Recovery, Renewal, Resilience

We identify the core barriers to co-production during the pandemic: Pace, distance and complexity, and provide a broad framework which can be designed into a project's main policy framework to facilitate co-production in preparedness and response.

Follow the source link below to TMB Issue 33 to read this briefing in full (p.3-6).

While the vaccine programme may be in its early stage in many countries, thought is required on how to access people who are not on any social services list or registered in any location. This includes homeless people, illegal immigrants, stateless people and refugees who are not in the 'system'. Excluding such people from the programme risks the virus continuing to affect them, and then spreading into other parts of society. Consider:

• Take a national perspective on how to involve people who are marginalised from mainstream public services in the vaccine programme
• Establish who is responsible for vaccinating unregistered people
• Decide whether all vaccination centres are open to vaccinating unregistered people
• How partners that have strong community links can disseminate the vaccine message to unregistered people
• Assess the consequences of unregistered people not being vaccinated
• When the first vaccination of an unregistered person should take place and a target time frame in which to vaccinate all unregistered people
• Identify challenges for the vaccination programme in vaccinating unregistered people
• Recognise that un-registered people may be fearful or hesitant to come forward to receive the vaccine:
  • Consider a moratorium/amnesty on those who regard themselves to be illegally resident in the country to receive the vaccine
  • Work with partners and external organisations who have links to un-registered people to communicate that they can register to receive the vaccine without fear of immigration enforcement activities

Vaccines must be a global public good, which contribute to the equitable protection and promotion of human well-being among all people. At national level, a clear aim for vaccine programmes is essential, e.g. reduce immediate risk to life, in order to inform the identification of priority groups. As sufficient vaccine supply for whole populations will not be immediately available, WHO have provided a Prioritization Roadmap and a Values Framework, to assist with the prioritization of target groups. The WHO guidelines and framework advise to:

• Identify groups that will achieve the vaccine programme aim where there is an immediate risk to life, e.g. Stage 1 Priority Group - Care home residents, staff and volunteers working in care homes; Stage 2 Priority - Frontline health workers and those of 80 years of age and over. Priority groups should be listed and detailed to cover the whole population that is to be vaccinated
• Clearly define groups within priority phases, e.g. workers who are at very high risk of becoming infected and transmitting COVID-19 because they work in, for example, frontline health care, COVID-19 treatment centres, COVID-19 testing laboratories, or have direct contact with COVID-19 infected patients
• Avoid classifying groups as 'essential workers' as a qualifier
• Make priority groups explicit, straightforward, concise and publicly available
• Assess the prioritisation of those who are in high population density settings, e.g. refugees/detention camps, prisons; or who are not recorded in existing systems, e.g. un-registered persons
• Recognise vaccination as a global issue to begin conversations that identify how we will achieve the aim of reducing immediate risk to life globally, through international collaboration

Interface management considers how to streamline communication, monitor progress and mitigate risks when working with multiple contractors, subcontractors, and clients. This is particularly important during COVID-19 where the government may set out its requirements in contracts, but the actual delivery of a service is done through third parties. One example where effective interface management failed was in the outsourcing of a security firm to supervise quarantined travellers in a hotel in Victoria, Australia. The firm were asked to undertake their 'normal' tasks monitoring movement, alongside biohazard containment which required extensive specialised training they did not have - ultimately leading to widespread transmission of COVID-19. Given the number of outsourced services (e.g. in transportation, security, and health), consideration should be given to the new ways in which service delivery and health merge:

• Evaluate what can reasonably be expected from a contractor given their expertise and resources and provide additional training or resources to ensure COVID-safe services are delivered
• Ensure agreements, resources and expectations for COVID-safe provision are discussed and understood by all parties involved in delivering a service e.g. from government to outsourced supply chains
• Evaluate the impacts of performance-based metrics for services against short and long-term risks to delivery and to health
• Consider who is responsible for 'regular risks' (e.g. costs, lateness and cancellations of services etc.) during COVID-19 and who should manage the public health risks -ensure regular updates are communicated amongst all parties to provide an informed approach of regular and COVID risk and where they converge

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)

Vulnerable people and people with disabilities are most at risk during disasters. The impacts of COVID-19 have exacerbated the risk to vulnerable people and people with disabilities, and has exacerbated the risks for marginalised groups of people. Consider assessing:

• How well evacuation plans incorporate vulnerable people and people with disabilities. This should include consideration of compounding impacts on at risk groups from COVID-19, and new vulnerable groups such as those with new underlying health conditions from contracting the virus
• The inclusiveness of disaster preparedness activities e.g. the accessibility of hygiene facilities, and accessibility of early warning messaging for those with disabilities, in poverty or with limited access to information
• The availability of alternative evacuation accommodation (rather than mass shelters) for particularly vulnerable people, where specialised care can be provided

Compound disaster pose a serious risk during the pandemic, which requires a dual focus on the constant threat of COVID-19 to people’s health and to economies, and on natural disasters. The compound nature of natural disasters and COVID-19 intensifies the scale and broadens the scope of human, social, economic and environmental impacts[1]. Disasters have continued to rise year on year. In 2019, EM-DAT recorded 396 natural disasters globally, that led to 11,755 deaths, affected 95 million people, and resulted in 103 billion US$ in economic losses across the world. Floods were the deadliest type of disaster accounting for 43.5% of deaths, followed by extreme temperatures at 25% (mainly due to heat waves in Europe) and storms at 21.5%. Storms affected the highest number of people, accounting for 35% of the total people affected[2].

This trend has continued, 2020 is on course to be the hottest year on record[3] - impacts of this have been witnessed in parts of Africa and the Middle East where crops have been devastated by locust swarms that begun breeding several months earlier than normal due to weather conditions[4]. Of the 132 unique extreme weather events that have occurred in 2020 (as of late September), 92 have overlapped with the COVID-19 pandemic[5].

Learning from two cases: Vanuatu and Bangladesh

A recent example of a large scale disaster during COVID-19 is the category 5 Tropical Cyclone (TC) Harold that struck Vanuatu on 5 April 2020, affecting over 130,000 people (approx. 43% of the population) and resulting in three deaths. TC Harold caused significant damage to schools, medical facilities, homes, agricultural crops, telecommunications and the local boat fleet[6]. More vulnerable groups such as women were reportedly dealing with multiple concurrent crises, namely drought, scarcity of portable water, volcanic ash, acid rain and sulphur gas as there are also several active volcanoes[7].

While Australia did provide humanitarian aid, strict protocols were implemented when delivering supplies to minimise any chance of transmission to Vanuatu[8], and to date there are no, nor have been any cases of COVID-19 in Vanuatu[9]. However, much of the humanitarian support was offered remotely which demonstrates a shift in how aid is provides e.g. aerial surveillance to assess the scale of impact, logistics support to release relief items that were locally pre-positioned.

The cyclone that hit Bangladesh in May 2020 presents the opposite scenario. The impacts of cyclone Amphan were lessened by decades of disaster risk reduction strategies and a weakening of the storm as it made landfall, which meant the death toll was in the dozens rather than thousands[10]. However, the large number of COVID-19 cases in Bangladesh had serious ramifications for ‘normal’ disaster response. Coastal communities in the path of the cyclone had to make choices between braving the cyclone’s impacts as it hit land, and risking COVID-19 infection as 2.2 million people in Bangladesh were evacuated to shelters[11].

The combination of these cases – heavy impact on people and resources from a natural disaster, combined with high COVID-19 infection rates – demonstrate the worst case for which emergency planners and the humanitarian community need to plan. Going forward, disaster affected countries will be impacted by limitations faced globally, as countries contend with COVID-19 and the impacts this has on their own health systems and economies, and the impacts of this on offers of humanitarian aid. Additionally, logistical support, made more complex by travel restrictions and pressures on global supply chains for resources also needs to be considered, for example:[12]

• Impacts of restricting travel on providing and receiving support, including legislation to override COVID-19 restrictions for assistance
• Implications for efficient response if 14 day isolation periods are required e.g. if dispatching urgent search and rescue teams; how do you choose between saving people from a collapsed building or (re)infecting a community with COVID-19?
• Availability of reliable partnerships for international support including financing, mutual aid and personnel when many countries’ own health systems and economies are under huge strain
• Availability of appropriate protective equipment for all personnel deployed to support a humanitarian effort, including those working in-country
• Pressures on internal mobilization of resources, including the health system which is required for first response to both COVID and disasters
• Risk of infection during evacuations while travelling to and from evacuation centres and residing there

Despite these challenges there are measures which can help countries better prepare for compound COVID-19 disasters. Consider how to:

• Reconceptualise all disaster response as simultaneous COVID-19 response and mitigation of virus transmission
• Develop strategies that incorporate both climate change adaptation and reducing global health threats, by building COVID-19 into disaster risk reduction strategies. Use pre-existing resources such as the Disaster Resilience Scorecard for Cities, and it’s related Public Health Addendum[13], or the UN’s Build Back Better approach[14]
• Partner with disaster risk reduction and emergency planning organisations to integrate health management and disaster management
• Integrate data on COVID-19 and disasters to inform early warning systems, and invest resources into upgrading and expanding systems to manage complex situations
• Deliver preparedness messaging about disasters and other diseases, alongside COVID-19 advice, to keep issues at the forefront of people’s minds and to ensure communities have up-to-date information about mitigating risks posed to them, and the support services available[15]
• Build an understanding based on expertise and skills guided by science, while also building capacity in communities to better understand the hazards of a double disaster and plan collective action[16]
• Keep messaging simple. COVID-19 messaging is already fraught with confusion and misinformation, detailing the risks from other hazards may doubly confuse people if not done in a simple way

The influences of climate change has resulted in disasters which have become seasonal, reoccurring and protracted. This, combined with COVID-19 results in compound disasters that are continually unravelling, which blurs the lines between response, recovery, preparedness, and prevention[17]. It is therefore important to consider humanitarian assistance for a world that is facing two chronic challenges; COVID-19 and climate change.

References:

[1] https://www.sheltercluster.org/sites/default/files/docs/tc_harold_and_covid-19_vanuatu_recovery_strategy_v3_130820.pdf

[2] https://www.cred.be/publications

[3] https://www.theguardian.com/environment/2020/apr/27/meteorologists-say-2020-on-course-to-be-hottest-year-since-records-began

[4] http://www.fao.org/ag/locusts/en/info/info/index.html

[5] https://media.ifrc.org/ifrc/press-release/least-51-6-million-people-doubly-hit-climate-related-disasters-covid-19-new-analysis-ifrc-reveals/

[6] https://www.dfat.gov.au/geo/vanuatu/development-assistance/Pages/supporting-cyclone-recovery-reconstruction-vanuatu

[7] https://actionaid.org.au/wp-content/uploads/2018/08/STPC-AdvocacyReport2020-FINAL-pages.pdf

[8] https://www.dfat.gov.au/crisis-hub/Pages/tropical-cyclone-harold

[9] https://covid19.gov.vu/

[10] https://www.wri.org/blog/2020/05/south-asia-confronts-double-disaster-cyclone-and-covid-19?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WRI_News_and_Views+%28WRI+Insights+Blog%2C+News%2C+and+Publications+%7C+World+Resources+Institute%29

[11] https://www.wri.org/blog/2020/05/south-asia-confronts-double-disaster-cyclone-and-covid-19?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WRI_News_and_Views+%28WRI+Insights+Blog%2C+News%2C+and+Publications+%7C+World+Resources+Institute%29

[12] http://nautil.us/blog/a-warning-from-history-about-simultaneous-disasters

[13]https://www.unisdr.org/campaign/resilientcities/assets/toolkit/documents/Disaster%20Resilience%20Scorecard_Public%20Health%20Addendum%20Ver1%20Final_July%202018.pdf

[14] https://www.unisdr.org/files/53213_bbb.pdf

[15] https://www.bnhcrc.com.au/hazardnotes/79

[16] https://www.wri.org/blog/2020/05/south-asia-confronts-double-disaster-cyclone-and-covid-19?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+WRI_News_and_Views+%28WRI+Insights+Blog%2C+News%2C+and+Publications+%7C+World+Resources+Institute%29

[17]https://www.sheltercluster.org/sites/default/files/docs/tc_harold_and_covid19_vanuatu_recovery_strategy_v3_130820.pdf

During COVID-19 decision makers have grappled with containing outbreaks and how to reopen or reclose business and services based on infection numbers and other measures. Research in Canada has shown that accounting for geography, epidemiology, and travel patterns, localized county approaches to lockdown result in fewer days of service and business closure, and impacts fewer people compared to entire province closures. The research suggests, when implementing a local lockdown, to consider:

• The trigger conditions that require a local lockdown to be enforced and ensure they are agreed with central government but can be enacted upon by local government
• Coordinating with neighbouring counties or metropolitan areas, including the criteria for when and how local lockdowns should be implemented and when a neighbouring region should also lockdown
• Gathering local lockdown lessons that can provide useful insights into compliance of measures, and implementing learning to help avoid ineffective strategies
• Decentralizing control over when a local lockdown should be enforced to ensure local decision makers can enact closures promptly

The compound impacts of COVID-19 and climate change are important examples of disruptive risks that require the renewal of existing risk-management systems and practices. Disruptive risks are defined as unexpected, widespread, protracted, transboundary and novel. To address these requires 'disruptive resilience' whereby the status quo in risk management is disrupted to encourage new and innovative way to enable towns and cities to respond and recover effectively from these risks. Consider how to use new kinds of data, modes of collaboration, financial mechanisms, innovation models and decision-making approaches meet challenges of 'disruptive resilience'. Consider:

• The development community should promote the notion of 'disruptive resilience' to respond to the rise in outlier and extreme events; the shift in established hazard patterns; the increase in multiple, simultaneous crises within single
• Policymakers and authorities need to revise urban risk-management practices, and embrace new kinds of data, collaboration, finance, innovation models and decision making
• Researchers must explore the financial, political, social and behavioural factors that inhibit or enhance disruptive resilience

Since the start of the pandemic there has reportedly been an increase in extremist narratives from a variety of groups. People (including vulnerable people who have been severely socially or economically impacted by the pandemic) are at risk of extremism which creates future security challenges. Organisations should remain vigilant about new and emerging threats to public safety and develop response plans that incorporate risks of extremist behaviour. Consider:

• Local assessments of old and new manifestations of local extremism which may have been exacerbated or triggered by the pandemic. Consider the form it takes, (potential) harm caused, and scale of mitigation or response strategies needed
• Developing interventions for those most susceptible to extremist narratives, this may include new groups e.g. a rise in far right groups, and conspiracy theory groups committing arson on 5G towers as they believe them to be the cause of COVID-19
• Assessing groups which have become more at risk since COVID-19 and increased public protections measures and support for these groups e.g. East Asian and South East Asian (since COVID, hate crimes towards this group has increased by 21%)
• Developing COVID-19 cohesion strategy to help bring different communities together to prevent extremist narratives from having significant reach and influence
• Working with researchers and practitioners to build a better understanding of 'what works' in relation to counter extremism online and offline. This should include consideration of dangerous conspiracy theories, and their classification based on the harm they cause

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

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

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)

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

Accelerating the use of online digital tools for improved resilience and pandemic preparedness is important for reducing the risk of transmission of the virus, for reaching a wider audience, and for sharing best practice more effectively.

However, when digitizing activities, it is important to consider those who may not have online access due to remoteness, digital illiteracy, and/or the costs of (smart)phones and mobile data, and to ensure important information still reaches these communities. This may be done by adapting activities into written or picture format, or providing necessary resources or training. Consider raising awareness of activities, training, and ways of organising the community:

• Raising awareness:
  • Conduct face-to-face health and hazard awareness programmes through infographics, podcasts, and videos on WhatsApp, Facebook, and Twitter
  • Use platforms that provide health advice about COVID-19 to raise awareness of other diseases that may have similar symptom e.g. influenza, dengue etc.
  • Use online community engagement as an opportunity to raise awareness about other risks, and resilience strategies e.g. flooding
• Training:
  • Establish 'community brigades' that can help prepare the community for emergency situations - educate and train them by creating and sharing instructional videos
  • Share podcasts promoting COVID-19 safety measures with local leaders and authorities, who play them on loudspeakers in the community
• Organising the community:
  • Develop virtual community networks that support the community to organise themselves, working with local leaders, authorities, schoolteachers etc. who can disseminate information widely
  • Conduct regular follow-up calls with community leaders to create feedback channels and to help monitor local situations

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.

We propose key considerations for local governments when managing wide-ranging change, such as that induced by a complex, rapid and uncertain events like COVID-19. Identifying and understanding the types of change and the extent to which change can be proactive rather than reactive, can help to support the development of resilience in local authorities and their communities.

To read this briefing in full, follow the source link below to TMB Issue 19 (p.2-6).

Part 3: Building on TMB 16 and 17, we present a detailed view of how to assess the performance of the system of resilience before/during/after COVID-19. This briefing presents a comprehensive Annex of aspects against which performance can be considered.

To read this briefing in full, follow the source link below to TMB Issue 18 (p.2-7).

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.

The all-of society impact of COVID-19 has required many organisations to adapt their operating procedures and deliver alternative activities, including frontline emergency services such as the Police, Fire Brigade, Ambulance and Search and Rescue organisations. We provide examples of first responder adaptation during COVID-19 to demonstrate how frontline services have modified their operations to help tackle the crisis.

Alternative activities undertaken by emergency services

• Supporting health and social care: In California (USA), the National Guard deployed rapid medical strike teams to assist overwhelmed health/nursing facilities[1]. Strike teams involved 8-10 people (e.g. included doctors, nurses, physical therapists, respiratory therapists, behavioural health professionals). Strike teams worked across 25 nursing homes – staying on-site for 3-6 days to establish stability of care, disinfected facilities, and staffed mobile COVID-19 testing sites2.
• House-to-house testing: In Guayaquil (Ecuador)municipal taskforces (involving firefighters, medics, and city workers) went house-to-house looking for potential cases[2] . Similarly, in Cambridge (USA), Fire Department paramedics were enlisted to go door-to-door in public housing developments that predominantly housed the elderly and younger disabled tenants to offer Covid-19 tests to residents[3]
• Disinfecting public spaces: In Pune (India) , sanitary workers disinfected and fumigated public areas[4]
• Managing sanitation services: In Ganjam (India), the fire brigade supported the COVID-19 effort by heading the country’s sanitation programme[5]
• Delivering food/medication parcels to vulnerable people: In West Bengal (India), all police stations were made responsible for delivering food and medication to those who are vulnerable and sheltering to avoid food scarcity - the programme was monitored by the State’s District Magistrates and Police Superintendents[6]. In Georgia (USA), a similar scheme involved police officers delivering groceries/medicine to vulnerable people who had placed/paid for orders[7]
• Distributing $100 gift cards: In Smyrna (USA), police handed out $100 gift cards from a community grocery assistance fund to help vulnerable residents purchase essential items[8]
• Counteracting misinformation: In Göttingen (Germany), clashes with tower block residents under enforced lockdown were caused by communication problems between authorities and residents. Translators, working through first responding services, communicated important public health information to relevant residents in German and Romanian via text messaging[9]

Consider the demand for alternative activities from emergency services

To determine how, when and where emergency services can support alternative activities, consider:

• The demand for alternative support:
  • Identify current needs where additional capacity to deliver activities is required
  • Identify future areas where demand is foreseeable, and where additional capacity may need to be built e.g. through retraining
• How responders can support alternative activities[10]:
  • Identify potential capacity in responder organisations, or how this capacity can be created, protected, and prioritised, and how long this capacity may be available[11]
  • Obtain strategic-level agreement on the direction, scope and parameters of the alternative activities
  • Gather information to understand activities e.g. from partner databases, existing measures, knowledgeable people
  • Assess the impact of redeploying staff to other activities and the effects of this on their ability, and the organisation’s ability to cope[12]
• Preparing redeployed resources:
  • Identify and source training and safety measures required to redeploy staff to alternative activities (including health and wellbeing of staff and the public)[13]
  • Capability of the resources, including:
    • Transactional activities i.e. single short-term actions
    • Transformational activities i.e. complex, interconnected, longer-term actions needing strategic partnerships

Consider the benefits to the emergency services from delivering alternative activities

The involvement of emergency services in alternative activities has the potential to increase services’ visibility in communities which can help build community trust and engagement[14], reduce misinformation and non-compliance to COVID-19, and bolster local multi-agency partnerships for a more efficient and effective response and recovery[15].

On benefits, consider:

• Working with partners to capitalise on increased contact with marginalised and vulnerable communities e.g. from door-to-door visits. This may include:
  • Addressing additional social or health issues, fire safety, safeguarding, or referral to other services
  • Community engagement activities and visible street presence through renewing the Neighbourhood Watch Scheme and police Safer Neighbourhood Teams[16]
• Developing joint local/national approaches to provide alternative response to support COVID-19 activities. This may include:
  • Emergency services delivering essential items like food and medicines to vulnerable people, driving ambulances, assisting ambulance staff, attending homes of people who have fallen but are not injured[17],[18]
  • Increase multi-agency coordination with civil organisations should be central in the design and review measures for COVID-19 response and recovery[19]
• How to capitalise on increased community engagement and volunteerism to help disseminate public health information. Consider working with volunteer and civil society organisations that are close to communities and know their specific needs to:
  • Increase capacity for response and recovery considering short and long-term requirements of the need, and of volunteers
  • Translate and disseminate timely information in relevant languages and tackle misinformation[20]
  • Build relationships in the community to encourage adherence to COVD-19 behaviours, especially with people who have not had previous contact with emergency services
  • Enhance community engagement and information sharing to combat misinformation and non-compliance about COVID-19 working with Crime and Disorder Reduction Partnerships (CDRPs)18
    

[1] https://www.cpr.org/2020/08/06/national-guard-helps-fill-long-term-care-staff-shortages-in-california/

[2] https://www.theguardian.com/world/2020/apr/22/ecuador-guayaquil-mayor-

[3] https://www.cambridgeday.com/2020/05/16/plans-to-test-most-vulnerable-for-covid-19-evolve-enlisting-fire-paramedics-to-visit-public-housing/

[4] http://cdri.world/casestudy/response_to_covid19_by_pune.pdf

[5] https://www.newindianexpress.com/states/odisha/2020/aug/07/ganjam-to-conduct-home-survey-again-as-cases-rise-2180291.html

[6] https://www.hindustantimes.com/india-news/covid-19-lockdown-police-stations-will-take-responsibility-to-deliver-food-at-doorsteps-says-mamata-banerjee/story-YOYnHAdwmTHAZzzcTLYYuI.html

[7] https://cobbcountycourier.com/2020/04/smyrna-police-deliver-food-and-medicine-to-seniors/

[8] https://cobbcountycourier.com/2020/04/smyrna-police-deliver-food-and-medicine-to-seniors/

[9] https://www.bbc.co.uk/news/world-europe-53131941

[10] The Manchester Briefing on COVID-19. Fifteenth briefing: Week beginning 13th July 2020. ambs.ac.uk/covidrecovery

[11] https://www.nga.org/wp-content/uploads/2020/05/NGA-Memo_Concurrent-Emergencies_FINAL.pdf

[12] https://www.cipd.co.uk/knowledge/strategy/resourcing/transferable-skills-redeploying-during-COVID-19

[13] https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/03/C0666_Redeploying-your-secondary-care-medical-workforce-safely-v-2_14July.pdf

[14] https://www.app.college.police.uk/app-content/engagement-and-communication/engaging-with-communities/

[15] https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=25788&LangID=E

[16] https://policyexchange.org.uk/wp-content/uploads/Policing-a-Pandemic.pdf

[17] https://www.nationalfirechiefs.org.uk/News/Page-2/covid-19-firefighters-to-deliver-food-and-medicines-drive-ambulances-and-retrieve-bodies/249304

[18] https://www.westyorksfire.gov.uk/news/fire-service-staff-volunteer-to-help-people-get-back-on-their-feet-during-coronavirus-pandemic/

[19] https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=25788&LangID=E

[20] https://www.theguardian.com/australia-news/2020/jul/06/melbourne-towers-residents-translated-covid-19-information-sheet-into-10-different-languages-in-24-hours

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

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

Part 2: We build on TMB 16 and consider how to apply the VSM's 5 systems to understand and debrief on experiences of COVID-19 in a structured, systems manner.

To read this briefing in full, follow the source link below (p.2-6).

Part 1: We begin by exploring how the experience of COVID-19 prompts consideration of what national and local (ambitious) renewal of systems to develop resilience to crises and major emergencies could look like. We present a model of 5 systems: operational delivery; coordination; management; intelligence; and policy. This briefing elevates thinking from the performance of individual organisations into considering the performance of the system as a whole.

To read this briefing in full, follow the source link below to TMB Issue 16 (p.2-7).

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

To plan for local outbreaks of the pandemic, local government in England were required to develop and publicise their Local Outbreak Plan on how they will manage any sporadic surges of the virus in their local area. To structure these outbreak control plans, UK public health authorities identified seven connected themes to cover: care homes and schools; high risk places and communities; methods for local mobile testing units; contact tracing and infection control in complex settings; integrating local and national data; supporting vulnerable people to self-isolate; establishing governance structures. Other countries (e.g. Ireland and New Zealand) have also required the development of outbreak control plans, especially for outbreaks in care homes.Consider how to:

• Review how other organisations have planned for outbreaks and learn from the contents of those plans
• Develop an outbreak control plan for how to manage a spike in COVID-19 case
• Use others' plans to confirm the contents of your plans and/or expand those contents
• How to exercise those plans and how to share the learning from those exercises with other organisations
• Developing bespoke outbreak control plans for specific sectors e.g. care homes

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

Amenable death research can analyse:

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

Preventable death research can analyse:

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

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

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

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.

Recently, European Union countries have begun enforced lockdowns in smaller regions in response to new outbreaks of COVID-19, rather than bringing the entire country to a halt. 'Smart lockdowns' have been undertaken in Germany, Portugal, Italy, and the UK where local governments have declared local lockdown where cases of COVID-19 could not be contained.

Special consideration should be given to the identified causes of spikes in transmission. Localised COVID-19 outbreaks in Europe and the USA share a number of similarities. In most cases, overcrowded living conditions, poor working conditions, cultural practices, and/or limited socio-economic capital point to increased risk of infection and transmission. In Warendorf (Germany) and Cleckheaton (England), outbreaks were attributed to abattoirs and meat factories , which often employ migrant workers in poor working conditions on low-paid contracts. While the outbreak in Cleckheaton does not seem to have spread into the community, the fallout from the abattoir in Germany resulted in the lockdown of the city of Warendorf. Similar patterns are being witnessed in the USA, where workers from meat processing plants in Georgia, Arkansas and Mississippi, who are predominantly migrant workers or people of colour, have died from the virus or have become infected.

Conversely, in Marche (Italy) and Lisbon (Portugal) outbreaks originated in migrant communities that were living in overcrowded quarters or experiencing unsafe working conditions. Similarly, this week in Leicester (England), a local lockdown has been enforced. Possible reasons for the spike in cases shares stark similarities to the local lockdowns that have gone on elsewhere.

Reportedly, in Leicester some garment factories continued to operate throughout the crisis and forced their workers to work despite high levels of infection. Wage exploitation of the largely immigrant workforce, failure to protect workers' rights in Leicester's garment factories (a subject of concern for years), and poor communication of lockdown rules with Leicester's large ethnic minority community have all contributed to a resurgence in the disease.

Secondly, the East of the city, suspected to be the epicenter of the outbreak, has extreme levels of poverty, is densely packed with terraced housing, and has a high proportion of ethnic minority families where multi-generational living is common.

These patterns barely differ from the spike in cases in Singapore in May 2020 in which Singapore's progress on tackling COVID-19 was halted as tens of thousands of migrant workers contracted the disease due to poor living conditions and being neglected by testing schemes as their migrant status and relative poverty meant they were overlooked by the government.

Implementing smart lockdowns requires:

• Outbreak control plans for the COVID-19 partnership to be developed, written, and communicated to wider partners, specifying their role in the outbreak response
• Collaborate closely across the public sector to understand possible at-risk communities e.g. minority groups, migrant workers, those in poor or insecure housing, those in particular occupations
• Identify new cases early through rapid testing and contact tracing and sharing timely data across agencies
• Decide the threshold at which a cluster of new cases become an outbreak
• Decide the threshold at which an outbreak triggers the lockdown of an area, and how the size of that area is determined
• Collaborate closely with the public sector to communicate and enforce local lockdowns e.g. the police, the health and social sector, local leaders
• Ensure there is capacity in local-health care systems to respond to the outbreak
• Collaborate with citizens to ensure good behavioural practices are understood and adhered to e.g. hand washing, social distancing at work and in public areas
• Ensure the parameters of the local lockdown are clear. For example, in a UK "local authority boundaries can run down the middle of a street" which makes it different to differentiate what is appropriate for a city or region, and to understand how a local community identifies with the place and boundaries in which they live

Local outbreaks, whether in migrant worker accommodation, meat factories or impoverished areas of a city, clearly underscore the disproportionate impact of COVID-19 on minority, migrant, and poor communities. Increased engagement with, and attention to ethnic minority groups, marginalised people and impoverished communities is key to staving off local and national resurgences of COVID-19. Strong multi-organisational partnerships are required to account for varying needs and concerns with certain communities including addressing their living and working conditions and the risks this poses to public health.

To read this case study in its original format (including source links and references, follow the source link below.

The evacuation and shelter of people during a major emergency is a challenging task under normal conditions but, in the context of COVID-19, social restrictions, and potential to transmit the virus, it becomes even more complex. When planning for evacuation and shelter during COVID-19, consider:

• Provide more transport to comply with social distancing measures
• Rapidly expand shelter capacity, through building or identifying a greater number of current buildings for use as shelters, so as provide greater areas for social distancing
• Consider adapting industries to help prepare for a safer evacuation of populations away from high risk areas. For example, repurposing the garment industry to manufacture personal protective equipment (PPE) for volunteers use in Bangladesh
• Separate suspected COVID-19 patients in specific separate shelters
• Reducing chances of person to person contact by introducing public announcements/mass communication tools such as community radio and electronic media
• Create operational systems which allow for autonomy so responders can work efficiently without constant contact with HQ's if they happen to be under different lockdown restrictions
• Combine early warning messages with Covid-19 warning messages

Consider using the Emergency Planning College Business Continuity (BC) checklist to understand how well BC is incorporated into core areas such as risk management (see BS65000 for further examples). The checklist provides signposting to relevant guidance. Example guidance includes:

Roles, responsibilities and competencies

• Identify BC roles and command and control structures e.g. strategic leads; BC advisor/coordinator; incident management etc
• Promote effective leadership (e.g. ISO22301; ISO22330)
• Document information including plans, procedures, roles and competencies, and the recording of decisions, actions and rationale (e.g. ISO22301: Clause 7.5)

Monitoring and evaluation and decision making

• Effectively monitor impacts and use of trusted, key guidance for BC to inform decisions
• Agree decision-making methodology and governance structures for BC
• Use models such as the Joint Decision Model (JDM) for making decisions for multi-agency response or organisational level
• Agree processes for effectively standing response down, including decision makers and deciding factors (e.g. ISO22301: Clause 8.4.4.3)

Recovery of businesses and Maintenance of BC

• Promote recovery as a chance for innovation of current processes, organizations, communities and behaviours, which is in keeping with 'Continual Improvement' (e.g. ISO22301: Clause 10.2; 'Innovation' in BS65000)
• Advocate the lifecycle of the BC plan and the accuracy of priorities and how lessons are learned from incidents

Consider a consistent approach to the response to, and management of, risks arising from COVID-19. This includes consideration of impacts on transition periods from emergency response into recovery, or recovery into renewal.

• Agree a process to approve any declaration of a state of local emergency or local transition period for emergencies that need to consider COVID-19 related matters. For example, consider who declares the emergency, the powers to enforce, what enforcement means, the role of political leaders in approval
• Agree plans for concurrent emergencies - to declare a state of local emergency (for a non-COVID-19 event, such as a flood) when a state of national emergency is in place for COVID-19. Consider impacts on these transitions
• Agree plans to declare a local state of emergency (for a non-COVID-19 event, such as a flood) that does not end any national transition period in force for COVID-19
• Agree plans for a local transition period for a non-COVID-19 related emergency when in a national transition period for COVID19

Standards-making organisations have made freely available a range of standards which may be useful to tackling COVID-19. These cover topics such as:

• Humanitarian (ISO22395 vulnerable people, ISO22319 spontaneous volunteers)
• Economic (ISO22316 organizational resilience, ISO 22301 business continuity management systems)
• Infrastructure (ISO/TS 22318 supply chain continuity, CSA Z8002 infection control systems)
• Environment (BS 67000 city resilience)
• Communication (C63.27 evaluation of wireless co-existence)
• Governance and Legislation (ISO 22320 emergency management, ISO31000 risk management)
• Medical (ISO 10651 lung ventilators, EN14683 face masks)

Such bodies have also been taking various sources of government guidance and synthesising their messages into a single guide to support their members to understand how to follow those guidance (e.g. safe working, working in the new normal).

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).

This briefing builds on The Manchester Briefing (TMB) 8 to discuss more about the effects and impacts of, and opportunities arising from, COVID-19; what these mean for developing recovery strategies and for Local Resilience Forums (LRFs) which plan the response to crisis.

Follow the source link below to TMB Issue 9 to read this briefing in full (p.2-10).

Annex A of this week's 'Briefing A' contains a menu of impact themes and impact areas that could be used to help local government plan an impact assessment (p.7-10). Follow the source link below to view this briefing.

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

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

Local government should develop recovery plans that include potential for cascading, simultaneous disasters which may require emergency responses activities e.g. evacuation of homes during a flood, amid the epidemic.