How Can Architecture Make Communities and Urban Environments More Resilient to Disease?

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Jeffrey Garofalo


Today, a gathering storm of forces are building that will increase the frequency and intensity of infectious disease outbreaks. According to disease ecologist Peter Daszak, “Pandemics are like terrorist attacks: we know roughly where they originate and what’s responsible for them, but we don’t know exactly when the next one will happen.”[1] The world community must take steps to prepare for this threat and to mitigate the forces that are driving individual contagions.[2] Architecture can play an important role in dampening the risk. The built environment can be shaped to support infection control.

I began working on the thesis a few months before the Coronavirus (COVID-19) broke out. COVID-19 originated in Wuhan, China, an area of 11 million people. By March 2020, the disease had spread to Italy and across Europe, Asia, Canada, and the United States. According to the World Health Organization (WHO), “The disease spreads primarily from person to person through small droplets of saliva or discharge from the nose or mouth, which are expelled when a person with COVID-19 coughs, sneezes, or speaks.”[3] The virus is also transmitted via contact with contaminated surfaces. In July 2020, the WHO reported that the virus may be transmitted through the air.[4] The virus spreads as easily as the seasonal flu and is more lethal. At the time of this writing, there was no vaccine for the disease.

Disease specialists like Daszak contend that economic development that drives people and wildlife together is elevating the risk for diseases like COVID-19.[5] As parts of Asia, Africa, and India add hundreds of millions of people to densely populated areas over the next thirty years, the risk of similar spillover effects—with pathogens jumping from animals to humans—will accelerate. As the spread of COVID-19 has shown, a disease outbreak in one corner of the globe has the potential of crossing borders and continents. COVID-19 has also demonstrated how infectious disease thrives in dense urban environments.

Rapid urbanization will create new mega-cities in the developing world that will struggle to provide such basic services as adequate housing, access to clean drinking water, and the removal of waste.[6] In the past, urban expansion gave rise to unsanitary conditions in slums, which led to the transmission of diseases like cholera, typhoid, tuberculosis, and hepatitis A. In developing countries, unplanned squatter settlements like slums, favelas, and shantytowns will grow at a faster pace than ever before.[7] These informal urban centers are likely to be overcrowded and dangerous, and breeding grounds for pathogens.

In the 19th century, cities like London and New York enacted building codes to improve the living conditions in tenements and other housing units in each city. In Paris, Baron Haussmann redesigned the city to make it healthier, passing zoning laws that protected light and air in the built environment, and by building new water and sewerage systems. At about the same time, London and New York built massive public works projects to provide clean drinking water.

In recent years, organizations like MASS Design Group and ARCHIVE Global have begun applying some of the lessons from the past to promote architectural design as an important strategy to combat disease around the world.[8] These organizations have been making design decisions—from the selection of materials to spatial layouts and the circulation of air—to support infection control.[9] Under the banner of healing design, they are employing health-giving strategies to design and retrofit spaces that may be applied to the built environment in the developing world and here at home.

In 2020, phrases like community spread and density reduction have become a part of everyday conversations. Back in February 2017, Bill Gates gave a speech at a security conference in Munich where he warned that pandemics were one of the great challenges of our time.[10] In many respects, his speech presaged the current environment with entire regions of the world on lockdown and with millions of people across the globe under quarantine. Eventually, the spread of COVID-19 will be contained and controlled. But, unfortunately, COVID-19 will not be the last outbreak. It is much more likely that outbreaks will continue to occur, becoming more common and deadly. The world community must be better prepared for the next pandemic and to contain the process that drives individual contagions.[11]

Specifically, planners and officials need to reimagine how spaces are designed and how people move and interact in them. In March 2020, for example, many grocery stores throughout the country began applying tape and markings on the floor to separate people in line. In the near future, it is likely that visual cues like these will be used in public spaces to ensure social distancing. Today, these types of decisions are being made in some hospitals and firehouses where “hot zones” are separated from “living zones.” (In a firehouse, a “hot zone” is where members don and doff their variously contaminated gear.) In the post-COVID-19 era, these types of decisions will need to be made across all sectors of society.

The thesis examines some of the amplifiers that will increase the risk of outbreaks and pandemics in the years to come. It then explores how architecture may be an agent to help reduce this risk.[12] The thesis prescribes a set of guidelines to help planners, designers, builders, and architects shape urban form—from the design of buildings and public spaces to offices and homes—that support infection control.



[1] Peter Daszak, “We Knew Disease X Was Coming. It’s Here Now,” New York Times, February 7, 2020,

[2] Daszak.

[3] “Q&A on Coronaviruses (COVID-19),” World Health Organization, April 17, 2020, https://www.‌

[4] Linsey C. Marr, “Yes, the Coronavirus Is in the Air,” New York Times, July 30, 2020, https://www.‌

[5] Daszak, “We Knew Disease X Was Coming.”

[6] Jordan Yin, Urban Planning for Dummies (Mississauga, ON: Wiley Canada, 2012), Kindle.

[7] Andrew L. Dannenberg, Howard Frumkin, and Richard J. Jackson, Making Healthy Places (Washington, DC: Island Press, 2011), 353.

[8] “Our Story,” ARCHIVE Global, accessed September 1, 2020,

[9] MASS Design Group, “Designing Spaces for Infection Control” (fact sheet, MASS Design Group, March 27, 2020),‌default/‌files/multiple-file/2020-03/Designing%‌20Spaces%20for%20Infection%20Control_1.pdf.

[10] Bill Gates, “Speech before the Munich Security Conference” (Munich, Germany, February 17, 2017),

[11] Daszak, “We Knew Disease X Was Coming.”

[12] “Role of Architecture in Fighting COVID-19,” MASS Design Group, accessed March 30, 2020,

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