COVID-19: Are Cities Entering the era of Disruptive Transformations to Sustainability?

Kareem Buyan, from the the Urban Action Lab at Makerere University, Uganda, shares his thoughts on urban health systems in developing and developed cities in the wake of the COVID-19 pandemic.

The COVID-19 (coronavirus) disease, which emerged from Hubei Province in the city of Wuhan-China[i][ii], has affected not only health but also water, transport, sanitation, waste management, food and other urban systems in over 100 countries in a matter of weeks[iii]

Inter-ministerial and government-wide task forces have been constituted, at national and municipal levels, to respond to this global crisis with calls for frequent hand washing, travel restrictions, walk-and-drive-through testing, screening and social distancing interventions. As these step changes expand in scale and scope, tensions between the short-term gains associated with COVID-19 measures and the long-term sustainability of cities are likely.

Urban health systems of both developing and developed cities are already facing unprecedented demand, especially in systems that are under-resourced —like a cardiac arrest in a body that already carries the scars of chronic, untreated disease[iv]. In Italy, where the number of total confirmed cases rose by 115% within two days (20th March to 21st March 2020)[v], urban health systems in the cities of Milan, Tuscany, Liguria and Sicily are in a situation where demand for intensive care has exceeded capacity[vi]. Recently, National Health Services (NHS) hospitals in England have been told to suspend all non-urgent elective surgery for at least three months from 15th April 2020 to help the service deal with the COVID-19 pandemic[vii].

Although containment measures in China have reduced new cases by more than 90%, this reduction cannot be a source of comfort given the cases and system-wide implications elsewhere. In Africa, where COVID-19 has been confirmed in 40 from 12 nations between 12th and 21st March 2020[viii], urban households in informal settlements, which are often logistically challenging areas, may only practice prudence and patience around social distancing, hand-washing and self-isolation, if food, waste management services and water are channelled to them either free-of-charge or at a much reduced cost. Besides, there are systemic barriers to COVID-19 interventions, such as lack of effective reward structures for public health agents and common definitions for COVID-19 using local dialects vs. the English and other international language versions, if local communities are to understand the behavioural changes required and why. There are walls that have for long separated the different tribes of medicine and public health from transport authorities, waste management companies, police services and other communities of science, policy and practice, who now suddenly realise that there is need to be talking to each other, back-up their decisions with evidence from open research and conventional sources of data, and solve the unique speed of an unfolding global health crisis together.

What makes the era of disruptive transformations to sustainability plausible?

Looking ahead, cities across the world will inevitably have to make important public health, economic, governance and ecological decisions with less information than usual and reverse recently adopted policies, which means entering the era of disruptive transformations to sustainability. This argument is based on latest research published by medical professionals, the World Health Organisation (WHO), Center for Disease Control (CDC) and other highly-regarded sources. Doctors and clinicians will need to assess disease severity and work out treatment options without being able to examine patient or measure pulse, blood pressure, respiratory rate, or oxygen saturation[ix]. The call for robustness in global supply chains for testing kits, protective gear and drug supplies, will be met with possible disruptions in the manufacturing and air cargo industry and in the bureaucracies of government approval procedures for distribution and use. City corporations in New York, California, Arizona and other places in the world, are likely to fall short on the required tax remittances to municipal authorities, staffing levels and evenness in the distribution of work-loads in the months ahead, due to either the adoption of telecommuting practices or a drastic reduction in sales revenue[x]. Effective measures that match the constraints of the local context in African cities may call for a shift from reliance on centralised government-run water and sewerage systems, to innovative use of urban natural assets for water access (such as springs and swamps), and partnerships that create a safe and affordable system for sourcing clean water using locally-made water pumps[xi].

Quicker case identification and strengthening surveillance to trace contact and transmissions in communities, means exploring the interdependencies between analogue and technological options. Case data gathered as the outbreak proceeds (such as infections recorded at a health unit) will have to be coupled to the use of spatial media technologies for digitally mapping transmission rates in urban settlements, smart phones for visual content and artificial intelligence[xii][xiii]. This data will also have to be compared with information on increased frequency and reach of travel, changing patterns of land use, changing diets, wars and social upheaval and climate change[xiv], for the reason that such factors influence interactions between humans and the reservoir hosts of emerging pathogens, facilitating exposure to zoonotic viruses and spill over infections in people, and allow emerging viruses to spread more easily through human populations. Amongst digitally literate urban populations, social distancing may be replaced by distant socialising, where people stay connected using smart technologies, due to the stress, loneliness and depression that arises from families and workmates being apart for a long time[xv]. Debunking myths and misinformation about the origins, spread and effects of infectious diseases, including COVID-19, is not only restricted to the mandates of Infectious Disease Institutes, CDC and WHO, but also Tech Companies like Google and Facebook, as well as governors and mayors of city states and parents using credible sources of information to talk to their children[xvi]. Street and urban artists in Vietnam have now stepped out from the traditional roles organising mass gatherings for launching their albums, to using digital technologies (such as YouTube) to educate their funs about  hand washing solutions using songs[xvii].

Re-thinking urban sustainability plans and policies along the long-term threats of COVID-19 is necessary

As the globe navigates the tensions and contradictions associated with COVID-19, cities will have to match their sustainability plans and policies with the need to not only pull back the speed of transmissions and infections, but also the risk of exacerbating poverty, inequality and environmental degradation. The suspension of intra-city public transport, closing entertainment venues and banning public gatherings[xviii] can bring about short-term gains, but there is need to know that such mobility restrictions may worsen existing sustainability challenges. Cities are habitats of mobile residents pursuing different livelihood options, which are part and parcel of the functioning of interconnected urban systems, including, employment, transport, food, water, security, energy, health, sanitation, waste management and housing systems. The lessons from the Ebola Outbreak of 2014/15 indicated that quarantines, which were used as response measure in Guinea, Liberia and Sierra Leone, resulted in large waste disposal needs and other water, sanitation and hygiene vulnerabilities that put a strain on the governance and delivery of services[xix]. At one point in Freetown-Liberia, nearly 50% of the population was under quarantine. This meant a huge number of households in often logistically challenging areas required food and water transported to them, coupled to flush floods that make neigbourhood paths impassable[xx]. Migrants in urban neigbourhoods, who fear deportation and retaliation by employers, have little incentive to embrace community-wide testing and report symptoms of COVID-19 at designated health units and labs.

In the United States, 45 percent of adults between the ages 19 to 64 are inadequately insured and 44 million are underinsured as of 2018 leading to high co-pays and out-of-pocket costs[xxi]. These individuals may be less likely to seek care for early symptoms of covid-19, at high-risk of contracting the disease, and to then facilitate spread through whole populations.  While they may help contain the spread of COVID-19, quarantines and isolation techniques that depend on demarcated borders between residential and commercial properties can be difficult to implement sustainably, because life and survival in cities is about inclusion, trust and power relations in urban spaces. The resolve and determination of different urban dwellers can challenge the ability of municipal agents to sustain social distancing techniques. This has already been indicated by spring breakers in Miami who have continued to go for beach life despite dire health warnings over the coronavirus[xxii]. City lockdowns along apartment complexes and commercial routes did not stop Reilly Jennings and Amanda Wheeler to tie the knot on 20th March 2020 at a ceremony held on a small street in the Manhattan neighborhood of Washington Heights[xxiii]. Schools and universities across cities in the world are closing for weeks or longer and this measure may be challenged by families that lack home-schooling habits and technology for virtual education, leading to delays in realizing the gains of containment strategies[xxiv]. Therefore risk-sensitive COVID-19 urban plans are required to reduce accumulated risk and to better consider the limitations of strategies that have worked in China.


Actions and inactions towards COVID-19 hold a transformative turn in the promise of inclusive and sustainable cities.  Since the features and trends of this global health crisis pay no attention to boundaries between municipal territories or departmental units, understanding the interdependencies between urban system functions can bring context to the feasibility and sustainability of measures for preparedness, response, and recovery.




















[xix] ACAPS (2015) WASH in Guinea, Liberia, and Sierra Leone: The impact of Ebola. Geneva: ACAPS. Available at

[xx] Associated Press (2014) ‘Liberian soldiers seal slum to halt Ebola’. NBC News, 20 August. Available at





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