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Coronavirus outbreak also a town planning issue

Towards the end of 2019, the world witnessed the outbreak of a new strain of virus that had not previously been identified in humans. The Novel coronavirus was detected in the Chinese city of Wuhan (Hubei province). The World Health Organization swiftly declared a public health emergency of international concern at the end of January 2020, as infections spread rapidly within China. Since then an increasing number of cases have been confirmed outside of China, including South Africa. The situation is evolving rapidly.

The fact that rapid urbanisation and increasing international travel render epidemic outbreaks a global and not simply a local phenomenon imply that it is important for all countries to take necessary measures to counter this threat. The first line of defence against the pandemic is surveillance: monitoring human and animal populations to spot outbreaks and contain them quickly. The South African government has assured its citizens not to panic as they are prepared to fight and contain the coronavirus outbreak.

Despite government's efforts to fight and contain the coronavirus outbreak, significant gaps, challenges and unevenness exist with regards to pandemic preparedness. Progress towards preventing the spread of coronavirus has been uneven, and many parts of the country have been unable to meet basic requirements for compliance. When epidemics or pandemics hit, they usually hit the poor first and worst. We have known this for a while. This history has exposed gaps related to the timely detection of disease, availability of basic care, tracing of contacts, quarantine and isolation procedures, and preparedness outside the health sector, including co-ordination and response mobilisation. In a country with high inequality like South Africa, these gaps are especially evident in resource-limited settings of townships and informal settlements, and threaten to pose dire implications for what may happen during a coronavirus outbreak in these settings.

In the light of this revelation, there is therefore an opportunity to pre-empt the worst of coronavirus effects through concerted action to reach those furthest behind. I therefore submit that coronavirus outbreak is also a town planning issue and planners can influence the trajectory of this virus.

Given the variable, the current strategy that SA is employing is not sufficient to contain the virus. The strategy indeed needs to be recalibrated. We must start moving beyond national systems and prioritise interventions in hard-to-reach areas. Many of these locations within South Africa may be remote, with health facilities and other services beyond the reach of people in poverty. Urban informal settlements are hotspots for the spread of diseases, and so targeting these areas of extreme poverty through health interventions alongside provision of proper water and sanitation services and other forms of sustainable development would offer a longer-term solution to preventing the spread of the outbreaks and reducing or prevent death. All of this points to a critical need to situate the response to the coronavirus within wider risk-informed development strategies to ensure the inclusion of those furthest behind, who may otherwise face the worst effects of the pandemic in the months ahead.

Despite growing international and national attention, the coronavirus disease (COVID-19) surveillance remains weakest in marginalised areas at greatest risk. Such areas are short of water and sanitation infrastructure and health facilities. They struggle for clean drinking water on a daily basis. Water to wash their hands on regular basis might seem to be a luxury they cannot afford. The underinvestment in preparedness in these communities reflects the painful choice facing poor and marginalised communities with high disease burdens. These weaknesses mean that in poor communities, isolated outbreaks are likely to go undetected for a longer time and, thus, to smoulder and spread. In such circumstances, we will all be doomed. Coronavirus does not discriminate.

Regardless of where a pandemic starts, once under way, the poor tend to bear the brunt. They have weaker health and poor infrastructure systems and limited capacity to handle surges in cases. These distributional inequalities are likely to play out within South Africa. In facing coronavirus pandemic, people are advised to avoid public places like markets or public gatherings, to maintain personal space and quarantine. Contrary to this intervention measure, the very nature of marginalised communities like informal settlements is a very high concentration of people or households in a small piece of land with very high interaction of people and domestic animals. These areas need to be paid attention to, lest they serve as ticking time bomb for us all.

Since poor populations face a higher spark risk, a greater chance that an outbreak will spread in these communities, and a higher likelihood of health and worse-off mortality shocks, pandemic preparedness efforts must preferentially target these poor and marginalised communities whose livelihoods are already precarious. Without vigorous efforts to secure equitable access to basic services for everyone, we are doomed to face the worst pandemic ever seen in the history of this country. Coronavirus outbreak is also a town planning issue.

Dr Hangwelani Hope Magidimisha-Chipungu, SARChi chair for Inclusive cities (NRF-SACN), academic leader for Planning and Housing at University of KwaZulu-Natal, [email protected]