Recovery, Renewal, Resilience

TMB Issue 38 discussed the importance of community involvement in tackling disease outbreaks and presented the recommendations set out by the Independent Panel for Pandemic Preparedness and Response. This briefing offers examples of good practice in community participation during the COVID-19 pandemic. Consider:

• Tanzania: local government co-produced infection control measures with business leaders based in markets to integrate leaders’ understanding & knowledge of the challenges of implementing such measures
• Nigeria: the “community informer model” was employed by local authorities for COVID “surveillance, tracing and monitoring” – community informers are key trusted individuals in a community (e.g. faith leaders)
• Pakistan: community volunteers “set up quarantine wards, manufactured and provided free protective suits for medics”, and distributed food to vulnerable people
• India: Community volunteers came together to investigate and identify unknown (“hidden”) COVID-19 fatalities. The volunteer group comprised of expert physicians and data analysts who developed comparisons of official health data and other reports. This encouraged a review of the national death audit process and resulted in improvements in the process so that COVID-19 deaths were accurate and transparent
• USA: Volunteers built a public “Testing Site Locator” app which visualized the geographical location of testing centres to support collection of testing centre-related information and dissemination at the national level. This supported people to locate the nearest available testing centres and also the “health system to plan and distribute centres more effectively”

The pandemic, and previous disasters, have evidenced that communities play a crucial role when preparing for, responding to and recovering from, crisis. Communities and civil societies should be “partners early on in the design, planning, implementation, and assessment of preparedness and response efforts on all levels”, particularly at the local level. We have covered community participation and co-production with communities in various briefings, see TMB Issue 38; Issue 34; Issue 33.

Vulnerable groups of people are those that are disproportionately exposed to a risk. This can change dynamically and it is not a simple process of dividing populations into two groups of 'vulnerable' and 'not vulnerable'. Amid the pandemic, vulnerable groups have emerged from a diversity of communities. They are not only older people, those with ill health or disabilities, or homeless persons, but also people from a range of socioeconomic groups who might 'struggle to cope financially, mentally or physically' with crises precipitated by the pandemic. Consider:

• If the definitions and categories we use to identify vulnerable people, and consider their needs, adequately represents their lived experiences - whether their vulnerability existed prior to COVID-19, has been exacerbated by it, or has been newly created by it?
• Identify the people behind the 'vulnerable' label - who are they, where are they, and why are they vulnerable? - to increase our understanding of the person and the conditions or environment (root causes) that may be making them vulnerable to certain risks
• If there are different levels/spectrums of vulnerability, do we need to organise vulnerability with respect to different forms of risk (e.g. immediate risk to life, risk to mental health, social/financial security, geographic location)?
• Assessing those who may have been defined as vulnerable prior to COVID-19 and the conditions associated with this vulnerability, those who have become newly vulnerable as a direct result of COVID-19, and what factors lead to these people/groups becoming vulnerable
• The risk of under-supporting those who face severe risk if we rely only on our previous (to COVID-19) assumptions or understanding of vulnerability
• Whether re-defining vulnerability may support more effective recovery and renewal strategies e.g. classifying vulnerable groups according to risk levels/spectrums, creating vulnerability indexes and identifying the root cause of each
• Recovery strategies should aim to provide transactional aid to alleviate the negative effects of vulnerability exacerbated or caused by the pandemic
• Renewal initiatives should address the root cause of vulnerabilities through transformational initiatives that aim to prevent people from becoming vulnerable

COVID-19 has dominated news, media, and local and national government communications for the best part of a year since the pandemic began. One study found that excessive media use was associated with negative psychological outcomes, such as anxiety and stress. Positivity can aid stress management and reduce levels of anxiety/depression. Consider:

• Demonstrate that there is a world outside of COVID-19 by communicating positive stories unrelated to COVID-19
• Encourage more positive COVID-19 stories to come through, for example:
  • Create a local news special that celebrates the effort of local volunteers or local government during the pandemic
• Use communication channels (e.g. social media/newsletters) to communicate positive stories:
  • Invite local community members to share positive news and stories that can be shared and promoted through these channels
  • Invite school children to draw and write positive messages and hang them on the trees/fences of local parks/buildings
  • Encourage people to take regular breaks from consumption of COVID-19 news (signpost to community groups that may be running weekly bingo/quizzes online)
• Create a call-to-action for local volunteers and begin inviting the community to take part in and create new positive local initiatives that are focused on recovery and renewal from COVID-19

While restrictions are gradually eased, religious festivals will also take place, e.g. Easter, Ramadan, and Ridvan. These occasions are often celebrated through community gatherings and special religious services/activities that enhance connectivity for people. As traditional celebratory activities have been unable to go ahead over the last year, and the message of lockdown easing takes hold, consider the need to:

• Review local plans that were in place during religious festivals in 2020:
  • Consult with community members when revising previous plans, to understand what has gone well and what could be improved this year
  • Support communities in the planning of COVID-safe celebrations for 2021, e.g. by allowing worship to be held in community spaces such as parks or public gardens
• Recognise and acknowledge the influence of faith and faith leaders in building trust and influencing behaviour:
  • By directly engaging in conversations with communities about religious celebration planning, other conversations can emerge, e.g. vaccination safety, concerns and attitudes towards uptake

Important parts of recovery are mourning the loss of loved ones, and remembering those who have tragically lost their lives through the pandemic. Consider opportunities to memorialise, including:

• Develop a website dedicated to those who have died during the pandemic, allowing families to create obituaries, find a network of support, and help those who may feel alone in their grief
• Hold online memorial services to enable people to come together and remember loved ones
• Build and dedicate a memorial to those who have died, e.g. St Paul's Cathedral will build an inner portico at the North Transept and dedicate it as a physical memorial to those who have died due to COVID-19
• Invite those of all faiths and none to join in remembering loved ones to offer a safe and inclusive space of refuge, solace and hope

To ensure appropriate memorialisation, consider:

• coproduction of memorialisation options with communities
• collaboration with partners that specialise in supporting those who have been affected by bereavement
• whether the memorial is to those who have died, those who have been otherwise affected by the crisis, and/or those who have helped in the response to the crisis

COVID-19 has shed new light on the way in which countries respond to, and recover from emergencies. This includes COVID-19 specific advice and broader lessons about emergency preparedness and management. For example, previous guidance on volunteer management has traditionally assumed a point of convergence at a disaster site, while this still holds true for many emergencies e.g. floods, lessons from COVID-19 demonstrate that volunteer management may also be dispersed, large-scale and without face-to-face contact. Consider how lessons from COVID-19 may help to revise emergency plans:

• Conduct a 'stock take' of current emergency guidance, and consider what may be missing or no longer fit for purpose
• Implement debriefs, peer reviews and impact assessments, drawing on expertise from local government and emergency practitioners, to evaluate how well current guidance worked and where it needs revising
• Consider that emergency planning must remain relevant to specific types of emergencies, but that broader lessons from COVID-19 can help strengthen guidance e.g. issues of inclusion such as gender, ethnicity, sexuality; health and socio-economic disparities and vulnerabilities; volunteering capacity; supply chain stability; green agenda; and partnerships arrangements
• Draw on resources beyond government guidance from global networks e.g. Resilient Cities Network's revised toolkit which builds recovery from COVID-19 into a wider resilience agenda for a safe and equitable world, and resources from International Organization for Standardization (ISO) which is developing new recovery standards in light of COVID-19 lessons (ISO 22393)

The impacts of COVID-19 have seen millions of children worldwide lose months of face-to-face education with their teachers at school. Globally, children continue to be sent home from school due to outbreaks or face complete school closure. The availability of adequate digital technology and internet access at home has a huge impact on the ability of children to engage in e-learning. The rapid shift to e-learning prompted by the pandemic has resurfaced long-standing issues of inequality, including the digital divide once bridged by schools. Consider:

• Shortening online lessons by a small margin to create a space for one-to-one discussions or problem solving with tutors that are often missing when lessons go online
• Household disparities in access to the internet and technology and the impacts this may have on girls. If there is competition in the home over resources it may be that the male child is given priority access while girls are increasingly asked to support with domestic chores rather than complete school work. Consider how schools can be supported in providing technology or access to technology to vulnerable children
• Ensure teachers are trained to use new technology for online teaching. This includes making use of more innovative modes of engagement beyond a lecture e.g. interactive voting, message boards etc.

Planning for the mass gathering of people after a disaster amid COVID-19 is essential to mitigate the transmission of disease. Mass gatherings may occur at health facilities, evacuation shelters, or distribution centres supporting the immediate needs of those affected by a disaster. Consider adapting plans for mass gatherings at sites such as health facilities to accommodate COVID-19 safety measures including:

• Identify facilities for phased relocation of hospitalised patients to manage the influx of new patients considering risks of COVID transmission
• Outline capacity arrangements for on-site emergency care, and special care options for people with pre-existing conditions who are at increased risk of the virus
• Identify resources for further disease outbreaks to counter the increased burden of additional infections and strains on resources (e.g. PPE) that are needed to mitigate COVID-19 transmissions
• Revise estimates of requirements for shelters and transportation for mass movement of people. Increase estimates by at least a 3-times to account for physical distancing
• Maintain an inventory of available dwellings (e.g.school buildings, community halls, places of worship) that will allow enough space for socially distance emergency accommodation
• Plan for distribution centres that distribute basic necessities such as food and medicine. Consider capitalising on community engagement at these sites to continue pandemic risk communication

Information asymmetry means that one party has more or better information than the other. During COVID-19 information asymmetry has led to food waste and unsustainable farming practices as information about food production is only available to a small number of people in the supply chain. Decentralised information that includes small-scale and flexible production can support more uncertain operating environments such as those needed during COVID-19. Producers and retailers can consider how to increase the flexibility and sustainability of their supply chains by:

• De-concentrating markets and supply chains by ensuring they are not concentrated in a small number of large companies by using online platforms that create more access for businesses to sell goods and provide producers and consumers more options:
  • In Peru, 80% of merchants at a major market tested positive for COVID-19, but authorities felt closing the market would result in significant food shortages as the supply was concentrated. However in India, by selling through digital platforms, coffee producers were able to keep selling, and obtain significantly higher prices than usual
• Tracing food throughout the supply chain in a decentralized manner creates opportunities for safer, more sustainable food to protect from zoonotic disease:
  • In Uruguay, foot and mouth transmission was mitigated through de-centralized information sharing where the system would assign an identification code to cattle, letting you know its treatment and location on the production chain in real time
• Disseminating open data throughout the complex food system to: correct information asymmetries, encourage innovation, and increase efficiency of public spending

Government organisations in India have been directing substantial effort to tackling the crisis. Part of this effort has involved producing a series of case study articles on how cities have tackled COVID-19. The actions those cities have implemented contain lessons which are transferable on: managing the spread of the virus, the use of technology, communication approaches, approaches to governance, and the participation of the community. Sharing case studies is a great contribution to the local, national and international effort to tackle the virus. Consider preparing case studies similar to:

• In Pune, how it took a people-based approach to responding to hotspot areas: https://www.cdri.world/casestudy/response_to_covid19_by_pune.pdf
• In Karnataka, how it worked with the IT sector to develop its technological approach to responding to the effects of COVID-19: http://cdri.world/casestudy/response-to-covid19-by-Karnataka.pdf
• In Goa, how it repurposed manufacturing capacity to produce hand sanitizer, and recovering production capacity of its pharmaceutical industry: http://cdri.world/casestudy/response_to_covid19_by_goa.pdf
• In Odisha, how women lead the fight against COVID-19 and child-focused interventions: http://cdri.world/casestudy/response-to-covid19-by-odisha.pdf

In all, there are eight case studies on the site, all detailing different approaches to responding to COVID-19.

Other case studies to consider:

Lahaul and Spiti:

http://cdri.world/casestudy/response_to_covid19_by_lahaul-and-spiti.pdf

Jharkhand:

http://cdri.world/casestudy/response_to_covid19_by_Jharkhand.pdf

Madhya Prades:

http://cdri.world/casestudy/response_to_covid19_by_madhya_pradesh.pdf

To prepare for the impact of a natural disaster alongside COVID-19, research should focus on modelling natural hazards beside epidemiological risks. This can inform public health responses to manage, for example, the dual challenges of dealing with the effects of flooding and preventing localised COVID-19 outbreaks). Consider pre-emptive strategies to counter the compounded risks of COVID-19 and natural hazards:

• Identify possible pandemic-natural disaster hybrid scenarios including worst-case scenarios
• Work with multiple organisations to build new hybrid forecast models that combine existing pandemic projection models and natural hazard forecasting
• Consider seasonal weather forecasting models in advance and their impact on transmission and health and response capacity
• Re-design response plans to focus on COVID-19 restrictions e.g. impacts on emergency aid distribution, involvement of volunteers, access to PPE, providing shelter, food distribution
• Exercise the impact of concurrent emergencies to identify key learning and integrate that learning refreshing plans in the light of COVID-19

In Pune, an 'Action Plan for Hotspot Areas' was developed in which the local police force supported implementation of contact tracing and wide-spread testing, water and sanitation support, food and shelter planning and public awareness. Teams carried out local door-to-door check-ups of all households in the hotspot areas. Consider how to take public health interventions and information into the community:

• Establish dedicated COVID care booths in hotspot areas
• Allot dedicated ambulances in case serious cases are detected
• Designate, specific localised teams within the hotspot area, including police, medical staff and community engagement officers to conduct thorough, localised door-to-door check-ups of all households in the hotspot areas (including virus testing)
• Use teams to distribute medication to those who need it, and to provide discharge public health packages. These may include:
  • A packet of masks
  • Sanitizer
  • Soap
  • Cleaning products
• Ensure comprehensive medical, nutritional, and psycho-social care for those identified as COVID-19 positive
• To maximise identification of cases, adopt standardized systems for testing

Reference: representative of the Australian Department of Justice and Community Safety

Heat waves pose a particular risk to those already vulnerable to COVID-19 including the elderly (>65 years), and those with pre-existing health conditions (e.g. cardiovascular, pulmonary, kidney disease), and essential workers. COVID-19 and heat can put strains on health, and on surge capacity plans for hospitals to deal with concurrent risks. Additionally, people may expose themselves to other risks such as limiting social distancing measures to check in on older neighbours. Consider how to:

• Collaborate with formal and informal social service systems to identify and reach vulnerable individuals with information and support to protect them
• Increase the use of telephone outreach programmes for daily check-ins with the most vulnerable
• Increase enrolment of vulnerable people into check-ins and resources to run the system
• Review plans for in-home safety checks. Ensure the health and safety of staff, volunteers and the people they visit through training and the provision of PPE
• Identify high-risk communities by reviewing where local heat islands occur, and where this may overlap with high incidence or risk of COVID-19
• Assist efforts to review and expand social safety net programmes to support at-home cooling strategies for the most vulnerable e.g. utilise expanding energy subsidies to ensure households can afford home cooling measures

Further information on how to carry out public outreach on heatwaves during the COVID-19 pandemic can be found here: http://climatecentre.org/downloads/files/HWG%20appendix%20Extreme%20Heat%20during%20the%20COVID-19%20pandemic.pdf

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

In Pune, 7,500 Special Police Officers (SPO) were given specific powers to help manage areas which had seen a rise in COVID-19 infections. They provided an important role in managing the spread of the virus, in partnership with the community and public health officials. Consider how to:

• Implement a standard operating procedures which include the police in public health interventions for COVID-19
• Use efficient reporting structures, and easy-to-use methods of communication (such as WhatsApp) to manage situations in real time
• Utilise the police to help provide essential response services (e.g. to those who are shielding), and in spreading awareness of social distancing and lockdown norms (e.g. by being out in public or by going door-to-door)
• Utilise the increased widespread interactions of the police with the community for voluntary operations supporting COVID-19 interventions

The avoidable death framework (ADF) considers avoidable deaths from disasters, including pandemics which are amenable (treatable), preventable, or both. Amenable deaths require timely and effective healthcare. Preventable deaths can be avoided through public health interventions such as epidemiology and surveillance, outreach, screening and health teaching.

Amenable death research can analyse:

• Waiting times and the impacts of delays on those who receive and those who give care e.g. the time interval between onset of symptoms and seeking medical interventions; the time interval between the arrival of the patient and commencing treatment
• Effectiveness of the health system including outcomes that are affected by the way the system works e.g. the application of COVID-19 treatment protocol. More amenable (treatable) deaths in a given region would indicate a less effective system

Preventable death research can analyse:

• Effectiveness of health interventions e.g. hand hygiene, respiratory etiquette, social distancing, crowd control and lockdown
• Indirect deaths e.g. hunger, suicide

Consider how amenable and preventable deaths could be further effectively avoided through disaster risk governance which includes:

• Risk communication
• Coordination, collaboration and cooperation between the government and the general public; between governmental departments; and between the government and civil societies/multilateral organisations

By circulating through social media, encrypted messaging services, online discussion boards and face to face interaction. To achieve this, organisations might consider:

• Identifying fake news and actively debunking it on own social media accounts and public display boards
• Closely monitor automated systems for errors. In Australia the CovidSafe App alarmed and confused users with a message telling them that they had contracted coronavirus when trying to upload their information, despite not being tested. Additionally, in Ukraine, residents attacked busses with evacuees from China after a hoax email falsely attributed to the Ministry of Health suggested some carried the virus
• Supporting the public to think critically about, question and fact-check information they receive
• Working with community leaders to circulate useful, accurate information
• Monitoring and evaluating the impact of their own communication strategy, possibly working with partners such as universities to undertake social media analytics

Consider:

• Images are a useful tool for educating and reassuring children about COVID-19 and how they can stay safe
• Images are a useful tool to convey messages, or practices i.e. effective hand washing, those who speak another language and for those who are not able to read
• Images are a useful tool to provide information to people with disabilities to communicate ideas and practices in an accessible format

This lesson was offered by a Digital Transformation Specialist in India during project data collection.

Lockdown could be eased through:

• Gradual school reopening because children are at low risk, and there are high economic and educational costs to school closure
• Gradual return to work with younger people first (age segmentation) as they are relatively less at risk of COVID-19 than older people
• Gradual return to work by sector/workplace (sector segmentation) as some pose less risky than others
• Gradual release of lockdown by geography (geographic segmentation) as COVID-19 cases and NHS capacity vary across regions

Consider risk assessments for each of these options, since there are challenges with each e.g. cross-sector supply chains limit the benefits of sector segmentation.

Consider the following factors in the assessment:

• Costs vs. benefits
• How quickly can it be done?
• Will it be seen as fair?
• How practical is it?
• Can it be enforced?

Delhi, Mumbai and Calcutta have seen reduction in Nitrogen oxides (NOx) and Sulphur oxides (SOx). Bird species are recovering and animals are reclaiming roads and beaches. Rainfall patterns also appear to be changing. Consider the impact on the environment when production and supply chains recover.

Reference: Government of India representative