A Life-or-Death Moment for Cities

A DoorDash food delivery person makes his way through slushy snow in New York City during a second wave of the COVID-19 pandemic. (AP Photo, Anthony Behar)
A DoorDash food delivery person makes his way through slushy snow in New York City during a second wave of the COVID-19 pandemic. (AP Photo, Anthony Behar)
From the Editor: This article was first published in the opinion section of the New York Daily News on May 10, 2020.

COVID-19 has killed at least 19,000 New Yorkers and dealt a body blow with lasting consequences to the city. Two paths lie ahead. If pandemics become common, then not only New York City, but all of America’s service-based economy faces a bleak future. If this terrible plague is a unique event, then things will eventually get almost back to normal. To save both the nation’s biggest and most productive metropolis and tens of millions of service jobs across the county, we must invest enormously to prevent future pandemics.

For urban areas in the global economy, pandemic risk comes with the territory. Cities like New York are the nodes of a great transportation network that spans across oceans and continents. Consequently, cities are also ports of entry for contagious disease.

Cities are defined by their density. New York exists to bring people near to one another to enable economic, social and cultural collaborations. Those collaborations have made America rich, strengthened democracy and produced great art, from the painting of Jackson Pollock to the writing of F. Scott Fitzgerald and Jimmy Breslin. But proximity also spreads disease.

Because New York is both hyper-connected and hyper-dense, COVID-19 hit the five boroughs hard. To date, New York City accounts for one-fourth of the total COVID-19 deaths in the United States. Gotham accounts for 0.1% of the world’s population, but over 7% of total global COVID-19 deaths.

The COVID-19 pandemic is a more terrible event for New York than the 9/11 terrorist attacks because the harm goes beyond the death toll. People come to cities to connect with other people, but fear of infection undermines the desire for connection. When contagious diseases make us terrified of strangers, then crowded city streets become hellish. For many who are sheltering in place, a meager cabin in Wyoming beats a fantastic studio in Soho.

If fear of plague becomes permanent, then the COVID-19 pandemic could become a hinge in history, after which people flee the cities that made us. Past plagues have destroyed urban civilizations, but other pandemics have been potholes rather than roadblocks for New York. We need to make sure that COVID-19 is a terrible aberration rather than a turning point.

The Black Death first struck Constantinople in 541 A.D., just as the Emperor Justinian was reconquering Italy. Justinian dreamed of bringing back the Pax Romana to the Mediterranean World; the plague destroyed that hope. Year after year, century after century, the Black Death returned to Europe’s cities and cast that continent into a millennium of terrible rural poverty. That is our bleak ghost of pandemics past.

Cholera emerged out of India’s Ganges Delta in 1817 and spread to the East India Company’s trading capital of Calcutta. From there, the pandemic traveled across the planet, ultimately striking New York City in 1832. Thousands of New Yorkers died then and in the two subsequent outbreaks that started in 1849 and 1866 respectively. My great-great-great grandfather died in New York’s 1849 cholera epidemic.

New York City survived the city-slaying cholera pandemics of the 19th century, just as it survived the Influenza Pandemic of 1919. These examples tell us that New York can also survive COVID-19, and even emerge stronger, but we cannot just trust to luck.

The Black Death killed people and cities for centuries, because the disease was not understood. There was no cure and the plague came back again and again.

Cholera didn’t end 19th century urban growth because doctors discovered the cause of that water-borne disease. That knowledge then justified the enormous municipal spending on water and sewers that practically defined urban government throughout the 1800s.

London’s Dr. John Snow is rightly revered as a founding father of epidemiology, because his medical detective work revealed the secret of London’s 1854 cholera epidemic. By studying his ghost maps of cholera deaths, he discovered that the source of the disease was an infected water pump. The low rates of disease among local brewery workers, who had something better than water to drink, confirmed his hypothesis that cholera was a water-borne illness.

Cities spread knowledge as well as disease, and Snow’s insight passed over to Dr. Stephen Smith, a Bellevue surgeon who is one of New York’s great unsung heroes. Smith first built up public outcry over the terrible sanitary conditions in the city; New York had the Croton Aqueduct since 1842, but poorer New Yorkers didn’t want to pay the hefty connection fee.

Smith became the first leader of the Metropolitan Board of Health in 1866, which required that the city’s tenement owners pay for connections to the water and sewer system. Cholera would never again kill thousands of New Yorkers, and the city started to live with less fear.

Across the U.S., cities became safe because they invested enormous amounts in public health. City and local governments were spending as much on clean water and sewers at the start of the 20th century as the federal government was spending on everything except for the Post Office and the Army.

We may also have to spend vast sums to make our urban world safe again today. Billions on preemptive vaccines and ventilators and virology research could save trillions lost in future lockdowns. We are now paying the price for ignoring the warning signs offered by the 2003 SARS epidemic, the 2009 H1N1 outbreak and the 2014 Ebola outbreak.

New York isn’t in this alone. Most American workers will suffer enormously if we don’t prevent future pandemics. Over the past 150 years, Americans have moved from farms to factories to urban service jobs. One-fifth of employed Americans, or 32 million workers, labor in retail trade, leisure and hospitality.

These jobs provide a safe haven from automation, because people will pay extra for coffee that’s served with a smile. No New York deli experience would be the same if robots were serving the pastrami. But those jobs will disappear if having a human serve your coffee brings more fear than opportunity.

Ultimately, tens of millions of American workers from Dallas to Des Moines have jobs because people enjoy interacting with other human beings. If the risk of contagion remains with us for decades, then human contact will bring fear more than joy and those jobs will disappear. The result will be an employment Armageddon, especially for less-skilled American workers.

The 14.7% unemployment rate that was announced on Friday (May 8) is a foreshadow of that terrible future. The elite knowledge workers are the lucky ones. They can shelter in place and Zoom to their meetings. The cooks and the salesmen and the bartenders are already on the employment line and they will stay there if pandemic risk becomes permanent.

The non-employment rate among prime-aged American males was 5% in the 1960s, but it has been 15% for most of the past 10 years. America’s eastern heartland, which stretches from Detroit to New Orleans, is the epicenter of American joblessness. That region lost its manufacturing base, just like New York, but never experienced a service sector renaissance. If the pandemic kills off service sector jobs, then the whole country’s job market will resemble Appalachia’s job market today.

Manufacturing jobs may be a bit safer from a pandemic, but they are vulnerable both to machines and to low-cost labor in the developing world. The largest industrial cluster in the U.S. was once New York City’s Garment District, but don’t fool yourself. Our wages are too high to compete globally in light manufacturing, and our competitive manufacturing industries rely primarily on machines.

The stakes are so enormous that I am hopeful that America will do whatever it takes to stop the pandemics of the future.

Major investments in public health are the first step toward saving New York City, but even with that investment, the city will not be the same. New York will face tough years, as visitors shun its hotels, global tourism remains low and commuting dwindles, as many companies shift to work-from-home. For a few years, some people will switch to the suburbs.

But memories are short. If the pandemic ends and does not return, then within a decade, New York will come back. The city’s strengths will see it through as long as humans can meet safely with one another.

This is not to say we are ever going back to exactly the way things were.

Even without a new pandemic, people will become more cautious about colds and flu. Masks will become more common. Handshakes may be rarer. People will be more reticent about just hanging out in great crowds. It will be a more cautious city, as the shadow of at least 19,000 deaths overcasts the city’s streets.

Not all of that change will be terrible, at least as time passes. Tokyo is a great city and people wear masks there. A little more attention to public health will be good for the city, if a little less fun. But it will be different.

Some people may even choose to remain to live in their apartments, if the alternative is to live in a nursing home. In Massachusetts, almost 60% of COVID-19 deaths have been in nursing homes. The mortality rate in New Jersey nursing homes was even higher. The most obvious mistake that we made in the COVID-19 crisis was that we failed to protect our must vulnerable. We must not make that mistake again.

And we must never, ever, again ignore the risk of pandemic. New York City’s future depends on it.