Recovery, Renewal, Resilience

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

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)

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

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

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)

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

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

Consider whether immunity certificates would be helpful for residents who have safely survived the coronavirus and have antibodies in their blood to prove it. The article says that certificates might "have some merit under certain circumstances".