He cites an incident in 2007 where a particular brand of pet food was contaminated with melamine and caused renal failure in pets. Individual doctors didn’t notice the trend because it’s normal to see one or two such cases on a regular day. But a national veterinary clinic with access to data from 1,300 clinics across the country saw an overnight spike in renal failure and responded.
Similarly, cities could use algorithms to review anonymized data from electronic medical records on a nightly basis, with the goal of seeing a spike in hospital visits, or a certain type of condition or diagnosis, to better detect and respond to potential outbreaks.
And with better technology, real-time monitoring capabilities could move beyond the hospital. Dr. Karesh imagines using air monitoring stations in mass transit stations to detect changes in disease patterns in people that are commuting, for example. Or imagine swiping a metrocard and having the pathogen detection occurring all on the same reader. Rather than identify individuals, cities would be able to see changes, in specific areas, overnight—and take action accordingly.
Communication Slows the Spread
In addition to detection, communication is a critical piece of managing a disease outbreak—and changing the way we think about who is involved in that communication process is key.
“All the money today is dumped into the medical community,” says Dr. Karesh. “But it’s about education systems, social networks, religious networks. There are lots of opportunities for society to engage in dealing with this that would solve our problems.”
The need for this kind of communication predicated a partnership between Bloomberg Philanthropies and the National League of Cities. On March 23, the organizations launched a joint initiative to actively track how cities and local leadership are responding to the crisis. The tracker, which includes over 650 entries and is growing, covers everything from Auburn, Alabama’s Water Works Board sustaining services regardless of late payments and suspending late fees through April 16, through to the City of Milwaukee, Wisconsin’s decisions to restrict food and beverage services in the city and increase the frequency of cleaning at its health centers.
“As city leaders’ responses to the crisis evolve, we want to provide them with tools, data, and resources needed to make informed decisions,” James Anderson, the head of Government Innovation at Bloomberg Philanthropies, said in the release. “This tool will allow local leaders to learn promising practices from their peers, share ideas, and work together during one of the most challenging times in this nation’s history.”
It’s a shining example of how, using technology already available today, cities are equipped with the means to quickly and efficiently disseminate information about how to manage an outbreak. And in the future, they will be even better armed in detecting and addressing any new threats.
Thinking Locally to Prevent the Next Pandemic
And even beyond communication at the federal, state, or even local leadership level, Dr. Karesh says we need to look to local communities to make a difference, too.
“Communities are powerful,” he says. “They’re part of the solution.”
For example, Dr. Karesh found during his experience managing outbreaks in Thailand that the government didn’t rely solely on medical professionals. Instead, it enlisted the entire community—from mechanics to street vendors—to volunteer. These individuals were front-line observers, able to talk with people and gather information about the spread of the disease. These individuals also relayed trusted information about prevention to their customers, friends, and neighbors.
In cities today, these community-wide efforts could have the same impact: imagine if your Grubhub delivery came with a reminder to wash your hands before you at the food that was just delivered to you. And Dr. Karesh says it’s these kinds of changes in how we leverage the community to address the spread of diseases that need to continue beyond the coronavirus outbreak to prevent the next pandemic.
“These pandemics are just like earthquakes and fires,” says Dr. Karesh. “People say you can’t predict them, but you can actually predict them really well.”
For example, since earthquakes occur along fault lines, we’ve changed building codes. Pandemics can be treated the same, since we can predict where they’re most likely to occur and what human behaviors cause them. Community gardens and community co-ops are places for ongoing conversations about food safety. Businesses can disseminate information to their employees about health conduct and implement flexible policies to prevent sick individuals from coming into contact with coworkers.
This ability for cities to take an active role in managing and mitigating the impact of pandemics will not only help reduce the spread of future infections, but will also address these socioeconomic impacts even as the incidence of infectious diseases is on the rise. And with 55% of the world’s population living in urban spaces, it’s necessary we make these changes in behavior for the sake of public health—ensuring future cities dampen, not amplify, the spread of disease.