Recovery, Renewal, Resilience

Vaccination certification for COVID-19, sometimes referred to as immunity/vaccine passports, are being considered by some countries as a strategy to relax the strict measures that have been imposed on society over the last year. The document is designed to certify people as immune to COVID-19 based on vaccination. Consider the ethical issues associated with varying restrictions on individual liberties based on possession of a vaccine certificate. Consider:

• If a vaccination certification programme could cause unequal treatment of individuals by segregating members of society into different tiers of infection risk and contagiousness, for example:
  • Members of groups who live with systemic discrimination and marginalization may face more barriers to accessing particular areas of society or activities if they are not certified as vaccinated
  • Differences in exposure, access to health care and vaccination certification may lead to some groups having higher or lower proportions of vaccine-certified people
• If the application of vaccination certification should only be used with existing precautions and should not prevent non-vaccine certified people from accessing areas or activities, e.g. people who have not received a vaccination certificate should not be prevented from travelling but may be required to take a test/quarantine on arrival as per the existing precautionary measure
• Whether vaccinations certifications should:
  • Impact a person's ability to exercise fundamental rights such as voting, accessing and social care or education
  • Cause an increase in cost or burden for vaccine-certified individuals, e.g. frontline healthcare workers who are vaccination certified should not be expected to manage more work
• If the perceived benefits of vaccine certifications could increase the risk of people increasing their exposure to intentionally become infected and receive a certificate, which poses risks to an increase in community spread and could potentially cause harm to others
• The perceived value of vaccine certificates and counterfeit market activity/certificates
• How to mitigate implementation risks, e.g. certification being managed by certified bodies, results being processed and confirmed by licensed laboratories, and certificates being issued by health authorities
• To protect personal data and minimize breaches of confidentiality, legal and regulatory measures should be put in place to limit the access to data by governmental authorities

Organisations must ensure they, their employees, and people who visit their workplace are complying with COVID-19 safety measures e.g. wear a mask, sanitize and maintain social distancing. As time goes on and people become fatigued with regulations, standards may slip. It is the organisation's responsibility to ensure due diligence in identifying risks and mitigating them. This may require increased surveillance of working practices and trained Compliance Officers who specialise in encouraging compliance. Consider that Compliance Officers can:

• Ensure that COVID-19 safe practices in the workplace are updated, communicated, trained, and monitored effectively
• Constantly seek good practices from elsewhere and systematise these to enhance protection of people at work
• Balance legal requirements with response actions to ensure safety comes first
• Be a single, expert point of contact to address issues related to COVID-19 in an organisation
• Constantly evaluate workplace compliance with the regulations and report on breaches

The Circular Economy calls for all materials in manufacturing to be reused, recycled or biodegradable. COVID-19 has raised new questions about plastics use and sustainability of, for example, using single-use surgical gowns, masks and gloves. Consider:

• investing in new protective materials that are reusable or biodegradable and that replace harmful plastics
• the environmental friendliness of cleaning products that will end up in waterways and oceans
• the potential health implications of contamination

This lesson was contributed to by a Chief Resilience Officer in Denmark, and the source below.

In one city in Denmark, a number of meetings are being held with local businesses to support local business and economic regeneration. These include:

• Weekly meetings with the local business association and the Mayor to explain the citys economic situation, advise on help packages for businesses, and explain business regeneration schemes
• Additional meetings to ask local businesses what type of projects they need to have funded immediately to inform local government's funding agenda
• Meetings to allow local businesses to bid for local regeneration projects funded by local government. These have included retrofitting schools with solar panels, renovation of local high street shops and buildings, and road works
• Local government have committed to paying invoices to business at the beginning of projects rather than the end, to provide businesses with more liquidity

This lesson was contributed by a Chief Resilience Officer in Denmark during project data collection.

In Denmark, an urban development project considers:

• Mitigating loneliness e.g. day-care for children has been integrated into a nursing home
• Bike lanes that link the suburbs to larger cities
• Availability of accessible green spaces to support mental and physical wellbeing
• Social housing to improve quality of life of poor or marginalized people. This includes a health focus on proximity living which can increase risk of disease
• Renewable energy supply to the building to provide energy security which is important during emergencies

This lesson was contributed by a Chief Resilience Officer in Denmark during project data collection.

Research in Denmark and China demonstrated that women were more adversely psychologically impacted by COVID-19 than men. In China, survey respondents demonstrated evidence of post-traumatic stress disorder (PTSD) Consider:

• Mental health services that are tailored for different genders to accommodate a safe space to discuss needs
• Ensuring increased access to mental health services through online systems and telephone calls
• Hand hygiene, mask-wearing and confidence in doctors have been observed to reduce psychological impact

The impact of school closures, especially nursery and primary schools, carries high social and economic costs as learning is interrupted, parents are unprepared for home schooling and for the impacts this has on childcare. Working parents may have no choice but to leave children alone when they have to work, or to miss work to take care of their children. This can impact child nutrition, social isolation and increase children's exposure to violence and exploitation. Schools in Denmark, China, Korea and Taiwan, have begun to open. In Korea, the government has incorporated the concept of digital classrooms into current educational legislation to develop a 'future-orientated' approach to online education.

A number of measures for adjusting the school day have been identified:

• Consider staggering the school day so children arrive in different time blocks. In Demark the start and end of the school day is split into three 15-minute windows, and the day finishes at 2pm to reduce risk of new rules feeling oppressive. This helps reduce crowding at the school gates
• Parents are not allowed inside the building and must collect their children at outside while observing social distancing rules- consider marking lines, and creating one-way systems for parents to collect children in playgrounds
• Consider rotating year groups into schools for a week at a time
• Consider changes to lesson delivery e.g. restrict movement of teachers one teacher per class. Consider how this may impact which classes teachers will need to deliver and how this can be effectively timetabled. Also consider making class sizes smaller by splitting classes in two and have taught rotas between staff
• Limit handling of children's books through increased self-marking activities
• Provide allocated desks to each child with social distancing requirements in place. Be pragmatic and realistic about how to ensure social distancing when children are not at their desks, e.g. how they will traverse corridors or stairways, how to manage behaviour at break times
• Consider reducing creative activities such as art, and 'carpet time' for primary school children. Or requesting personal supplies i.e. scissors or paintbrushes are brought in. Consider how creative classes can be taken outdoors to make learning fun, and safer
• Stagger lunch breaks and class times to avoid the risk of too many people moving through the school at one time

Alongside restructuring the school day, re-opening of schools requires attention to infrastructure. This may include:

• Installing additional handwashing facilities so children have to wash hands before entering school and then throughout the day - in Denmark children wash their hands six to eight times a day
• Measure temperatures before students are allowed on site. In China some schools have installed a system at the entrance of the school to record temperatures. Any person displaying a temperature above 37.3 degrees is taken for further temperature checks
• Installing hand sanitisation stations and bins for discarded masks in and around the school site. China also has isolation areas should anyone be taken ill during the course of the day
• Utilising additional buildings such as church halls or community centres if the school does not have the required space to maintain social distancing and its cohort of students
• Accounting for reduced workforce availability due to illness, and PPE requirements

There is an urgency to return pupils to schools to support their health and well-being and to relieve pressures on working families who may be experiencing increased financial hardship as a result of having children at home. It is important that robust scientific evidence is used to make such decisions; a study from Germany found children were as likely to spread coronavirus as adults which suggests caution is required. However, lessons from Denmark, China and Taiwan could provide useful insights into practical adaptation and innovation to support a safe return to school.

To read this case study in its original format with references etc., follow the source link to TMB Issue 7 p.16-17.