Recovery, Renewal, Resilience

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

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.

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