COVID-19: A Pandemic Analyzed As A “System” — And some suggested strategies for the future
My research and writing specialty is the economics of urban form and transport. I enjoy dialectical analysis of wicked problems, and discovering “unintended consequences” that are the explanation for failure of popular policies. For example, certain popular kinds of prescriptive urban planning create distortions that undermine the very intention of the planning. This is the focus of more than one of my essays.
As the COVID-19 pandemic has proceeded, I have noticed certain features that deserve more attention. I do not intend to delve into medical complexities; only to suggest extra-medical factors that might be missed because the focus is heavily on certain politicized factors.
For example, when borders were closed, when enforced quarantining of foreign arrivals was imposed, when lockdowns were imposed, how many ventilators were available, how much PPE was available, who was responsible. Quite enough is being said about these things already.
In my research about urban economies, I constantly find broad assumptions being made by policy makers and expert advisors based on “national data”; for example on housing affordability, home ownership, mortgage debt and so on. But some nations have a whole lot of completely disparate outcomes among their own cities; especially the USA. San Francisco, Houston and Detroit are worlds apart, as urban economies. National-aggregate data is useless. Within cities — more correctly, “urban areas”, there is a known variety of “forms” and densities. This means that “urban area” density data produces some surprising outcomes at times — for example, Los Angeles urban area is denser than the New York urban area. To understand urban areas properly, it is necessary to dig deeper into the data: New York is an extremely dense, tall urban core surrounded by low density suburban sprawl spreading for dozens of miles in several directions. Los Angeles lacks a significant core and lacks truly high density anywhere, and yet its suburbs are so overwhelmingly medium density (comparable in fact with Western European suburbs) rather than the very low density found in New York urban area’s suburbs, that its overall density is “dragged up” to exceed the other’s.
It is my familiarity with confusion among policy makers and advocates about how actual cities evolved, and the differences when looked at more closely, that has led me to making similar observations about the COVID-19 pandemic. We are obsessed with national data: deaths per million so far; numbers of ventilators still available; whether the curve has flattened yet; what difference lockdown policies made to the shape of the curve. Governments are being judged on the basis of how their nation is performing — but everywhere one looks, this pandemic is the story of extremely bad epicenters and clusters in relatively few locations, and a much less dramatic story everywhere else.
What are the features of all these extremely bad epicenters?
- Early exposure to arrival of the virus due to high human connectivity with Hubei Province either directly, or indirectly through global connectivity chains.
- Absence of caution until too late; partly because of being “the first affected” and not having cautionary examples to go by already. Later exposure to the virus, in all cases meant a much more alert population. I suspect from the data now, that distancing and hygiene measures, adopted early “in the spread” by a society already scared into action, is 95% of the explanation for lower rates of infection and death; and lockdowns cause excessive costs that are not justified to achieve the remaining 5% of containment. COVID-19 has the feature, unknown in the early days of the pandemic, of high rates of asymptomatic infection and actually low deadliness; which means that the pandemic spread much more widely than expected before becoming visible and creating a reaction in society. By this time, the elderly and vulnerable who would make up the death toll during following weeks, were already infected.
- An environment that is optimum for infection and for co-morbidities. This “environment” is primarily “the indoor environments” where large numbers of infections were contracted. Let us call these “Petri Dish” environments. Besides the spreading of the COVID-19 virus, these environments are incubators for all seasonal pathogens, and as a co-morbidity with COVID-19, these can make the difference between survival and death. In turn, the outdoor environment matters because it affects the indoor one; and also because the outdoor environment can be to varying degrees, a mitigater of infections.
- Multiple indoor environments where people are mixing in different patterns of socialization, work and living; that create a “reciprocal seeding” effect, where people are going back and forth between “petri dish” environments and increasing the certainty of becoming infected themselves, and of infecting others.
- Significant numbers of elderly and vulnerable people living at locations where infection is spread early and vigorously.
- Inclement outdoor conditions, increasing the time people spend indoors and at risk, and reducing the health benefits of sun and fresh air. Air pollution in combination with certain winter low-cloud weather patterns is doubly harmful.
- Crowding makes the pandemic worse if the above factors are present. High urban density, per se, is not the main problem. It does, however, tend to affect the likelihood of factors 3 and 4. It is quite possible to have a “cluster of infection” in a rural location, such as the South Dakota Meat Packing Plant or the Mt Vernon WA Church Choir; but these do not turn further into uncontrollable “community transfer” of infection like in crowded neighborhoods.
- Rest Homes and Care Centers for the elderly; the outcomes here completely skew statistics depending whether they have become an infection and death problem or not. This factor alone can render much of the highly charged political discussion about “national policy” invalid. It is policy specifically about these facilities that needs considering, not “when borders were closed or lockdowns were imposed”. It is also worth noting that Dementia patients and some other very frail elderly have their mortality greatly increased from any mere disruption; distancing, masked staff, confinement, curtailment of daily activities and entertainment, etc.
If we consider any part of the world under the above template, I believe it has major explanatory power.
China’s Asian neighbors have very high alertness to any new pandemic emerging from China, and have long since adopted aggressive border control measures, quarantining, and contact tracing systems. Furthermore they already habitually have high standards of behavioral hygiene because of their past experiences with disease and pandemics.
Initial success in containing COVID-19 starts to look like a failure in Singapore, but instead of dismissing Singapore’s success, which stands, we need to look at where it has specifically failed. This is specifically in crowded dormitories for low-paid immigrant workers.
Sweden is a controversial case but those who condemn its unwillingness to completely lock down need to consider that its statistics are dragged up by Rest Home deaths; Sweden’s Rest Home sector may be structured differently to many other nations; and it is also becoming clear that some nations have not been accounting as honestly as Sweden, for Rest Home deaths. Sweden also has a few clusters relating to immigrants in crowded apartments. Nevertheless, Sweden’s statistics are often said to be “twice as bad” as neighboring countries but those neighboring countries are excellent performers to start with. None of them have the “unlucky” factors I outline.
High rates of renewal of urban buildings represent a massive advantage in this pandemic. All the epicenters — Northern Italy, New York City, Barcelona etc — have a high incidence of very old buildings in which people live at high density, and in which they socialize (bars, restaurants etc). These old buildings are frequently causes of high rates of respiratory diseases already, especially when high numbers of elderly and vulnerable people live in such buildings at the locations of high risk on all points. Co-morbidities are higher, and “co-infections” along with COVID-19, increasing the chance of death, are high. “Mortality from all causes” tends to be higher at all times for these people, which should be a cause for scandal and an appropriate policy response, such as the deliberate suburbanization of these vulnerable people (this is a major factor in New Zealand’s excellent performance).
Many Asian nations that “developed” decades ago have had ongoing very high rates of renewal of urban buildings of all kinds, which as a result have high standards of sanitation and HVAC. Northern European nations tend to have much higher standards of housing than Southern ones, but the exceptions at specific locations tend to prove the point.
Tropical-climate nations, and Southern Hemisphere nations enjoying their warm months, are at an obvious advantage. Much more socializing will be done outside, or at least in extremely well-ventilated semi-indoors conditions. Sunlight is “the principle environmental virucide”, with virus half-life being around two minutes in direct sunshine versus six to twenty hours indoors. Some cities have the locations of their tall buildings better planned to allow sunshine to be more available at street level. Obviously low-rise cities and suburbs are at an inherent advantage. Likewise wide streets are an advantage over narrow.
There has been a lot of contradicting discussion about whether COVID-19 is spread via aerosols, airborne, or deposited on surfaces. The truth is that “it depends”. Viruses are extremely hygroscopic, affected by moisture content in the air. Humidity above 60% tends to cause viruses to “precipitate” onto surfaces, while humidity below 40% tends to allow viruses to remain airborne. Temperature in turn affects “relative humidity”. The HVAC challenges faced by any venue or home is greatly affected by the outdoor environment. HVAC is simple in temperate New Zealand because humidity and temperatures outdoors don’t make it expensive to attain optimum humidity levels indoors. Cold and dry conditions, without expensive humidification indoors as part of the HVAC system, mean that viruses are an airborne “pandemic cluster seeding disaster”. Cold and wet conditions outside require higher HVAC power and the result is suspected now to be that viruses are literally getting wafted around in air currents from the HVAC system. The type of air circulation and filtration has an obvious role too. This represents a HVAC “challenge” that is certainly surmountable, but has not been a “standard” enough of the time.
New Zealand is the outlier “success” case that tends to prove how the presence of some negative factors can be cancelled out by other positive factors. Progressives in the worldwide media have turned the Prime Minister Jacinda Ardern, a 39 year old “first time mother in office” into a kind of celebrity on the alleged assumption that she “managed the pandemic well”. What appeals to progressives, seems to be the extreme economic destructiveness of Ms Ardern’s lockdown policy, which however was adopted late, like her border control policy; not early. It seems to have been “early” in relation to the visible progress of COVID-19 in New Zealand, but it is absurd to assume that NZ, with China as a major trading partner, significant source of immigrants, and a major source of tourists, did not have inbound carriers of COVID-19 at least as early as, say, California, where asymptomatic or otherwise unnoticed spread is now estimated to have started in mid January. Starting a meaningful quarantining policy for overseas arrivals, and a lockdown, in late March, is not an “early” response!
Seeing infections take three to eight weeks to lead to deaths, it is absurd to claim that a mere handful of deaths as 3 weeks and then 4 weeks of lockdown passed, is “a successful outcome of lockdown”! These deaths were the deaths that were going to occur anyway, and are proof that the lockdown was superfluous. The economic damage is gratuitous and doubly tragic, and a reckoning of the deadliness of the lockdown policy itself has not been forthcoming as yet from Ms Ardern’s government.
In fact NZ represents the text-book case for lucky environmental conditions, its temperate climate and humidity levels; its urban form with abundant low-rise suburban housing; dispersed population; abundant “nature space”; strong winds and clean air; along with the fact that it was summertime and NZ has one of the world’s highest natural UV levels from sunlight.
One factor that progressives should note about NZ, is a decades-old program of “social housing” in the form of separate family homes on the suburban fringe. Not for them, the perpetuation of the inner-city apartment block as a form of “social housing”. One consequence in NZ is that these low socio-economic locations well out in the suburbs, have several degrees of separation from the globetrotting, “vibrant urbanista” locations where the virus is initially spread. These low socio-economic communities have a below average rate of infection and no deaths as yet. Dementia Care facilities in suburban Rest Homes, are however more than half of the very low NZ death statistics.
Almost all of the confirmed infections (below 1500 in number) have been traced to a handful of clusters seeded by overseas arrivals. In turn, those clusters almost all involved a party atmosphere in a room full of people for several hours. NZ had a small number of such “petri dish for one night” venues, and probably no “petri dish” housing at all; whereas NYC probably has thousands of these petri-dish venues on consecutive nights, plus petri-dish housing to which some people return home.
NZ’s publicly available statistics are transparent and informative, clearly enabling these conclusions. Having been infected at a specific venue on a specific night, the infected people have not become “community spreaders” as occurs in epicentres; they have further infected only those in immediate physical contact with them, such as spouses and close family. The mystery is why the NZ government’s “expert advisors” are so besotted with Garbage-In-Garbage-Out modelling and so deliberately dismissive of known “on the ground” factors even when these are argued by “contrarian” experts.
If the thousands of deaths “modelled” as a pretext for lockdown were to have had any foundation in reality, the “peak” three weeks into NZ lockdown would have had to be dozens of deaths per day, followed by a gradual easing for which the lockdown could be credited. The total toll would have reached the hundreds. This was not “averted because of the lockdown”, it was simply “not going to happen anyway”. Australia is a useful benchmark, having imposed far lighter restrictions and yet matching NZ for the low rate of infections and deaths per million population.
There is a shocking lack of curiosity in New Zealand for antibodies tests, which are being used in the USA and Europe to try to discover the likely incidence of early arrivals and infections of people who remained asymptomatic. The Ardern establishment has switched to claiming it wishes to “eliminate the virus” after having initially justified the lockdown as a means of “flattening the curve”. It remains to be seen whether winter conditions will enable the virus to make a comeback (likewise in Australia) but this comeback is still extremely unlikely to be as deadly as it was in the best-case northern hemisphere countries let alone the epicenters. But if so, the NZ government needs to consider, this time, the context of around 30,000 deaths per annum from all causes, the context of abundant empty ICU beds and hospital wards, and the context of “lockdown related mortality” including the consequences of denial of non-COVID-19 routine medical care to many thousands of people for weeks or longer. Having already run the experiment unnecessarily, at least there might be a better- balanced assessment available to inform policy decisions taken in a few weeks or months from now, and possibly political opposition will be strengthened (after having been invisible up till now). A policy of immediately improving Rest Home vulnerability is logical.
It also is stupid to not publicly, officially, emphasize the value of sunshine and fresh air, and stupid to err on the side of keeping ignorant and terrified people inside their homes. COVID-19 is not the only pathogen in the environment or society, and it is in fact a rare one. The common ones have potential to do ramped-up damage in a winter “lockdown”. This is probably a contributing factor to excess deaths from non-COVID-19 causes that has started to be reported in the northern hemisphere. The reduction in road accident deaths and workplace deaths seems to be getting more than offset in the “all cause mortality” statistics, and by considerably more than the COVID-19 deaths themselves would justify.
For the future, the lessons that need to be learned are:
- Pandemics do not spread through humans as mere “numbers in a computer model”
- Viral pandemics are as much environmental, building and HVAC issues as they are medical ones
- Draconian “social control” as a default coping mechanism is an indictment on the mindset, the competence and the good faith of government advisory “experts”.
- “Contrarian” experts who are proved right need to be promoted, and excessive “caution” and “kindness” must not be accepted as excuses when a worse evil rather than a lesser one has been selected as a result.
- Instead of listening to the WHO when a medical emergency appears to be developing somewhere in China, we need to look at what Singapore and Taiwan are doing.
- If there is going to be a “next time” involving something much more serious than COVID-19 (which is hundreds of times less deadly than the 1918 Spanish Flu), we need to have policies in place that avert a default to “doing 30 years worth of economic damage in a few weeks”. There is only so many “30 years of economic damage” impacts we can subject our economies to every century. It is nonsense to claim that “lives trump the economy” when the economy is “lives in the future”. If we bring the 1930’s on ourselves once a decade, say, we soon will be dying en mass of measles, smallpox and famine again, just like they still do in Africa. It is bad faith of progressive “eco alarmist” types to gloat over this as an inevitable “consequence of overpopulation and consumerism” when it is entirely gratuitous and self-imposed. The human ingenuity and markets they despise for getting us to this point, are in fact the solutions going forward; including HVAC even more than medical technology. Vibrant-urbanista global cities must accept programs of neighborhood renewal and expensive HVAC mandates for venues and multi-family housing. Rent controls and social housing programs that perpetuate the presence of poor vulnerable people in high risk locations, have unintended consequences.
- A fluid mind is needed on the part of urban planning visionaries, for the potential benefit of low density, closer-to-nature living for at least a significant percentage of the population. There has always been a lack of good faith on this subject, in that “sprawl” itself was associated with negative externalities that did not have to be inevitable with sprawl. There has been an unhealthy obsession with cramming people into tall concrete buildings and requiring mass transit to be the main form of transport. But there has never been any inherent reason that urban populaces spread out at low density cannot be efficient and sustainable. For example, what is the point of “working at home” in a CBD apartment? There is no advantage to the CBD apartment in this case, compared to an exurban lifestyle block. And the people on the exurban lifestyle block may well have the ability to be sustainable in their own food production and the cooking of it. There are many “maverick” advocates with amazing and convincing proposals for sustainable, resilient low density living, including master-planned communities. Employment is in any case, always naturally dispersed as cities spread out, so that the suburban dweller is not inevitably “driving a long way to a city center job”, which seems to be the central obsession of planners.