Recovery, Renewal, Resilience

COVID-19’s prolonged nature, and the intensity of measures taken to respond to it, have brought major disruptions with lasting consequences. Our relationship to mortality and death has been redefined, not least by disruption to traditional rituals that enable societies to cope with and overcome major trauma. A recent webinar, organised as part of the Manchester Webinar Series, considered how we might collectively remember the COVID-19 pandemic. Our speakers reviewed lessons from the past on building resilience through coproduced commemoration and discussed key considerations for policy makers and communities in planning to recognise and remember the huge losses caused by COVID-19. Consider the key lessons offered by our speakers:

• There is no one way to remember. Unlike most disasters, each individual’s experience of COVID-19 is a personal one and commemoration activities will require careful consideration around ways to bring people together to collectively to remember while also recognising the uniqueness of everyone’s experience
• The co-production of activities can provide a way to ensure commemoration is inclusive of all of those who would like to be involved, to create a collaborative and bottom-up as well as top-down delivery of remembrance, and enable communities to take ownership of their remembrance
• Consideration for who will lead and be involved in these conversation will be really important, to mediate, and to support communities to find ways to compromise on differing views and perspectives on commemoration
• The timing of commemoration is a challenge, considering that COVID-19 is now a long-term chronic problem and we are not at the end of the disaster. The pandemic has seen commemoration since the beginning, demonstrating how communities can begin to create spaces of remembrance even while the crisis persists. Some examples of these commemoration activities can be found in TMB Issue 34 and Issue 29
• Memorials can be political, and grand gestures such as monuments can fade, or be contested. This reinforces the need for co-produced commemoration, enabling the voices of those who will benefit most from commemoration activities to be heard and actively participate
• Education is a good form of remembering, through storytellers or creating spaces (online or in local newspapers) where people can share their individual experiences of the pandemic. Recording those memories now will enable authentic materials to support education in years to come
• Think about how those who have lower agency in communities will remember (e.g. children who have lost grandparents). Commemoration could be done by creating spaces in schools/community youth groups for teachers/youth volunteers to support children

Last month, Japan’s Nuclear Energy Agency (NEA) marked ten years since the Great East Japan Earthquake (GEJE), and the subsequent tsunami that devastated the region and caused a nuclear accident at the Fukushima Daiichi Nuclear Power Plant[1]. Post-accident analysis verified that radiation from the accident at the power plant has not had any direct impacts on human health. However, the evacuation of hundreds of thousands of people living in surrounding areas resulted in premature deaths, due to issues such as lack of access to healthcare or medicines, and stress-related problems[2]. COVID-19 is like Fukushima, in that it presents both policy makers and the general public with a range of multi-dimensional challenges that need to be addressed through recovery and renewal processes. We explore three lessons from Fukushima recovery that can support and prompt thinking for recovery from COVID-19:

Preparedness and disaster management plans

Like COVID-19, the GEJE exposed fragilities in the planning for complex and extraordinary disasters, which were addressed by reformulating disaster management plans at national and local levels in Japan. Consider the following lessons and activities to recover and renew disaster management planning in the light of COVID-19:

• Review and revise disaster management plans at both national and local level to ensure plans are kept up to date:
  • Integrate lessons learned during the pandemic to inform new disaster management planning, legislation and policies - add a new section to disaster management plans that covers the management of pandemics
  • Focus on the following issues: coordination of administrative and operational functionalities; preventative measures, such as education, safety drills, and issuing and transmitting of information and warnings; evacuation and rescue activities, and primary goods supply and distribution in emergency situations; and overall coordination of reconstruction and restoring livelihoods during the recovery phase[3]

Engaging local stakeholders

‘Resilience is strengthened when it is shared’[4]. Establishing strong communication and collaboration - between communities and local medical staff, between central government and municipalities, and with experts - was found to build awareness amongst local residents about exposure risks to radiation, and how to reduce those risks in the future[5]. Stakeholder engagement is critical in the management of future outbreaks, recovery of preparedness for future crises, and recovery from the impacts of COVID-19. Consider:

• Authentic stakeholder engagement means meaningful, creative and impactful interactions with people and communities, and the co-production of recovery and renewal strategies[6]:
  • Recognise community voice, influence, and measurable local impact as part of recovery activities
  • Actively involve community members in recovery conversations and meetings, to bring together a range of knowledge, skills, abilities and perspectives
  • Build on collaborative relationships and integration initiatives that have been developed through the pandemic in local areas. Conduct a review to identify areas where these established relationships and initiatives offer opportunity for creative and impactful engagement in recovery[7]
• Effective participation requires leaders to utilise a range of models of engagement that[8]:
  • Encourage community participation (e.g. joint planning groups)
  • Develop interactive and partnership working, by providing the community with access to expertise, advice and training (e.g. disaster risk planning)
  • Facilitate community mobilisation and empowerment, by establishing partnerships with voluntary organisations and community groups, and initiating community development programmes[9]

Recognising the impacts on mental health

Fear of exposure to radiation, plus the evacuation itself, created significant psychological distress for those who experienced the events of Fukushima. These have some similarities to the psychological effects of COVID-19: risk to health due to exposure to the virus, isolation from family, friends and critical social support networks, and the uncertain economic conditions caused by the pandemic[10]. COVID-19 has shown how significantly social and economic determinants influence mental health. Our mental health is heavily reliant on a variety of factors such as the quality of our relationships, employment, education, and access to food, income and housing[11]. COVID-19 presents key challenges, but also an opportunity to rethink our approach to mental health and implement structural changes in mental health support so as to address the aftermath. Multifaceted-support and societal recovery progress has been found to help address the impacts of the Fukushima disaster on people’s mental health[12]. Mental Health Europe offer guidance to recovery and renewal of mental health support[13]:

• Establish comprehensive long-term strategies that aim to mitigate the consequences of the crisis, co-producing these strategies with service users and the organisations that represent them
• The promotion of ‘basic social rights’, together with targeted investment in economic protection, such as ‘universal basic income, income protection schemes, loan guarantees, rent protection’ and booster packages (e.g. recovery/renewal loans, business support and advice, targeted employment programmes)
• Invest in mental health literacy about the social determinants of mental health, and how ‘experiencing distress is a normal reaction’ in the exceptional circumstances of the pandemic. This will help tackle stigma and discrimination, and further strengthen the ‘sense of community and solidarity’ that has emerged throughout the pandemic
• ‘Promote cross-sectoral collaboration and more integrated social and health care, including investments in peer support’
• Facilitate and support community-based services that ‘respect the will and preferences of users, in line with the UN Convention on the Rights of Persons with Disabilities. Involve people with lived experience in the design, implementation and monitoring of these services’

References:

[1] https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-021-03109-1

[2] https://www.mhe-sme.org/position-paper-mental-health-in-the-aftermath-of-covid-19/

[3] file:///C:/Users/r66633rj/Downloads/ijerph-15-02381.pdf

[4] https://www.mhe-sme.org/position-paper-mental-health-in-the-aftermath-of-covid-19/

[5] https://www.worldbank.org/en/news/feature/2021/03/11/learning-from-megadisasters-a-decade-of-lessons-from-the-great-east-japan-earthquake-drmhubtokyo

[6] Hayano, R. S. (2015) ‘Engaging with local stakeholders: some lessons from Fukushima for recovery’, Annals of the ICRP, 44(1_suppl), pp. 144–152. doi: 10.1177/0146645315572291.

[7] Boyle, D and Harris, M. (2009). The Challenge of Co-Production: How equal partnerships between professionals and the public are crucial to improving public services. https://neweconomics.org/uploads/files/312ac8ce93a00d5973_3im6i6t0e.pdf

[8] http://www.scdn.scot/wp-content/uploads/2016/10/Models-of-Community-Engagement.pdf

[9] https://www.good-governance.org.uk/wp-content/uploads/2020/04/COVID-19-blog-07-04-20.pdf

[10] file:///C:/Users/r66633rj/Downloads/Empowerment-in-action-case-studies-of-local-authority-community-development.pdf

[11] https://openknowledge.worldbank.org/handle/10986/18864

[12] https://www.preventionweb.net/news/view/76401

[13] NEA, OECD (2021) Fukushima Daiichi nuclear power plant accident, ten years on. https://www.preventionweb.net/publications/view/76402?&a=email&utm_source=pw_email

Although home-based working has become the norm for a large percentage of the population, many workers have had to be physically present in their usual workplace. Many who have had to travel to workplaces during the pandemic have changed their mode of transport due to potential infection risks, delays and inconvenience due to cancelled or reduced public transport - i.e. they have changed their commute from public transport to private cars or bicycles. This has reduced their travel time, especially as traffic volumes are below pre-pandemic levels. Consider:

• That traffic congestion and the demand for parking space could increase dramatically as restrictions ease and more people opt for private transport, which may lead to increases in:
  • Infrastructure maintenance costs on roads and motorways
  • Negative environmental impacts, e.g. pollution
  • Road traffic accidents and increased risk to cyclists and pedestrians, plus loss of public space, which may reduce the number of people who choose to cycle or walk
  • Costs and challenges for freight and delivery services
• A travel awareness communication campaign, prior to an ease of restrictions:
  • Raise awareness of the benefits of sustainable travel for improving air quality and reducing pollution
  • Promote the health and well-being benefits of 'active transport' such as cycling
  • Communicate the stringent safety measures in place on public transport to increase confidence and encourage people to travel by bus/train
• Draw on learning from previous crises to predict likely behaviours and inform policies that are fit for purpose, e.g. following the 2008 economic crisis, increased traffic increased congestion (Madrid, Spain)
• Expand and improve cycling and walking space and infrastructure around workplaces
• In cities, reduce speed limits to allow pedestrians and cyclists to be more confident and allow for social distancing
• Promote and expand schemes such as 'Cycle2Work' by removing spending caps and allowing people to by bikes through the scheme that are appropriate and relevant for them (see TMB Issue 7):
  • Introduce a reimbursement scheme to reward cycling commuters, e.g. Netherlands offer 0.19 cent (euro) per kilometre cycled to work, or interest-free loans to purchase bikes
  • Trial an e-bike hire scheme in cities, e.g. Leicester (UK)
• Review congestions charge policies and assess if they are appropriate for post-COVID activity
• Introduce new policies, e.g. workplace parking levy, a charge on employers who provide workplace parking (Nottingham City Council, UK)

The SDGs, represent the world's agreed economic, social, and environmental targets for 2030, and can act as a common scorecard to ensure there are objective standards for assessing progress. Localising the ambition of the SDGs to develop local economic development strategies can help integrate social and environmental standards within local economic agendas, reduce disparities between regions, generate local business opportunities and jobs, and aim to include all marginalized communities. Consider how the SDG framework can support inclusive and diversified economic growth:

• Integrate SDG targets into on-going budget reviews process, thereby improving resource allocation and performance evaluation
• Examine the link between ongoing public policies, the SDG targets and budget expenditures
• Analyse the official indicators related to budget-planning instruments
• Partner with the private sector to launch impact investment initiatives that address the SDGs, recovery and renewal from COVID-19 and sustainable economic renewal

The public know that there are vast amounts of money being committed to tackling the COVID-19 pandemic. However, in many countries they do not know how much this is costing as the spending is constantly being adjusted as new responses and recovery initiatives are released. Consider producing an easy to read statement to make the costs transparent. See Japan's example: https://www.mofa.go.jp/files/100061342.pdf

The "Three Cs" are:

• Closed spaces
• Crowded places
• Close-contact settings

Advising people to avoid these three Cs may contribute to a communications message to prevent new outbreaks.

When the intensity of the crisis reduces, there is more opportunity for targeted measures that limit virus transmission. Testing should be pro-active and strategically targeted. Consider establishing 3 categories of people and places, and create suitable testing guidelines for each one, including:

People with symptoms. Consider testing this group immediately:

• Establish a system with quick consultation, diagnosis and testing (upon medical advice)
• Use antigen tests as results are available quickly
• Conduct antigen tests via saliva samples to minimize the risk and burden on patients and medical staff

People without symptoms, who have been assessed with a high pre-test risk of infection, and/or who work in high-risk areas. Consider testing this group pro-actively:

• Consider places that require close physical contact such as hospitals, senior-care facilities, or nightlife/entertainment-related industries
• Because of the high risk of infection and high pre-test risk of infection, consider thorough and rapid testing for this group

People without symptoms, who have been assessed with a low pre-test risk of infection, and who work in low-risk areas. Build consensus regarding action for this group:

• Include people who, for peace of mind, want to be tested in order to conduct societal, economic, cultural activities etc.
• Consider that testing is not perfectly accurate and only reflects a person's condition at one point in time. Continuous testing would be required to fully monitor the condition of an individual

Telecom data cover large populations and uses pre-existing technology that can be used to understand mobility patterns and human behaviour in near-real-time. Indicators from telecom data can inform provide information about:

• The number of people visiting hotspots
• Where those visiting hotspots came from
• Where they went afterwards
• How restrictions have impacted populations' movements
• How many people are away home and for how long

This can provide localised information on track and trace, and may be particularly useful for countries with less well developed infrastructure and access to smart technology.

This may help communities feel they have ownership over information rather than simply being told.

For particular groups consider:

• Providing parents with skills to handle their own anxieties and help manage those in their children
• Provide information in accessible formats for those with disabilities
• Offer multiple forms of communication e.g. text captioning, signed video, online material suitable for use with assistive technology
• Support the translation of information into the preferred languages for different groups, ensuring that refuges and migrant groups are included
• Adjust information for community perceptions, beliefs and practices

This can include the number of infected people, their status, characteristics (e.g. age, gender), number of inquiries to the call centre, number of people using subways, etc. The city can also provide the website's source code as open-data, so that other municipalities and institutions can use the data and replicate similar webpages.

Local government plays a key role in building trust in new measures and tackling misinformation. There may be a need for this in the UK. Of 2,250 adults surveyed:

• 15% of people thought seasonal flu was deadlier than coronavirus
• 31% believed "most people" in the UK had already had the virus without realising it
• 39% think they should be shopping "little and often to avoid long queues", when the advice is only to go out to shop for basic necessities and as infrequently as possible.
• 25% believed the conspiracy theory that coronavirus was "probably created in a lab" - one of several conspiracy theories currently circulating on social media platforms such as Facebook and YouTube.

Surveys like this help your organisation identify areas where their messaging is not as clear as it needs to be. Local government would benefit from continuing surveys on public opinion.

Local government should assess the health seeking behaviours of certain populations within their community. Health seeking behaviours will impact the success of disease suppression as behaviours impact access and understanding of public health measures (lessons from influenza A/H5N1 and 'swine influenza' A/H1N1).