Pandemics and Cities: Examples from History


A pandemic is the global outbreak of a disease that can occur through a variety of modes of transmission, ranging from blood and body fluids, to vector-borne, to fecal-oral, to respiratory (airborne and respiratory droplets). In contrast, epidemics are diseases that affect populations within a single community or region. The world has endured many notable pandemics, including the Black Death, Flu, HIV, and Ebola, that caused widespread morbidity and mortality as well as social and economic disruptions. Throughout modern history, epidemic and pandemic crises have had particularly adverse effects in cities due to increased exposure to the millions of people who live in high-density urban areas. Often the urban poor face the most severe incidence and longest recovery during pandemics, a phenomenon well documented using historic GIS methods in the London cholera epidemic.

Due to multiple modes of transmission, each pandemic requires specific preparedness and response strategies. Previous disease outbreaks – such as the flu pandemic of 1918 and localized epidemics of tuberculosis and cholera –  each led to specific and important urban transformations, such as introducing water and sewage systems to improve sanitation and prevent water-borne disease, public parks to improve air quality and opportunities for physical activities, and housing regulations to reduce overcrowding to prevent airborne disease.



This section provides an introduction to epidemiological definitions and statistics, illustrated by several prior pandemics and their effects on cities, that can help inform the present-day study of the COVID-19 pandemic.

1. Previous pandemics

    1. An outline of the most notable outbreaks in human history A Brief History of Pandemics (Psychiatry of Pandemics)
    2. How do pandemics historically reveal weaknesses in scientific methodology? Pandemics and methodological developments in epidemiology history (Journal of Clinical Epidemiology).
    3. How has urban planning been affected by the effects of 19th, 20th, and 21st century pandemics? Urban planning: Post-Pandemic America (California Polytechnic State University – San Luis Obispo)


2. Cholera

    1. Impacts of epidemics on urban landscape and housing prices Loss in the Time of Cholera: Long-Run Impact of a Disease Epidemic on the Urban Landscape (American Economic Association)
    2. A review of international hygiene guidelines related to disease outbreaks: Prevention and control of cholera with household and community water, sanitation and hygiene (WASH) interventions (PLOS ONE)
    3. The historical link between disease and greener cities: How Pandemics Spurred Cities to Make More Green Space for People (History)
    4. The interconnectedness of building design and health: In Search of the Water Pump: Architecture and Cholera (Harvard Design Magazine)


3. Flu

    1. Modeling pandemic-related economic outcomes for the 21st century: Economic Effects of the 1918 Influenza Pandemic: Implications for a Modern-day Pandemic (Federal Reserve Bank of St. Louis)
    2. Using the 1918 Flu to determine economic effects of non-pharmaceutical interventions such as social distancing: Pandemics Depress the Economy, Public Health Interventions Do Not: Evidence from the 1918 Flu (SSRN)
    3. Global health and economic consequences of the Pandemic of 1918 The 1918 Influenza Pandemic and its Lessons for Covid-19 what we have learned for COVID-19 (National Bureau of Economic Research)
    4. The H1N1 Flu (Influenza A) in megacities: Responses and Strategies Pandemic Influenza as 21st Century Urban Public Health Crisis (Emerging Infectious Diseases)
    5. Tracing urban and non-urban hotspots of 21st century flu outbreaks: Geographic transmission hubs of the 2009 Influenza Pandemic in the United States (Epidemics)


4. Tuberculosis

    1. The link between Modernism and Tuberculosis: Tuberculosis: The influence of a curative environment on modernist design and architecture (Medical History)
    2. How architecture and planning play a role in providing a healthy environment: Association between architectural parameters and burden of tuberculosis in three resettlement colonies Mumbai, India (Cities and Health)
    3. Urban Planning and its role in fighting TB: What architectural updates are needed? When Urban Planning Plays Doctor (Next City)