Can large cities cope with the coronavirus?

The Parisian metro always crowded, illustration -

• Marseille, Paris, Lyon for France, Madrid and so many other megalopolises in the world… This new peak of coronavirus is mainly concentrated in large cities.

• There are no shortage of reasons: population density, frequent contact, more diverse cultural and social life, large cities are increasingly appearing as real nests for transmission of Covid-19.

• Are they doomed to suffer frequent peaks of coronavirus or are there solutions to solve this problem? 

With each weekly review by Olivier Véran, a new French megalopolis goes into maximum alert zone.

First Marseille, then Paris last week, and this Thursday, Lyon.

Outside this podium of the country's largest cities, other large urban centers are experiencing the strongest circulation of the coronavirus: Lille, Grenoble, Toulouse ... Abroad, the observation also applies with the examples of Madrid or New York, and if we go back to the first wave, Milan, Wuhan, etc.

For Antoine Flahault, epidemiologist and director of the Institute of Global Health at the Faculty of Medicine of the University of Geneva, the thesis seems to be true: very dense urban environments favor the transmission of respiratory viruses, just as there is in the the opposite of more “rural” diseases, such as malaria (more conducive to developing in fields and areas with low human density).

Multiple propagation factors

"At the start of the first wave, we thought that the virus would be transmitted more in areas with poverty, today we make more the correlation with dense areas", supports the emergency physician Mathias Wargon.

As the virus circulates by transmission from humans to humans, "it is normal that it spreads more in Paris than in a countryside where each inhabitant lives more than 500 meters from any neighbor".

Moreover, this observation is not new.

From the Middle Ages, entire populations fled large cities during the various plague epidemics, recalls the emergency physician.

For Antoine Flahault, in addition to the density of the population, there is a large cultural and social life, a smaller proportion of isolated individual transport such as the car as well as in the context of France, the presence of most of the universities. and students.

Flaws, of course, but also strengths

Faced with so many propagation factors, the question arises: are large cities doomed to remain nests for transmission of coronavirus and experience a third, fourth, fifth waves over the seasons?

Since Paris, Madrid or Marseille will always remain very dense, are they facing an insoluble problem?

Taking his example of the plague, Mathias Wargon reassures: “Precisely, we are no longer in the Middle Ages!

Today, we have much more leeway because we know much better how epidemics are spread, so we can better adjust certain levers ”.

The recent examples of closing bars and restaurants in Marseille, which according to Olivier Véran would start to show their effects, reflect this reality.

Especially since for Antoine Flahault, the big cities, if they present many factors of the spread of the coronavirus, also have assets to assert.

First of all, the healthcare offer, particularly in hospitals, which is much more massive than in rural areas, makes it possible "not only to better manage the flow of patients, but also to better carry out epidemiological surveillance and therefore to know when to strengthen. barrier measures ”.

Teleworking and more responsible behavior

Then, a population on average better educated and informed, in which the health information messages would be better followed and would pass better.

Finally, a very large proportion of jobs in the tertiary sector, ie the possibility of far more extensive telework than in rural areas.

The epidemiologist takes the Swedish example, "one of the countries which best resist the onset of winter".

If the northern nation is far from being at the forefront of the preventive message, whether on masks or confinement, it is far ahead of teleworking, which for Antoine Flahault shows all its effectiveness.

And coincidence or not, cities with a massive face-to-face return - according to a study by Morgan Stanley dating from September 30, 86% of employees in Ile-de-France and 68% in Madrid - are experiencing a surge in the incidence of the virus .

“We could sum up by saying that large cities have strengths and weaknesses for the spread of the coronavirus, but that some strangely do not use what could be their strong point,” concludes Antoine Flahault.

For Mathias Wargon, one last point should not be overlooked, that of individual responsibility.

Taking the example of the capital, he adds that the most affected population - and by far - remains the 20-40 year olds.

"It is therefore also a question of behavior, beyond the density of cities," he comments.

It is not by chance for him that the measures concern bars, sports halls and restaurants, “places mainly frequented by this population”.

If he does not propose miracle solutions to save the big cities, “their salvation will necessarily pass through their inhabitants”.

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