Recovery, Renewal, Resilience

Many local governments have begun to take the lessons learn lessons from their COVID-19 response and amend strategies to improve emergency response plans for the future. E, ensuring these plans are disability inclusive is critical. Persons with disabilities can often be more vulnerable to risk during normal times and even more so in the height of a crisis. A recent paper explored the social determinants of disabled people’s vulnerability to COVID-19 and the impact of policy response strategies. The paper identifies recovery and renewal strategies that focus on reducing the social, economic, and environmental conditions that create disproportionate and unequal impacts. When re-evaluating local disaster preparedness and response, consider:

• Seek feedback from local people in your local community who live with a disability, and their carers, to understand how local response to COVID-19 met their needs or how their needs might be met more effectively in the future e.g. communications, access to services, community support mechanisms etc.
• Include strategies that recognise social vulnerability, as well as health related vulnerabilities, for example ‘universal basic income’ approaches to social security or ’housing first’ approaches to tackling homelessness
• Identify the various forms of risk that persons with disabilities might be exposed to, taking geographical and locale-specific risks into consideration. Needs will differ in the case of a flood/fire and evacuation than when faced with a health crisis
• Integrate the diverse and intersecting needs of persons with disabilities into preparedness and response plans. Co-produce these plans with them and their carers
• Identify the barriers that people with disabilities face in the community – work to reduce these barriers through long-term renewal initiatives, and not just in the case of emergency (e.g. re-designing local infrastructure to increase accessibility)
• Incorporate training for volunteers on the rights and diverse needs of people living with disabilities to maintain their dignity, safeguard against discrimination, and prevent inequalities in care provision (see UK guidance on supporting people with disabilities)

See: ‘Disability and Health Emergency Preparedness’ for guidance on identifying needs, tools and resources, and guidance for assessing preparedness and response programmes. See also: TMB Issue 19 for a further case study on disability-inclusive recovery and renewal.

Cities have grown considerably in the recent decades but this growth has exacerbated existing problems related to poverty and inequality. Deep-rooted inequalities have heavily influenced the degree and nature of COVID-19 impacts on society as whole. Thus, reducing inequalities, marginalization, and poverty should be a cornerstone of the strategy to recover and renew to increase resilience. Consider the following recommendations from the UN:

• Ensure that strategies provide un-registered people (e.g. people who are homeless or reside in slums) with access to basic and affordable services, like water, waste disposal and sanitation facilities. Longer-term strategies should work to build the resilience of people living in informal settlements and reduce their vulnerability to crises
  • For example, the DARAJA initiative is working to build the climate resilience of vulnerable communities who are living in informal settlements in Tanzania and Kenya. The goal is to improve the climate resilience of vulnerable people by increasing their access to climate and early warning information through feedback loops that enable hazard communication and awareness in informal communities
• Establish stronger labour and health protection for those not covered by formal government support systems e.g. casual/zero contract workers and people who work in the informal labour market
• “Plan for mixed use, socially diverse communities”, to avoid the creation of segregated communities (e.g. migrant worker complexes) of discriminated groups (e.g. ethnic minorities) when planning for public housing
• Establish policies that increase the long-term affordability of housing, by implementing measures such as “housing price caps, rent vouchers, subsidies, and investments in affordable or/and social housing”. Consider the example of Portugal, where the Resilience and Recovery Plan includes a total of EUR 2.7 million in affordable housing
• Implement strategies that improve connectivity in cities and affordable transport options, particularly for low-income neighbourhoods, including cycling and open, safe and affordable public transportation (e.g. buses, trains, among others)
• Invest in digital inclusion, by increasing infrastructure and training programmes, so that vulnerable populations can take advantage of recent trends such as digital government
• Support a comprehensive recovery and renewal strategy for densely populated areas e.g. slums and informal settlements, by implementing a variety of measures, such as “equitable land management, regulation of property markets, and application of progressive land-based finance and value capture instruments”
• Invest in communities, by engaging with them through meaningful participatory and inclusive methods (see TMB Issue 39 on co-production). Actively work to include “marginalized and minority groups, including persons of African descent, indigenous peoples, minorities and LGBTQ+”, so that their experiences and perspectives are fully heard and accounted for

TMB 39 noted how “tackling loneliness” was a key priority for community wellbeing in the next year, particularly in rural areas with high numbers of elderly residents. For example, ‘TED Ageing Better’ in East Lindsey is working to foster sustainable resilience in older people by strengthening social capital in the community and providing specific support services. Consider, from TED in East Lindsey’s recent report:

• When establishing community well-being initiatives, focus on “flexible and person-centred” activities. For example:
  • Magna Vitae's Community Health Activity Project employs a range of outreach mechanisms (online, telephone, one to one and group meetings) to ensure their service is inclusive. This has led to higher levels of engagement, enabling the development of innovative activities to meet diverse needs of the community
• Co-produce recovery initiatives (see TMB 38) and underpin these initiatives with a common goal e.g. to increase social capital and thus resilience amongst older people in the community
• Strengthen “peer-to-peer relationships” which can develop ties amongst residents and increase their sense of belonging. Such initiatives benefited from the delivery of “activity packs” that keep residents engaged and connected to people in their community during periods of isolation and social distancing
• Build on the relationships developed through well-being initiatives and co-production activities to support digital inclusion and build digital skills e.g. through community donation programmes (computers/laptops) and skill-building workshops facilitated by local volunteers
• Examples of strategies to tackle loneliness in Northern Ireland (NI) include:
  • The Department for Communities works with Libraries NI and National Museums NI to deliver projects that address loneliness, e.g. “Supporting People”, a programme which aims to improve levels of digital connectivity and digital inclusion
  • The Village Catalyst Pilot Project, which aims to tackle social isolation and rural poverty. The project will repair vacated buildings and repurpose them to improve local access to critical services and facilities, and provide increased space for community-led projects and social activities

Like many other sectors, agricultural production has been significantly impacted by COVID-19 restrictions. Farmers and workers in rural areas in developing countries live with low levels of income and scarce access to public services so disasters and pandemics increase their vulnerability. Even so, the sector provides an opportunity for economic recovery, given that in countries such as Mexico agriculture grew by up to 20% during 2020. The Agricultural Association of Culiacan River in Mexico has implemented measures to protect and prevent the spread of infection between agricultural workers and sustain their sources of income. Consider the priorities of their recovery approach for the sector:

Maintain agricultural production, livelihoods, and income (Michoacán experience)

• Strengthen the local chains of production and the local partnerships between agricultural and livestock producers and providers. In Michoacán, products that were mainly export-oriented are also being sold at the local level through the coordination of local farmers and governments
• Implement subsidies at the local and state levels to protect small and medium-sized producers against increases in the price of inputs (e.g. farming equipment), particularly given the increased demand for such inputs during the recovery stages
• Take advantage of existing local, regional, and international treaties and agreements that facilitate commerce and the exchange of products. In the absence of such arrangements, governments and financial institutions should provide financial guarantees to enable small producers to participate in these markets in the medium term

Protect the health and safety of agricultural workers and farmers. Increase preventive measures (Sinaloa experience)

• Supply PPE to agricultural workers and increase sanitization measures in agricultural facilities
• Implement sanitization protocols for the pickup and transport of workers to the field and back to their residency
• Identify workers at risk because of previous health conditions, or because of dangerous working environments. Identify and prevent children and young teenagers from working in the fields

The British Red Cross recently shared a report ‘Communities of Humanitarian Thought: The Case for Change in a Time of Crisis’. The report considers the next steps on the following prominent humanitarian issues: Displacement & Migration; Health Inequalities, and Disasters & Emergencies. The report highlights the need for real change for people experiencing, or at risk of experiencing, crisis across various priorities:

• ‘Eliminate the gaps in health and social care’, by employing a person-centred approach to reduce access barriers and prevent people from “falling through the gaps between services”. The inequalities in health and social care exacerbated by COVID-19 require a more integrated approach, along with investment in care and support at the community level
• ‘Ensure humanitarian needs are met in emergencies’, by clearly defining the statutory responsibilities of national government and emergency response organisations, to ensure that they “fully meet the humanitarian needs of their communities”
• Review social protection infrastructure to learn lessons from the pandemic and best practice across the world, e.g. ‘Cash-based assistance in emergencies’, which has shown to deliver a more “dignified response” and enables people to rapidly access the resources they need during crisis
• ‘Provide safe and legal routes for people seeking asylum’, by reviewing domestic policy to ensure that the “end-to-end experience of a person in the asylum system is efficient, fair and humane”. The Sovereign Borders Bill presents an opportunity to evaluate and take action to improve the entire system
• ‘Uphold international law and principled humanitarian action’, by committing to humanitarian action and support for the most vulnerable communities across the world
• Recognise how young people and civil society drive climate action, e.g. the Youth Advisory Group on Climate Change, which strives to amplify youth voices and engage young people in an open and transparent dialogue on climate action

The Rural Lives project examined the impacts of the COVID-19 pandemic and lockdowns on individuals experiencing financial hardship and vulnerability in rural areas, and the responses to address those impacts. It investigated the contributions of "societal processes, individual circumstances, and various support sources (e.g. markets, state, voluntary/community organisations, and family and friends)". The study finds that lockdowns delivered an acute shock to rural economies and societies, many of which rely heavily on tourism and hospitality, and that the pandemic amplified the impacts of digital exclusion. Pre-COVID, a substantial proportion of rural residents were found to be financially vulnerable. This study suggests that many more will be at risk of financial hardship in the coming months and years as "the full impacts of the pandemic play out and sources of support become more constrained". The study suggests future actions to support people living in rural communities:

• Diversify rural economies and support "good work" to offer people a fair and secure income, e.g. by providing targeted funding and support to help people to establish small businesses that increase the strength of other sectors (outside of those currently relied upon) and provide rural residents with "less precarious employment opportunities"
• Establish business support networks/signpost people to business advisory services to mitigate the negative effects of necessity entrepreneurship (e.g. people may lack confidence and/or knowledge about what is involved in setting up a viable business)
• Define and support the role of rural Voluntary and Community Social Enterprise (VCSE) sector, who have the potential to be a key actor when tackling the rise in rural youth unemployment
• Reinstate and support the expansion of mobile and outreach face-to-face services for the most vulnerable, especially those who may be more isolated due to physical distance from services, lack digital literacy or face mental health challenges
• "Continue partnership working and flexible funding" between service providers and VCSEs so that they can continue to play a joined-up signposting role, connecting rural communities to information, advice and services
• Integrate VCSEs into strategic planning to create effective partnership structures
• Explore the "rural potential for social care provision" review the experience of social care and carers during the pandemic to learn lessons. E.g. "deliver a more personalised and joined-up approach via informal cooperation between health and care workers, learning from more flexible work practices adopted during the pandemic"
• Enable communities to take a more active role in commissioning social care, and enable community groups to deliver care in their communities
• Co-produce service design with communities, pilot integrated ways of working with VCSEs and the community, and take locally-based approaches to service delivery that prioritise local community outcomes and individual needs/priorities
• Consider a combination of "person-based and place-based" social protection and welfare measures at national policy level

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

We bring together international lessons and actions to address the attainment gap and support vulnerable children who have lost out on significant learning time during the pandemic.

Read this case study in full by following the source link below to TMB Issue 33 (p.13-14).

Factors such as underlying health conditions, confined and over-crowded living spaces, limited facilities (e.g. running water, adequate sanitation), stigma and discrimination mean that Roma, Gypsy, Traveller and Boater communities are particularly vulnerable to the risks and associated impacts of COVID-19. Virus infection and death rates of these communities are currently unknown in the UK meaning formal data collection is needed. People in these communities are also likely to not be registered with a GP, to work in precarious job roles or be self-employed, meaning there is possibility that these communities will fall through the net with regards to COVID-19 vaccine programmes and the business/financial support initiatives provided during the pandemic. Consider:

• Partner with local and national organisations that work with Roma, Gypsy, Traveller and Boater communities to better understand their needs during the pandemic
• Work closely with the owners and managers of all residential sites and waterways for these communities to ensure that they stay open and alternative accommodation is arranged for people who become unwell and are required to self-isolate
• Provide additional temporary water, sanitation and waste disposal facilities to those communities who cannot access public facilities (due to closure of public infrastructure during lockdowns)
• Open additional local authority caravan sites temporarily to prevent overcrowding at designated caravan sites as COVID-19 requires these communities to remain static (e.g. holiday campsites that are not in use and would have basic facilities such as running water already in place)
• Establish a designated helpline in partnership with local health authorities (e.g. HSE Midlands Traveller Health Unit) to deal with COVID-19 queries
• Introduce a temporary moratorium to prevent people from being evicted from unauthorised camp locations
• Relax rules temporarily so those living on canal boats can moor in a safe place for an extended period of time
• Establish a targeted education support programme for children in these communities who are at risk of digital exclusion during periods of school closure
• Communicate with Roma, Gypsy, Traveller and Boater communities and the organisations that represent them to ensure that they are aware of and have access to social support mechanisms provided during the pandemic, e.g. Self-employment Income Support Scheme, vaccine programmes
• Include people who are living in these communities in research and outreach programmes to ensure learning is gained from their experiences and the diversity of impacts of COVID-19 on their lives is taken into account when planning for recovery

Billy Tusker Haworth, Lecturer in International Disaster Management at the Humanitarian and Conflict Response Institute, highlights the experiences of lesbian, gay, bisexual, transgender, intersex, and other queer identities during the pandemic and demonstrates the need for more nuanced and inclusive crisis response and recovery strategies. This briefing presents short term recovery strategies and longer term transformational activities to improve the care and wellbeing of LGBTIQ+ people during crises.

Read this briefing in full by following the source link below to TMB Issue 31 (p.2-5).

Data from the EU shows that 18 year olds who are in care are more likely to be not in employment, education or training, and experience higher levels of social exclusion or homelessness. COVID-19 has exacerbated their financial insecurity, poor mental health, and limited support networks as they transition to independent living. In addition to assessing the capacity of social work provision (TMB Issue 6), consider:

• Formally designate people who are leaving care as belonging to a vulnerable group
• Extend social protection programmes to make support services, such as financial support for food and accommodation, immediately available to those who leave care
• Ensure social services maintain regular personalised contact with those who leave care to advise them of what support is available during COVID-19
• Increase the capacity and flexibility of online communication with those who leave care, including availability of support forums
• Increase the capacity of mental health services, including outreach services and crisis support teams, by drawing on trained volunteers and enhance training in psychological first aid and safeguarding
• Partner with private care agencies, non-governmental organisations, corporate partners and care professionals to establish support and training/employment programmes
  • Establish a mentor programme to strengthen the support network of care leavers during their transition from care to independent living (e.g. ProgramaMentor, Galicia, Spain)
  • Provide employment advice to those who leave care, such as guidance on CV writing via an online workshop
  • Host virtual career or industry insights days to support those who leave care in making decisions on their next steps regarding education and employment
  • Establish targeted education and employment support for those who leave care, such as practical skills training on computing, email writing, giving presentations, and interviews; plus volunteering opportunities, work experience and apprenticeships for when lockdowns and restrictions end

Prisons are high risk environments as places of close physical proximity[1]. Persistent overcrowding[2], close living spaces, and staff moving in and out, make social distancing and the isolation and management of any contagion difficult to arrange[3]. National strategies to suppress COVID-19 should focus on reducing outbreaks within prisons, recognising that prison health is public health[4]. Coordinating evidence-based approaches to managing outbreaks of COVID-19 in prison settings can address the spread of the virus in potentially vulnerable people inside prisons and to communities where staff live[5].

In March 2020, WHO published interim guidance on how to deal with COVID-19 in prisons through a whole-of-society approach, with comprehensive guidance in the following key areas[6]:

• Preparation - through collaborative working with health and justice sectors, local and national public health authorities, and civil protection agencies; risk assessment and continuous evaluation; action planning to mitigate risks; assessment of essential infectious control supplies such as PPE, environmental sanitation, hand hygiene and disinfection
• Prevention - through implementation of public health guidelines, such as hand hygiene, social distancing and facemasks; monitoring of staff travelling into prisons from affected communities or who have a history of exposure; reviewing continuity and contingency plans to ensure critical functions can be delivered with reduced numbers of personnel
• Training and Education - planned and targeted at healthcare and custodial staff, including basic disease knowledge, hand hygiene practice, respiratory etiquette, the effective use of PPE and environmental prevention measures such as cleaning and disinfection. WHO have developed several online resources and training that can support this[7]
• Control - through robust prevention strategies; diagnostic strategies, including contact tracing, and interventions, including the environmental cleaning of health-care rooms or cells, where the management of a suspected case has taken place

A recent study identified some core challenges in managing infectious disease in prisons[8], such as:

• Overcrowding and a lack of best practice on managing the early release of prisoners
• Prisoners withholding symptoms for fear of stigma, leading to outbreaks
• Limited capacity of staff and resources to facilitate isolation, quarantine, and contact tracing

Addressing overcrowding, including communicating complex policies, such as an amnesty

Governments and judiciaries globally are considering strategies to tackle overcrowding and reduce prison populations through early release and alternative incarceration for vulnerable detainees and low-risk offenders[9]. Although strongly supported by human rights groups[10] and recommended by the UN[11], COVID-19 amnesties in the Ukraine were however rejected by legislators, media, and the public. This highlights that the explanation and communication of complex policies are just as vital as their design[12]. When communicating amnesties, consider:

• Work closely with civil society, particularly NGOs directly engaged with the public, to assess views and perceptions of amnesties, using this information to inform policy design and implementation
• Establish a clear communication strategy to accompany all elements of the process of transitioning incarcerated persons back into society, with a tailored approach to different social and regional groups
• Communicate informed and factual information through government and trusted civil society organisations, explaining the different elements of amnesties and their place in the larger reintegration framework to help the public feel more informed, secure and resilient

Inmate Volunteers

Irish Red Cross inmate volunteers are trained annually in Infection Control as part of the Community Based Health and First Aid Programme[13]. The activities of the inmate volunteers helped to contribute to zero positive cases amongst prisoners across the country for more than six months. Consider supporting a targeted inmate volunteer training programme to aid the management of infectious disease in prisons:

• As part of preparation and contingency planning, train inmate volunteers and staff on infectious disease and contact tracing to support the education of prisoners and custodial staff, and efforts to control transmission
• Train volunteers to support inmates who face mental health challenges/fears of stigma, e.g., distributing information and education packs, and supplementing support from psychologists, teachers, chaplains, and family visitation services, where these lack capacity
• Inmate volunteers can support the establishment of prison communication strategies on COVID-19, e.g. volunteers can write newsletters that can be distributed throughout prisons each week to provide updated information and educational material regarding COVID-19. Newsletters can include services that are available for inmates, and instructions for exercises and other activities that inmates can do while isolating and in quarantine

References:

[1] Redondo, S. et al. (2020) Corrections and Crime in Spain and Portugal during the Covid-19 Pandemic: Impact, Prevention and Lessons for the Future, Victims & Offenders, 15:7-8, 1156 – 1185, doi: 10.1080/15564886.2020. 1827108

[2] https://www.amnesty.org/en/latest/news/2020/12/pakistan-overcrowding-in-pakistans-prisons-is-a-ticking-time-bomb/

[3] Pagano, M. (2020). COVID-19 Risk Management and Screening in the Penitentiary Facilities of the Salerno Province in Southern Italy. International journal of environmental research and public health, 17(21), p.8033.

[4] https://www.unodc.org/documents/middleeastandnorthafrica//2020/COVID19/COVID_19_Egypt_Final.pdf

[5] https://www.psych.ox.ac.uk/news/people-in-prison-must-be-part-of-public-health-response-to-covid-19

[6] https://apps.who.int/iris/bitstream/handle/10665/336525/WHO-EURO-2020-1405-41155-55954-eng.pdf?sequence=1&isAllowed=y

[7] Emerging respiratory viruses, including COVID-19: methods for detection, prevention, response and control [OpenWHO online course]. Geneva: World Health Organization; 2020 (https://openwho.org/courses/introduction-to-ncov)

[8] Beaudry, G., Zhong, S., Whiting, D., Javid, B., Frater, J. and Fazel, S., 2020. Managing outbreaks of highly contagious diseases in prisons: a systematic review. BMJ global health, 5(11), p.e003201 https://gh.bmj.com/content/5/11/e003201

[9] Amnesty International (2020) https://www.amnesty.org/en/latest/news/2020/12/pakistan-overcrowding-in-pakistans-prisons-is-a-ticking-time-bomb/

[10] https://uacrisis.org/uk/amnistiya-ye-realnym-sposobom-borotby-z-poshyrennyam-koronavirusu-u-mistsyah-nesvobody-pravozahysnyky

[11] https://www.unian.info/society/human-rights-un-recommends-ukraine-grant-amnesty-to-certain-convicts-amid-covid-19-pandemic-11155589.html

[12] https://www.chathamhouse.org/2020/11/covid-19-holds-lessons-ukraines-amnesty-policy

[13] https://www.redcross.ie/national-news/irish-red-cross-responds-to-covid19/

Migrants and refugees face a multitude of health and safety challenges that have been intensified by the pandemic, such as: losing employment and income; eviction and homelessness; and lack of access to 'safety net' support. In addition, some countries have temporarily suspended issuing residency permits, leaving people with irregular status in their country of asylum and further impacting their access to employment and social services. To support migrants and refugees, consider:

• Participate in national resettlement programmes (e.g. SRP UK) to guide preparations, ongoing support and integration of migrants and refugees into local communities
• Establish a working group to enable collaborative working between local councils, community groups and related agencies to determine how local authorities can meet legislative requirements of resettlement programmes
• Inform and prepare local communities where migrants and refugees are to be resettled
• Identify registered and unregistered refugee populations in communities
• Conduct risk and vulnerability assessment mapping
• Include migrants and refugees in social protection schemes to support those who have lost income generating opportunities
• How systems will protect migrants and refugees from harm, irrespective of their status, with access to essential health and social care
• Agree that immigration status is not a legitimate basis to deny access to essential public services (e.g. healthcare, vaccination), and communicate this to public services, migrant and refugee populations, and wider groups
• Invest in risk communication and community engagement at local levels to disseminate information in the relevant languages of migrants and refugees
• Partner with humanitarian actors to provide services
• Establish humanitarian service points or 'safe spaces' which are not subject to immigration enforcement activities, where humanitarian actors can provide essential services to vulnerable migrants

Schools have an increased need for support during lockdowns to provide children with the resources they need to learn effectively. Many other organisations are also under significant pressure during COVID-19, but some are coping particularly well as customer demand has increased hugely. Such organisations may have the capacity, capability and willingness to support the parents of schoolchildren in their local community. Consider encouraging local organisations and others to:

• Coordinate community activities on behalf of a school, for example, to:
  • Collect unused computers from businesses and the public so they can be reformatted and given to school children to enable them to access online learning support
  • Provide computer training and skills for local parents so they can assist their children, particularly young children
• Offer free printing of schoolwork for parents of school children who do not have printing services at home
• Make servers available to host school content which can be downloaded by parents
• Contribute financially to support schools to pay for new forms of online schooling, new content, and access to privileged services
• Work with schools to support them to build capability, for example, to:
  • Evaluate and learn the technology that is available and how to use this in online learning
  • Convert materials to make them suitable for online learning
  • Remap donated computers to enable them to be distributed to school children
• Provide specialist services to schools, e.g. readers of braille, sign language, adapting written materials into the spoken word, supporting children with disabilities
• Provide COVID-19 hygiene supplies to schools (e.g. facemasks and hand sanitising stations)
• Actively help Head Teachers in their role, for example, to interpret guidance and its application in their schools, and to support networking and mutual aid between schools

COVID-19 has created new uncertainties that challenge the provision of critical support services to vulnerable families and children. Food programmes need to ensure that vulnerable children receive nutritious food, both inside and outside of school. They also need to facilitate access to other support services, and be delivered in ways that maintain the dignity and respect of recipients, their families and communities. Consider the need to:

• Integrate access to sufficient, nutritious food as part of an overarching plan to combat COVID-19, promote healthy societies, and mitigate long-term health issues
• Establish an assurance programme with service level agreements to increase confidence in emergency food provision, create feedback systems, and enable rapid amendment to services
• Provide guidance to parents so they know what services they are entitled to access
• Ensure parents are aware of "wrap-around" services e.g. anti-poverty schemes
• Analyse the impacts of food programmes on children's diets
• Consult parents and community groups about how to build dignity and choice into emergency and ongoing food provision, and develop opportunities for active involvement planning and delivery
• Develop community-based nutrition awareness and home-based cooking training programmes to support parents in providing balanced meals on a low budget
• Strengthen working partnerships with local government agencies, civic groups, voluntary sector, and social arms of corporations to improve implementation of food programmes
• Remove financial barriers to receiving food support and minimize stigma about 'handouts' e.g. by using a 'pay-as-you-feel' system

Mobile home residents face a number of health and environmental challenges that have been exacerbated during the pandemic. Residents face compounding health issues as mobile homes are difficult to keep warm in winter and cool in summer. Heating and ventilation costs can also create financial burdens which can have negative health impacts - especially as many people living in mobile homes have lower incomes and face job insecurity. This demographic also face increased risk due to site locations and occupancy agreements. In the UK, many mobile home sites are at risk of flooding and storm damage due to their proximity to water. To combat this, residents are normally asked to leave for 6 weeks of the year- during storm season. During COVID-19 this creates a number of issues as movement of people during these 6 weeks is a huge infection risk. The UK government has therefore requested that sites remain open for those using mobile homes as their primary residence. Consider:

• Emergency planning for extreme weather events/ COVID-19, including COVID-safe evacuation plans
• Increased community liaison and communication to share evacuation plans clearly to residents so they are able to prepare and act quickly and safely
• Identify local COVID-secure emergency accommodation in case evacuation of residents is needed
• Increase community liaison during periods of extreme heat to ensure residents are able to stay safe, especially during periods of lockdown, shielding or quarantine
• Provide clear information to residents in multiple languages and have multi-lingual community health visitors to ensure health and wellbeing information is translated

Research into MNCH demonstrates that early-life determinants of health help create more resilient societies. Previous trends indicate that socioeconomic shocks lead to an increase in markers of poor MNCH including low birthweight, maternal and infant malnutrition, and maternal drug or alcohol misuse etc. These factors can have impacts across a person's life and effects the next generation. At particular risk are people from Black, Asian, or minority ethnicities who are more likely to be socio-economically disadvantaged, and at higher risk of pre-existing health conditions, contracting COVID-19, and having poor markers of MNCH. Consider:

• Research and data collection to monitor the immediate and longer-term effect of COVID-19 and related socioeconomic crisis on MNCH, using routine data collection systems and reinstating systems that have been suspended during COVID-19 e.g.:
  • the short, medium, and longer-term consequences of COVID-19 on neurocognitive development in children
  • disruptions as a result of COVID-19 e.g. on food insecurity, access to health services and impacts on MNCH
• Investment of resources into promotion of early-childhood health and development, including the training and provision of community health workers
• Promotion of MNCH care as an essential service and human right, including investment to access to contraception/reproductive health services, antenatal/postnatal care, and child health etc
• Strengthen community-based interventions to promote MNCH, such as home visits during and after pregnancy and in the early years
• Develop new policies to drive gender equity and reduce the penalties of motherhood e.g. parental leave for each parent on a use it or lose it basis

COVID-19 has added thousands more cases to the backlog faced by courts in England and Wales, has delayed proceedings for those already in the justice system, impacted police capacity and could negatively impact reporting of more serious crimes. Delays in processing and handling criminal cases has negative impacts on the health and wellbeing of victims, and could lower confidence in the justice system. Consider how to effectively support those involved in criminal proceedings by:

• Making arrangements with telecoms companies to provide free access to websites that provide information/support to victims of crime to avoid mobile data usage. This should include websites run by organisations such as charities, official government sites (including health), the police, and law courts
• Increasing communications with victims about the progress of their cases. This may require careful partnership working with specialist organisations to mitigate victims' anxieties and create additional capacity for services such as the police, who may be increasingly stretched during COVID
• Ensuring there is support for specialist communications from all partnering organisations. This may include the use of translators, experts able to speak with children, or those with special educational needs

Some people who are not able to not wear a face covering are reporting being confronted in enclosed public places and, as a result, being fearful and unwilling to leave their homes. Consider:

• Information campaigns to make the public aware that some people may not be able to wear face coverings. For example, the UK government provides three 'reasonable' reasons for not wearing a covering:
  • You have a physical/mental illness, impairment, or disability that means you cannot put on, wear or remove a face covering
  • Putting on, wearing or removing a face covering would cause you severe distress
  • You are travelling with/providing assistance to, someone who relies on lip-reading
• Whether it is appropriate to encourage those who cannot wear a face covering to get an exemption card or wear an exemption badge to reduce the likelihood of confrontation

Example face covering exemption card: https://hiddendisabilitiesstore.com/hidden-disabilities-face-covering.html

Lockdowns and COVID-19 have exacerbated inequalities in the most deprived areas. Many responses assume people have adequate living space, access to affordable basic services, and social safety nets. However, many lack adequate resources to survive lockdowns without defying COVID-19 restrictions e.g. leaving the house to work. Consider working with civil society, government, and charities to:

• Provide support for informal sector providers and workers to encourage tenure security schemes that can offer benefits to informal workers such as more secure housing, and increased legitimacy to work or trade. This may help reduce unauthorised working and living conditions that may increase transmission of COVID-19
• Regular situation monitoring of deprived areas to track key concerns relating to working and living conditions that can inform COVID-19 responses and transmission mitigation. Use online surveys completed by the community or local organisations that know the population
• Creating or maintaining effective use of public spaces for to provide COVID safe community care to reduce isolation, counter misinformation and collect reliable data on COVID-19 impacts

Inclusive recovery practices are essential as additional groups of vulnerable people emerge from the COVID-19 pandemic, alongside data on the disproportionate effects of COVID-19 on vulnerable and marginalised people. In particular, people living with visible and invisible disabilities have been adversely impacted by the virus due to challenges in accessing health services, and because they are at greater risk of experiencing complex health needs, worse health outcomes, and stigma[1].

While disability alone may not be related to an increased risk of contracting COVID-19, some people with disabilities might be at a higher risk of infection or severe illness because of their underlying medical conditions[2]. In particular, “adults with disabilities are three times more likely than adults without disabilities to have heart disease, stroke, diabetes, or cancer than adults without disabilities”2. In the UK, working-age women with a disability are more than 11 times more likely to die from COVID-19 than women without a disability, and for men, the death rate was 6.5 times higher than for men without a disability[3].

Health-care staff should be provided with rapid awareness training on the rights and diverse needs of people living with disabilities to maintain their dignity, safeguard against discrimination, and prevent inequities in care provision[4]. Advice on how to do this is extremely important. In the UK, guidance on how to safely care for people with disabilities is provided to protect carers and the person they are caring for, and includes consideration of[5]:

• Protecting yourself and the person you care for e.g. appropriate use of PPE in specific settings
• Supporting the person you care for through change e.g. providing accessible information
• Maintaining the health and wellbeing of carers

In recovery, some people with disabilities may have restricted access to social networks, systems that provide support, job security, consistency of income, education – aspects that others may take for granted. “The more a person is excluded, the more challenging the recovery, and persons with disabilities often fall in this category.”[6] Recovery from COVID-19 must therefore reflect disability-inclusive strategies to provide action-oriented directions for government officials and decision makers responsible for post-disaster recovery and reconstruction.

The Disability-Inclusive Disaster Risk Recovery Guidance Note[7] developed by the World Bank / Global Facility for Disaster Reduction and Recovery (GFDRR) aims to accelerate global action to address the needs of persons with disabilities. Overall, the World Bank and GFDRR estimate that a quicker and more inclusive recovery could reduce losses to well-being by $65 billion a year[8].

Disability-inclusive recovery is about including people with disabilities in recovery planning and enabling equal opportunities through the removal of barriers. This can be done by gathering baseline disability data and incorporating it into needs assessments, by mainstreaming disability inclusion in recovery programmes, and by recommending specific interventions. There are four essential steps to support inclusive risk planning:[9]

• Collect data on barriers and accessibility improvements to understand and assess disability inclusion in recovery and reconstruction
• Adopt appropriate disability legislation to support a disability-inclusive recovery process that will prioritize needs and allocate resources. New policies should be in alignment with the UN Convention on the Rights of Persons with Disabilities to guide disability-inclusive recovery and reconstruction
• Establish institutional mechanisms to ensure the meaningful participation of persons with disabilities in the planning and designing of recovery and reconstruction processes. Also identify and designate an agency with responsibility for coordinating and overseeing disability affairs in recovery and reconstruction. Additionally, ensure standards for disability inclusion in recovery are established and communicated
• Target households and groups that have limited ability to self-recover, including households with persons with disabilities, to receive financial support and other interventions. Set standards for disability inclusion in budgeting and procurement quickly and ensure they are applied across the recovery and reconstruction process. Also require full consideration of accessibility, including the principles of universal design, as a condition of financial contributions and assistance by all involved in recovery.

Disability-inclusive recovery can help reduce poor representation of people living with disabilities in post-disaster recovery efforts. This provides an opportunity to build a more accessible environment that is inclusive and resilient to future disasters, and to reduce the disproportionate risks faced by people living with disabilities by[10]:

• Making infrastructure resilient and accessible (barrier-free buildings and land use planning)
• Setting up programs to actively employ persons with disabilities, such as hiring them in the recovery and reconstruction planning and implementation process
• Making healthcare and education readily available and ensuring healthcare is accessible to persons with disabilities before and after a disaster
• Communicating hazard exposure and risk information in a way that can be understood and acted upon (for example, sign language interpretation and plain language)
• Improved accessibility before and after a disaster also benefits older people, those who are ill or have been injured, pregnant women, and some indigenous and non-native language speakers

Recovery is often tumultuous and traumatic, but it is also an opportunity to renew systems and processes by understanding and addressing unequal practices and structures. By making disability inclusion a priority in the recovery agenda, we can ensure more self-sufficient, inclusive, and resilient societies for all.

[1] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[2] https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-at-increased-risk.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fneed-extra-precautions%2Fpeople-at-higher-risk.html

[3] https://www.bbc.co.uk/news/uk-53221435

[4] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[5] https://www.gov.uk/government/publications/covid-19-supporting-adults-with-learning-disabilities-and-autistic-adults

[6] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[7] http://documents1.worldbank.org/curated/en/559111587448620405/pdf/Disability-Inclusive-Disaster-Recovery-Guidance-Note.pdf

[8] https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30076-1/fulltext

[9] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

[10] https://blogs.worldbank.org/sustainablecities/ensuring-equitable-recovery-disability-inclusion-post-disaster-planning

To read this case study in its original format follow the source link below to TMB Issue 19 (p.15-16).

COVID-19 has exacerbated the health and social care inequalities experienced by LGBTQ+ people as they are likely to living with conditions that impact their health and well-being. LGBTQ+ people are at high risk of pre-existing poor mental health; social isolation; substance misuse; living in unsafe environments; financial instability; homelessness; and negative experiences with health services as a result of their sexual orientation or gender identity. Consider partnering with LGBTQ+ organisations to:

• Support test track and trace. The LGBT Foundation's community survey on COVID-19found that: 64% of respondents would rather receive COVID-19 support from an LGBT specific organisation. This rises in other LGBTQ+ groups to: 71% of Black, Asian and minority ethnic LGBT people; 69% of disabled LGBT people, 76% of trans people and 74% of non-binary people
• Collect sexual orientation and trans status data alongside COVID-19 transmission and infection data to provide reliable data on the impact of COVID-19 on LGBTQ+ people
• Provide safe accommodation during COVID-19; 8% of respondents to the LGBT Foundation's community survey said they felt unsafe where they were currently staying
• Prepare for the hospitalisation of trans people (e.g. allocation to wards with the gender they identify with, or providing private areas)

COVID-19 has been a struggle for client-facing businesses - and sex work is no different[1]. What complicates support for those in sex work is the stigmatisation and lack of recognition workers receive[2]. Sex workers are less likely to seek, or even be eligible for, government-led social protection or economic initiatives to support small businesses[3] which has proved a serious issue during COVID-19. Most sex work has ceased due to social distancing and travel restrictions, leaving many marginalised, and economically precarious people even more vulnerable[4]. While some sex workers have been trying to move their work online4, many have been financially compromised3 resulting in potentially unsafe practices, both in terms of contracting COVID-19, and increased risk of homelessness and abuse[5]

Sex worker-led organisations have therefore had to set up hardship funds to fill the gap left by exclusionary government policies2. Such policies are demonstrated by delays in opening licensed sex work premises in Germany, where sex work is legal[6]. The Association of Sex Workers in Germany argued that brothels “could easily incorporate pandemic safety measures adopted by other industries, including face masks, ventilating premises and recording visitors’ contact details”6. Such measures have been successful in Zambia where authorities were able to trace a number of COVID-19 cases working with sex workers as investigations aimed not to “stigmatise or discriminate against them”[7].

Key interventions to address the impacts of COVID-19 among sex workers have been identified, with a view that “all interventions and services must be designed and implemented in collaboration with sex-worker-led organisations”[3]. These include[3]:

• Providing financial benefits and social protection for all sex workers, including migrants with illegal or uncertain residency status
• Stopping arrests and prosecutions for sex work which have been shown to be harmful to health
• Targeting health promotion advice on prevention of COVID-19 with language translation
• Distributing of hand sanitiser, soap, condoms, and personal protective equipment
• Maintaining and extending person-centred services to address needs e.g. mental health, substance use, physical and sexual violence, and sexual and reproductive health
• COVID-19 testing and contact tracing among sex workers

[1] https://www.bbc.co.uk/news/technology-52183773

[2] https://www.opendemocracy.net/en/beyond-trafficking-and-slavery/covid-19-illuminates-discriminatory-sex-work-policies/

[3] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31033-3/fulltext

[4] https://www.bbc.co.uk/news/business-52821861

[5] https://www.swarmcollective.org/blog

[6] https://www.reuters.com/article/us-health-coronavirus-germany-brothels/hamburg-sex-workers-demand-germanys-brothels-reopen-idUSKCN24D09U

[7] https://www.bbc.co.uk/news/world-africa-52604961

To read this case study in its original format, follow the source link below to TMB Issue 17 (p.18).

Self-isolation, and limited access to school, has driven more children online during the pandemic. Spending more time on virtual platforms can leave children vulnerable to online sexual exploitation by predators (see also The Manchester Briefing Week 14). Increased and unstructured time online, alongside limited face-to-face contact with friends or partners, can lead to heightened risk-taking such as: sending sexualized images, exposure to potentially harmful content, and cyberbullying. Consider:

• Some children may be more vulnerable than others (e.g. those with learning disabilities) and may need specific types of support and training for them and their guardians
• Retaining access to child services and keeping guardians informed of where to find online safety information for themselves and for young people (e.g. antivirus software, parental controls on devices)
• Information for guardians on talking with young people about who they communicate with online
• Training health, education and social service workers on the impacts that COVID-19 may have on increased online risks for young people
• Educational initiatives on cyber safety and to provide local helplines and hotlines for adults and young people, including counselling
• Enhancing online safety measures, especially while using virtual learning tools
• Schools updating safeguarding policies to reflect the new realities for children learning online

The COVID-19 pandemic has been a challenging time for everyone, especially in trying to adjust to new routines and living and working environments. This may be particularly true for children with autism and their parents, as children with autism have trouble adjusting to, coping with, and understanding change. To help with this, help parents to explain the current situation in clear and simple ways and can help children with autism to adjust to the 'new normal'. One way of doing this is to provide parents with access to materials that frame COVID-19 as a germ that can make people sick, so it is important to stay away from others and not touch things.

Advise parents to reiterate important rules to children with autism is also important to help them cope, such as:

• Washing hands well and often (for at least 20 seconds)
• Not touching their nose, mouth, and eyes
• Keeping at least 6 feet away from other people
• Wearing a cloth face covering or face mask in public places

Face coverings may be difficult for autistic children, some parents have had successes in attaching the ear loops on masks to their child's favourite hat with buttons to reduce sensitivity. Make authorities (such as transport providers, Police) aware of "Facemask Exemption Cards" that have been produced by organisations for parents to print out for those who cannot wear a mask. Local government can support parents of children with autism by working with respected specialist organisations to advise parents e.g. one encouraging mask wearing

• Demonstrate using the face mask on a preferred object or person, such as a stuffed animal, a doll, or a family member
• Allow the person to choose among different types of fabric face masks to find one that is most comfortable
• Start by practicing wearing the face mask for short durations of time, allowing for breaks when needed
• Plan initial outings in low-demand environments that are quiet and calm, so that the individual can experience success wearing the face mask
• Use a printed photo or digital photo of the individual wearing a face mask as a visual cue to wear the mask before outings

In addition to these changes, losing the daily routine that going school provides adds an additional layer of complexity for children with autism, and outs them at risk of not receiving the social care and support they require. While, some children may have found home schooling difficult, the time spent away from school may have resulted in the development of a new routine at home where they feel safe. As such, returning to school may cause anxiety and distress. Local government should inform teachers that some ways of reducing these anxieties include:

• Providing a visit to the school before it reopens if possible, to help children familiarise themselves with their environment and staff again
• Encouraging homes to introduce changes that are made in school at home e.g. explain social distancing measures, ask for photos of new classroom layouts to show children
• Asking parents for information about your child during COVID-19 so they have an understanding of their needs and how these may have changed due to COVID-19 restrictions

COVID-19 has also been a challenging time for parents of children with autism. One parent in the UK stated that support for them and their child had been reduced to occasional phone calls and they felt like they had been "left to struggle alone". They also stated that they were repeating the same or similar activities with their child from before lockdown and that it felt like their child's development had stalled. They stated that increased resources from their child's support worker such as a timetable of activities and development would have helped and made the experience of self-isolation and lockdown "less distressing".

Providing specialised phone lines and centralised hubs with resources for parents is vital, to ensure their well-being and that of their children, via reliable information and support. Local government can help employers to realise that parents also need to find ways to balance work and childcare responsibilities this can include:

• Arrange to work from home to ensure supervision, or childcare sharing arrangements with friends and family
• Prepare information about the child's support needs and successful learning and behaviour strategies for anyone caring for the child
• Develop an emergency contact list, and discuss it with friends and family. Include names and numbers of your personal autism support network, as well as medical providers
• Contact local organizations who may be able to offer support.
• Look through the child's medical records or evaluations related to autism as these may have recommendations on areas to focus on and can help you with making learning plans while schools are closed
• Reach out to others to maintain social support for the whole family e.g. social media, social media groups for autistic people and their families, and other virtual support groups that provide online resources for finding empathy and ideas while self-isolating or in lockdown

To read this case study in its original format (including references) follow the source link below to TMB Issue 16 (p.19-20).

With many schools closed, and young people adapting to learning remotely from home, access to the internet and digital devices has become imperative. As a result there is a growing divide between children who have internet access and those who do not. In Spain, disadvantaged students are 14% less likely to get online, compared to students who were not disadvantaged. Additionally, disadvantaged students in the country were without a tablet, a laptop or any way of linking into online platforms, and many disadvantaged families were not confident with technology when it was provided to them. In some cases teachers have resorted to using class WhatsApp groups, as most households had access to a mobile phone. To support online learning from home consider:

• Training teachers, students and their families to use online platforms and technology (and not assuming that they already have those skills)
• The availability of technology at home (e.g. mobile phones) and alternative teaching/ communication methods such as using WhatsApp
• Partnerships with internet providers to support disadvantaged families with the cost of internet access
• Partnering with software and technology firms to support disadvantaged children to gain access to hardware such as tablets and software
• Donation campaigns through schools to collect old phones, laptops and tablets that can be refurbished and distributed

Including gender-inclusive perspectives can address gender inequalities in health outcomes, the economy and wider society. For example, in the EU, women make up: 93% of child care workers; 86% of personal care workers in health services; and 95% of domestic cleaners (https://eige.europa.eu/covid-19-and-gender-equality/frontline-workers). This exposes women to the virus, heighten the potential of poverty and mental health issues as these jobs are undervalued, precarious, and underpaid. Women also bear an unequal burden in unpaid household labour which can undermine access to paid employment. There is a need to assess the implications of COVID-19 policies to ensure gendered experiences are recognised and addressed. Consider:

• The level of exposure of genders to COVID-19 due to gender segregation in the labour market
• The increased risks to occupational health and well-being of women in caring professions
• Increased consultation with, and inclusion of, women in decision-making during crises
• Working with community/religious leaders to promote caregiving/caretaking as everyone's responsibility
• How gender-balanced teams can provide treatment or support for mental health and well-being
• Innovating to mitigate other social issues such as gender based violence
• Offering guidance on domestic violence into existing services e.g. give volunteers, who provide other services, information on victim support
• Educating organisations about the heighten risk of gender based violence since COVID-19 so that they can be part of safeguarding women and girls

The UN reports that measures to curb the spread of COVID-19 are exposing victims of human trafficking to further exploitation and limiting their access to essential services. The restrictions on movements, diversion in law enforcement, and reduced public health and social services is impacting victims of human trafficking before, during and after their ordeal. Children are also at increased risk of exploitation as a result of being forced onto the streets to find food or work; and women are at risk of sexual exploitation. Consider how to:

• Protect those still at risk from abuse from captors through maintaining dedicated law enforcement departments and social workers for victims of human trafficking. Including the need for adequate PPE for these departments
• Provide safe housing for victims who have been rescued from captivity but are unable to return home due to travel restrictions
• Support those experiencing delays in legal proceedings, including regular updates on the status of their case
• Provide hotlines to emotional, financial, legal and safe housing advice
• Encourage communication between schools, law enforcement and social workers to identify, and check-up on, children at risk of exploitation
• Increase attention to tackling online child sexual exploitation. Travel restrictions have spawned an easy way to groom children, gain access to (or create) child sexual abuse material and establish "delivery" services
• Conduct evaluations into the impact of COVID-19 on resources for victims, law enforcement and justice systems to better understand needs of victims and gaps in provision

The main housing insecure groups include:

1. Asylum seekers (with and without access to statutory support)
2. Private renters
3. Prisoners who have been released

To support these groups consider:

• Mapping housing supply and working in partnership with private businesses, landlords and public services to develop ethical lettings agencies
• Leasing properties off private landlords for a substantial period and letting through ethical lettings agencies
• Ask contractors for commitments to build affordable housing rather than contribute cash donations
• Removing caps on housing benefits
• Ensuring housing allowances for renters meets the rent profile of the area they are renting in
• Mapping facilities e.g. recreation centres that can be turned into emergency shelters for homeless people
• Mapping risks of shared accommodation and capacity during heat waves/winter and risk of infection
• Providing prepaid cards for use for essential shopping e.g. food, medication

References: Chief Resilience Officer, USA and a representative of a UK Local Authority

Poor sanitation, cramped living conditions, and insufficient health facilities put those living in informal settlements at high risk from COVID-19. Outbreaks of Ebola and Cholera have shown that public health policies are most effective when governments work closely with informal communities. Consider:

• Ensuring government efforts tackling COVID-19 are interwoven with local community coordinating committees, volunteer networks, and reporting systems
• Utilising community knowledge, information and networks to understand information about the area, and its population. Tapping into this data is important to effectively target the most vulnerable and understand needs
• Working with communities to develop public heath campaigns and to stop the spread of misinformation. Targeted radio campaigns are more effective than TV public health campaigns, as few can afford televisions and electricity is sporadic
• Working with well-informed and respected community leaders as they are often best placed to spread accurate messages and materials about COVID-19 and how to avoid it
• Developing community-driven track and trace systems to help reduce transmission
• Prioritising serious investment into local clinics, hospitals and infrastructure including sanitation and water supply
• Advocating the rights of Africa's urban poor that has left them more exposed to disease outbreaks

This briefing details how to consider people who have been disproportionately impacted by COVID-19; how they can be identified; and how they could be involved and supported in recovery and renewal. We offer a methodology for identifying those impacts (the process), developed from the steps taken by Greater Manchester to identify the people in their area impacted by the pandemic.

Follow the source link below to read this briefing in full (p.2-7).

Every local government area is likely to have a large number of people who are vulnerable but not eligible for a government food parcel delivery. Some of these people will not be able to access the food they need to stay at home due to:

• Too little money to buy food (including problems with benefits payments)
• Personal crisis for reasons other than COVID-19 (e.g. domestic violence)
• Health issues, disability or caring roles personally, or in the household
• Lack of friends, family or social support to deliver food

In Greenwich, strategic 'food pathways' have been mapped to organise partnerships for large-scale food provision for vulnerable groups, and to relieve pressure on food banks. Pathways include:

• • A model for local governments, local resilience forums and the voluntary sector to work in partnership.
  • To determine appropriate interventions, local governments triage those requiring food support into people who are:
    • financially secure but cannot shop
    • financially insecure and can shop
    • financially insecure and cannot shop
  • A model for community/ third sector groups. Based on this triage, community groups can assess the needs of community and provide appropriate interventions e.g. emergency individual meals or signposting to services

COVID-19 has put a spotlight on wider socioeconomic and health inequalities and vulnerabilities which require long-term interventions. Social justice perspectives address creating fair and just relations between individuals and society through societal transformation to ensure the dignity and rights of people. A social justice perspective would support tackling a number of important inequalities highlighted globally during COVID-19 response and recovery. These include:

• Disparities in the risk and outcomes of COVID-19 for black, Asian and minority ethnic (BAME) people
• Increased risk to women from domestic violence within their homes
• Safety of LGBTQI+ community- safety at home for these communities may be more precarious as they're at a higher risk of homelessness (especially young people) and domestic abuse. Additionally, specific safe community spaces for LGBTQI+ communities have been lost, and access to healthcare can be difficult due to specific needs (this can be especially hard for trans people)
• Significant financial risk to those with precarious employment, which can lead to extreme poverty and homelessness
• Vulnerability of children as a result of any of the above issues - compounded by reduced safe spaces, such as schools, which also provide access to meals, pastoral care and resources e.g. internet and computers

TMB Issue 10 brings together the reflections of our learning from the first 10 weeks of gathering lessons on recovery and renewal from COVID-19. Follow the source link below to read all of the reflections from our team (p.9-15)

The youth may have vulnerabilities that include:

• Safeguarding concerns e.g. those with special educational needs, carers
• Exposed to domestic abuse, financial pressures and poverty, and additional caring responsibilities
• Limited access to computers for studies
• No internet access or costly data packages
• Reliance on public hotspots (currently unavailable)

Consider:

• Free, publicly available internet as part of corporate, and social responsibility providers
• Strategic investments that promote the safety of youth and information to counteract 'fake news'
• Wellbeing and safety of youth via specialised youth work during/post COVID-19 for those at risk of domestic abuse or exploitation (gangs, sexual)
• Creatively engage with youth through established organisations (schools, Youth Parliament and Young Peoples Foundations, community, faith-based organisations)
• Review of additional risks and legalities from COVID-19 legislation, in particular those 'at risk' of offending due to lack of understanding and communication aimed at youth
• Youth engagement in future recovery and renewal plans to co-develop preventative plans to support meaningful transitions to education, employment and training

PPE shortages, lack of testing, and a vulnerable population have seen care homes in England and Wales become hotspots of the COVID-19 epidemic[1]. The impacts of COVID-19 have been hugely disruptive in the care home sector; affecting patients and all aspects of care. The context of these challenges has been attributed to:

• A decline in funding for social care in the past 10 years, even as demand for care has risen as a result of an ageing population[2]
• Daily ~1.5 million older people – one in seven over-65s – go without the help they need with tasks such as washing, dressing and eating2
• Deaths in care homes (from all causes and Covid-19) are increasing - the increased community deaths reflects the prioritisation of social care[3]
• Moving such populations out of hospitals during Covid-19 means systems pressures are pushed elsewhere including into the community:
  • people were reportedly discharged from hospital to care homes without testing for Covid-19[4]
  • people who became ill in care homes were largely not tested for the virus and most were not admitted to hospital[5]

The UK Government has stated that their number one priority for adult social care is infection control during the COVID-19 pandemic[6]. While mitigating the spread of the disease is of paramount importance, protective measures such as isolation are associated with a morbidity of its own[7]. The lack of supervision as a result of staff shortages put care home residents at increased risk of injury and mental health issues, for example those with dementia often stop eating as a result of depression which can hasten death7.

Before the UK Government released their Plan to Rebuild[8] which includes a section on protecting care homes, a number of actions were identified within the sector to address growing concerns over how COVID-19 was being managed in care homes.

Actions to address the situation for care homes include:

• Central/local government and the care home sector should work together to make testing in care homes happen[9].
• More PPE, testing and funding to:
  • Ensure care home residents are safeguarded
  • Prevent avoidable hospital admissions
  • Improve the mental health of families who may be worried that their relatives in care do not have the support they need[10]
• More guidance for care home managers on:
  • Receiving residents from hospitals when they have not been tested
  • Permitting relatives to say goodbye to loved ones
  • Preventing staff making a dozen home visits a day - potentially spreading virus
  • Facilitating staff speaking out about unsafe conditions (five carers reportedly lost their jobs in the past fortnight after speaking out about their concerns)[11]
• In Scotland, the Care Inspectorate (the sector’s regulator) would examine every care home’s conduct during the pandemic12
• Social care should be viewed as part of healthcare and vice versa
• Nurses are working continually on helplines to support families affected[12]
• Consider relatives’ visitation/entry permissions to nursing homes as lockdowns ease[13]:
  • Limit the number of visitations per week and permit only one family member to visit at a time
  • Prevent children and young people (under 14) from visiting
  • Require visitors to reserve a time-slot– and not allow visitors unless they have made a reservation
  • Space visitors throughout the day and across the week to preserve social distancing
  • Prevent entry to visitors if they are ill, under quarantine or in isolation, or if they are waiting for the results of COVID-testing
  • Escort each visitor to use hand sanitizer on entering the care home and on departure
  • Escort each visitor to the resident’s room and back without stopping in the common areas
  • Visitors must adhere to the 2-meter distance regulations, and avoid direct contact with other care home residents
  • Urge visitors to download the COVID tracing app to their smartphone
  • Adapt this advice to circumstances of each care home (e.g. the size of the home, the situation at any given time, the number of confirmed infections in the local community)

The call to address these actions has been met by £3.2bn of additional funding for local authorities from the UK Government, which can be used to meet rising care home and additional pressures on social care. Additionally, a further £1.3bn has been provided for the NHS and local authorities to work together to fund the additional needs of people leaving hospital during the pandemic. The Governments priority areas are[14]:

1. Testing;
2. Infection prevention and control;
3. Workforce expansion through a recruitment campaign;
4. Clinical support through accelerated introduction of enhanced health support in care homes from GPs and community health services;
5. Guidance.
   

References:

[1] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[2] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[3] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[4] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[5] https://blogs.lse.ac.uk/politicsandpolicy/covid19-deaths-social-care/

[6] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[7] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31199-5/fulltext

[8] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

[9] Age UK. https://www.ageuk.org.uk/latest-press/articles/2020/04/age-uk-response-to-more-care-home-deaths/

[10] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[11] https://www.theguardian.com/commentisfree/2020/may/03/the-observer-view-on-care-home-deaths-being-an-indictment-of-our-society

[12] Dementia UK https://www.dementiauk.org/coronavirus-care-home-deaths-up-hospital-cases-fall-our-response/

[13] National Commissioner of the Icelandic Police, Status Report on 24-4-20

[14] https://www.gov.uk/government/publications/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy/our-plan-to-rebuild-the-uk-governments-covid-19-recovery-strategy#our-roadmap-to-lift-restrictions-step-by-step

LGTBIQ+ people have a number of vulnerabilities. Consider:

• LGBTIQ+ people are less likely to have safe homes and are at a higher risk of homelessness (especially young people) and are at a high risk of domestic abuse
• The impacts of losing safe community spaces and the additional mental health impacts of this
• The complications with access to healthcare which can be especially hard for trans people who have specific medical needs
• The use of test, track and trace facilities for this vulnerable group. In South Korea a new wave of infections have been attributed to 3,000 people attending clubs that accommodated the LGBTIQ+ community. But only half of people in attendance have gone for testing, due to fears that doing so would reveal their sexuality. Confidence in personal safety and confidentiality is paramount in track, trace and treat processes

Consider:

• Women are more likely to carry out unpaid work or serve as care givers. The pandemic is likely to negatively impact their livelihoods and dramatically increase their unpaid care work
• Women constitute over two-thirds of workers in the health and social sector globally, placing them on the frontlines of the pandemic response, but with a persistent gender pay gap and fewer leadership positions than their male counterparts
• These issues can restrict access to resources, decision making and the ability to take preventive measures

Close consultation is needed with women's organisations i.e. groups for mothers, carers, women's rights, domestic violence

In California, the "Stay Home. Save Lives. Check In." initiative has been developed in partnership with the California Department of Aging, and three founding partners from the public, private and academic sectors. The project aims to counter strict social distancing with social bridging (one-on-one communication with older adults through check-in phone calls). The project will:

• Train and mobilise >1000 people to telephone call older Californians to check on their well-being, direct them to resources, and connect them on a personal level
• Prioritise reaching the most isolated older adults those living in pandemic hot spots, and those likely to be facing food insecurity via "Social Bridgers"
• Train callers to assess basic needs and make referrals. Callers will use a tested call script to ensure consistency and reliability and will empathise with each individual's experience of this pandemic
• Use Community Emergency Response Teams (CERT), trained volunteers affiliated with local public safety agencies
• Utilise United Airlines employees in San Francisco, San Jose and Los Angeles as they have a robust employee donation and volunteer system for disasters
• Use Sacramento State University gerontology students
• Expand partnerships in the coming weeks. Members of the public are not being solicited as callers at this time

Additionally the need to identify a social work action plan to support families and vulnerable people as restricted movements are relaxed. This plan can identify:

• The social work skills needed to support families and vulnerable children
• The projected demand for such skills
• The capacity of the current social work system to deliver those skills
• Shortfalls in supply versus demand of skills
• Skills can be supported through non-social work providers such as volunteer organisations
• The training, supervision and resources are needed for volunteers to be safely involved
• What types of families and vulnerable children may be supported with those skills from non-social work providers
• The shortfall in families and vulnerable children who will need professionally-trained social workers
• How that shortfall can be addressed by professional social workers
• How many professional social workers can be trained, and when they will be available to work
• How to address any remaining shortfall in the short term

Including:

• The pressure on vital sexual and reproductive health services (including for women subjected to violence) and how provisions can be maintained
• The provision of hotlines, crisis centres, shelters, legal aid, and protection services and impacts of scaling these back
• Identifying and evaluating outreach methods to support those at risk of abuse within their own home
• Plans for the safety of health workers (the majority of whom are women) who may be at risk of violence in their own home and at work
• How to include men in conversations about violence towards women

While most of the messages on COVID-19 have been directed at adults, children have been significantly affected by COVID-19 too. Children have been taken away from their friends, cannot see grandparents, are prevented from attending school, not have gardens to play in, and the clubs they attend have been disrupted. This should be acknowledged and children should be thanked for their patience. This can help support children in their understanding of evolving recovery measures such as exit strategies from lockdown and phased school return.

This lesson was offered by a Risk Management expert in Iceland during project data collection.

Understanding children's perspectives is important to provide children with an outlet to express themselves, and for adults to gain a better understanding of how children view their situation.

• Consider creative activities where children can explore their feelings about COVID-19, this could include drawings, video blogs or music. One example, is a collection of drawings and messages collated by the BBC, showcasing children's perspectives about the world they are living in. These types of activities could be recurring, and could be developed to address a number of issues i.e. lockdown, not going to school, fear, bereavement.
• Similar activities could support communities in emotional and social recovery from the impacts of COVID-19 and could provide innovative ways for adults and children to explore bereavement, memorials and commemoration.
• Children's pictures of colourful flowers in windows can make their walks more enjoyable and brighten the nation. The rainbows can be refreshed to create a refreshed vibe for the children to engage with.

This can help to prevent deaths and stop the number of cases accelerating as suppression measures are eased. The benefits of these measures are:

1. Containment measures allow us to reduce suppression measures without the spread of the virus accelerating
2. Shielding the vulnerable allows us to reduce the death toll of the virus even if the spread of the virus does accelerate. Older people and people with relevant health conditions would be protected

European countries are starting to ease, but containment and shielding capacity appears limited, risking acceleration of the virus. East Asia has advanced containment capacity and anticipate better testing and tracing capacity and widespread use of masks.

It is critical that governments and civil society proactively combat stigma and discrimination through regular and transparent communication on the transmission of the virus and other aspects of the pandemic, cautioning against laying blame or accusations against any group of people.

This includes elderly, those with pre-existing health conditions, migrants and homeless. Consult with organisations representing these groups to develop understanding of how they might be affected by complex emergencies and what measures could be taken. (UN -75 People's consultations established for this). For example, in the UK some LRFs are considering how to evacuate during lockdowns or social distancing.

Including those without safe accommodation e.g. homeless, victims of domestic abuse. Consider the sustainability of these measures into longer-term recovery.

Reference: Chief Resilience Officers, USA and Italy

For example, the Vietnam National COVID-19 Plan commits to engaging the national women's association to collaborate with local governments to effectively manage the outbreak. Such collaborations can inform holistic recovery.

Including care for persons living with disabilities or ante-natal care. The potential negative impacts of COVID-19 prevention and treatment actions need to be considered in decision-making so that vulnerable groups are not doubly affected by both the hazard and the response.

In the Asia Pacific region this is around 65% of working women. They, along with other daily wage earners, are the least likely to be able to take preventive measures such as self-isolation or physical distancing.

Local government should ensure appropriate composition of their community engagement teams, and the impacts this can have on women and other marginalised groups. Women face specific constraints when gaining access to information on outbreaks and services that they need to access. This can be further hindered by community engagement teams that are dominated by men.