Recovery, Renewal, Resilience

The pandemic has highlighted the multitude of ways that community action has supported resilience (see TMB Issue 30). The British Psychological Society (BPS) recognises that although this is very much the case, it is critical that we don’t overlook those communities who have “long faced and struggled to overcome adversity”. As with many other impacts of the pandemic, the psychological impacts vary significantly in “scale and social distribution”. Those who have limited local/neighbourhood connections have been found to be more socially, economically and clinically vulnerable to psychological strain and distress. The BPS have provided guidance on the potential benefits and possibilities of appointing a Neighbourhood Community Psychologist which may be of use to local government teams, civil society organisations/other community workers. Consider embedding psychologists in local authorities to:

• Improve community engagement and prevent distress by co-creating with local communities, and to research and provide the evidence base for preventative interventions to improve community health
• Bring distinct knowledge, skills, and capabilities, such as:
  • Extensive theoretical and evidence-based knowledge and understanding with regards to behaviour and experiences in various contexts e.g. social, cultural, policy and politics
  • Understanding of important forms of capital (social, economic, cultural) and factors of place that affect people’s lives
  • Experience of directly working with individuals, groups and across organisational boundaries, with abilities to work with and balance power, conflict and diversity
  • Co-designing research that tackles complex societal challenges and places reflection and learning at the heart of practice

The guidance helpfully offers a job description which could be used in full to create a new post within a local authority or could be used in part to align with another role.

Case study example from the pandemic:

• MAC-UK, a group of community psychologists, have been working in communities with vulnerable young people during COVID-19. Some of their activities include:
  • Investigating the ‘underground economy’ where many excluded young people work to identify ways in which they can be supported in the event of income loss due to the economic impacts of the pandemic
  • Developing strategies on ‘what next’ in the aftermath of COVID by exploring the potential role of community psychologists in creating social change in communities

TMB Issue 36 mentioned the need to identify and address the impacts of ‘Long COVID’ on people who receive and provide care and support in local communities (e.g. social care services/unpaid carers). The most recent Office for National Statistics (ONS) figures (July 2021) report that just under one million people in the UK have self-reported symptoms of Long COVID. The symptoms associated with ‘Long COVID’ (e.g. fatigue, shortness of breath, joint pain, cognitive dysfunction) have the potential to impact people’s ability to work, and their physical and mental health. The impacts of Long COVID have the potential to increase long-term demand on local health and social care services. Consider:

• How a rise in demand will impact current capacities and resources in local health and social care services
• Where re-deployment (e.g. of volunteers) may be possible to alleviate pressure on health and social care workers and meet the needs of people who might require continuous support e.g. with transport/shopping
• What training and safeguards would need to be put in place to ensure any additional support provided by volunteers is done safely
• The impacts of Long COVID on other services such as housing, transport, welfare and employment
• Conduct a review to:
  • assess current resources and surge capacities
  • understand who in the community does and might need additional support and estimate the length of time this might be for (using information such as people who have underlying health conditions)
  • estimate what funding might be required to meet a rise in demand and how this potential rise can be forecasted, budgeted, and planned for

The pandemic has disrupted children and young people’s education, physical health, mental well-being, and social development. There is an abundance of evidence that shows how play is crucial for children’s “health, their physical-and emotional growth, and intellectual and educational development”. The social and behavioural skills that children acquire during play can support the development of resilience, increasing children’s ability to manage stress and adversity. Local areas now have an opportunity to increase spaces for play through city infrastructure and land use planning in their Recovery Strategies and Renewal Initiatives. Resilient Cities Network (RCN) explored this topic in a recent webinar. Consider:

• The Reclaiming Play in Cities initiative, which recognises how the “built environment as a critical play and learning resource for children”. Increasing opportunities for play in cities can support communities to build resilience. For example:
  • Barnet, London have taken full advantage of urban regeneration to invest in play infrastructure. Core strategies include “balancing private development with adequate resourcing for the local voluntary and community sector (VCS) to provide play activities for the most vulnerable children in the area”, and the redesign of two local parks
  • Khayelitsha, Cape Town, with the support of the Urban Play Framework (discussed below), began a two-phase intervention to develop a local play culture in the area. With community participation, the first phase upgrades a series of existing courtyards to create a network of designated play spaces. The second phase will link this network to a refurbished nursery which will serve as a central hub to establish a safer, more varied and stimulating environment for play
• The Urban Play Framework which offers guidance on design and ‘placemaking’ in cities:
  • The Urban Play Framework Toolkit which provides methods and tools to support local governments and communities to conduct a play assessment of their area, and identify and co-design play activation initiatives
• The importance of participatory processes and community engagement in the assessment, design, and evaluation of play initiatives so that children are active participants in the process to increase their agency

Throughout the pandemic, many health systems across the world have come within days of being overwhelmed with COVID-19 patients, and others have been unable to prevent their systems from being overwhelmed. Pakistan have adopted “health stewardship” as an approach to ensure public health is a “joint function of national and provincial governments, where service delivery relies on mixed health systems”. The response in Singh district, which has the highest rate of COVID-19 cases in Pakistan, was underpinned by public-private partnerships with local government. This provides insights into how public-private engagement can be accelerated during the crisis and how “existing policy windows can be used for longer-term planning for pandemics and Universal Health Coverage”. Consider that:

• Stewarding partnerships enabled rapid acceleration of testing through private laboratories, supported surge capacity to be met in local private hospitals and increased “critical care training of public sector hospitals” through partnerships with private hospitals
• “Health stewardship” can enable advisory relationships with the private sector to create a joint operational response and strategic communications during crisis
• Procurement (e.g. of PPE) and supply chain management can be enhanced through “digitalised data-sharing of cases and hospital capacity across private and public providers”
• Stewardship relationships may be transactional (e.g. limited to purchasing arrangements) but can also include “wide-ranging formal agreements for co-production”, providing an opportunity to reform public and private health partnerships
• Devolved operations have proven to offer a flexible and effective response where there is rapid “data sharing for national-provincial coordination, and well-informed local governments who can mobilize inclusive and co-produced responses”

COVID-19’s prolonged nature, and the intensity of measures taken to respond to it, have brought major disruptions with lasting consequences. Our relationship to mortality and death has been redefined, not least by disruption to traditional rituals that enable societies to cope with and overcome major trauma. A recent webinar, organised as part of the Manchester Webinar Series, considered how we might collectively remember the COVID-19 pandemic. Our speakers reviewed lessons from the past on building resilience through coproduced commemoration and discussed key considerations for policy makers and communities in planning to recognise and remember the huge losses caused by COVID-19. Consider the key lessons offered by our speakers:

• There is no one way to remember. Unlike most disasters, each individual’s experience of COVID-19 is a personal one and commemoration activities will require careful consideration around ways to bring people together to collectively to remember while also recognising the uniqueness of everyone’s experience
• The co-production of activities can provide a way to ensure commemoration is inclusive of all of those who would like to be involved, to create a collaborative and bottom-up as well as top-down delivery of remembrance, and enable communities to take ownership of their remembrance
• Consideration for who will lead and be involved in these conversation will be really important, to mediate, and to support communities to find ways to compromise on differing views and perspectives on commemoration
• The timing of commemoration is a challenge, considering that COVID-19 is now a long-term chronic problem and we are not at the end of the disaster. The pandemic has seen commemoration since the beginning, demonstrating how communities can begin to create spaces of remembrance even while the crisis persists. Some examples of these commemoration activities can be found in TMB Issue 34 and Issue 29
• Memorials can be political, and grand gestures such as monuments can fade, or be contested. This reinforces the need for co-produced commemoration, enabling the voices of those who will benefit most from commemoration activities to be heard and actively participate
• Education is a good form of remembering, through storytellers or creating spaces (online or in local newspapers) where people can share their individual experiences of the pandemic. Recording those memories now will enable authentic materials to support education in years to come
• Think about how those who have lower agency in communities will remember (e.g. children who have lost grandparents). Commemoration could be done by creating spaces in schools/community youth groups for teachers/youth volunteers to support children

Social innovations in health and care are “inclusive solutions that meet the needs of end users through a multi-stakeholder, community-engaged process to address the healthcare delivery gap”. They concentrate on local community needs and priorities, strive to establish “low-cost solutions” and build upon the pre-existing strengths in a community. This paper produced by the LSHTM demonstrates how social innovation during COVID-19 has mobilised local communities, adapted existing health services at rapid pace and developed partnerships between local government and civil society. Consider the following international examples of social innovations in health during the pandemic:

• Peru mobilised communities by adapting their ‘Mamás Del Río’ programme which “selects and trains local people as community health workers”. This project adapted during COVID to both ensure the “continuity of maternal and neonatal health services” while also educating and training local people on COVID-19 prevention
• Malawi’s existing free hotline created by local people to provide health advice was scaled up nationally during the pandemic. The government then capitalised on the capabilities of this local service to “triage people with COVID-19 symptoms, identify and refer people at risk of domestic violence, provide health information to the public and gain a greater understanding of local needs”
• The Philippine’s multi-sectoral partnership brings together the “strengths and resources from the private sector, academia, local government and communities”. COVID-19 response was strengthened by these partnerships which enabled rapid deployment of a “hunger management campaign, the establishment of a call centre to manage returning resident’s and a role out of local testing teams”

Social innovation initiatives have proven a “powerful means of mobilising communities to respond to emergencies that can complement and extend government and private sector responses, and in turn build more resilient communities”.

London School of Hygiene and Tropical Medicine (LSHTM)

The city of Napier, New Zealand conducted a wellbeing survey to understand how the community was feeling about the pandemic, its impacts, their concerns and expectations for the future. This survey was then used to inform planning for recovery, renewal and other Council programmes. The Napier Recovery Plan identifies five key initiatives which can address issues for recovery and opportunities for renewal:

• “Support and Celebrate Napier” by launching a “We are Team Napier” campaign which focuses on promoting innovation and achievement in the local economy and within communities, e.g. “Environmental restoration of green spaces” comprising of a community-led partnership with the Council, land agencies and other relevant stakeholders
• Investment in local infrastructure and community facilities, e.g. “3 Waters projects supporting the renewal of Napier’s water supply and strategic water services”, to ensure everyone in the community has access to safe drinking water
• Establish a coordinated approach to housing and accommodation to ensure everyone has access to safe housing, e.g. “Continue partnerships established during Alert Level 4 to provide emergency accommodation” and establish “public-private partnerships to repurpose city centre visitor accommodation for transition and/or permanent residential accommodation”
• Introduce a targeted ‘Jump Start Innovation Fund’ to promote innovation in business and not-for-profit sector. Other initiatives include: Appointing business support liaisons to assist and advise on Napier Council regulations and initiating a “redeployment scheme” for SMEs
• A focus on advancing sustainability within the tourism sector, e.g. establishing a partnership with the Art Deco heritage trust to drive domestic tourism

Public health has taken centre stage throughout the pandemic. Pre-existing fragilities have been exposed, but opportunities for reform and renewal have also presented. The White Paper ‘Integration and innovation: working together to improve health and social care for all’, recently presented legislative proposals for a health and care Bill in the UK. A recent briefing by the NHS recognises an opportunity for change, which lies in reform of “how population health is prioritised and resourced in the future”, to not only recover from the pandemic, but to renew systems so that they prepare for (and protect against) future public health risks by building resilience.

The White Paper is a complex and intricate document which is hard to summarise. Discussions of it with a health professional may help to illuminate its main implications for civil resilience. We identify a few lessons from it, but there are others that you may find. We focus on the challenges that lie ahead as part of a restructure of public health functions. Some challenges include:

• How to retain existing expertise:
  • Taking into consideration that responsibilities will change hands, such as those for health improvement functions, those which Public Health England are currently responsible
  • Continuing to fulfil local and national leadership responsibilities
  • Investment to “make up significant shortfalls over recent years”
  • Ensure effectiveness in health improvement functions moving forward
• The sustainability of public health services given budgetary pressures:
  • “Robust and long-term investments in public health services”
  • Acknowledging the critical role they play in building resilience to crises is crucial
• The potentially reduced agency and disempowerment of local government and local partners:
  • By considering that they are positioned most effectively to tailor services and communications to the needs and priorities of the communities they serve
  • Strategic partnership working between NHS organisations, local government and the voluntary sector is essential to promote empowered and flexible working at the local level
• Ensuring that local authorities are involved in resource discussions to locally distribute health improvement responsibilities
• Improving the commissioning arrangements for public health services to address the vulnerabilities exposed by funding cuts and resource shortages

The health and social care system is complex, spanning a broad range of services delivered by both statutory and third sector organisations. COVID-19 has had a significant impact on society and on health and social care services. A recent impact assessment ‘Health and Social Care in Wales COVID-19: Looking Froward’ presents “high level expectations” for NHS and social care recovery. It also identifies the challenges and constraints ahead, and priorities for each part of the system. Social care services are one of the key priorities, recognising the critical role that social care workers (including unpaid carers) have played in frontline responses to COVID. Consider:

• Learn lessons from the pandemic. Assess and identify the “hidden harms” caused by COVID-19 and implement services that can mitigate the longer term impacts of COVID on communities and individuals
• Facilitate opportunities for families to “identify and own solutions to challenges brought about or exacerbated by COVID”, to support families to remain together
• Identify and address the impacts of ‘Long COVID’, work to understand the effect of this on people who receive care and support, including unpaid carers and the social care workforce
• Introduce strategies that tackle the disproportionate impacts of COVID-19 on unpaid carers, focusing particularly on challenges related to “respite and support for carers”
• Recognise that the Local Authority Hardship Fund has been central to the continuity of many critical social care organisations during the pandemic. “Ensure that commissioners of care and support services, in local authorities and health boards, use this financial support in ways that enable them to match the provision of services to changing population need” as the full impacts of the pandemic play out
• Introduce the ‘Real Living Wage’ across the social care sector, to support wellbeing and mental health
• “Build on and improve the collaborative working that has been evident across the health and social care sector throughout the pandemic”

A recent UN policy brief identified the significant gap in health coverage as a core reason for COVID-19 having such devastating impacts on people's lives. Universal health coverages means that all people and communities can access the health services that they need, with three key priorities; "equity in access, sufficient quality and no undue financial risk". Consider:

• Establish universal provision for "COVID-19 testing, isolating, contact tracing" and treatment
• Ensure protection of essential health services during the critical phases of the pandemic (e.g. services for sexual and reproductive health)
• Through international partnerships, ensure future COVID-19 vaccines are a "global public good with equitable access for everyone, everywhere"
• Protect and invest in core health systems functions that are critical to protecting and promoting health and well-being, known as "Common goods for health"
• Suspend user fees for COVID-19 and other essential health care; reduce financial barriers to service use
• Strengthen local, national and global pandemic preparedness and aim for healthy societies for the future through a whole-of-society approach

Memorialisation and remembrance will be an essential component of recovery, as discussed in TMB Issue 29. Online memorial services, a website and a dedicated memorial space were three of the opportunities discussed in this recent Issue. An increasing number of activities to memorialise are taking place, including;

The devastating psychological impacts of COVID-19 and associated measures (e.g. quarantine/social distancing) is widely acknowledged. A recent UK study found that 'expertise-by-experience' can enhance the effectiveness of policy design, service development (and renewal) and research. Consider:

• Conduct a service user analysis to identify current and potential service users
• Use this analysis to target service users to involve through consultation when developing mental health strategies e.g. to gain knowledge and insights on their perspectives and experiences of mental health services prior to and during COVID-19. For example, investigate COVID-19 impacts on service delivery (e.g. remote provisions via telephone/video calls) and identify the benefits, challenges and opportunities created by these changes
• Develop a strategy that reflects the insights and knowledge gained through consultation with users' on their experiences and needs
• Revise current legislation, regulation and policy to assess the effectiveness of current frameworks based on knowledge and insights gained from service user experience
• Translate the knowledge gained into visible action by integrating learning from these insights into mental health recovery strategies and renewal initiatives
Secure and allocate appropriate funding and resources to demonstrate a long-term commitment to co-production of service strategy design, delivery and research with mental health service users, to build trust and increase participation

People have experienced different levels of isolation during the COVID-19 lockdowns. Many people will be enthusiastic about socialising again, but others may be nervous or anxious about resuming activities that they once took for granted, such as returning to shops or busy spaces. Having to process and remember new rules as restrictions ease may be an additional concern for people who are already feeling overwhelmed. Consider:

• Work with befriending services and community organisations to mobilise volunteer 'buddies' to help those who are feeling anxious about coming out of isolation. For example, buddies can:
  • Accompany people on their initial outings, perhaps starting with a walk down the street and working up to a trip to shop for food
  • Support those who are socially isolated for reasons other than 'vulnerability', e.g. they have recently moved into an area and have not established social networks
• Communicate directly with community members to help them understand their local restrictions as lockdown is relaxed, and the support that is available, e.g. through traditional media outlets, social media, or leaflets directly to people's homes
• Educating on how people can reduce their stress through self-care, e.g. breathing exercises, or signpost to support from mental health services (see TMB Issue 7)

In health systems across the world, screening programmes and non-emergency surgical operations have been postponed and cancelled to reduce transmission and free up capacity to treat Covid-19 patients. The USA, UK and Canada have been working to re-start non-COVID related healthcare since the first wave of COVID-19, with subsequent COVID-19 surges creating further challenges, particularly for those countries who are yet to tackle healthcare waiting lists. Those working to reduce the backlog report that some patients continue to defer seeking care so not to increase pressure on services, or because they fear catching the virus. Continued delays will decrease quality of life, increase treatment costs, and worsen outcomes, as the conditions individuals are suffering from deteriorate. There may also be knock-on effects on social care. Consider the measures explored by the UK, USA and Canada:

• Proactively engage the public (e.g. through local communications) to instill confidence in the safety and continued functioning of healthcare systems and encourage them to seek care if they need it
• Ensure ample PPE is available to prevent unnecessary challenges in the delivery of health and social care
• Inform plans by developing rigorous forecasts of future patient demand and service pressures
• Enhance national and local partnerships developed during the pandemic to address the backlog of people needing care. For example:
  • Begin to increase resource capacity through recruitment now to ensure sufficient capacity is available in the future
  • Extend surgical operating hours, including at weekends
  • Draw on volunteers to support vaccination programmes to enable trained healthcare staff to focus on elective care
  • Pool resources between local hospitals and centralize waiting lists so that patients can be treated wherever there is capacity
  • Make greater use of virtual care to increase outpatient access
  • Pilot alternative health care testing programmes (e.g.home testing kits for HPV)

Lockdowns, shielding and school closures have significantly reduced social contact for many people, including older people, children, people with underlying health conditions and those with disabilities. Prolonged isolation from family, friends and social activities poses significant risks to mental health and well-being. To address the impacts of this, consider:

• Establish a community-led mental health and well-being initiative, to support those who may be at risk of more serious distress, to keep people in the community connected and enable socialisation for those who are isolated
• Provide Psychological Frist Aid (PFA) training for those involved in the initiative (see TMB 17)
• Involve local voluntary organisations and groups, and local businesses in establishing and funding the initiative
• Develop a 'check-in' system to build relationships with people in the community and develop an understanding of needs and concerns of those shielding or isolating
• Establish a buddying or be-friending programme to enable local volunteers to support the needs of people in the community by shopping for food, picking up prescriptions or simply just calling virtually/popping by for a chat from the garden:
  • Match a volunteer buddy with up to 10 vulnerable adults/families
  • Buddies can link those who are isolating into existing groups and social activities in the community
• Set up online social activities:
  • Virtual story-telling for children by senior citizens, and vice versa
  • Weekly bingo, book club, quiz night, coffee mornings and kids discos
  • Add humour and prizes for all, such as drawings made by children, to mitigate competitive behaviour in games
  • Online home exercise classes or gardening tutorials
• Recognise that vulnerable people who are isolating may not have access to the internet for virtual activities so also run non-online events:
  • 'Door-step book club', where buddies call to those shielding and discuss books from the person's garden, ensuring they are socially distanced
  • Encourage community donations from businesses/households of unused computers/tablets
  • Develop and deliver local newsletters to include activities such as crosswords/puzzles, and stories written by community members

Important parts of recovery are mourning the loss of loved ones, and remembering those who have tragically lost their lives through the pandemic. Consider opportunities to memorialise, including:

• Develop a website dedicated to those who have died during the pandemic, allowing families to create obituaries, find a network of support, and help those who may feel alone in their grief
• Hold online memorial services to enable people to come together and remember loved ones
• Build and dedicate a memorial to those who have died, e.g. St Paul's Cathedral will build an inner portico at the North Transept and dedicate it as a physical memorial to those who have died due to COVID-19
• Invite those of all faiths and none to join in remembering loved ones to offer a safe and inclusive space of refuge, solace and hope

To ensure appropriate memorialisation, consider:

• coproduction of memorialisation options with communities
• collaboration with partners that specialise in supporting those who have been affected by bereavement
• whether the memorial is to those who have died, those who have been otherwise affected by the crisis, and/or those who have helped in the response to the crisis

Vaccine programmes will need to source sufficient vaccine, notify recipients of their eligibility, and arrange processes to administer the vaccine. Vaccine wastage, recipient confusion over invitations, and inefficient processes will risk undermining the programme's efficacy. To build early confidence in vaccine programmes:

• Agree the current aim for the vaccine programme e.g. to reduce immediate risk to life
• Identify the priority groups to vaccinate to achieve the current aim
• Identify individual citizens who belong to those priority groups
• Disseminate public information on current priority groups to manage expectations
• Explain to agencies that lobby for their staff to be given higher priority why they are currently prioritised as set out in the priority groups - and explain how this achieves the current aim
• Establish a national register of healthcare staff who are qualified to administer the vaccine -including volunteers and other staff who have been recently trained and approved
• Identify suitable facilities that can act as vaccine centres e.g. doctor surgeries, schools, public buildings, mass vaccine centres
• Identify the demand for vaccine at each vaccine centre (based on estimated throughput) and ensure that sufficient supply is available when it is needed
• Identify how the vaccine will be transported to centres and stored appropriately
• Maintain close communication with each vaccine centre to share information, for example, on:
  • Stock levels, delivery schedules, and projected demand
  • Which patients have received the vaccine
  • Which patients have been refused the vaccine and for what reason
• Track the performance of vaccine centres to analyse programme risks and capacities, for example, implement an inventory management system to reduce vaccine waste such as by tracking expiry dates (continued)
• Consider future aims for later in the vaccine programme and the timing of vaccinating different priority groups to achieve those aims e.g. to re-open non-essential business
• Seek process-related advice from countries that have already established vaccine centres e.g. Germany

Alexander Kreh, MSc and Prof. Dr. Barbara Juen, University of Innsbruck, discuss stressors and challenges faced by healthcare workers, and presents results of a survey of healthcare personnel and the stressors they experience. The authors conclude by suggesting how organisations can build and maintain personal resilience among their frontline workers during COVID-19.

To read this briefing in full, follow the source link below to TMB Issue 28 (p.2-9).

COVID-19 vaccination rollout is taking place in many countries, with many more planning to implement mass vaccination strategies for in the near future. The widespread nature of the pandemic has meant that huge numbers of people require vaccination, and a result, demand for vaccines currently far outstrips supply in some countries[1]. Fear surrounding COVID-19 has led to criminals utilising black markets to develop and sell fake vaccinations on the dark web[2]. The demands on government vaccination programmes has also promoted the online sale of other fake medicines such as the malaria drug hydroxychloroquine and the steroid dexamethasone[3] as these have been associated with COVID-19 treatment. In other cases, some online vendors were claiming to sell vaccinations or medicines that would have never been shipped to buyers[4],

And in the UK, there were incidents of scammers turning up at people’s doorsteps offering a vaccine for payment, following a spate of fake text messages[5].

Vaccines are a financially lucrative commodity, and while the pharmaceutical industry is prepared with regular audits and vetting of supply chains, minimising human contact, stops and handovers during distribution, and real-time digital devices which measure temperature and location, there are other risks. Some of those at risk include:

• Desperate consumers believing they can purchase the vaccine online
• Hospitals and healthcare facilities that have been hit with a barrage of phishing and ransomware attacks which can try to sell fake vaccines
• Vaccination centres which may be points of vulnerability; one supply chain security expert stated “we need to tell people at the vaccine centres that they carry gold”[6].

The rise in fake vaccines and medications requires approaches that protect people, and infrastructure.

Protecting people

• Widespread information campaigns that advise people not to buy any vaccines online, with particular focus on informing people with pre-existing health conditions or those in certain vaccine priority groups as these groups may feel an urgency to be vaccinated
• Remind people that they should consult their registered doctor about vaccination, and only be vaccinated at an official vaccination point[7] and that NHS England will never ask for bank details, Pin numbers or passwords, when contacting you about a vaccination
• Monitor online chatrooms and forums that may be regularly used by vulnerable groups to scan for attempts to sell fake vaccines and medications
• Set up and regulate certification organisations which undertake due diligence on sources of drugs (e.g. pharmacies) and medications e.g. pharmacychecker.com to create a transparent solution for the public to check the sources of their online medications to ensure their legitimacy and safety
• Work with healthcare professionals to build trust in vaccinations. The spread of fake vaccines may deter people from legitimately being vaccinated

Protecting infrastructure

• Regularly assess cyber security and train staff in recognising and reporting any phishing scams or malware attacks
• Train staff and volunteers administering vaccinations in the safe and careful disposal of empty vaccine vials which could be stolen and used to package fake vaccines that look authentic[8]
• If required, consider security at vaccination centre sites, especially those which have been set up in temporary locations or do not have adequate security systems

References:

[1] https://www.swissinfo.ch/eng/swiss-regulator-warns-of-fake-covid-19-vaccines-online/46279734

[2] https://www.japantimes.co.jp/news/2020/11/27/asia-pacific/covid-19-vaccine-china-black-market/

[3] https://iea.org.uk/will-there-be-a-black-market-in-covid-vaccines/

[4] https://www.ft.com/content/8bfc674e-efe6-4ee0-b860-7fcb5716bed6

[5] https://www.bbc.co.uk/news/uk-england-london-55577426

[6] https://www.ft.com/content/8bfc674e-efe6-4ee0-b860-7fcb5716bed6

[7] https://www.swissinfo.ch/eng/swiss-regulator-warns-of-fake-covid-19-vaccines-online/46279734

[8]https://www.dw.com/en/officials-warn-of-fake-covid-19-vaccines/a-56123830

All areas of peoples' lives have been impacted by COVID-19 in a multitude of different ways. Compassion acknowledges that people may be suffering, and promotes sensitivity about the issues affecting people. Compassion during COVID-19 should acknowledge that while everyone has been impacted, they will have been impacted differently. Recognising these differences will help to build transparency and authenticity within the organisations. Consider how to develop a compassionate organisation through:

• Creating safe spaces where people can air their concerns and views
• Ensure there are processes in place to address legitimate concerns and views
• Regularly check-in with those within the organisation to actively enquire about their wellbeing - reducing the expectation and pressure on people to self-mobilise support mechanisms
• Anticipate needs e.g. be aware of pressures, deadlines and potential for burnout
• Believe people when they say they are struggling and trust that they are doing their best
• Consider being transparent about your own struggles, but be aware of establishing boundaries
• Note that compassion does not lower expectations within the organisation or undermine people's roles and responsibilities. Rather, it creates a healthier organisational environment that can reduce anxiety, fear and shame

Period poverty has increased sharply in the UK since the COVID-19 pandemic. Period poverty is defined as the struggle to pay for basic sanitary products on a monthly basis. Reports from one charity state they have supplied almost six times as many menstrual products compared with before the pandemic started. Around one in five people have experienced period poverty in the UK which has a significant impact on hygiene, health and wellbeing. Period poverty has risen as result of self-isolation, loss of income, and loss of access to services which may have provided free sanitary products. Scotland has become the first country in the world to provide free and universal access to period products, and places a legal duty on local authorities to make period products available for all those who need them. Consider how to:

• Encourage schools, colleges and universities to provide sanitary products for free
• Encourage businesses and places of work to provide sanitary products
• Establish programmes where sanitary products are distributed to low-income households
• Partner with pharmacies to offer free sanitary products to those eligible for free prescriptions
• Raise awareness of trans, non-binary, and genderqueer people's rights to access sanitary products and ensure provision to them

Primary health care workers providing care in remote areas have faced challenges during COVID-19 including inaccessibility to locales, poor hospital infrastructure and facilities, and meeting the needs of vulnerable communities. In Australia, remote health services also face challenges in maintaining adequate appointment and retention of healthcare workers. Consider how to protect remote healthcare staff and remote communities, for example:

• Be mindful of competition between remote and metropolitan areas for staff and resources during COVID-19
• Consider the reliance of remote health services' on short-term or fly-in, fly-out/drive-in, drive-out staff, and the increased risk of transmission into remote areas
• Ensure there are adequate point-of-care COVID-19 testing sites in remote communities to avoid unnecessary travel to centralised locations and to reduce delays in test results
• Consider distribution and storage challenges in maintaining adequate stocks of PPE. Remote health service may also benefit from stocks of hygiene products to distribute to community households through remote health services
• Ensure remote health services are meeting regularly with other essential services e.g. police, schools, and hospitals locally and regionally, to develop local plans for concurrent emergencies in isolated areas
• Ensure the availability of an adequate, appropriately trained local workforce, especially for outbreaks in healthcare buildings
• Consider heightened costs for accommodation for remote healthcare workers due to staffing constraints or COVID-related isolation
• Consider staff burnout due to impact of insufficient staff, frequent orientation of new staff, concerns about the clinical and cultural competency of incoming short-term staff and continuity of care

In Ecuador, efforts have been made to engage children with music to help support their mental health during lockdown and periods where they are away from school. Consider the pressures on children to catch-up with purely academic subjects in light of school closures and online learning, and how to promote mental health and wellbeing through the arts. Consider:

• Inviting children to send in videos of themselves singing or dancing to songs that make them feel happy or empowered, and encourage family members to join in
• Editing the videos to create short films or creating virtual choirs if the same song is assigned/chosen
• How music and the arts can help children express their anxieties and the benefits of this for their mental health and wellbeing

Establishing new ways to include music and song safely throughout the school day and how this can also contribute to teachers' continuing Professional Development and their own mental health

Well-being hubs strategically placed across a location could build on successful initiatives already delivered by the voluntary sector. Such hubs can be used to tackle health inequalities, and help reduce the rise in mental health issues due to the COVID-19 pandemic. Hubs would ideally offer face-to-face support, and would have to ensure COVID-19 safety measures. Hubs may support:

• Health services during the COVID-19 pandemic and relieve pressures on the system through partnership working between healthcare providers, local councils, housing and the voluntary sector e.g. The Hubs in Wakefield, West Yorkshire, relieve pressure on primary care - in six months The Hubs have seen almost 2,000 people including 636 urgent referrals
• Preventative health and wellbeing policies that protect people and reduce potential strains on health and social care services
• Social prescribing, whereby local agencies can refer people to a Link Worker who support people in focusing on 'what matters to me' and taking a holistic approach to health and wellbeing. They connect people to community groups and statutory services for practical and emotional support

Many people may be concerned about the rising cases in some areas and the risks of returning to work. So, the return to workplaces, including the risks this may pose to people’s health, may cause anxiety due to a heightened sense of risk of COVID-19 infection and uncertainty. Consider how new routines may be developed to avoid people becoming overwhelmed. Consider:

• Regular team meetings and debriefs to discuss anxieties about returning to work and any concerns or learning that may arise
• Allocating dedicated ‘buddies’ to support colleagues at work. These people could be from other departments to support confidentiality, and have specific training on helping people to manage their anxieties, on the organisations’ process and plans for safe working, and additional services staff may want to access
• Clear and simple protocols that outline how workplaces will keep employees safe and any workplace adaptations that have taken place
• Accessible ‘Frequently Asked Questions’ sections on organisations’ websites to provide answers to the most common concerns, including signposting to other relevant services such as health and wellbeing support at work
• Providing opportunities for e-learning or training on managing anxiety about returning to work and COVID-safe practices in the workplace
• Surveying staff to understand their enthusiasm for returning to work and addressing concerns raised

Organisations should carefully consider the impacts on staff of re-entry into the workplace. Understanding the mental and physical condition of staff can help organisations to prepare accordingly. Some staff be enthusiastic about returning to the office, others may not want to return, and others may want to theoretically return to work but have anxieties about the risks to their health and the health of loved ones. Consider steps to include staff in strategic planning for a return to work including the need to:

• Ask staff if they are able to return to the office, or if there are not able to return - rather than assume that everyone should return
• Regularly survey employees so you understand the anxiety levels in your organisations - seek to identify and remedy practical concerns
• Understand why some staff may not wish to return, whether this is because they are in high-risk groups, or have other challenges such as reliable childcare
• Make the return to work planning processes transparent. Include staff in these processes and communicate to staff who is working on the plan in your organisations, how they are thinking about it, and when announcements will be communicated
• Mitigate uncertainty where possible by sharing what is definitely happening, what is definitely not happening, and when firmer answers can be expected
• Seek feedback from all stakeholders on a regular basis. Consider establishing a task force to process feedback, and set up regular, recurring dialogues with employees
• Clarify how people can get their questions addressed and who will address them

Consider some example plans:

https://www.shearman.com/perspectives/2020/04/key-considerations-in-designing-a-return-to-work-plan-covid-19

https://www2.deloitte.com/content/dam/Deloitte/uk/Documents/human-capital/deloitte-uk-workforce-strategies-for-post-covid-recovery-workbook.pdf

University students are beginning to return to communal housing located in residential areas. This, alongside rising COVID-19 infections in younger people and fatigue for COVID-19 restrictions, requires consideration of student welfare, and the management of potential transmission. Consider:

• Who should lead the management of a new community of students in cities (e.g. voluntary sector, universities, local authority) including responsibilities for welfare checks, test and trace, GP registration, and food distribution to student households if they are required to isolate
• Providing a point of local support for students, outside of their academic institution, for students who may have moved away from home. Consider partnership with local voluntary sector to coordinate with the local authority such as the OneSlough project which uses 'Community Champions' to provide information and resources to residents
• How the potential movement of students will be managed e.g. if they become ill and decide to go back home, and the impacts of this on potential transmission in two communities i.e. where they reside as students, and their home
• Targeting local online social media influencers to reach younger audiences to communicate COVID-19 messaging and promote track and trace

There is much concern about the combination of coronavirus with winter flu and the effects on transmission rates and a recent report outlines concerns and plans. It recommends to plan for coronavirus during winter months by:

• Analysing current COVID-19 data to develop prevention and mitigation strategies for winter, considering the rise in other illnesses during colder weather
• Considering how mitigation strategies should protect, and pose no further disadvantages to high risk patients or communities
• Engaging with patients, carers, public and healthcare professionals with enhanced coordination, collaboration and data sharing between central and local initiatives

It also suggests considering:

• Minimising community SARS-CoV-2 transmission and impact through:
  • developing effective policies to maximise population engagement in essential control measures e.g. participation in test, trace and isolate (TTI)
  • extensive autumn public information campaigns co-produced by communities and professional organisations
  • guidance for commercial, public and domestic properties on temperature, humidity and ventilation to reduce virus transmission indoors
  • consideration of those most vulnerable to COVID-19 who are least able to heat their homes adequately in winter
• Maximise infection control and ensure that COVID-19 and routine care can take place in parallel by:
  • prioritising system-wide infection prevention and control measures
  • o providing training to use personal protective equipment (PPE) and other infection prevention and control measures
  • maximising remote consultations for hospital and community care
  • testing and quarantining patients being discharged into the community or care
  • prioritising the backlog of clinical care by clinical need, not waiting times
• Improving public health surveillance for COVID-19, influenza and other winter diseases through:
  • comprehensive, population-wide, near-real-time, health surveillance systems
  • conducting large-scale population surveys comparable data collected from hospitals and the community
  • overseeing and coordinating data centrally
• Minimise influenza transmission and impact by maximising influenza vaccination uptake

Test and trace systems have been implemented worldwide to try to track and contain the transmission of COVID-19. While these efforts have been broadly successful, there are some communities in which the test and trace process is inefficient due to limited uptake[1]. This has been particularly relevant in communities where there are language barriers[2], and in work environments in which sharing colleague’s information may be difficult because a positive result could mean unpaid sick days[3]. Commonly, such occupations include those with a large number of migrant workers, or where workers are employed through agencies and staff members are inconsistent or turnover is high[4]. In these cases alternative mechanisms such as mass swabbing through mobile testing units have been employed to try to boost the number of people tested, including those who may be asymptomatic[5]. Taking swabs can be unpleasant, however, using saliva samples can be less invasive, more reliable than nasal swabs, and can be done more frequently, even once a week which would help mitigate the false negatives swabs can produce[6].

Targeted mass swabbing is currently being undertaken in some countries such as Canada, where there have been outbreaks and deaths of those working in agriculture due to poor living and working conditions5. The vulnerability of these groups to COVID-19 was addressed in The Manchester Briefing 13 where it addressed localised spikes in COVID-19 transmission as a result of poor working conditions in food and garment industries.

Mass swabbing could help to mitigate the lack of reporting to contact tracers, improve the transparency of information within the health system, and improve the efficiency of testing[7]. Efficient mass testing should consider:

• Effectively mapping all existing testing and laboratories capabilities including those in health services, research centres[8], and scientific institutes to reduce the risk of running parallel systems with the private sectors which may encourage competition for supplies and potentially reduce the capacity of existing systems13
• Use existing capacities to help develop important localised approaches to improve the coordination of mass testing through involvement with local authorities and industries13
• Develop partnerships with life science industries to build resources and capacity for mass testing14 that should account for, and complement, existing local capacity
• Be mindful of how targeted mass testing may (further) stigmatise certain communities. Careful consideration should be given to the location of testing centres so not to create an association between a particular community and the virus
• Ensure there is clear and simple dissemination of public information in areas in which mass testing takes place. This should include sensitivity to the local conditions including languages, culture and the level of community (dis)harmony

Increasing effective capacity for mass testing, especially in high risk populations, is central to limiting the spread of COVID-19. Developing an integrated localised system that is capable of regular, repeat testing may not only help stem the spread of the virus, it may also help support other sectors adversely affected by COVID-19. For example, this type of testing may help mitigate the issue of quarantine after travel as the virus can be more closely monitored, even in asymptomatic patients. In addition, particularly vulnerable groups may be protected through close observation, including those who work in jobs where there is a high risk of infection, and those who may feel forced to go to go to work due to financial insecurity.

[1] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[2] https://www.theguardian.com/world/2020/aug/04/four-key-failings-of-england-covid-19-test-and-trace-system

[3] https://www.theglobeandmail.com/canada/article-ontario-pivots-on-testing-strategy-for-migrant-workers-to-contain/

[4] https://www.iheartradio.ca/am800/news/mass-testing-planned-after-24-year-old-migrant-worker-dies-of-covid-19-1.12612356

[5] https://windsor.ctvnews.ca/mass-testing-for-migrant-workers-planned-following-death-of-24-year-old-man-1.4972533?cache

[6] https://www.newscientist.com/article/2246880-city-in-uk-takes-steps-to-test-entire-population-for-coronavirus/

[7] https://www.bma.org.uk/news-and-opinion/a-hidden-threat-test-and-trace-failure-edges-closer

[8]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/878121/coronavirus-covid-19-testing-strategy.pdf

To read this case study in its original format, follow the source link below to TMB Issue 20 (p.22-23).

There is research being done on most conceivable topics related to COVID-19. Many projects are looking to expand the range of governments, cities, organisations and individuals that will get involved in the project to contribute information into the project and provide a testbed for their work. Participation may enable you to influence the project towards your priorities, get early access to project findings that could change the ways you deliver, get funding to support your involvement, and provide access to a wider network that can help you in your job. Consider whether to:

• Identify what knowledge gaps you have in your organisation that research could usefully help to fill
• Identify the information that you can feed into projects and other contributions you can make to a project
• Approach local universities and research institutes to partner on research or mutual interest
• Talk to national bodies on what research they have funded
• Contact national and overseas researchers to request participation and/or early notice of their emerging findings
• Joining research webinars, research network email-lists, and research observatories to receive notification of project results
• Join advisory boards of projects to direct their focus
• Search databases of funded projects to find those that align with your interests

The health impacts of COVID-19 such as organ scarring, and long-term lung problems are gradually coming to light. However, wider implications from lockdown on working socialising and living in small spaces is less understood. Consider the impacts of this and the steps that can be taken to address them:

• Eye strain. Consider the amount of time being spent on online calls e.g. on Zoom or Skype:
  • Where possible replace Zoom with phone calls
  • Make meetings shorter and limit them to 40 minutes
  • Use the 20/20/20 rule. In a 40 minute meeting, take a mid-time break to rest your eyes and look at something 20 feet away for 20 second
• Back pain. Consider impacts of home working environments on back pain such as working from the sofa:
  • Ensure employees have a set-up that's fit for purpose like they do at their office
  • Do not stay seated all day as the spine is out of alignment - set reminders to walk every hour for a few minutes or do simple stretches
• Circulation. Improve awareness of the risk from poor circulation as a result of moving less:
  • Look for signs of varicose veins such as aching legs, swollen ankles, and red or brown stains around the ankles
  • Keep hydrated and mobile to decrease the risk of deep vein thrombosis (DVT), or clotting in the deep veins of the legs
• Maintain contact with your doctor as DVT is associated with underlying health issues that may go undiagnosed

When the intensity of the crisis reduces, there is more opportunity for targeted measures that limit virus transmission. Testing should be pro-active and strategically targeted. Consider establishing 3 categories of people and places, and create suitable testing guidelines for each one, including:

People with symptoms. Consider testing this group immediately:

• Establish a system with quick consultation, diagnosis and testing (upon medical advice)
• Use antigen tests as results are available quickly
• Conduct antigen tests via saliva samples to minimize the risk and burden on patients and medical staff

People without symptoms, who have been assessed with a high pre-test risk of infection, and/or who work in high-risk areas. Consider testing this group pro-actively:

• Consider places that require close physical contact such as hospitals, senior-care facilities, or nightlife/entertainment-related industries
• Because of the high risk of infection and high pre-test risk of infection, consider thorough and rapid testing for this group

People without symptoms, who have been assessed with a low pre-test risk of infection, and who work in low-risk areas. Build consensus regarding action for this group:

• Include people who, for peace of mind, want to be tested in order to conduct societal, economic, cultural activities etc.
• Consider that testing is not perfectly accurate and only reflects a person's condition at one point in time. Continuous testing would be required to fully monitor the condition of an individual

Psychological First Aid (PFA) provides basic emotional and practical support to help reduce distress and enable a person to adapt, cope and recover. Specific amendments may be needed to include COVID-19-related issues and recognised that some people may be at risk of more serious distress. For COVID-19 some of these risk factors include:

• Being at higher risk of contracting COVID-19
• Have serious losses, e.g. of loved ones, livelihood
• Already experiencing significant stress
• Have pre-existing mental illness
• Absence of a well-developed social network

Consider:

• Providing PFA training for organisations and the wider community e.g. schools, religious groups (as it is not just for professionals) to alleviate strains on health and social care services
• Providing additional training to volunteers on how to safely recognise when someone may need more specialised support
• Ensuring that those who provide PFA have sufficiently accurate and up-to-date information on COVID-19
• That those who provide PFA have cultural and social sensitivities for the locale
• Offering additional training to volunteers on how to recognise if their own mental health and well-being needs are being met

The basic idea of pooled testing is that instead of testing samples from individuals one at a time, samples from multiple individuals (pools) would be mixed together at a testing facility, and tested as one sample. If the test comes back negative the whole pool is clear. If the test is positive, the pool can be tested individually instead. Pooled testing is a means to test more people faster, using few tests, and for less money, and has long been used to test large asymptomatic populations for disease e.g. to screen for sexually transmitted diseases, and to test donated blood for Hepatitis B and C, Zika virus and HIV. Consider:

• The cost saving benefits of pooled testing over testing each individual - schools and businesses saddled with testing costs could lower costs by as much as 75%
• The scalability of pooled testing - batched testing of pools can provide data covering large areas such as schools and businesses
• Pooled testing could ramp up the number of coronavirus tests while lowering testing costs, especially in low-prevalence areas

With social distancing, limited public transport, and advice on safe working practices, some employers have closed work sites and have required staff to work from home. Many staff report that they work from home diligently, often putting in extra time to support their employer. However, some staff report suspicion that colleagues who are being paid to work from home are not working diligently; for example, logging onto work but not working, failing to attend meetings or provide agreed deliverables, enjoying alternative activities when they should be working, or working reduced hours. In recognition of the disparity between peoples' approaches to working from home, consider:

• how perceived disparity of effort may build resentment across the workforce
• how resentment may manifest itself, create difficult interpersonal working environments, and when intervention from senior staff is needed
• whether this perceived disparity will change work cultures and expectations beyond COVID-19

To address any resentment, consider:

• keeping an open mind on why resentment has developed
• addressing resentment by talking with staff regularly and when resentment is first detected
• identifying how different staff contribute to the organisation in different ways and why these may not always be visible to other colleagues
• communicating justification for work allocation across staff, ensuring fairness at work
• how the organisations may support staff to improve arrangements for working from home
• when conversations are needed to address performance concerns

Extreme fatigue, nausea, chest tightness, severe headaches, "brain fog" and limb pains are among the recurring symptoms described by some sufferers of COVID-19 for weeks/months after their diagnosis. NHS England has developed an online portal for people in England to access tutorials, contact healthcare workers and track their progress called "Your COVID Recovery". Consider development of similar services that include:

• Access to a clinical team including nurses and physiotherapists who can respond online or over the phone to any enquiries from patients
• An online peer-support community for survivors - particularly helpful to those who may be recovering alone
• Exercise tutorials that people can do from home to help them regain muscle strength, and lung function in particular
• Mental health support, which may include a psychologist within the service or referral into other mental health services along with information on what to expect post-COVID
• Face-to-face provision for physical rehabilitation where possible, ensuring the safety of staff and patients
• Support from professionals such as dieticians, speech and language therapists, occupational therapists
• Cultural practices and relationships with rehabilitation needs

There is also an ongoing need for data collection about a nation's health to understand the long-term effects of this disease.

Agoraphobia is an anxiety disorder characterized by symptoms of anxiety in situations where the person perceives their environment to be unsafe with no easy way to escape. People may feel ill, nervous, embarrassed or fearful in public places. With self-isolation and social distancing being a core component of 'living with COVID-19', people may feel trapped or particularly concerned about contamination and infection. Consider the provisions required to support people including:

• Helplines for those wanting to talk over the phone and support lines via live chat, text or email for those who don't wish to call or are unable to
• Webinars for the general public such as: how to be kind & compassionate to yourself', and 'dealing with COVID-19 negative thoughts when you already have anxiety'
• Access to approved therapists able to offer 1:1 support through therapies such as Cognitive Behavioural Therapy (CBT) and counselling

Signposting to supportive apps such as Headspace (www.headspace.com) or Calm (www.calm.com)

Public Health England have adopted a place-based, whole system approach to improving the health of the poorest. This strategy aims to build healthy, resilient, connected and empowered communities on mental health - and sits alongside wider strategies on "Place-Based Approaches for Reducing Health Inequalities". This involves scaling a range of community-centred approaches, addressing community level determinants. Consider addressing the following principles:

1. Scaling: Rolling out a flexible approach rather than applying a standard model using integrated community-centred approaches e.g. integrated wellness services at the local neighbourhood level. Utilise local resources and expertise
2. Involving: Gather community insights and encourage participation to better understand people's health needs
3. Strengthening: Grow local capacity and knowledge through workforce development to build core skills in the community. Encourage a thriving voluntary, community and social enterprise sector
4. Sustaining: Address social determinants of health, as they directly impact on people's resilience and ability to participate. Develop short, medium and long-term indicators about what matters to communities and share between agencies and communities

COVID-19 has had widespread consequences on all aspects of health and wellbeing. In particular, it has taken a toll on emotional health and wellbeing as a result of remaining isolated or physically distant from friends, family and normal support structures. Additionally, the effects of COVID-19 on risk factors including socioeconomic inequalities, poverty, debt, unemployment, food insecurity, and physical inactivity have had significant impacts on the emotional health and well-being of many

These impacts can be understood on a continuum, from those experiencing some effects on their emotional health and wellbeing, perhaps for the first time, such as intermittent loneliness; to those suffering from more serious mental health disorders such as anxiety, depression or post-traumatic stress disorder; and those who require medical intervention and psychiatric care. This presents three core challenges for mental health provision:

1. Prevent an associated increase in mental health disorders and a reduction in mental health wellbeing across populations
2. Protect people with a mental disorders from COVID-19, and the associated consequences, such as increased risk of COVID-19 infection and mortality due to increased vulnerability
3. Provide appropriate public mental health interventions including for health professionals and carers

The challenges of understanding how emotional health and wellbeing have been affected is complex as many people may develop negative psychological responses after an event, so, even as the threat of the pandemic lessens, more people may reach out for support. This is a particular concern for frontline medical staff, many of whom have not had time or space to process their experiences and may suffer from mental and physical fatigue.

The challenges faced in providing adequate care and support are not just related to the increasing numbers of people who require mental health services. Mental health services claim historically under-funding , and the expected compounding of the impacts of a global recession on the resources available; further stretching the sector. Across the UK, the voluntary sector has played a key role in service provision and developing innovative and flexible care models. Voluntary sector support ranges from helplines to peer support, and alternatives to inpatient care. They may be large national charities delivering a range of responses in different localities or smaller local social enterprises providing a specific service, such as a crisis cafe.

To meet the expected demand for mental health support, the Voluntary, Community and Social Enterprise (VCSE) sector organisations are working with their NHS and local government partners to respond to the pressing needs of the communities they serve and come from. Key priorities have been identified to maintain these services

• Rising service demands - there is a significant rises in helpline usage which has led to concerns about the provision of effective support to every caller; especially those in crisis
• Workforce - consideration of: reductions in personnel due to isolation or secondments to statutory services; gaining key worker status and recognition for voluntary mental health providers, and testing
• Loss of access to care coordinators - a care coordinator plays a key role in helping people to manage and monitor their care, including support with medication, physical health, housing, employment, finances and home care. Support service users who have not been able to contact their care coordinators due to their redeployment to COVID-19 response teams, and/or sickness, self-isolation, etc
• Infection control - PPE and clear guidance on its use is needed for regulated and unregulated services. A considerable number of staff are also working on the frontline with service users, and require protection
• Collaboration with statutory services - VCSE organisations have extensive experience of working alongside statutory bodies in the provision of mental health services. In many areas, partnership working between the VCSE sector, NHS and local government is well-established but, in other areas, it has not always been easy to form effective working relationships
• Advocacy services - appropriate access to advocacy services is important for people with mental health conditions. During COVID-19, some people who have been sectioned need more contact with others. While some people have been provided with mobile phones by hospitals, other people need more support to make contact with others to avoid isolation
• Adapting service delivery - with social distancing policies in place, many services are being moved online or to telephone. Provision for anxiety and crisis support have reported an increase in calls to helplines. Some have reconfigured services but consideration needs to be given to the sustainability of this
• Changes to legislation - emergency legislation (Coronavirus Act 2020) includes temporary changes to the Mental Health Act and local authorities Care Act. Consideration of the effects of this on the availability, accessibility, commissioning and provision of mental health care and support services is needed
• Sustainability of the VCSE sector - concerns about funding streams, cash flow, and long-term sustainability of service providers has been raised. While the Government have provided financial support, the long-term sustainability of the mental health sector at a time when services are needed should be considered

Follow the source link below to read this case study in its orgininal format, including references and source links.

[2] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[3] https://www.hrw.org/news/2020/06/08/mental-health-support-necessary-during-covid-19-pandemic

[4] https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(20)30240-6/fulltext

[5] https://scienmag.com/global-study-launched-to-examine-impact-of-covid-19-on-health-and-wellbeing/

[6] https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[7] https://www.tuc.org.uk/sites/default/files/Mentalhealthfundingreport2_0.pdf

[8]https://www.theguardian.com/world/2020/jun/07/health-experts-on-the-psychological-cost-of-covid-19

[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

[10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5695387/

This week in the UK is Carers Week. Carers Week aims to raise awareness of caring and the challenges carers face. It is also a time to help people who may not identify as having caring responsibilities and to help them recognize this so they can access much-needed support[1]. This is particularly important as an estimated 4.5 million people in the UK have become unpaid carers for elderly, disabled or physically or mentally ill relatives since the COVID-19 pandemic[2]. This is on top of the existing 9.1 million unpaid carers that already provide support in the UK[3].

Around 2.7 million women and 1.8 million men have become new carers, typically helping with food shopping, finances, collecting medication and providing emotional support2. Others may be taking on more intense roles that include helping people with personal hygiene, movement around the home and meal preparation. 62% who have started caring since the outbreak are also juggling paid work alongside their caring responsibilities[4].

Unpaid carers in the UK have described facing mounting anxiety and frustration regarding getting access to vital medication from pharmacies and time spent queuing for medication or food shopping due to social distancing rules[5]. As a result, the following advice has been provided to improve carers’ experiences and ability to access the medicines they need. These include:

• Allowing two people into store when the carer has no choice but to take the person being cared for to the pharmacy with them
• Considering prioritising un-paid carers of vulnerable/shielding people for medicine delivery slots
• Recognising that, for some families, young carers are the only people able to collect medicines in the household

Recognising the role of young carers is extremely important. Of the 13 and a half million unpaid carers in the UK, an estimated 700,000 are children[6]. Evidence suggests that young carers and young adult carers are being disproportionately impacted by COVID-19 and are experiencing high levels of anxiety and isolation as a result of lockdown[7]. Many young carers are under increasing strain while schools remain closed as caring responsibilities increase and time away from these at school decreases[8].

Additionally, other systems used to support and safeguard young carers such as health and social care systems, are struggling under the pressure from COVID-19 impacts[9] as they continue to make changes to accommodate the needs of disabled and vulnerable people[10]. While this is vital, it may draw attention away from the often hidden and marginalised needs of young carers[11], and may miss many new young carers[12]. Where young carers are in contact with local authorities, they are encouraged to discuss with what support or services they need by[13]:

• Thinking about good and bad days being a carer
• Making notes about a typical day helping the person they care for, including their own needs and concerns
• Thinking about things which would help them cope, their aims, hopes, and what is important to them

Although there a huge challenges for unpaid carers, the issue is gaining visibility as a result of the rising numbers of people providing care and has led to calls to government to deliver social care reforms that detail long-term investment into care and support services[14]. This is increasingly important as the timeframes of the pandemic are unknown, and more people may be required to provide care for longer periods of time. Charities supporting carers have called for4:

• An increase in Carer’s Allowance – currently £67.25 a week
• A “one-off coronavirus supplement” in recognition of the role unpaid carers have played in the pandemic and the significant costs associated with caring
• Increased recognition of the vital work unpaid carers provide and the limited support they can currently receive due to COVID-19 restrictions
• Physical and mental support for carers and increased investment in support services
• Carers must be a priority for regular testing and PPE, particularly where they care for the most vulnerable

The government recommends that all carers create an emergency plan with the person they care for to use in circumstances where help from other people to deliver care is needed. This may be from family, friends or another care provider[15]. They advise the following details are provided:

• The name and address and any other contact details of the person you look after
• Who you and the person you look after would like to be contacted in an emergency
• Details of any medication the person you look after is taking

Details of any ongoing treatment they need and any medical appointments they need to take

References:

[1] https://www.carersweek.org/about-us

[2] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[3] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[4] https://www.carersweek.org/media-and-updates/item/493439-covid-19-pandemic-4-5-million-become-unpaid-carers-in-a-matter-of-weeks

[5] https://carers.org/news-and-media/news/post/42-organisations-work-together-to-improve-unpaid-carersa-access-to-medicines-during-the-covid-19-pandemic

[6] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[7]https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[8] https://www.bbc.co.uk/news/av/uk-52948236/coronavirus-life-as-a-young-carer-under-lockdown

[9] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[10] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[11] https://www.uea.ac.uk/about/-/new-project-examines-impact-of-covid-19-on-young-carers

[12] https://carers.org/what-we-do/our-survey-on-the-impact-of-coronavirus-on-young-carers-and-young-adult-carers-

[13] https://www.southlanarkshire.gov.uk/info/200220/carers_and_caring/505/carers/11

[14] https://www.itv.com/news/2020-06-08/millions-have-become-carers-due-to-covid-crisis-new-research-finds/

[15] https://www.gov.uk/government/publications/coronavirus-covid-19-providing-unpaid-care/guidance-for-those-who-provide-unpaid-care-to-friends-or-family

Consider:

• That systems are not always focused on all the needs of people but rather on specific health conditions. Support for people and their overall health is vital rather than the restoration of specific services.
• That there will be challenges about aligning all the different health and care activities that are required in each place. Central government organisation may mean a lack of alignment at a place level depending on the department. For example, health systems, local resilience forums and environmental infrastructure are all different in England. We have learned that effective partnerships need to be developed 'bottom up' at place level, and many of these have worked well during COVID-19 response.
• Partnerships between organisations and between and in communities have worked well because of relaxation of information governance, financial constraints, central guidance and regulation. Careful consideration must be given to the extent to which these are reinstated and the timing of this.
• New processes that have been established during response, and the extent to which they can and should be continued. IN particular, remote consultations between health care providers, both in hospital and primary care, currently comprise the vast majority of interaction. Reverting to the pre-COVID method of primarily face to face will have both positive and negative consequences, which will differ across society. Careful thought needs to be given to the equality impact of retaining these changes.
• The power of each part of the health system - including that of the large health service providers (hospitals) but also the power of the people who live in each place. The longer-term consequences of e.g. establishing COVID-free (cold) hospital sties must be considered from a population perspective.

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).

Such issues include loneliness and anxiety about returning to the outside world and recovering from the physical impacts of the disease. Consider:

• Maintain coordinating arrangements with the charity and non-profit sector to support those suffering with physical and mental health impacts of COVID-19
• Share information about vulnerable populations with non-profit and the charity sector where they have permission so that they are able to offer appropriate support
• Retain communication channels such as hotlines to facilitate community engagement
• The needs of those who have survived COVID-19, thinking of the mental health impacts such as fear of going outside, and physical impacts such as organ scarring, impaired vision and mobility, which may require ongoing support

This lesson was contributed by a representative of the Social Welfare Department in Portugal and UNDRR City Resilience Stories Australia during project data collection.

The Mental Health Commission of Canada has developed three programmes: Caring for Yourself/Caring for your Team, and Caring for Others:

• Caring for Yourself/Caring for your Team - Participants learn how to better understand their own mental wellness, and that of their team. They learn to notice if they might be moving into unwell areas, use practical actions to help with stress, and know when to reach out to get professional help, and learn tips to support team members
• Caring for Others - Participants focus on how to create a safe space to have conversations about mental health and/or substance use problems, and the skills required to respond to a mental health crisis until professional help arrives. This prepares participants to have conversations confidently about mental health during a crisis, with their family, friends, communities, and in their workplaces

A number of track and trace mechanisms to support treatment have been credited with supporting the response in Korea[1]. These include: Self-diagnosis Apps for in-bound travellers; the self-quarantine Safety APP; contact tracing and epidemiological investigations.

Self-diagnosis Apps for in-bound travellers

This self-diagnosis mobile application has been available to in-bound travellers at airports and harbours. The apps:

• Have been developed by the government to monitor symptoms of inbound travellers and provide them with prompt medical advice.
• Are downloaded onto a mobile device and:
  • Is required at entry by all inbound travellers since 1st April 2020.
  • Is available through the URL and QR codes available around the airport or harbour immigration gates and on special arrival cards.
• Require the in-bound traveller to:
  • Install the app and use it to submit passport information, nationality, name, address and other necessary information for quarantine.
  • Connect directly to a call centre and social media channels and provides medical answers against suspected symptoms to enable early treatment.
  • Report their health condition (body temperature, cough, sore throat, or difficulty breathing) through the application once a day during their 14 days of quarantine.
  • Seek medical advice if they are showing symptoms. This can be done through call centres operated by the Korea Centres for Disease Control and Prevention (KCDC), or at COVID-19 screening centres.
• Collect data entered by the user during the self-diagnosis which:
  • Is checked against immigration data before being sent to the public health clinics under jurisdiction of local governments.
  • Is transferred to local governments so that the corresponding public health clinics can provide medical advice, testing and instructions on how to receive care. This is done for travellers reporting symptoms for more than 2 days.

Self-quarantine Safety APP

This is a voluntary application for residents of Korea. The app:

• Has three functions to:
  • Conduct a self-diagnosis for the users to conduct and submit the results with the assigned government officers
  • Provide necessary information including self-quarantine guidelines and the contact info of the assigned government case officers.
  • Ensure that self-quarantine orders are kept by setting off a GPS-based location tracking alarm whenever a user ventures out from the designated quarantine area - to prevent possible violation of orders. A case officer is also notified when quarantine is disobeyed; the case officer takes appropriate measures to have the subject return to the quarantine area.
• Has two types of application available:
  • One for the users under self-quarantine – they use the application twice a day to monitor themselves for four symptoms: fever, cough, sore throat, and respiratory difficulties.
  • One for the assigned government case officers – once submitted, the self-diagnostic data will automatically be shared with an assigned case officer, who will be notified if the user does not submit the self-diagnostic data or becomes symptomatic.
• Has been effective in monitoring those under self-quarantine and making sure that they stay in designated locations. The alarm function of the application has demonstrated to encourage the quarantined to follow regulations.

Contact tracing and epidemiological investigations

The COVID-19 Data Platform supports investigators as they trace infected people. The app:

• Is designed to:
  • Support epidemiological surveyors to quickly identify the transmission routes and places that the infected person has visited
  • Use real-time analysis of data through location tracking, card transactions, and CCTV recordings for accurate tracing of routes and places
• Takes users through a process of using the app as:
  • Citizens voluntarily record their whereabouts on their smartphones using Google Timeline
  • Using a ‘My Timeline’ function on Google Map application, the user whereabouts and routes are recorded automatically.
  • Data on Google Timeline can be captured as screenshots and shared with epidemiological investigators, who will use the data to trace contacts and patient routes.
• Supports health officials in:
  • Confirming the interview results of patient transmission routes with data on the system.
  • Allowing big data analysis from real-time data feeds on COVID-19 patients, including their whereabouts and the time spent on each location.
  • Using these multiple data points, so that the system can detect incidents of cluster infection and show the source of transmission.
  • Enabling prompt data-driven COVID-19 epidemiological investigations.

Further details on the apps are available[2],[3].

References:

[1] Flattening the curve on COVID-19: How Korea responded to a pandemic using ICT http://www.undp.org/content/seoul_policy_center/en/home/presscenter/articles/2019/flattening-the-curve-on-covid-19.html

[2]http://ncov.mohw.go.kr/upload/ncov/file/202004/1587521842434_20200422111722.pdf

[3]http://ncov.mohw.go.kr/upload/viewer/skin/doc.html?fn=1587107400738_20200417161001.pdf&rs=/upload/viewer/result/202005/

Research in Denmark and China demonstrated that women were more adversely psychologically impacted by COVID-19 than men. In China, survey respondents demonstrated evidence of post-traumatic stress disorder (PTSD) Consider:

• Mental health services that are tailored for different genders to accommodate a safe space to discuss needs
• Ensuring increased access to mental health services through online systems and telephone calls
• Hand hygiene, mask-wearing and confidence in doctors have been observed to reduce psychological impact

Councils maintain crucial services, have set up community hubs, and established local teams for tracing and tracking. Councils provide food and shelter to people at risk, help local businesses stay afloat and have mobilised volunteers and therefore know their communities in depth which can support trace and track. Councils:

• Are naturally placed to respond quickly to the distinct needs, challenges and infection rates of their own area
• Are equipped with their own teams of public health professionals

In Louisville a city of 800k people in the USA, the Mayor led three activities to promote compassion in dealing with the effect of COVID-19. This has been underpinned by a value-based renewal of the city:

• Respect for each other
• Compassion for everyone to protect people
• Equity so that everyone feels connected to a bright and hopeful future

Three important actions to facilitate this were:

• Donations which generated $10m USD which could be allocated to good causes
• Digital equality for all

The "Lift Up Lou" campaign; a morale building initiative to help the city to focus on working together. 'Lift Up Lou' involved shared online activities that citizens could jointly participate in and a community song produced collaboratively by 30 local, notable musicians

Including:

• Dissemination of information about resurgence on a transparent website
• Encourage private healthcare facilities to undertake free testing
• Use volunteers to distribute testing kits as widely as possible, considering their safety

This lesson was contributed by a Civil Defence expert in Iceland during project data collection.

By taking the following steps:

• Take deep breaths, stretch, or meditate. Try to eat healthy, well-balanced meals, exercise regularly, and get plenty of sleep
• Take breaks from watching, reading, or listening to news stories, including social media
• Make time to unwind. Try to do some activities you enjoy
• Connect with others while practicing social distancing. Talk with people you trust about your concerns and how you are feeling
• Call your healthcare provider if stress gets in the way of your daily activities for several days in a row
• Only share accurate information about COVID-19 with others, and understand the actual risk that you and the people you care about face

In Korea, the COVID-19 Data Platform is:

Designed to:

• Support epidemiological analysts to quickly identify the transmission routes and places that an infected person has visited
• Use real-time analysis of data through location tracking, card transactions, and CCTV recordings for accurate tracing of routes and places

The process of using the app is:

• Citizens voluntarily record their whereabouts on their smartphones using Google Timeline
• The 'My Timeline' function on the Google Maps automatically records the users location and routes
• Data on Google Timeline can be captured as screenshots and shared with epidemiological investigators, who will use the data to trace contacts

The platform supports health officials to:

• Confirm the interview results of patient transmission routes with data on the system
• Allow big data analysis from real-time data feeds on COVID-19 patients, including their whereabouts and the time spent on each location
• Use these multiple data points to detect incidents of cluster infection and transmission sources for prompt