Author : Dhaval Desai

Expert Speak Urban Futures
Published on Apr 19, 2020
The COVID19 pandemic is a wake-up call to the world to realise that the sustainability quotient, in terms of the scale that city population densities provide, need to be looked through the lens of the grave risks that densities pose.
Disease and urban densities

The ten countries most affected by the coronavirus, barring a few exceptions, show how their cities and urban agglomerations have not only witnessed the maximum spread of the disease, but also registered maximum fatalities. As shown in the table below, on average, just one overpopulated and hyperdense large urban agglomeration or metropolis in each of these top-affected countries has witnessed up to 32.19 percent of the total cases recorded in the entire country. Even in terms of the respective total coronavirus-related deaths, about 29.53 percentage fatalities have been recorded in just one of their megacities each.

Country Total cases Total Deaths Metropolitan Area/Province most affected Total city cases as % of national count Total city deaths as % of national count
United States 636,776 28,583 New York 213,779 (33.57 %) 11,586 (40.53 %)
Spain 180,659 18,812 Madrid 49,526 (27.41 %) 6,724 (35.83 %)
Italy 165,155 21,645 Lombardy 60,314 (36.51 %) 10,901 (50.36 %)
France 106,206 17,167 Île-de-France 7,660 (7.21 %) 3,416 (19.89 %)
Germany 134,753 3,804 Bavaria 35,142 (26.22 %) 1,049 (27.57 %)
United Kingdom 98,476 12,868 London 16,335 (16.60 %) 3,224 (25.05 %)
China 82,295 3,342 Hubei 67,803 (82.39 %) 3,212 (96.11 %)
Iran 76,389 4,777 Tehran 5,098 (6.66 %) --
Turkey 69,392 1,518 Istanbul 12,231 (17.63 %) --
Belgium 33,573 4,440 Flanders 19,666 (58.67 %) 2,243 (50.51 %)
Percentage of cases and deaths in metropolitan area/ province against the national figures 32.19 % 29.53 %

Source: Newspaper reports, WHO data,,,, etc. (Up to 12-15 April 2020).

The devastation experienced by some of the richest global cities with world-class medical infrastructure as a result of COVID19 clearly indicates that though high-density urban agglomerations may be sustainable in terms of the scale their populations provide, they are weak and defenceless in times of such unprecedented outbreaks. From the point of view of urban planners, city densities lend the resilience to enhance economic activity and also ensure that scarce public resources and services are justifiably used for the simultaneous benefit of a large number of people. However, population densities become a dangerous liability, especially in the face of pandemics such as the COVID19, which run amok among human habitats. In the megacities of developing countries where people live, travel and work in highly cramped, and often insanitary, conditions are especially vulnerable. These conditions provide an ideal environment for infections to erupt at the community level, considered to be the stage three (maximum-spread) of the outbreak.

Exploding city densities — A global concern

More than half of the world's population — 55 percent — lives in cities. By 2050, that figure is predicted to jump to 68 percent. This growth will largely be propelled by only a handful of countries. India, China in Asia and Nigeria in Africa are expected to lead the global urbanisation bandwagon, cumulatively contributing to 35 percent of the world’s rural to urban transition between 2018 and 2050. Currently, North America, with 82 percent of its people in urban areas, Latin America and the Caribbean (81 percent) and Europe (78 percent) account for most of the world’s urbanised regions, while Africa remains the most rural. However, Africa, despite a majority of its population living in rural areas, faces high risk of rapid transmission of the disease, as many of its countries are also home to some of the world’s densest slum settlements. For example, Sub-Saharan Africa has the world’s highest percentage of the urban population (62 percent) living in slums. With no sign of a vaccine for COVID19 in the near future, the coming weeks will be critical for the millions in these urban agglomerations.

India’s preparedness and response in the context of urban densities

The government of India has chosen a top-down approach to control the spread by clamping a nationwide lockdown. Despite the difficulties, the disciplined adherence of the people of Mumbai and other urban agglomerations of India to social distancing and other norms of prevention is the only reliable method available to prevent the situation from quickly worsening.

However, with nearly 93 percent of its workforce engaged in the informal sector, and a sizeable number of those subsisting on daily wages, India’s 1.3 billion people face a Catch 22 situation in dealing with such lockdowns, especially if they continue over an elongated timeframe. Already, scores of India’s cities are witnessing reverse migration, as thousands of migrant workers, robbed of their means to survival in cities because of the lockdown, have started returning to their villages. Such trends, which flout social distancing norms, are being reported from nearly all major cities of India. They have also raised the prospect of the infections spreading to rural areas, where the public health infrastructure is woefully inadequate. Even with partial relaxation, any further extension of the lockdown is bound to lead to widespread social unrest and violent protests across the country. The scenes witnessed at the Bandra Terminus in Mumbai and Surat recently highlight the extreme degree of discontent and increasing impatience and anger brewing among the migrant workers who are trapped in cities without any means of livelihood.

Despite the difficulties, the disciplined adherence of the people of Mumbai and other urban agglomerations of India to social distancing and other norms of prevention is the only reliable method available to prevent the situation from quickly worsening.

Unrestrained population densities in urban sprawls not only put severe strain on public resources and services, but also incapacitate and overwhelm public health systems in case of medical emergencies or epidemics of the scale of COVID19. Within a just few weeks of the first case being reported, the pandemic has exposed the weakness of even those global cities which boast of highly advanced medical and public health systems. For example, the public health and medical services of New York and London, two of the richest and infrastructurally well-endowed global urban citadels, have been put under severe strain owing to the sudden and sharp spurt in the number of cases.

With some of the world’s highest population densities, relatively inadequate health facilities in its cities, and one of the lowest testing rates in the world, India — at this stage of the outbreak — could therefore be witnessing just the tip of the iceberg of the larger impact this outbreak can cause.

Source: ORF Coronavirus Tracker, Our World in Data, ICMR, media reports (Up to 14-15 April 2020)

However, its not just the negligible testing ratio and shortage of other necessary equipment, including critical care infrastructure. The government and even the private sector are working against time to bridge such shortfalls. In case the number of cases witness a sudden increase, the real challenge faced by India’s cities would be in terms of availability of doctors and other medical professionals.

Country Year Medical doctors (including general practitioners, specialists & others) Medical doctors/ 10,000 people
United States 2017 1,698,252 26.12
Italy 2018 482,272 39.77
Spain 2017 361,326 38.72
Germany 2017 702,390 42.48
China 2017 2,828,999 19.80
France 2018 424,674 32.67
Iran 2018 259,208 15.84
United Kingdom 2018 377,078 28.11
Switzerland 2017 72,648 42.95
Turkey 2017 299,994 18.49
India 2018 1,159,309 8.57

Source: Compiled by the author on the basis of data from Global Health Observatory Data Repository, WHO, April 2020.


No megacity in the world — irrespective of its economic prowess and the overall robustness of social infrastructure — has been able to withstand the onslaught of the COVID19 pandemic; their population densities or human capital proving to be their biggest burden. The pandemic therefore is a wake-up call to the world to realise that the sustainability quotient in terms of the scale that city population densities provide need to be looked at also from the lens of the grave risks that densities pose. India and other countries must therefore do everything possible to tackle the increasingly unmanageable population densities of their urban agglomerations. Urban planning will have to factor in realistic estimates of population growth and demographics to arrive at a “critical mass” against which cities will have to ensure provision of public amenities and services. They may also study some of China’s interventions to deal with ‘Chengshi Bing’ (literally meaning ‘big city disease’) that have successfully led to population decline in Beijing and Shanghai, two of its densest cities. The task is not easy, but the next, more severe biological disaster may be just around the corner. It will be unwise and indeed perilous to allow nature to play the balancing act.

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Dhaval Desai

Dhaval Desai

Dhaval is Senior Fellow and Vice President at Observer Research Foundation, Mumbai. His spectrum of work covers diverse topics ranging from urban renewal to international ...

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