Recovery, Renewal, Resilience

Many cities have been severely impacted by the pandemic due to inadequate access to basic services, healthcare, and adequate accommodation. Lessons from the pandemic can be used to reimagine city design and deploy solutions that can build health, equity and climate resilience. Areas with high deprivation have been hardest hit by COVID and are more susceptible to other emergencies. Steps made pre-pandemic in Rotterdam to improve the region of BoTu, a densely populated area and one of the most deprived in the Netherlands, offers lessons for recovery and renewal from COVID-19:

• Tackle climate change, social and economic challenges and resilience building in one overarching plan due to the crosscutting nature of COVID-19 and its impacts
• Consider partnerships that link multiple services with households such as Go BoTu, a collective comprising doctors, health workers, teachers, local business people, and community workers that help involve local people in city planning and wider resilience measures e.g. workers replacing heating systems with environmentally friendly alternatives in BoTu will be trained to identify households with other needs, such as debt counselling
• Expand the use of green spaces to meet community needs e.g. more sports fields or cycle lanes. Use community capacity for building and renovation work to stimulate the local economy
• Climate change adaptability will depend on greater water absorbance to prevent flooding, consider how the city stores rainwater and how stored water can be used

Vaccines are highly perishable and must be kept at very cold, specific temperatures. The majority of COVID-19 vaccines under development will spoil, and need to be discarded, if they are not kept at the right temperature. National and local governments, alongside health systems and the private sector, need to imminently consider their cold chains to avoid unnecessary spoiling of vaccines. The cold chain is a supply chain that can keep vaccines in tightly controlled temperatures from the moment they are made to the moment that they are administered to a person. Preparing the cold chain may take months, so investments into planning and resources now can help expand and support the current vaccine cold chain so it is ready and able to meet the scale of the mass vaccination programmes required. To prepare/scale up the cold chain consider:

• Where vaccines will be produced and transported, and the requirements for transportation including planes and trucks within countries and for distribution abroad
• There are a number of vaccines under development, many of which require different temperatures and handling procedures. Which will be approved first is unknown, therefore to prepare staff when one is approved staff in the cold chain should be trained to handle all possible vaccines to save time and avoid spoilage
• The frequency of deliveries that may be needed to facilities where dispensing will take place. This depends on the refrigeration capacity of health care organizations and hospitals, staffing resources, the locations the vaccines, and the shelf life of the vaccine
• How to expand shipping and storage capacity, including the specialised equipment needed to store vaccines at certain temperatures. Encourage airports and logistics companies to evaluate how well they could meet cold chain requirements

Wastewater-based epidemiology groups in Australia, the Netherlands, Sweden, and the USA have already reported detecting traces of COVID-19 in wastewater. Although COVID-19 is not known to infect humans through sewage or wastewater, similar diseases can, and so monitoring the behaviour of COVID-19 in these environments is important. Consider integrating sewer surveillance and wastewater inspections into systems for COVID-19 monitoring:

• Develop a 'dashboard' of data to assess the correlations between all collated COVD-19-related indicators as seen in the Netherlands
• Provide information on potential transmission pathways and improve the early warning of new outbreaks by understanding the relationships between: wastewater analysis, the number registered infected people, and societal or behavioural traits