Recovery, Renewal, Resilience

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

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)

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