Recovery, Renewal, Resilience

Research has found that additional statistical modelling based on cultural and demographic factors can help to predict how disease outbreaks such as COVID-19 can accelerate and progress. The aim of this ongoing research is to project the spread of future pandemics by utilising the predictive power of cultural and demographic data. Effectiveness of response interventions should consider cultural values among people in communities. Consider:

• A data driven approach to modelling disease outbreak prevalence based on cultural and demographic factors such as:
  • Population size
  • Population density
  • Public transport
  • Health (e.g. obesity)
  • Culture (e.g. voting patterns – research has shown that societies/communities with low trust in institutions tended to have higher COVID-19 death rates)

This paper offers a predictive model of COVID-19 prevalence – finding that the above 5 risk factors can predict between 47% and 60% of variation in COVID-19 prevalence in US counties. A second paper explores how cultural values can support the prediction of how outbreaks could progress and also what population groups may be most vulnerable.

Local people and organisations are vital to delivering change, however, many face barriers and lack the resources to undertake resilience building activities. In the USA, Community Development Financial Institutions work to promote economic revitalization and community development in low-income communities through ‘values driven, locally informed and locally targeted investments’. Consider:

• That investment in community resilience can mitigate the impacts of shocks and stresses caused by crises and accelerate recovery from crisis
• When investing in community resilience, it is important to consider the life span of projects to ensure all communities have the opportunity to achieve their resilience goals
• That all people and communities should have equal access to the ability to build resilience and some may require additional or targeted support
• Engagement of all stakeholders is critical, to ensure that investment will benefit all people in the community

Involving citizens in the recovery planning and development process can lead to more effective policy outcomes and build trust and a two way dialogue between citizens and government. COVID-19 has had diverse impacts on the lives of individuals and communities, and their involvement in deciding the routes to long-term recovery following the pandemic is crucial. Consider the good practice principles for deliberative processes offered by the OECD, which will support the achievement of "high-quality processes that result in useful recommendations and meaningful opportunities for citizens to shape public decisions":

• Clearly define the issue as a question that is aligned with the concerns and challenges faced by different communities
• Invite people to make recommendations for addressing the issues that affect them, respond to recommendations in a timely manner, and monitor and feedback regularly to people on the progress of their implementation (e.g. Scotland's Citizens' Assembly)
• Ensure the process is inclusive and representative of all people in the community, e.g. stratified random sampling to select a participant group which fully represents a community's demographic profile
• Make information easily accessible through public communications. Include the purpose, design, methodology, recruitment details, experts, recommendations, the response, and implementation follow-up
• Establish a mechanism through which people can request additional information, ask questions and keep up to date on progress of activities
• Appoint a liaison person who can feed information in from and out to the community
• Take time to reflect on and evaluate deliberative processes, to ensure learning, help improve future practice and understand impact

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

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

Conventional campaigning tactics, such as door-to-door visits and town hall meetings to connect and talk to constituents, are not currently possible in many countries due to COVID-19 guidelines and concerns over risk of virus transmission. Clear guidelines that have the agreement of major parties are needed to ensure appropriate electioneering keeps election candidates and voters safe. Consider the need to:

• Develop an agreement between major political parties on the rules they commit to follow to ensure the safety of their election campaigns
• Identify alternative campaigning methods that are appropriate, such as:
  • Increased use of telephone and postal campaigning
  • Online platforms to support webinars and online town hall meetings with candidates to interact with voters
  • Increased involvement of volunteer helpers in constituencies
• Identify campaigning methods that are not appropriate, for example:
  • Driving voters to voting booths
  • In-person public appearances in places where crowds may then gather
• Appoint an arbitrator to advise on the adherence to agreed rules and the appropriateness of campaigning methods
• Consider how positive and negative campaigning may affect public mood at an already stressful time
• Communicate rules to campaign offices well in advance to allow preparation
• Communicate the campaign rules to the public

As the roll out of the COVID-19 vaccine gains pace, there has been reporting of a rise in criminal activity targeting people who await information about their vaccine. Examples of how fraudsters are exploiting the vaccine launch includes: scam text messages that request personal information such as bank details; fraudsters turning up at peoples' houses posing as National Health Service employees and offering vaccination for immediate payment. Fraud undermines public confidence in official programmes and contribute to a negative narrative around the vaccine programme. Consider public messaging to:

• Use a range of communication channels to build public awareness of fraudsters' tactics to encourage vigilance regarding vaccination communications
• Ensure communications about fraud awareness are available in different languages and different media e.g. to support migrants or support people with disabilities such as via informational videos: https://signhealth.org.uk/resources/coronavirus/
• Publish a list official government and health websites/social media channels that are authorised to provide official information on the vaccine
• Include in fraud communications information on the ways in which people will be invited for an official vaccine, and ways that they will not be invited
• Identify partnering organisations that can distribute messages about vaccine fraud e.g. organisations that run befriending schemes, check-in and chat services, vaccination partners
• Disseminate consistent information to these partnering organisations to advise them of how to provide information about fraud without concerning people about the safety of the vaccine itself

Research suggests that the effectiveness of the COVID-19 vaccine will be heavily affected public attitudes about vaccination. For a highly infectious disease, even a vaccine with adequate efficacy, pace, and coverage may be insufficient to tackle population dynamics (e.g. age and population size) that produce high disease prevalence. Consider public messaging to:

• Foster widespread public understanding and enthusiasm for vaccination, while addressing sources of hesitancy for vaccines (generally and for COVID-19)
• Promote vaccine acceptance through culturally-sensitive, evidence-based and local communication
• Promote the continued need for other prevention practices even after a vaccine becomes available as reducing transmission requires a sustained commitment to public health practices
• Ensure that vaccines are understood by all communities, particularly underserved groups for which longstanding disparities in vaccination coverage have been evident

Time is a main barrier to learning lessons and implementing actions from those lessons. However, learning lessons while an event is still unfolding provides contemporaneous thinking to help guide actions. Organisations or all sorts can identify and learn their own lessons, feeding into industry/association calls for learning. Consider:

• Appointing someone to identify lessons during events
• Maintaining an up-to-date log of lessons to capture learning and support institutional memory
• Using the log of lessons dynamically and reflectively to asses performance and guide debriefs
• Coordinating the lessons learned across an area or industry to pool learning for greater effect, to bring the system together to share context specific learning through:
  • Holding workshops and industry seminars
  • Liaising with academic institutions, networks/associations, and business centres
  • Promoting information widely through various medias e.g. online and in print
• Guidance on collating lessons to assess performance and processes for debriefing can be found in TMBs 18 and 22

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

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

The scale of COVID-19 requires information to the shared across countries and regions effectively. Consider how your organization can contribute to open data sets such as The Living Repository and the 'OECD - GOVLAB- Call for Evidence: Use of Open Government Data in COVID-19 Outbreak'. Consider contributing or using open data to identify:

• COVID-19 cases, individuals at risk, and forecasting future scenarios, including disease spread/contraction, and possible treatments for those infected
• Availability and demand for supplies, locating and connecting actors with medical supplies
• Whether communities adhere to guidelines and recommendations outlined by health authorities
• Public perceptions and how restrictions are affecting well-being, including crime e.g. the rise in domestic violence and child abuse
• Whether efforts are efficient, transparent, meet needs, and do not violate democracy, privacy, ethics or fundamental human rights
• Misinformation including accuracy, speed and scale of fact-checking
• How, where, and when lockdowns are lifted
• How the pandemic affects those who live and travel outside their country of national origin
• The most effective forms of aid to those most vulnerable to the pandemic's economic shocks
• The risks and challenges workers face to their health and safety and the protections available
• The impact on the ability of students and workers to meet learning and training outcomes
• Institutions most likely to close as a result of the pandemic and providing support
• The pandemic's effect on climate-related activities, global emissions, energy usage, and wildlife
• Disruptions caused by confinement measures on the economy e.g. analysing data on supply chains, trade, impacts on inclusive growth

Children with hearing loss return will increasingly come into contact with other school students and members of staff wearing masks. Consider how to optimise communication with children with hearing loss by adapting the use of face coverings in schools:

• Use face shields instead of masks as these have been reported to improve communication through visual cues and lip reading
• Be aware of how sound may be reduced when wearing a face shield so utilise technology such as personal microphones to mitigate loss of sound
• Ensure staff's face is visible to children by mitigating fogging of face shields by rubbing a small amount of soap, using an 'anti fogging' spray, or inserting a folded facial tissue between the face and top edge of the mask
• Remind staff of basic communication strategies such as use of clear speech. This can include clear enunciation, speaking slowly, minimizing background noise as much as possible, and facing the class while speaking. Teachers should also remember to repeat the questions and answers provided by other students in the classroom to provide a better opportunity for every child to hear peers' comments
• Offer a recorded version of the lesson whether this is in written or video form, or speech-to-text technology to provide real-time notation

To avoid singling out students with hearing loss, teachers can develop a silent communication system with the student to signal comprehension or misunderstanding e.g. a card system where a red card on the child's desk indicates their need for assistance and a green card indicates comprehension.

The outbreak of COVID-19 has resulted in countries closing their borders at short notice, and the suspension or severe curtailing of transport. These measures have implications for those who are not in their country of residence including those working, temporarily living, or holidaying abroad. At the time of the first outbreak, over 200,000 EU citizens were estimated to be stranded outside of the EU, and faced difficulties returning home[1].

As travel restrictions for work and holidays ease amidst the ongoing pandemic, but as the possibility of overnight changes to such easements, there is an increased need to consider how repatriations may be managed. This includes COVID-safe travel arrangements for returning citizens, the safety of staff, and the effective test and trace of those returning home. Facilitating the swift and safe repatriation of people via evacuation flights or ground transport requires multiple state and non-state actors. Significant attention has been given to the amazing efforts of commercial and chartered flights in repatriating citizens, but less focus has been paid to the important role that emergency services can play in supporting repatriation efforts.

In the US, air ambulance teams were deployed to support 39 flights, repatriating over 2,000 individuals. Air ambulance teams were able to supplement flights and reduced over reliance on commercial flights for repatriations (a critique of the UK response[2]). This required monumental effort from emergency service providers. After medical screening or treatment at specific facilities, emergency services (such as police) helped to escort people to their homes to ensure they had accurate public health information and that they understood they should self-isolate.

Authorities should consider how to work with emergency services to develop plans for COVID-19 travel scenarios, to better understand how to capitalise on and protect the capacity and resources of emergency services. Consider how to:

• Develop emergency plans that include a host of emergency service personnel who have technical expertise, and know their communities. Plans should[3]:
  • Be trained and practiced
  • Regularly incorporate best practices gained from previous lessons learned
• Build capacity in emergency services to support COVID-19 operations through increased staffing and resources
• Anticipate and plan for adequate rest periods for emergency service staff before they go back on call during an emergency period
• Protect emergency service staff. Pay special attention to safe removal and disposal of PPE to avoid contamination, including use of a trained observer[4] / “spotter”[5] who:
  • is vigilant in spotting defects in equipment;
  • is proactive in identifying upcoming risks;
  • follows the provided checklist, but focuses on the big picture;
  • is informative, supportive and well-paced in issuing instructions or advice;
  • always practices hand hygiene immediately after providing assistance

Consideration can also be given to what happens to repatriated citizens when they arrive in their country of origin. In Victoria (Australia), research determined that 99% of COVID-19 cases since the end of May could be traced to two hotels housing returning travellers in quarantine[6]. Lesson learnt from this case suggest the need to:

• Ensure clear and appropriate advice for any personnel involved in repatriation and subsequent quarantine of citizens
• Ensure training modules for personnel specifically relates to issues of repatriation and subsequent quarantine and is not generalised. Ensure training materials are overseen by experts and are up-to-date
• Strategically use law enforcement (and army personnel) to provide assistance to a locale when mandatory quarantine is required
• Be aware that some citizens being asked to quarantine may have competing priorities such as the need to provide financially.
• Consider how to understand these needs and provide localised assistance to ensure quarantine is not broken

References:

[1] https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/649359/EPRS_BRI(2020)649359_EN.pdf

[2] https://www.bbc.co.uk/news/uk-politics-53561756

[3] https://ancile.tech/how-to-manage-repatriation-in-a-world-crisis/

[4] https://www.cdc.gov/vhf/ebola/hcp/ppe-training/trained-observer/observer_01.html

[5] https://www.airmedicaljournal.com/article/S1067-991X(20)30076-6/fulltext

[6] https://www.theguardian.com/australia-news/2020/aug/18/hotel-quarantine-linked-to-99-of-victorias-covid-cases-inquiry-told

To read this case study in its original format follow the source link below to TMB Issue 21 (p.20-21)

Sharing information is a powerful way to relate the changing situation of the COVID-19 crisis to the public. We know that local information is best for keeping people up-to-date on how the virus is affecting people in their area – essentially, by communicating what is happening in their local community. Boise State University (Idaho) have developed an online interactive dashboard to communicate an array of information to the public about Idaho State and its counties. Johns Hopkins University provides a similar dashboard for global cases of COVID-19, providing country-level information. Consider providing:

• An interactive map of the area for the public clicked on and drill down to access area-specific information
• Colour coded areas of the region to communicate comparisons across key measures
• Updates of the number of cases and deaths presented numerically and graphically
• Layer on information on where to get local support i.e. available community resources
• Providing updates of:
  • key behaviours that officials want the public to adopt
  • changes in guidelines
  • significant decisions made by the crisis committee
• The date/time when the information was last updated
• The dashboard in relevant languages for the area

In the USA, the impacts of natural disasters are being felt more frequently and earlier than expected. As a result, emergency planning for potential evacuation is of increasing importance. Consider: Locale specific, local guidance on evacuating safely during the pandemic:

• Reviewing agreements and plans with neighbouring regions to provide mutual aid resources
• Adequate stocks of personal protective equipment for staff, and to distribute to evacuees and residents at risk of evacuation
• Adequate stocks of COVID-19 testing kits to evacuation centres to avoid spread of the virus during evacuation
• Capacity to perform temperature checks on all arrivals at shelters
• Ensure residents are prepared to make plans for alternative arrangements during an evacuation such as staying with friends/family, or in hotels, rather than relying on communal shelters (which should be the last option)
• Ensure residents have adequately prepared for an evacuation and understand they should bring their own personal bedding and care items to mitigate transmission

FEMA (USA) has made freely available some training materials on a range of topics. The trainings below are not specific to COVID-19 but are helpful to the broader issues of planning for emergencies. These links are to just the slides, but they provide a helpful background and sources for further study. Consider reviewing the materials in the following FEMA courses:

• Animals in Disasters: Awareness and Preparedness
• Animals in Disasters: Community Planning
• An Introduction to Exercises
• Leadership and Influence
• Decision Making and Problem Solving
• Effective Communication
• Developing and Managing Volunteers

Each of these courses have online materials available on the URLs given above - often over 100 slides are freely available.

There is a glut of information on COVID-19 and more often we are seeing news outlets attempting to check and correct misinformation that be being shared. This should aim to ensure that the public have conclusions about the virus which are substantiated, correct, and without political interference. Myths can be debunked, misinformation corrected, and poor advice challenged. Consider whether to:

• Provide your own fact-checking website
• Contribute to others' fact-checking sources
• Check facts of colleagues and partners to ensure correct information prevails
• Remind others of the importance of not spreading misinformation and checking other peoples' facts
• Link your website to official sources of information so not to promulgate misinformation

FEMA (USA) make freely available training materials on a range of topics which are of relevance to the current pandemic. The list of training below is not specific to COVID-19 but is helpful for the broader issues of planning for emergencies and commanding emergency response to incidents. These links are to just the slides, but they provide a helpful background and sources for further study. Consider reviewing the materials in the following FEMA courses:

• Emergency Planning
• Fundamentals of Emergency Management
• Introduction to the Incident Command System
• Basic Incident Command System for Initial Response
• An Introduction to the National Incident Management System
• National Response Framework: An Introduction

Each of these courses have online materials available on the URLs given above - often over 100 slides are freely available.

Spare capacity is expensive when it is not being used so, in many cases, systems are lean and focus on maximising their utilisation, ongoing value for money, efficiency and return on initial investment. However, this reduces ability to rapidly access capacity and to react quickly in emergency situations. During the early stages of COVID-19 in different countries we witnessed the attempt to delay the impact of the virus so that the system could create needed capacity in areas of healthcare. This time was used to create spare capacity by freeing up beds, sourcing equipment and supplies expected to be needed, preparing staff, identifying processes to pause or reduce to redeploy resources to more critical activities, retrain staff in other critical activities. As countries analyse the potential of future waves of the pandemic, consider:

• What important services are/have been stretched to (or exceed) maximum capacity during the response e.g. healthcare (intensive care), schools (number of socially distanced pupils in classrooms)
• Where demand for important services could exceed available capacity during recovery and Renewal e.g. provision of mental health support, financial advice, unemployment services, retraining
• Where spare capacity should be built into the system so that an appropriate response can be rapidly provided to emergencies e.g. ongoing response to COVID-19, concurrent emergencies, future outbreaks of the virus
• How spare capacity can be created, protected, and prioritised for rapid use when needed
• The need for spare capacity on an ongoing basis after the crisis lessens

Reference: Interview with German Fire Department

Existing resilience strategies should be amended in real-time to include long and short-term actions to combat the effects of COVID-19. This should include consideration of pre-existing vulnerabilities such as local socio-economic conditions, and environmental risk such as heatwaves and floods. Consider evaluating all indicators of all resilience programmes to weave COVID-19 impacts and indicators into sustainable resilience planning. This helps accommodate COVID-19 into existing long-term city plans, rather than trying to build resilience purely around COVID concerns

This lesson was contributed to by Chief Resilience Officers in the USA and Colombia, during project data collection.

The Centres for Disease Control and Prevention (CDC) advises to:

• Avoid language that blames others or leads to stigmas
• Pay attention to what children see or hear, whether it's online, on television, or media such as newspapers
• Reduce the amount of screen time focused on COVID-19 as too much information can lead to anxiety
• Talk to children about how some internet stories on COVID-19 may be based on inaccurate information
• Help children thoroughly wash their hands for at least 20 seconds
• Teach and remind children to practice healthy habits e.g. coughing or sneezing into a tissue

Including:

• Advising citizens to remain prepared for a future lockdown - provide information to citizens about 'preparedness kits' that they may still want to keep available. This kit can include non-perishable foods, hygiene and cleaning products, basic medical supplies, and entertainment items. Consider providing information on items to purchase based on age or gender
• Advising citizens not to panic buy - if advising citizens to develop 'preparedness kits', provide clear information about how many items are reasonable per household, explain why over-stockpiling is not needed and detrimental
• Advising citizens about lockdown procedures - if advising citizens to develop 'preparedness kits', provide clear information to reiterate lockdown procedures such as social distancing, self-isolation, monitoring of systems, access to services during a lockdown

Strategies should broadly include:

• Sending alerts to the public so they know what to do
• Encouraging the public to make a plan to protect and connect with people close to them
• Educating the public about getting to safety with key items they would need
• Educating the public about staying safe at home when they can't leave
• Encouraging the public to help friends and neighbours get ready

Workers' compensation benefits may be required for registered volunteers that are injured while participating in authorized disaster-related activities. This can include injury sustained during pre-approved training, and covers activities undertaken in the response or recovery phases of a disaster or emergency. It does not include the day-to-day emergency response activities typically associated with, for example, law enforcement, fire services or emergency medical services. This may need to be supported by appropriate legislation.

This lesson was contributed by a Disaster Management expert in the USA during project data collection.

And ensure the consistency of all planning. For example:

Consider a national emergency plan with uniform standards for the gradual return to normality that:

1. Supports hospital systems and expand surge and testing capacity
2. Protects vulnerable populations, including seniors and those with access and functional needs
3. Supports homeless population and shelters through emergency protective measures
4. Ensures continuity of first responders and healthcare workforce
5. Provides state and federal economic impact assistance, including financial support for those economical areas that may only be allowed to resume operations at the last moment
6. Executes task force objectives and continue mid and long-term advance planning

Reference: Civil Protection experts in Germany and the USA.

Acting on information is a result not only of how the information is presented but of the way the subconscious operates; underlying beliefs, attitudes and motivations. The following can be considered:

• Connect precautions for COVID-19 to aspirational movements, like community spirit and local pride – keeping your community safe
• Leverage people’s desire to do the right thing for others in all aspects of their lives – e.g. what would your own grandmother want?
• Use images of famous people in protective gear delivering food – e.g. members of the Royal Family
• Feature celebrity athletes and movie stars telling people to shelter at home – e.g. through TV advertising

It will take a steady stream of messages to shift behaviour: this is not a one-off activity

Impact Assessments can inform evolving governance during recovery, and incorporate the views of multiple stakeholders.

Reference: Chief Resilience Officer, USA

Rather than different pieces of reference information in different places. This will support recovery as people will know exactly where to get information that is in line with the developing situation relating to Covid-19.

Reference: Officer of the Governor, California, USA

To prepare for natural disasters or malicious cyber-attacks.

Reference: Chief Resilience Officer, USA

Consider how first responders can develop a 'code compliant, agile public safety office' that can support the public through shared responsibilities.

This lesson was offered by a Chief Resilience Officer in the USA during project data collection.

This can help to ensure as wide a community outreach as possible.

Local government should assess the continuity of recovery strategies across national boundaries to ensure all areas understand the strategic objectives of their neighbours. This should consider how the control of population movement could minimise risk of resurgence of Covid-19, and how the simultaneous opening of services could support national economy but compromise other aspects of recovery including the prevention of subsequent waves of infection.

Reference: State Volunteer Coordinator, USA

Local government should identify lessons learned and update their DRR plans, procedures and practices with knowledge gained during the Covid-19 response. This should integrate lessons from all sectors to improve DRR practices with information about epidemics that effect all aspects of society, commerce and life. Covid-19 has change thinking that pandemics were limited to the health sector and has moved its prominence into all sectors and to all stakeholder. Cities are now epidemic aware and this social and institutional memory should be recorded and used to inform plans.

Reference: American Red Cross