Medicalization of Mumbai comparative study of three epidemics: PLAGUE, tuberculosis and covid-19
Pramada Jagtap, Sarine Vosgueritchian MIT SA+P 4.241J / 11.330J. Spring 2022. The Making of Cities
PATHOGEN AND THE HUMAN BODY
CROSSING ANTHROPOGENIC BOUNDARIES
BIOPOLITICS AND BIOPOWER
TIMELINE of plague
TIMELINE of tuberculosis
TIMELINE of covid-19
evolving medical infrastructure
politics of water
SPIRAL OF DOOM
Pathogen and the Human Body
Pathogen and the human body We know that viruses replicate and create other viruses, same is true for bateria. We will be discussing in detail the movement of three pathogens, within the human body, across mammals, within an urban area, across a country and then worldwide. When the pathogen affects a large number of people within a community, population, or region, it is termed as an ‘epidemic’. A ‘pandemic’ is an epidemic occurring on a scale that crosses international boundaries, usually affecting people on a worldwide scale. In the case of plague, which is divided into three main types — bubonic, septicemic and pneumonic — depending on which part of your body is involved. People infected with Y. pestis often develop symptoms after an incubation period of one to seven days. Bubonic plague is the most common form and is characterized by painful swollen lymph nodes or ‘buboes’. COVID-19 can cause lasting damage to multiple organs, including the lungs, heart, kidneys, liver and brain. SARS CoV-2 first affects the lungs through the nasal passages. When the lungs are severely affected, it threatens the heart, resulting in death. It is impossible to prevent any virus from infecting humans, through the experience of generations and the help of science, the human body should be able to defend itself from foreign agents. The multiplication of the pathogen is possible as they can adapt very easily to any environment and any host. Diseases however, can be prevented with vaccines. As seen in the case of COVID and other dormant infections, this is the most efficient approach used. The vaccine produces a specific immunity against a disease because it trains antibodies and cells to recognize the infectious agent. What does this approach mean when applied to the urban realm? Through this research project, we will be looking at the specific case of Mumbai and how three pathogens changed and continue to change the fabric of the city and look for ways in which urban form can prepare itself to recognize and prepare for a pathogen.
1. “Plague.” World Health Organization. World Health Organization. Accessed May 12, 2022. https://www.who.int/news-room/factsheets/detail/plague.
Crossing Anthropogenic Boundaries
CROSSING ANTHROPOGENIC BOUNDARIES When speaking of epidemics, it is important to to imagine the interrelated history of humans and pathogens. In Guns Germs and Steel, Jaren Diamond presents a model of disease in which domestication of animals was the major turning point in the long relationship between humanity and pathogens. While farm animals account for a few pathogens, the bulk of those affecting humans have come from wild animals like rodents, bats, and primates that are reservoirs of zoonotic diseases and sources of emerging human infections. Kyle Harper writes, human occupation of the planet has changed the ecological setting for other animals that play crucial roles in pathogen evolution and transmission. Even before the onset of anthropogenic climate change, natural climate change has been a major force in the dynamics of infectious diseases. The plague pandemic, for instance, seem to have had a climate trigger. Yersinia Pestis, a zoonotic bacteria that causes plague is ususally found in smaller mammals like rats, mice, squirrels, rabbits, chipmunks. It had a much higher fatality rate in humans than the SARS-COV-2 and Mycobacterium Tuberculosis, of 61-81%. Susceptibility to Mycobacterium tuberculosis is relatively high in humans, other primates and guinea pigs. This means that living conditions are highly responsible for the spread and severity of tuberculosis. In case of COVID-19, SARS-CoV-2 first emerged in Wuhan city, which is more than1500 km from the closest known naturally occurring sarbecovirus collected from horseshoe bats in Yunnan province, leading to an apparent puzzle: How did SARS-CoV-2 arrive in Wuhan? Are we breeding pathogens within the design of our cities? If so, how can we design for resilience from pathogens. How does human kind interact with pathogens? How do we create more sustainable relationships?
1. Jared M. Diamond. Guns, Germs, and Steel : the Fates of Human Societies. 20th Anniversary edition. New York: Norton, 2017. 2. Kyle Harper. Pathogens and the Anthropocene: Germs, Genes, Geography, Part 2: Inhabiting the anthropocene, online. 3. Lytras, Spyros, Wei Xia, Joseph Hughes, Xiaowei Jiang, and David L. Robertson. “The Animal Origin of SARS-COV-2.” Science 373, no. 6558 (2021): 968–70. https://doi.org/10.1126/science.abh0117.
Biopolitics and Biopower
Biopolitics and Biopower Foucault defines Biopolitics as political relations between the administration or regulation of the life of species and a locality’s population, where politics and law evaluate life based on perceived constants and traits. Pathogens remind us of our common belonging to the same biological species, blurring the social and racial inequalities. Ironically, biopolitics structurally relies on the establishment of hierarchies in the value of lives, producing and multiplying vulnerability as a means of governing people.  Today, nearly half the population of Mumbai lives in high density low rise complexes termed as slums, occuping a land area of 0.5-1 sqm per person. Towering skyscrapers are interspersed with blue tarpolene covered shanties that were settled here to construct the skyscrapers. The city with the most unequal neighbourhoods in the world has harboured numerous epidemics including the plague of 1896, covid-19 and lives with tuberculosis. The virus does not put us on a basis of equality. On the contrary, it blatantly reveals that our society structurally relies on the incessant production of differential vulnerability and social inequalities.  In the same city, Antilla the worlds most expensive private residence with 5 member family and 600 staff stands tall, and is surrounded with communities living in shanties, both of them governed as political subjects of law, but differentially representated on city maps and population census. Our current experienece of the pandemic, with a forcinbly enforrced sense of order on one type of class, represents that that we all collectively form a mortality rate, morbidity rate, and life expectancy, but the realities of their breakup are far from equal. Daniel Lorenzi writes that next time that we collectively applaud the “medical heroes” and “care workers” who are “fighting the coronavirus.” we may want to think about whether they are the only ones who are “taking care” of us? How is power affecting the delivery persons, maintainence staff of the quarantined apartment, cashiers at pharmacy, public transport drivers, facrory workers- are they counted as care workers? Bruno Latour stresses that the current “health crisis” should incite us to prepare for climate change. Can we relook at our crisis response and dig further to create long-term cirtiical care infrastructure?
1. Michel Foucault, The History of Sexuality (London: Penguin Books, 2020). 2. Daniel Lorenzini. Biopolitics in the time of coronavirus, Critical inquiry, VOL 47, Number S2, online. 3. Ibid. 4. Bruno Latour, “Is This a Dress Rehearsal?,” Critical Inquiry 47, no. S2 (January 2021), https://doi.org/10.1086/711428, 25-27.
Timeline of Plague
Timeline of Plague The first case of plague in Mumbai–then Bombay– was reported in 1896, about a century ago. It was discovered that the bubonic plague arrived in Mumbai through a ship from China that had rodents carrying fleas infected with the Yersinia Pestis bacteria. Being airborne, the disease quickly spread through Mumbai and the rest of India and caused millions of deaths in British India in the decades that followed. The most heavily afflicted part of the population were the poor who were living in cramped spaces with little to no sunlight and ventilation in their homes. Sadikot characterized the Plague as a moment of rupture, one that not only shaped the memory of the Indian population but also physically changed the city of Mumbai. One can describe parts of the city of Mumbai as pre-plague and post-plague. Pre-Plague Mumbai was colonial Mumbai, designed and planned by the British and christened by them as “Urbs Prima in Indis—Latin for ‘India’s Premier City’.” This is when the dichotomy between the rich and poor parts of the city began, as British elites had villas and bungalows on the highest hills of the city and the locals or as they called them, “natives” lived in “Really congested neighborhoods; incredibly unsanitary, subhuman conditions of life; people living in dark, damp ill-ventilated housing,” says Sadikot. “And this is where the plague hits.” Post-plague Mumbai was heavily influenced by the British colonial government’s establishment of the “Bombay Improvement Trust.” This trust was tasked with the job of cleaning the city, ridding it of congested neighborhoods, constructing new sanitary buildings for the poor, and opening up new streets that could act as avenues for wind and breeze to pass through the city. The biggest wave of plague ended in the turn of the 20th century, but cases of bubonic plague are still present in India, impacting thousands every year.
1. Sushmita Pathak, “How Bubonic Plague Reshaped the Streets of Mumbai,” NPR (NPR, March 7, 2021), https://www.npr.org/sections/goatsandsoda/2021/03/07/968856331/how-bubonic-plague-reshaped-the-streets-of-mumbai. 2. Ibid.
Tiemline of Tuberculosis
TIMELINE of Tuberculosis When Tuberculosis was first found in Mumbai, the British were still colonizing India and had the same issue in the UK. They quickly scrambled and worked on the improvement of their living infrastructure, the clearing of slums, and the reduction of household overcrowding. Meanwhile, TB cases were growing in Mumbai and getting more and more severe. Soon, the number of HIVinfected people being tubercular increased. Additionally, a new form of Tuberculosis evolved that was drug-resistant and later, one that was multiple drug resistant. It is important to understand that Tuberculosis is airborne and can infect someone who is just living in a space where an infected person lives, even without close contact. In that, the British colonial government’s laxness in dealing with the epidemic left a severe burden on the new Indian government who established a National TB program in 1962. But it was already too late as TB had infected too many people. This made TB a silent killer. Yet the government’s reaction to eradicating TB by removing slums and moving its residents to badly constructed, poorly lit and ventilated housing towers had an even worse effect on the epidemic. Soon enough, these housing complexes became a breeding ground for the disease. This might be one of the reasons the Indian government hasn’t declared TB to be an epidemic, and instead takes a more national approach to treating it and attempting to eradicate it. Compared to the impact of Covid-19, TB is much more severe, and is also the longest running epidemic in India. This might also be the reason why a lot of statistics and conrete information on TB cases and deaths in India are not detailed. That, or the inability of the government to track every case. Is it possible to deal with TB with the seriousness in which other countries have been tracking cross-contamination and close contact of Covid-19? Additionally, is it possible to separate the infection and healing of the population of Mumbai from TB without more advance medical research and treatment solutions?
Vidya Krishnan, Phantom Plague: How Tuberculosis Shaped History (New York: PublicAffairs, 2022), 78. B Mahadev and Prahlad Kumar, “History of Tuberculosis in India,” Practical Approach to Tuberculosis Management, 2006, pp. 1-1, https://doi.org/10.5005/jp/books/10639_1.
Timeline of Covid-19
TIMELINE of COVID-19 About a century and a quarter after Plague changed the face of Mumbai, Covid-19 changed the world. This pandemic wasn’t localized to a city or a country but rather every urban part of the world. Using the word urban here is debatable here; I am implying it to mean all parts of the world where humans have created infrastructures, buildings, and living habitats. But why did Covid-19 severely affect some parts of the urban world more than others? Looking at Mumbai, one can deduce that social distinctions and questions of class play a big role in it. But it is also about how different cities or villages are designed and how people in the lower class, in the case of Mumbai for example, don’t have access to sanitary spaces or homes large enough for different members of a family to quarantine safely without affecting another. While extended families occupy small homes or working-class families live in slums, the rich of Mumbai have empty bedrooms, large mansions, and summer homes. During the beginning of Covid-19’s spread in India, the massive emergency lockdown that was announced forced the working-class population to resort to the only free and accessible mode of transportation available to them to reach home – walking. The challenge imposed on the poor in India was phenomenal as the infrastructure of the cities and that which connects them wasn’t able to accommodate billions being on lockdown and in quarantine. Covid-19 also changed the face of Mumbai but this time with the building of temporary infrastructure, and the adaptation of death and burial practices, yet a more concrete change in the architecture and urban fabric of the city is not visible yet.
Al Jazeera, “Photos: Mass Funeral Pyres Reflect India’s Covid Tragedy,” Gallery News | Al Jazeera (Al Jazeera, April 26, 2021), https:// www.aljazeera.com/gallery/2021/4/26/mass-funeral-pyres-reflect-indias-covid-crisis. “A Foucauldian Enquiry in the Origins of the COVID-19 Pandemic Management (Critique in Times of Coronavirus),” Critical Legal Thinking, May 11, 2020, https://criticallegalthinking.com/2020/05/11/a-foucauldian-enquiry-in-the-origins-of-the-covid-19-pandemicmanagement-critique-in-times-of-coronavirus/.
URBAN FORM As mentioned before, the change in the urban form of Mumbai, or lack thereof is visible in the urban fabric. In addition to the Bombay Improvement Trust literally paving new streets to increase ventilation in the city and revamping neighborhoods to be less congested, they took on the huge project of sea reclamation, using them to expand the city. This project changed the coastline of Mumbai, adding a large avenue that connected different parts of the city through the coat but also creating new open spaces accessible to the public. It’s interesting to see that years and a century later, the changes they made to the urban fabric of Mumbai did not reduce the vulnerability of its population to the future epidemics of Tuberculosis and Covid-19. Chawls were the homes of the working class society in Mumbai. After the Plague, the 63.5 degree angle rule was implemented to ensure enough light and ventilation entered living quarters. Yet the rule designed to create distance between building to ensure light and ventilation in living spaces was not carried over when designing the Slum Rehabilitation Authority into their projects, even though the authority was created to ensure sanitary and pleasant living conditions for the population of Mumbai and India. These projects were built with a totally opposite purpose architecturally – to maximize the use of distant plots in the city to rehouse slum dwellers in towers designed to kill people. Looking at the plan of the city, one can see the same building built over and over again next to each other, reaching heights of fifteen to twenty floors and only three meters apart. What the Bombay Improvement Trust tried to achieve during and after the Plague was completely disregarded when designing these new living quarters for the poor. They had no choice but to live in these towers where Tuberculosis spread like wildfire, other than to create new slums next to their new homes. This is what happened in several cases of SRA projects. Slum-dwellers were moved to these towers, decided they don’t want to live in such living quarters with barely any light and ventilation, and created new slums in a new plot. The SRA projects failed. So, when Covid-19 hit Mumbai, there was still no sanitary housing in the city for the poor to live in and quarantine during the lockdown. This is exactly why the Dharavi slum became a breeding ground for Covid-19 and eventually a containment zone as the government had no other solution but to prevent them from exiting the slums. 1. Sushmita Pathak, “How Bubonic Plague Reshaped the Streets of Mumbai,” NPR (NPR, March 7, 2021), https://www.npr.org/sections/goatsandsoda/2021/03/07/968856331/how-bubonic-plague-reshaped-the-streets-of-mumbai.
ARCHITECTURAL FORM Over history, we’ve seen how crowded unsanitary spaces such as chawls have become breeding grounds for the Plague. The 63.5 degree light angle rule was implemented on the construction of chawls – where if you coughed, you were assumed to have the Plague or Tuberculosis– to make sure enough light and ventilation reached all the living spaces. This rule “determined the distance between a building and its boundary wall to allow improved light and ventilation.” They also made sure to enlarge the windows in the rooms of the chawl in order to encourage more light to enter the room. A study in the journal Cities & Health shows that residents of affordable-housing complexes in Mumbai that have little natural light or breeze are more likely to contract tuberculosis. In Mumbai, it was the Slum Rehabilitation Authority (SRA) that indirectly and perhaps unintentionally built towers that became breeding grounds for Tuberculosis. In a way, these architecture and urban planning norms adopted by the SRA are aiding the national public health disaster. In Mumbai’s outskirts, in Mahul, housing blocks built to displace slum dwellers in Mumbai. An epidemic that has lasted for decades in India is completely ignored when designing and building these blocks. “The government-funded report blamed the relaxation of building norms for slumrehousing projects. The result: too many people in buildings stacked too close together, with poorly designed windows that residents keep shut, and lower floors with little natural light or air circulation.” With only three meters between each block, air circulation and sunlight are blocked and the living conditions of these apartments are lower than those of the slums the residents lived in previously. These blocks are designed and built for death. Their proximity to industrial factory exhaust does not make the case any better. An account of a resident convalescing after TB living in Mankhurd housing blocks explains how she cannot open the windows to have fresh air due to the polluted exhaust that would make her condition worse. Conversely, TB is in the air, which means neighboring residents are more susceptible to catching it and have a hard time recovering due to their living conditions. Chawls were a housing typology first developed to house industrial workers and had a similar effect on spreading bubonic plague during the plague epidemic. “Part of the reason for the amnesia is that the historical link between health and urban planning weakened as incomes grew, sewers became the norm, and – most importantly – medicine became better at treating disease.” But TB medicine is not effective at treating the disease and it is also only administered to patients who show active and severe symptoms. The fight to treat TB is long, and architecture is an important tool for overcoming this epidemic. As for Covid-19, it is the presence of packed slums as a result of big developments in the city that Covid-19 quickly spread through the poor population of Mumbai. 1. Sushmita Pathak, “How Bubonic Plague Reshaped the Streets of Mumbai,” NPR (NPR, March 7, 2021), https://www.npr.org/sections/ goatsandsoda/2021/03/07/968856331/how-bubonic-plague-reshaped-the-streets-of-mumbai. “‘Designed for Death’: The Mumbai Housing Blocks Breeding TB,” The Guardian (Guardian News and Media, April 26, 2018), https:// www.theguardian.com/cities/2018/apr/26/mumbai-housing-blocks-breeding-tuberculosis-death.
Evolving Medical Infrastructure
evolving Medical Infrastructure The evolution of the medical infrastructure in Mumbai was severely affected by the three epidemics. During the plague, new temporary hospitals were built in order to treat patients and isolate them. Although at smaller scales, their growth helped with the containment of the epidemic. Similarly, during Covid-19, Isolation centers and temporary Covid hospitals were built by the government in order to quarantine infected patients. This time, the isolation wards were massive, especially after the peak of Covid, the government decided to keep building these isolation wards even when cases were subsiding. In anticipation of another intense wave of Covid. It was a pre-emptive preparation driven by the failure of the government to fully contain Covid, perhaps as a symptom of their inability to shape the housing and urban fabric of the city even after experiencing and dealing with several epidemics before. In the case of Tuberculosis, however, due to the government’s inability to control the epidemic, its numbers were not monitored properly, especially after the main TB wave. At the Slum Rehabilitation housing projects, several Direct Observation Treatment Short (DOTS) centers were set up where residents were tested for TB and treated yet the number of TB cases in these projects was not subsiding . In a way, these treatment centers were the clue that put the puzzle together in understanding the failure of these housing projects. Additionally, the medical field of Tuberculosis was privatized as Tuberculosis hospital groups were established around Mumbai which increased the inaccuracy in the amount of the spread of TB in Mumbai. Because the medical centers and hospitals were privatized, the poor population, who were the ones contacting TB the most, due to their unventilated and poorly lit living conditions, were less inclined to go to these hospitals due to affordability and inaccessibility. Tuberculosis continues to be a major issue in India, and compared to Covid-19, it seems there Is a long way to go in the eradication of this disease. Is the solution in the improvement of the urban and living environments or is it too far gone for any improvement in these to make a change in the number of TB infected population? Is the solution in the publicization of the TB medical centers instead?
1. Vidya Krishnan, Phantom Plague: How Tuberculosis Shaped History (New York: PublicAffairs, 2022), 70-80. Sushmita Pathak, “How Bubonic Plague Reshaped the Streets of Mumbai,” NPR (NPR, March 7, 2021), https://www.npr.org/sections/ goatsandsoda/2021/03/07/968856331/how-bubonic-plague-reshaped-the-streets-of-mumbai.
Politics of Water
politics of water We now look at the history of public health in Mumbai from the lens of waterborne disease and look at the intersection of Covid-19 hotspots with the most vulnerable informal settlements in the city. In 1860, Henry Conybeare put in motion the first piped water in Mumbai, the Vihar Pipeline. This was in direct response to the cholera epidemic and the growing understanding of miasma, the theory that diseases spread through odour. In 1863, the Royal Sanitary commission dictated the death of british soldiers to the faulty water supply and sanitation of the city, and consequestly tanks and wells that were the primary source of water for the city were filled up. Once the plague of 1890s hit the city, the Epidemic Diseases act was put in place that let authorities pump large amounts of seawater into the drainage systems, and officials washed the streets with lime, the “disinfection of dwellings” was also enforced.  This disinfection was largely carried out in cramped quarters, like chawls, and during COVID, slums. 19th century mumbai received the water supply from wells, and tanks, that held extremely contaminated water, often filled with soils or liquid sewage, water from washed utensils. This resulted in the construction of the Tansa pipeline project, in 1892, which became ‘the most important undertaking of the period’, according to The Viceroy, Lord Landsowne and supplied 77 lakh litres per day. But the broken drains of the island city and the enormous quantity of water brought into the city by the Tansa pipeline ensured flooding in the dense central areas Bombay. These floods further led to loss of life and home for years. Covid, another epidemic, whose prevention measures heavily relied on water and its cleanliness. Abhijit Ekbote writes that more than half of the COVID hotspots were within 200 meters of each other and access to water in these areas is as low as 20 to 30 liters per capita per day (lpcd), whereas planned or formal areas enjoy over 135 lpcd, showing a clear relationship between COVID spread, population density and access to water.  While we stress upon washing hands for 20 seconds, a lot of urban areas do not enjoy the luxury of 24 hour piped water, making the control of disease more difficult. Nikhil Anand, Associate Professor of Anthropology at the University of Pennsylvania, argues that it is not the deficiency of water but the problem of leakage and inefficient distribution that ails Mumbai. What then, does investment in water look like?
1. Basia Irland, Ipshita Karmakar, Mridula Ramanna, Sara Ahmed , Water and Public Health, living waters museum, Online. 2. Abhijit Ekbote, Washing away the Pandemic, Living waters Museum, Online. 3. Sushmita Pathak, “How Bubonic Plague Reshaped the Streets of Mumbai,” NPR (NPR, March 7, 2021), https://www.npr.org/sections/ goatsandsoda/2021/03/07/968856331/how-bubonic-plague-reshaped-the-streets-of-mumbai. 4. Image data source: https://www.brookings.edu/blog/up-front/2020/04/16/are-slums-more-vulnerable-to-the-covid-19pandemic-evidence-from-mumbai/
DEATH TRAVELS Now, we look at contested epidemic corpses and burials, and explore how they become sites of debate and confict. Similar to most other epidemic diseases, authorities’ interferences with funerals could provoke protest and violence. At Rander in the Surat district, plague legislation in 1897 limited funeral attendance to fifteen and forced victims to be buried in new cemeteries outside the city, despite any evidence of the disease being spread through corpses.  Evens Lynteris observes that the Indian press reported similar protests against colonial plague measures, provoked by governmental violations of traditional burial and funerary rites, as in early March 1897, when ‘a large meeting of the Mohamedans of Surat’ met to oppose the new and unannounced practices of burying plague victims with quicklime and preventing relatives from reciting funeral prayers over the dead body. During Covid-19, the infections spread too quick for people to voice concern over funerals, however, the plight of the gravediggers was slow to be noted. Gravediggers worked 24/7 shifts as Mumbai’s Covid-19 deaths soared, and space for bodies in this high density urban sprawl reduced. During the peak of Covid-19 in Mumbai, crematoriums were overwhelmed. Mumbai experienced one of the worst waves of covid in India. One in fourteen were exposed to Covid and out of those, one in 782 died. Crematoriums had to adjust their practices and started stacking bodies on top of each other during cremation. Additionally, the demand for wood to burn bodies also increased which led to a lot of ecological damage as authorities gave permission to cut down trees in parks to use as kindling.The site reminded crematorium operators of war, the volumes of bodies brought for burning exceeding the expected. Here again, the containment zones didn’t allow for movement of the family from homes to burial/cremation grounds. While the burial grounds and other infrastructure was in close proximity to areas with high property value, the areas with most cases and containment zones were far. While there were initially restrictions on the the handling of the corpse in COVID, as in other disease ridden bodies, there seems to be no real evidence that the epidemic corpse is a cause for contagion. Can we think about the epidemic corpse as an object beyond the infected body? Can we include cultural rituals and practices when planning for the containment of the virus?
1. Lynteris, C., Evans, N.H.A. (2018). Introduction: The Challenge of the Epidemic Corpse. In: Lynteris, C., Evans, N. (eds) Histories of Post-Mortem Contagion. Medicine and Biomedical Sciences in Modern History. Palgrave Macmillan, Cham. Pooja Biraia Jaiswal, “No Dignity Even in Death for Mumbai’s Covid-19 Victims,” The Week (The Week, June 16, 2020), https://www. theweek.in/news/india/2020/06/16/no-dignity-even-in-death-for-mumbai-s-covid-19-victims.html.
REVERSE MIGRATION Economic activity ground to a halt when the bubonic plague reached Bombay in 1896. Poor mill workers started leaving the city and moving back to their native villages, inadvertently spreading the plague across the subcontinent. In March 2020, Indian Prime Minister Narendra Modi’s announcement of a total lockdown — with just four hours’ notice — triggered a similar migrant exodus, as poor day laborers walked, sometimes hundreds of miles, back to their rural hometowns. In this context, Foucault offers us the model of inclusion of the plague victims, which is a model similar to COVID-19, where containment zones were placed in the centre of the city rather than outside, as in the case of leprosy’s “model of exclusion” .  The purpose of this new disciplinary mechanism was to prevent the spread of the contagious disease by imposing a strict control on the circulation of bodies. While leprosy required the leper’s exclusion from society for putting everyone in danger, the management of the plague placed in the centre of a disciplinary mechanism not only the plague victim but the general population in its totality. This entrapment of the diseased body led to fear and disorder, which was in direct contrast to the state’s attempt at enforcing control over the pathogen. In case of COVID-19, the centre enforced its first lockdow on March 25th, with a mere 4 hour notice to the country. In Mumbai, as in other parts, this caused fear amongst migrant population, that resulted in the pathogen carrying bodies travelling to other states, evetually becoming super spreader virus. The lockdown happened in three phases- Phase 1: 25 March 2020 – 14 April 2020 (21 days) Phase 2: 15 April 2020 – 3 May 2020 (19 days) Phase 3: 4 May 2020 – 17 May 2020 (14 days). During each phase, the population primarily moved from Mumbai to Goa, Uttar pradesh, Jharkhand. Each time, that infected bodies moved, surveillance on the borders increased, instilling more fear on restriction of movement. while leprosy called for distance, the plague and COVID-19 called for more observation and control. In case of Mumbai, we saw power taken away from the individual and moved to state insitutions by way of limiting movement.
1. Michel Foucault and Alan Sheridan, Discipline and Punish: The Birth of the Prison (London: Penguin Books, 2020).
GLOBAL MOVEMENT Epidemics are global. The three epidemics of the Plague, Tuberculosis, and Covid-19, among others, were not unique to Mumbai but because they happened at different times, their movements were contained differently. Additionally, travel across oceans was expensive and rare during the Plague which is reflected in the extent to which it spread worldwide. Tuberculosis on the other hand was controlled through isolation and hospitalization which explains how it was also contained in TB hotspots. That said, TB continues to be a global issue today in China, Africa, and mainly India. Meanwhile, Covid-19 is a different story as we all witnessed. The pathogens that cause epidemics and travel across borders are invisible. Unlike products, the movement of these pathogens cannot be controlled easily. During Covid-19, many countries would not permit travel to and from countries that were experiencing high surges of cases. Globalization is the reason why Covid-19 was able to travel as easily as it did. The ease and affordability of flying from country to country allowed for the transmission of Covid-19 and its proliferation in almost every country in the world. Although globalization is the result of conglomerates originating and thriving in developed and economically thriving countries, its impact was felt the most by the lower class or poorer population of the world due to the unsanitary and difficult living conditions. This is not only applicable to the spread of illness and the high rates of deaths in said countries, but also to the economic instability and difficulty in coming out of that and regaining power and control over the medical, economic, and social conditions. This is directly related to the concept of a global city. Even though Mumbai is full of millions living in poor conditions, it is also home to some of the wealthiest people in the world who control most of the industries in India. The dichotomy between the rich and poor has shaped the medicalization of Mumbai immensely.
“A Foucauldian Enquiry in the Origins of the COVID-19 Pandemic Management (Critique in Times of Coronavirus),” Critical Legal Thinking, May 11, 2020, https://criticallegalthinking.com/2020/05/11/a-foucauldian-enquiry-in-the-origins-of-the-covid-19-pandemic-management-critique-intimes-of-coronavirus/. “The Impact of Globalization on Infectious Disease Emergence and Control,” January 2006, https://doi.org/10.17226/11588.
ISOTROPIC URBANISM Can isotropic urban design bridge the gap of politics of inequitable vulnerability? In context of plague, as for covid, WHO states that “In order to effectively and efficiently manage plague outbreaks it is crucial to have an informed and vigilant health care work force (and community) to quickly diagnose and manage patients with infection, to identify risk factors, to conduct ongoing surveillance, to control vectors and hosts, to confirm diagnosis with laboratory tests, and to communicate findings with appropriate authorities.” In cities like mumbai, where the urban fabric is organic and uncontrolled, i believe that measures of control, surveillance as adopted during Plague and Covid-19 can and have exacerbate the spread of the disease. In Cerda’s Barcelona plan, we see isotropy in all aspects of what he calls the ‘distribution of urban equipment, within the grid city. Here, he explains how districts are arranged, and within them how cemeteries, hospitals, parks, and industries are arranged at equal distances. Distributed centres and urban equipment were his constituents for isotropic urbanisation- this is where the formation of an octagonal grid came in place. We see that roads(whether private or public), were an important aspect of the execution of isotropy in any city, since they are connectors for the urban equipment and dictate the access. In our mapping for urban environements, can we look at pedestrian pathways instead of vehicular roads and circles that indicate abstract distance, so that accessiblity is ensured for all sections of society. Adopting this for the future epidemic city could ensure that the epidemic is looked at as a space of material production, instead of a passing entity.
Spiral of Doom
SPIRAL OF DOOM Looking at globalization, we see the phenomenon of the Anthropocene and how it affects many aspects of how we observe, experience, and live in this world. When Sabine Barles concluded her paper on “The nitrogen Question” in Paris, she left the reader questioning how the anthroposphere is the new lens through which the nitrogen question should be approached in the future . The same can be said about epidemics and how over the century between which the bubonic plague and Covid-19 immensely changed Mumbai, the experience and reaction in relation to the urban environment were severely different. That said, the improvement of the urban environment after the Plague, the attempt at creating new and sanitary housing for the poor after Tuberculosis, and the process of containment and lockdown policies during Covid-19 don’t seem to have made much of a difference in the amount of impact each epidemic had on the population of Mumbai. One might classify each of the changes as, urban, architectural, and related to policy, or better yet a mixture of all three. But to really understand how one might deal with an epidemic in the best one, is it worth the research to look into countries such as New Zealand or China to understand how a mixture of these three efforts can lead to better results? In the case of Mumbai, the population is constantly growing, and spaces for living in the center of the city are decreasing. The spread and urbanization of the city are visibly seen in the urban growth and yet living conditions remain poor for most. Is it possible to create a formula that combines urban, architectural, and policy changes in order to face the future epidemic? In a world that is constantly split between economic power, environmental degradation, and social instability, what is the future anthropogenic response to the cycles of epidemics that won’t stop coming?
1. Sabine Barles and Laurence Lestel, “The Nitrogen Question,” Journal of Urban History 33, no. 5 (2007): pp. 794-812, https://doi. org/10.1177/0096144207301421, 809. Vijay Prashad, “Government Failure and Healthcare Privatization at Root of India’s Covid Crisis,” People’s World, April 26, 2021, https://www.peoplesworld.org/article/government-failure-and-healthcare-privatization-at-root-of-indias-covid-crisis/.
bibliography “Absolute Hell: The Toxic Outpost Where Mumbai’s Poorest Are ‘Sent to Die’.” The Guardian. Guardian News and Media, February 26, 2018. https://www.theguardian.com/cities/2018/feb/26/ mumbai-poor-mahul-gentrification-polluted. Al Jazeera. “Photos: Mass Funeral Pyres Reflect India’s Covid Tragedy.” Gallery News | Al Jazeera. Al Jazeera, April 26, 2021. https://www.aljazeera.com/gallery/2021/4/26/mass-funeral-pyres-reflect-indias-covid-crisis. Barles, Sabine, and Laurence Lestel. “The Nitrogen Question.” Journal of Urban History 33, no. 5 (2007): 794–812. https://doi.org/10.1177/0096144207301421. Brink, Susan. “Before Covid, TB Was the World’s Worst Pathogen. It’s Still a ‘Monster’ Killer.” NPR. NPR, February 13, 2022. https://www.npr.org/sections/goatsandsoda/2022/02/13/1079505737/before-covid-tb-was-the-worlds-worst-pathogen-its-still-a-monster-killer. “‘Designed for Death’: The Mumbai Housing Blocks Breeding TB.” The Guardian. Guardian News and Media, April 26, 2018. https://www.theguardian.com/cities/2018/apr/26/mumbai-housing-blocks-breeding-tuberculosis-death. Dhamnetiya, Deepak, Priyanka Patel, Ravi Prakash Jha, Neha Shri, Mayank Singh, and Krittika Bhattacharyya. “Trends in Incidence and Mortality of Tuberculosis in India over Past Three Decades: A Joinpoint and Age-Period- Cohort Analysis,” 2021. https://doi.org/10.21203/rs.3.rs-342519/v1. “A Foucauldian Enquiry in the Origins of the COVID-19 Pandemic Management (Critique in Times of Coronavirus).” Critical Legal Thinking, May 11, 2020. https://criticallegalthinking.com/2020/05/11/ a-foucauldian-enquiry-in-the-origins-of-the-covid-19-pandemic-management-critique-intimes-of-coronavirus/. Foucault, Michel, and Alan Sheridan. Discipline and Punish: The Birth of the Prison. London: Penguin Books, 2020. Foucault, Michel. The History of Sexuality. London: Penguin Books, 2020. Diamond, Jared M. Guns, Germs, and Steel : the Fates of Human Societies. 20th Anniversary edition. New York: Norton, 2017. Harper, Kyle. Pathogens and the Anthropocene: Germs, Genes, Geography, Part 2: Inhabiting the anthropocene, online. “The Impact of Globalization on Infectious Disease Emergence and Control,” 2006. https://doi. org/10.17226/11588. Jaiswal, Pooja Biraia. “No Dignity Even in Death for Mumbai’s Covid-19 Victims.” The Week. The Week, June 16, 2020. https://www.theweek.in/news/india/2020/06/16/no-dignity-even-indeath-for-mumbai-s-covid-19-victims.html.
John, T. J., Vipin M. Vashishtha, and S. M. John. “50 Years of Tuberculosis Control in India: Progress, Pitfalls and the Way Forward.” Indian Pediatrics 50, no. 1 (2013): 93–98. https://doi.org/10.1007/ s13312-013-0021-4. Kelkar, Madhu. “Sanitizing Heritage—Hydraulic Water Supply and the Erosion of the Traditional Water Management System in Colonial Bombay City (1860–1947).” Journal of Heritage Management 4, no. 2 (2019): 123–40. https://doi.org/10.1177/2455929619877014. Krishnan, Vidya. Phantom Plague: How Tuberculosis Shaped History. New York: PublicAffairs, 2022. Lynteris, Christos, and Nicholas H. Evans. “Introduction: The Challenge of the Epidemic Corpse.” Histories of Post-Mortem Contagion, 2017, 1–25. https://doi.org/10.1007/978-3-319-629292_1. Latour, Bruno. “Is This a Dress Rehearsal?” Critical Inquiry 47, no. S2 (2021). https://doi. org/10.1086/711428. Lynteris, C., Evans, N.H.A. (2018). Introduction: The Challenge of the Epidemic Corpse. In: Lynteris, C., Evans, N. (eds) Histories of Post-Mortem Contagion. Medicine and Biomedical Sciences in Modern History. Palgrave Macmillan, Cham. Lynteris, Christos, Nicholas H. A. Evans , and Samuel Cohn. “Fear and the Corpse: Cholera and Plague Riots Compared.” Essay. In Histories of Post-Mortem Contagion: Infectious Corpses and Contested Burials, 55–81. London: Palgrave Macmillan, 2018. Lytras, Spyros, Wei Xia, Joseph Hughes, Xiaowei Jiang, and David L. Robertson. “The Animal Origin of SARS-COV-2.” Science 373, no. 6558 (2021): 968–70. https://doi.org/10.1126/science.abh0117. Mahadev, B, and Prahlad Kumar. “History of Tuberculosis in India.” Practical Approach to Tuberculosis Management, 2006, 1–1. https://doi.org/10.5005/jp/books/10639_1. Nooreyezdan, Nadia. “How the 1896 Bombay Plague Changed Mumbai Forever.” Atlas Obscura. Atlas Obscura, May 18, 2020. https://www.atlasobscura.com/articles/how-bombay-plaguechanged-mumbai. Pathak, Sushmita. “How Bubonic Plague Reshaped the Streets of Mumbai.” NPR. NPR, March 7, 2021. https://www.npr.org/sections/goatsandsoda/2021/03/07/968856331/how-bubonicplague-reshaped-the-streets-of-mumbai. “Plague.” World Health Organization. World Health Organization. Accessed May 12, 2022. https:// www.who.int/news-room/fact-sheets/detail/plague. Prashad, Vijay. “Government Failure and Healthcare Privatization at Root of India’s Covid Crisis.” People’s World, April 26, 2021. https://www.peoplesworld.org/article/government-failure-and-healthcare-privatization-at-root-of-indias-covid-crisis/. Rao, Vyjayanthi V. “Beneath the Tent of a Horizonless Sky - Architecture - e-Flux.” e-flux. Accessed May 12, 2022. https://www.e-flux.com/architecture/conditions/296455/beneath-the-tent-of-ahorizonless-sky/.