Monday 14 December 2020

Four Questions About the Covid-19 Pandemic

1. What are, and have been, the key challenges in coping with the Covid-19 pandemic?

The first challenge is to understand the behaviour of an emerging disease caused by a new variant of a virus. This concerns its infectiousness, mode of transmission, lethality, symptoms and effects, mutation, longevity on various kinds of surface, and so on. Information on these characteristics takes a long time to assemble, as at the start the virus is new and unknown, its relationship with the host population is unknown and its ability to disseminate is also unknown.

Viral pandemics can have impacts that are as significant in the socio-economic field as they are in epidemiology and viral medicine. The epidemiological approach to the virus involves constantly tracking the progress of the disease and applying measures where it flares up. It also involves promoting appropriate forms of behaviour, principally the need to practise good hygiene, physical distancing and sanitisation of environments. Hospitals need to develop very substantial surge capacity and greatly increase their infection control measures. This may involve deploying field hospitals and using the resources of military medicine.

In the socio-economic sphere, welfare suddenly becomes a vitally important issue. Basic services depend on the work of people who are in the front line of infection, such as nurses, doctors, carers, cleaners and delivery drivers. They will need a constant supply of adequate personal protective equipment. Huge changes in the pattern of demand and supply will occur during a pandemic. Sectors such as travel, hospitality, tourism, retail, the arts and entertainment will suffer closures and reorganisations. Income support will be vitally important. Lockdowns will seriously affect people's mental health.

Specific challenges involve safeguarding the residents and staffs of care homes. Covid-19 is far more lethal for frail elderly people than it is for other categories of the population. Outbreaks in care homes need to be prevented by extraordinary distancing, sanitising and protection measures. Provision of continuity of care for people with non-Covid illnesses is also a major problem. When hospital capacity is absorbed by large influxes of people suffering from Covid, the tendency is to defer treatment of patients with other illnesses. This can lead to widespread failure to diagnose and treat life-threatening and seriously debilitating conditions. It can also lead to treatment that fails because it is applied too late in the development of illnesses such as fast-growing cancers. Finally, Covid-19 can have a disproportionate impact on people with disabilities. As the range of disabilities is very wide, the effects are highly varied and they require a variety of different solutions and remedies.

Amid all the risks associated with a pandemic the policing function is important. In the interests of safeguarding the entire population, restrictions on personal freedom are necessary. These need to be measured, proportional to the risk and applied with fairness and a degree of tolerance.

2. Can we draw on expertise in the field of disaster risk management?

We can regard Covid-19 as a 'wave-disaster'. It is characterised by fluxes of infection and a wide geographical spread of 'flare-ups', which leads to a constantly changing, highly dynamic situation. Under such circumstances, disaster risk management is vitally important, especially as one is dealing with a medical emergency and a social, economic and psychological one.

It is necessary to understand people's perceptions of and attitudes to risk. Human behaviour must be studied and comprehended under the unusual conditions of lockdown, and amidst the far-reaching changes in employment, personal freedom, the risk of illness and the morale of people who suffer disruption to their normal lives.

Although the medical, virological and epidemiological aspects of a pandemic are obviously vital and extremely complex, as an emergency and disaster, the outbreak must be managed with many of the tools and precepts that apply to other kinds of crisis. It is important to understand the relative nature of risk in geographical terms, with respect to the co-occurrence of different kinds of risk, and so as to prioritise risk management interventions.

Emergency planning is an essential tool in the response to a pandemic. Planning is more a process than an outcome. It helps anticipate needs and therefore create the conditions in which preparations can be made to satisfy them. Emergency response has three ingredients: plans, procedures and improvisation. The plans orchestrate the procedures. They ensure that responsibilities are fully assigned, that participants in the response have well-defined roles and that needs are identified in time to supply them. As all emergencies contain some final, irreducible uniqueness, improvisation cannot be ruled out. However, it needs to be reduced to a minimum. Otherwise, the result is tantamount to negligence, a failure to anticipate needs in time to prepare for them. Detailed scenarios of a major viral pandemic have existed since the mid-2000s. They gave the opportunity to recognise what would need to be done during a viral emergency, what equipment and preparations would be needed, and now society would abruptly change.

Communication is a vital element of the pandemic response. It should be honest, open, transparent, measured, consistent, frequent and clear. Moreover, leaders must lead by example, as this is an essential means of maintaining the consistency in communication. There is no virtue in minimising the problems associated with facing up to the pandemic. There should be no exaggeration, distortion or concealment of the facts. Building a relationship of trust with the recipients of information, particularly with the general population, is the only way of inducing people to follow sensible regulations.

3. What should be the role of civil protection on a national and international level in this context?

No matter how large they are, all disasters are local events. The theatre of operations is invariably local. Because of the vast scale of the resources needed to manage a viral pandemic, the response must be national. Moreover, the global nature of the crisis places emphasis on international coordination of the response: sharing data, following other countries' good practices, learning from the experience of other countries, and practising international solidarity, for example in access to vaccines, palliative drugs and the fruits of research. However, the pandemic must be managed at the local level. This means that coordination between national, regional and local authorities needs to be strong and extensive. Higher levels of government need fully to support local efforts to bring the pandemic under control.

Countries need to have good, robust, extensive civil protection systems with well-thought-out national coordination systems and a strong local presence throughout the country. These systems are usually established by the passing of a national law that sets up and defines the system and specifies how it will function. Flanking civil protection, there needs to be a national higher institute of health, or similar organisation designed to manage the public health elements of a disease.

In all disasters, there is a tension between centralisation and devolution. In most countries, an excessively centralised response to the pandemic will be less than optimal because it will not promote responses that are sufficiently tailored to local realities. On the other hand, local authorities should not be abandoned as they struggle to bring the disease under control. Local services understand local conditions much better than external forces do, and for this reason they need to have a lead role, and executive authority, in managing the event, but they need to be endowed with adequate resources to be able to do so.

4. What important lessons are to be learned?

The first lesson of the Covid-19 pandemic is that there was a need to develop and take heed of international monitoring and to put measures in place quickly. Prompt reaction to the threat and the evolving situation was capable of saving many lives. This was contingent upon having plans that would enable the reaction to take place.

The second lesson is that there could be a gap, an abyss even, between a pandemic plan and its ability to be activated. For example, one of the most essential aspects to be planned and managed is the supply chain network. Personal protective equipment, palliative drugs, ventilators and other materials and supplies needed to be stockpiled and the stockpiled maintained over time. If this could not be done, there needed to be pre-arranged agreements to manufacture equipment and supplies very rapidly and predetermined logistical supply-lines. Improvisation of supply and logistics could prove to be lethal. Blockages, chronic shortages and imbalances would be inevitable.

The third lesson is the importance of regional and local approaches to managing the crisis, coordinated and harmonised (or at least mediated) nationally. Many national initiatives have failed or have proved to be inappropriate or wrongly calibrated for particular local areas. While one has to avoid interregional chaos, highly centralised command and supply is also ineffective.

The fourth lesson is that communication must be clear, consistent, honest, open, transparent and frequent. The problems must not be obscured or minimised. The response must be fair and equitable. Authorities and politicians must work hard to build up a relationship of trust with the public. The aim should be to build a consensus about responsible behaviour and sharing the burden.

Covid-19 has produced an existential crisis, not in the sense that the existence of the human race is threatened, but because it calls into question the very bases of modern life. Welfare, equity and the right to life, employment and basic necessities are all strongly implicated. Fighting the pandemic is a matter of collective action. It requires collective effort and discipline. Institutional and political responses must take this fully into account.