City Responses: Public Health Systems and Building Resiliency

I. Public Health Responses to Pandemics


Preparedness planning is essential for effective responses to pandemics and epidemics. The extent of a city’s preparedness depends on its capacity to prevent, detect, and respond to infections and to care for patients. Access to laboratories to test for infectious disease for real-time monitoring and analysis and to develop vaccines is critical. Other components of response systems include the availability of hospitals, clinics, care facilities, and necessary equipment and, finally, the ability to communicate and implement emergency response plans.

While developing vaccines to fight pandemics has historically required years of research, in the case of COVID-19, scientists produced effective vaccines in record time. A new phase of fighting COVID-19 began in the US in December 2020 after a few vaccines were authorized for emergency use and distributed around the globe

Developing resilient systems against infectious diseases has become a priority for many countries. Identifying gaps in local health systems, effectiveness of city infrastructure and development codes, and analyzing socio-economic determinants of population health are required to achieve more effective resource flows to vulnerable areas. Since individual communities are unique in terms of specific epidemiological conditions, community characteristics, healthcare, and public health capacities, strategies must be carefully tailored to each location.



The links below address several different measures to mitigate COVID impacts on urban communities, including detection, health service preparedness, infrastructure risk, and vaccine research capacity.

1. Detection of an epidemic

  1. Detecting respiratory virus through community surveillance in Seattle: Early detection of COVID-19 through a citywide pandemic surveillance platform. (New England Journal of Medicine)
  2. Assessing technologies to address the COVID-19 pandemic: Modern technologies for tackling COVID-19: data science, machine learning and AI. (Diabetes and Metabolic Syndrome)
  3. Socioeconomic predictors of COVID-19 in NYC: City(BMC Medicine)
  4. Epidemic preparedness and management in China: China’s Response to the COVID-19 Outbreak: A Model for Epidemic Preparedness and Management (Dubai Medical Journal)


2. Health services preparedness

  1. CDC guidelines for protecting workforces in healthcare facilities: Steps Healthcare Facilities Can Take to Stay Prepared for COVID-19 (CDC-Center for Disease Control and Prevention)
  2. Preparedness Planning in Europe: Preparedness for COVID-19 (European Centre for Disease Prevention and Control)
  3. Early hospital preparation of the pandemic (February 2020): What should hospitals do now to prepare for COVID-19 Pandemic? (John Hopkins University—Center for Health Security)


    3. Urban infrastructure and risk management

    1. Rethinking urban design for future pandemics: How do you build a city of a pandemic (BBC Future)
    2. How to use wastewater for early detection of the COVID virus? Pilot shows early COVID-19 detection in city wastewater (Smart Cities Dive)
    3. How cities should prepare for and react to pandemics? Preparedness Through Urban Resilience (Springer)
    4. How can cities manage risks associated with pandemics? Urban and Disaster Risk Management Responses to COVID-19 (World Bank)


    4. Long Term Resilience: Vaccine research and development

    1. Assessment of trials for Pfizer mRNA vaccines: Safety and efficacy of the BNT162b2 [Pfizer] mRNA vaccine (New England Journal of Medicine)
    2. How were vaccines so quickly developed? How science beat the virus (The Atlantic)
    3. Timely COVID-19 vaccine news and updates from the CDC: S. COVID-19 Vaccine Product Information. (CDC-Center for Disease Control and Prevention)
    4. Timely COVID-19 vaccine news and updates from the FDA. COVID-19 Vaccines (FDA-US Food and Drug Administration)

    II. The Future of Cities: Building Resiliency for Future Pandemics


    Building urban resilience to pandemics requires strategies reduce their impacts, enhance responsiveness, and facilitate longer-term recovery. In the case of COVID-19, short term, emergency driven responses have not necessarily mitigated the underlying causes of its rapid and extensive spread. Now is the moment to rethink the COVID-19 experience and build strategies to transform cities and prepare for future pandemics and thereby create more resilient, inclusive, and sustainable cities.



    The priority areas are many, but three present ample opportunity for innovative strategies: Urban mobility, Population Densities, and Sustainable and Healthy Buildings.

    1. Urban mobility 

    Declining population mobility due to COVID-19 has brought certain environmental benefits, such as an improvement in air quality and reduction in emissions, as noted above. Several cities have encouraged biking and walking as safe alternatives to public transport, enabling new user groups to take advantage of the affordability and health benefits of these modes of transportation. However, the decline in usage of public transportation could jeopardize the transition to safe and sustainable transport and constrain long term efforts to address climate change and air pollution.


    1. Can public confidence in pre-pandemic mobility options be restored? How COVID-19 Will Shape Urban Mobility (Boston Consulting Group)
    2. Can urban mobility patterns affect infection rates? Human mobility patterns predict divergent epidemic dynamics among cities (Proceedings of the Royal Society)
    3. Assessing the effects of social distancing and mobility on COVID infection rates: Association between mobility patterns and COVID transmission in the USA: investigating social distancing metrics. (The Lancet)
    4. Do mobility rates affect infection rates? Mobile device data reveal the dynamics in a positive relationship between human mobility and COVID-19 infections (Proceedings of the National Academy of Sciences of the United States)
    5. Using mobility patterns and sociodemographic characteristics to explain differences in spatial infection rates in Los Angeles: Characterizing the spread of COVID-19 from human mobility patterns and SocioDemographic indicators (3rd ACM SIGSPATIAL International Workshop on Advances on Resilient and Intelligent Cities)
    6. How is public transit ridership affect by COVID-19 (Oct. 2020)? Monthly public transit ridership is 65% lower than before the pandemic (USA Facts)
    7. What is the connection between public transportation ridership and disease transmission? Public transit has lost its momentum during the pandemic. Can it be regained? (Rice University-Kinder Institute)


     2. Population Densities

    Large cities with high population densities are spatially integrated through economic, social, and commuting relationships that can increase their vulnerability to pandemic outbreaks. High density leads to closer physical contact and more interaction among residents, facilitating the spread of airborne diseases such as COVID-19. Complex interactions of the microclimates caused by the built environment – especially air circulation, temperature and humidity – affect the impact of density on the spread of airborne diseases. However, populations in metropolitan areas tend to have better access to health care facilities, including high quality infrastructure, ICU beds, and staffing than populations in more rural settings. The interaction of potential adverse effects of climate and positive impacts of health infrastructure suggests that net impacts of high population densities are complex and differ by city.


    1. Separating effects of population density and connectivity in COVID-19 transmission: Does density aggravate the pandemic? (Journal of American Planning Association)
    2. Exploring the relationship of population demographics, social characteristics and social distancing in COVID-19 transmission: Strong Effects of Population Density and Social Characteristics on Distribution of COVID-19 Infections in the United States (medRxiv-The Preprint Server for Health Science)
    3. Not just density, but crowding affects COVID-19 in NYC: Density and its effect on COVID-19 (New York City Economic Development Commission)
    4. Is density a real enemy? Population Density Does Not Doom Cities to Pandemic Dangers (Scientific American)
    5. How winds are spreading the disease: The spread of COVID-19 virus through population density and wind in Turkey cities (Science of the Total Environment)


      3. The Built Environment: Sustainable and Healthy Buildings

      Current calls for reform of the urban built environment, often due to climate change and resource sustainability issues, could be amended to align with mitigating effects of pandemics.  For example, one set of priorities has been energy efficiency in HVAC systems, and ecologically sustainable building materials. Given the relevance of these reforms to air circulation, this reform agenda could be adapted to mitigate disease transmissions. Critical tools for reforming the built environment include municipal building codes and urban design practices, as observed above in early efforts to reduce the spread of the tuberculosis. In the context of COVID-19, building design, especially air quality and circulation, has been identified as a major tool for reducing airborne transmission.


      1. Looking toward construction innovations after the pandemic: Will COVID-19 change the future of building design? (Build Magazine)
      2. Airborne transmission is forcing reconsideration of energy efficiency: How will COVID-19 change building standards for energy efficiency (Energy Management Network, Energy Efficiency Group)
      3. After the pandemic: Designing healthy and sustainable built environments: Antivirus built environment: Lessons learned from COVID-19 pandemic (Sustainable Cities and Society)
      4. What has been learned about the design of healthy buildings: Bringing the outside into the office: Coronavirus bolsters push towards healthier building design (CNBC Environment)