KeyMessages:ActSwiftly–Test,TraceandContaintheSpread
TakeitSeriously:Demonstratecourageousleadership,andestablishglobal,nationalandlocalemergencycommitteestooverseestrategicresponsesasbelow:
CoordinateandCommunicate:Ensureclearlinesofco-ordinationbetweensectorsandgeographicallevels,andestablishdailycommunicationssupportedbysocialmedia
StoptheSpread:Prioritisetestingandsurveillancetomonitorandtargetproportionateresponseswithbasicpublichealthmeasurestocontrolandcontaintheoutbreak
SaveLives:Preparesurgecapacityofthehealthsector,withtriagesystems,re-deploystaffandbuildingssuppliedwithprotectiveequipment,bedsandrespirators
ProtectandSecure:Createcaringcommunities,targetandprotectvulnerablepopulations;stabiliseeconomicimpacts,ensureessentialservicesandwidersecurity
Research,RecoverandReflect:Fasttrackresearchprioritisingvaccines;establishaRecoveryCommitteeforlong-termplanning;evaluateandreflectforthefuture
Istosavelivesandprotectvulnerablepopulations,nationallyandglobally,whilstminimisinginadvertentharmtosocialandeconomicdisruptionandhumanrights,aswellasprogressondeliveringtheSustainableDevelopmentGoals.
Weareonlyasstrongasourweakesthealthsystem:
PoliticalLeadership:AsthishasnowbeendeclaredaPandemic,whichriskseveryoneacrosstheworld,courageousleadershipisrequiredatthemostseniorlevelsingovernment.Declaringanationalemergencyandestablishingnationalandlocalemergencycommitteestooverseethedevelopmentandimplementationofanemergencyplanbaseduponscientificandexpertadvice;putinplaceappropriateandresponsivelegislativepowers;andestablishanethicsgrouptoadviseoncompetingprioritiesgoingforward.AkeyroleoftheEmergencyCommitteeistoensureclearlinesofresponsibilityandreportingacrossgovernmentsectorsandtheprivatesectortoensureaco-ordinatedresponseandtocommunicatekeymessagesdaily.
Legislation:BuilduponexistingPublicHealthActs,andNationalSecurityandEmergencyLegislation;developrapidamendmentstoprovidethenecessarypoliticalpowerstocontroltheCovid-19epidemicthroughthedifferentstagesoftheplan.Ensureabalanceofrightswithresponsibilities,whilstprotectingvulnerablepopulations;provideaclearrationaleandjustificationthatarecommunicatedtothegeneralpublic.
ExamplesofemergencyandpublichealthlegislationfromtheUK:
ExpertGroups:EstablishexpertgroupstoinformtheNationalEmergencyCommitteeaswellaspublicfacingcommunicationsmessages.FromtheHealthSectorperspective,expertisecandrawuponinternationalevidenceandadvisorsfromtheWHO,aswellasnationalexpertsinhealthservicedelivery,emergencyplanning,infectiousdiseasecontrol,modellersandvirologists.Additionally,establishamulti-sectorexpertgroup,coveringpublicandprivatesectorsaswellassecurity,inordertodevelopatailoredriskassessmentandcontingencyplanforthenationalcommittee.
EthicsGroup:Establishanethicsgroupatnationalleveltodrawupguidingprinciplesfordealingwithconflictingprioritiesandlimitedresourcesinhealthandcaresettingsandacrossthekeyaspectsoftheemergencyplanandlegislation.TheEthicsCommitteecanalsobeengagedinadvisingcommunicationsmessagestoensurebalancedmessagesaregivenbetweenprotectingrightswithourresponsibilitiestopreventharmtoothers.
GenderandEquity:
Co-ordinateandCommunicate:
Co-ordinate:Establishamechanismtoensuremulti-sectorco-ordinationacrosskeypublicandprivateservicesinvolvedinrespondingtothenationalepidemic,inordertodeliverthenationalplanorstrategy.Ensureclearrolesandresponsibilitiesareidentified,alongwithlinesofaccountabilityanddecisionmaking.Communicateclearlyacrossthesystemdefinitions,goals,rationaleandprinciplesforeachstageoftheplan.
LessonsfromChina:Aco-ordinatedresponse
Aclearstrategywasdeveloped,andgoalswerewellarticulatedandcommunicatedacrosstheentireresponsearchitecture.Thisstrategywasrapidlyadaptedandadjustedtotheoutbreak,bothintermsoftheepidemiologicalsituationovertimeandindifferentpartsofthecountry.
Theepidemiologicalsituationhasbeenusedtodefinelocationintofourareas:
The“LessonsfromChina”boxesaredrawnfromtheWHO-ChinaJointMissiononCoronavirusDisease(COVID-19)inFebruary2020–toprovideearlylearningfromthefirstcountrytodealwiththeoutbreak.
Communications:Developacommunicationsstrategytomatchthestagesofthenationalplan,includinginternalcommunicationstofacilitatecoordination.Includedailymultimediacommunicationsresponsesforthegeneralpublic,providingkeymessagesaboutthenatureoftheinfection,howtoprotectthemselvesandtheirfamilies,therationaleforthenationalplanandresponsibilitiestoothersintheircommunitytosavelives.
Messagesfrompoliticalleadershelpstoconveytheseriousnessofrespondingappropriatelytocontrolorders.Additionally,regularcommunicationsaboutthenationalplan,itsimplicationsandfuturestepsallowscommunitiesandfamiliestofeelasstableandsecureaspossibleandmakeappropriatearrangementsastheprocessunfolds.
Communicatingasenseofpullingtogetherforacommongood,aswellasemphasisingaspectsthatareprotective,enhanceresilienceandbringoutthebestinpeople,arekeytoagoodmediacampaign,includingconveyingasenseofcalmnessandsecurity.
Goingforward,providingaclearplanandrationalefordifferentresponseswillgiveasenseofcertaintyinwhatcanbefelttobeachaoticprocess.Activelycommunicatepositivemessagesofhopeandinspirationaboutcompassionatecommunityresponses.
TheCoronavirus:TheCoronavirusCOVID-19comesfromthesamefamilyofvirusesthatcausethecommoncold.COVID-19isthoughttohaveoriginatedbyamutationinananimal(possiblybat),thatthenpassedtohumans,probablywithintheWuhananimalmarket,whereanatypicalpneumoniawasfirstdetectedinDecemberinChina,2019.Thevirushasspreadrapidlyinourglobalizedworld,andtheWorldHealthOrganizationdeclaredaPandemiconthe11thMarch,whichhassincespreadtovirtuallyeverycountryintheworld.
ClinicalManifestationandProgression:theincubationperiodisbetween1-14days,mostcommonlyaround5days.Themostcommonsymptomsincludefever,fatigueandadrycough.Thebelowoutlinestherangeofsymptomsthatcanbeexperiencedastheillnessprogresses:
Outcomes:
FromexperienceinChina,themajorityofcasesaremildtomoderate(approximately80%),thoughworsethanacommoncold,mildcasesdonotdevelopapneumoniaanddonotalwayshaveafeverandcanbetreatedandrecoverathome.Whilstmoderatecasesexperienceacoughwithshortnessofbreath.Mildandmoderatecasescansuddenlydeteriorateintosevereorcritical,afteraboutaweekofsymptoms.Approximately20%ofallcasesareclassedassevereorcriticalanddeveloppneumoniathatrequireshospitalcarewithoxygen.Approximately14%ofcasesareclassedassevereandexperiencerespiratorydistress,whilst6%experienceacriticalillnesswithrespiratoryandmulti-organfailureandrequirearespiratorandintensivecare.Fatalityratesappeartobeminimizedwithearlierinterventionandrangefromapproximately1-3%.
Demographics:AnalysisfromtheoutbreakinChinafoundthemedianageis51years(range2days-100yearsold)withthemajorityofcases(77.8%)agedbetween30–69years.Dataonchildrenagedupto18yearssuggeststhatthereisarelativelylowattackrateinthisagegroup(2.4%ofallreportedcases).Inaninvestigationof147pregnantwomen(64confirmed,82suspectedand1asymptomatic),8%hadseverediseaseand1%werecritical.Populationswithhigherratesofolderandvulnerablepeoplewillexperiencetheepidemicdifferently,astheirriskofdeathwasfoundtorangefrom5-20%.Vulnerablegroupsincludethoseover60,males,peoplewithunderlyingconditionsincludinghypertension,diabetes,cardiovasculardisease,respiratorydiseaseandcancer.Obesityandsmokinghavealsobeenidentifiedasriskfactors.
Howitisspread:COVID-19istransmittedviadropletsfromaninfectedpersonfromrespiratorysecretions,includingcoughingandsneezingandsubsequentcontactwithinfectedsurfaces.Metalandhardsurfacescanstaycontaminatedforapproximately2-3days.AirbornespreadhasnotbeendeterminedasyetforCOVID-19,howeveritmaybeafactorinitsrapidtransmission,alongwithdroplets,frombreathing,speaking,sneezingandcoughing.InChina,human-to-humantransmissionoftheCOVID-19virushaslargelyoccurredinfamilies.
Periodofinfectivity:althoughfurtherresearchisrequired,initialsmallstudiesindicatethatindividualsmaybeinfectiveacoupleofdaysbeforetheydevelopsymptoms,andthattheyaremainlycontagiousinthefirstweekontheillness.Initialfindingssuggestthatafteranindividualdevelopsantibodiesbyabout10daysorso,theystopbeinginfectious.
Howtoreduceinfection:
HowtokeepyourselfhealthyduringtheCoronaviruspandemic:
Treatsymptomswithparacetamol,restanddrinkregularfluids.Currentlythereisnocure,andavaccinewilltakebetween12-18monthsbeforeitisavailable.Traditionalhomeremediesforcolds,coughsandfeversmayalsohelptorelievesymptoms.Olderormalnourishedpeoplemaybenefitfrommultivitaminsandmicronutrientsupplementsasprotectivemeasures.
WHOQandAonCoronavirus:
YouTube,WhatCoronavirusSymptomslooklikedaytoday–(fromtheWHOJointmissiontoChina):
Themostimportantprincipletoprioritiseistostopthespreadthroughbasicpublichealthmeasures.Expandingsurveillanceandmonitoringthroughwidespreadtestingandsyndromicsurveillance,hasthepotentialtotargetcontrolresponsesandpreventawidespreadepidemicwithconsequentdeathsandsocialandeconomicdisruption.Thisisespeciallyimportantforcountrieswhosehealthsystemsmaybeoverwhelmedbytheepidemicandwhoseeconomiesandsocialfabricareputatriskofbecomingde-stabilisedortherearesignificantsecurityrisksiftheepidemicspreadsrapidly.
LessonscanbedrawnfromseveralAsianCountries,includingHongKongandSingapore,whichfollowingtheirexperienceofrespondingtotheSARSoutbreakin2003,appliedextensivepublichealthmeasurestopreventtheinfectionbecomingawidespreadpandemic.AftertheinitialoutbreakofSARS,itwassuccessfullycontainedbysyndromicsurveillance,contacttracingwithpromptisolationandtargetedquarantinemeasures.Themeasuresattributedtointerruptinghuman-tohumantransmission,whicheffectivelyeradicatedSARS.
TheCOVID-19pandemichassignificantlysurpassedthatoftheSARSoutbreak.However,thesameprinciplescanandhavebeenappliedtoprotectindividualcountriesandcommunities,andreducedtheoverallpeakoftheepidemic,thussavingnumerouslives.
LessonsfromAsia–HowtoStoptheSpread
Lessonone:Takeitseriously-andactquickly
Lessontwo:Maketestsextensive,andaffordable
Lessonthree:Traceandisolate
Lessonfour:Earlysocialdistancing
Lessonfive:Keepthepublicwellinformedandonside
Unfortunately,manyEuropeancountriesandtheUSA,haverespondedslowlytotherisksoftheCOVID-19Pandemic,andlostvaluabletimeinstoppingthespreadwithbasicpublichealthmeasures.Thisinturnwillresultinunnecessaryharmandwidersocialandeconomicimpactsthatcouldpotentiallybeavoidedbyswiftactioninothercountries.ThebelowchartoutlinesthetrajectoryofChina’soutbreakcomparedtothatofItalybywayofillustrationtotheimportanceofbringinginkeypublichealthmeasuresswiftlytopreventtheepidemicfromspreading.By19thMarch,Chinaappearstohavenonewcases–exceptforthosethatareimported,andcurrentlyplanstoliftcommunityquarantinesinAprilaftera3-monthperiodoflockdown.
ExtensiveTesting&SyndromicSurveillance-iskeytoallowingacountryorcommunitytoappreciatewhatstagetheyareat,toapplytargetedandappropriatemeasures.Withoutthisinformation,responsesarelimitedtoreactingtohospitaladmissions–bywhichtimetheserviceswillbecomeeasilyoverwhelmed.Manycountriesareproducingtheirowntestsinordertoensuretestingofthosewithsymptomsandtheircontacts,healthcareworkers,aswellaswidespreadcommunitytestingtoprovideacomprehensivepictureoftheepidemic.
Wheretestsarenotsufficientlyavailable,syndromicsurveillancecanbeutilized–(seeAnnex2forachartoncomparativesymptomsandLessonsfromSriLankabelowredigitalsurveillancetools).Thisapproachreliesonestimatingnumbersofpatientsseekingadvicefromhealthcarecentres,helplinesorsearchingonwebsites,thosewhomeetkeysymptomsrelatedtoCOVID-19.ThisapproachwassuccessfullyusedtocontroltheSARsepidemic.
LessonsfromChina:Clinicalsignsthatcanbeadaptedforsyndromicsurveillance:
Typicalsignsandsymptomsinclude:fever(87.9%),drycough(67.7%),fatigue(38.1%),sputumproduction(33.4%),shortnessofbreath(18.6%),sorethroat(13.9%),headache(13.6%),myalgiaorarthralgia(14.8%),chills(11.4%),nauseaorvomiting(5.0%),nasalcongestion(4.8%),diarrhea(3.7%),andhemoptysis(0.9%),andconjunctivalcongestion(0.8%).
LessonsfromSriLanka-DigitalSurveillancetoolsandapplications:
Trends:Informationfromtestsandsyndromicsurveillancecanbecollatedanonymously,withDigitalMonitoringtoinformtrendanalysis,modellingandprojections.Wheredataonconfirmedcasesislacking,therateofdeathscanprovideinformationontrends.TheWHOismonitoringadailyupdateontheoutbreak,whichisacceleratingexponentially,andisnowdoublinginnumberseveryfewdays,forexample,ittook:
ModelRisks:Ifnomeasuresareundertakenwithinacountry,theepidemicwillpeakwithinapproximately3monthsfromtheirfirstcase.Deathrateswillbehigherincountrieswitholderpopulationsandinthosewithweakerimmunesystems.ImperialCollegemodelledpotentialoutcomesfortheUKandUSAbasedupondifferentscenariosoutlinedbelowandinthegraph:
Projectedcriticalcarecasesovertime,accordingtodifferentinterventions
TheaimofContainmentandControlmeasuresistokeepaheadoftheepidemiccurveandstopthespreadofhuman-to-humantransmissionwiththepotentialtoeliminatethevirus.Strategicsurveillanceandmonitoringallowstargetedcontrolmeasurestocontainandideallysupressandeliminatetheepidemicwithinapopulation.ThisapproachhasbeenespeciallysuccessfulinmanyoftheAsiancountries,especiallywhentheywereinstigatedearlyandswiftlyatscale.
However,aswecanseefromChina,theyhavesuccessfullyappliedthesebasicpublichealthmeasurestoreducetheoverallimpactoftheepidemicevenwhenithadspreadintothecommunity.Enhancedsurveillanceisespeciallyrequiredduringthistimetoinformwhencommunityquarantinemeasurescanbeliftedandtoidentifyanycasesafterthequarantinehasended.Withrigoroussurveillanceandtargetedcontainment,thisapproachhasthepotentialtoeliminatetransmission,howeverthekeychallengeistheabilityofthisvirustospreadbeforesymptomsdeveloporwhentheyaremild.Weneedtowatch,learnandapplysuccessfulresponsesfromAsiaandChina.
LessonsfromChina–containinganepidemicatpopulationlevel
China’suncompromisingandrigoroususeofnon-pharmaceuticalmeasurestocontaintransmissionoftheCOVID-19virusinmultiplesettingsprovidesvitallessonsfortheglobalresponse.ThisratheruniqueandunprecedentedpublichealthresponseinChinareversedtheescalatingcasesinbothHubei,wheretherehasbeenwidespreadcommunitytransmission,andintheimportationprovinces,wherefamilyclustersappeartohavedriventheoutbreak.
Containingandcontrollinganemergingepidemiccanbeachievedbyarobustandco-ordinatedapproachtothefollowingactivities:
LessonsfromChina–thesuccessofrigorouscontacttracing
Chinahasaprincipleofearlyidentification,earlyisolation,earlydiagnosisandearlytreatment.Earlyidentificationofsuspectcasesiscriticaltocontainmenteffortsandoccursviaaprocessoftemperaturescreeningandquestioningatentrancestomanyinstitutions,communities,travelvenues(airports,trainstations)andhospitals.ChinahasapolicyofmeticulouscaseandcontactidentificationforCOVID-19.Forexample,inWuhanmorethan1,800teamsofepidemiologists,withaminimumof5people/team,aretracingtensofthousandsofcontactsaday.
Challengingenvironments:Akeypriorityistoidentifyandinterveneearlyinhigh-riskcommunitieswithcrowdedhighdensitylivingofvulnerablepopulations,suchasslums,refugeecamps,carehomesandprisons.Thesehigh-riskcommunitiesshouldhaveenhancedbasicpublichealthmeasures,combinedwithextensivesurveillanceandmonitoringtobeabletocontainandcontrolanyinfectionsearlyon.Somecountrieshavereleasedprisonersearlytoreduceovercrowding,andothershaverapidlyimprovedbasicsanitationmeasuresinslumandrefugeecamps.
LessonsfromJordan
Jordanishometoapproximately750,000refugees,mainlyfromSyria,livinginrefugeecampsandurbanareas.Withlittlecapacitytorespondtoamajoroutbreakintheirhealthsystems,theyprioritizedbasicpublichealthmeasurestostopthespreadofCOVID-19acrosstheircountry.
FollowingthefirstcaseofCOVID-19inlateJanuary,localauthoritiesactedswiftlytoquarantineandcontainpatientsandcontacts.Airportsandbordersweremonitored,andfollowinganinfluxofinfectedvisitorsfro65mItaly,inMarchthegovernmentimplementedacurfewandcloseditsborders,andsubsequentlyimported200,000testkits.Officialsproactivelytested,contacttraced,andquarantinedandtreatedinfectedcases.Targetedcommunityandcityquarantinescomplementedthisstrategy,followedbyrandomtestingacrossthecountrytomonitorcommunitytransmission.Thegovernmentprovideddailyinformationoneachcase,regardingthelocation,modeofinfectionandactiontakenforeachnewcase.
AccordingtoJordan’sMinistryofHealth(MoH),asof17April,therewere402confirmedcasesofCOVID-19,with250individualsdischargedfromhospitals,and7deaths.Jordan’sexperiencedemonstrateshow,byfocusingonearlyriskassessment,migration,effectivecommunicationandgovernment-citizenco-operation,thepandemiccanbemanaged.
SaveLives–theHealthSectorResponse:
ThepreviousSARSepidemicintheearly2000swaseffectivelycontainedandeliminatedthroughtheabovetraditionalpublichealthmeasuresthatstoppedallhuman-to-humantransmission.AlthoughamoreseverediseasewithahigherfatalityratethanCOVID-19,itspreadlesseasily,whichmadeitmorestraightforwardtocontain.Additionally,COVID-19appearstobemostinfectiousintheearlystagesoftheillness,whensymptomsaremildorasymptomatic.This,alongwitharelativelycomplacentPublicHealthresponseinsomecountrieshasallowedtheoutbreaktospreadacrosscommunities.Inthesesituations,countriesareessentiallyreactingtotheoutbreakasitunfoldsandrampingupthehealthsectorresponsethroughmitigationmeasures.
*Thiscanbeachievedthroughacombinationofpublichealthmeasures,suchasrapididentification,diagnosisandmanagementofthecases,identificationandfollowupofthecontacts,infectionpreventionandcontrolinhealthcaresettings,implementationofhealthmeasuresfortravellers,awareness-raisinginthepopulationandriskcommunication.
Countriesthathaveallowedthecoronavirustospreadwidelyacrosstheircommunitieswillreachahighpeakoftheepidemicwithin3monthsoftheirfirstcase.Evenatthisstage,proactiveandmoreaggressivecommunitycontainmentmeasurescanassistinmitigatingoverwhelminghealthsystemsandtheresultanthighnumberofdeaths.Atthisstage,keylearningfromChinaincludestheimportanceofscalinguprigoroussurveillancewithtesting,andsubsequenttargetingofcontainmentandcontrolmeasuresinordertomitigatetheimpactandminimiseoverallharm.Thisisdescribedas“flatteningthecurve”andcanbeillustratedinthebelowgraph.
EuropeanobjectivesofcommunitymitigationmeasuresinascenarioofwidespreadcommunitytransmissionofCOVID-19(EuropeanCDC2020)
Forcountriesatanearlierstageoftheepidemic–akeylessonistobeproactiveandgetaheadofthecurvebyscalinguppublichealthmeasuresinordertoavoidwidespreadcommunityinfections,withitssubsequentavoidabledeathsandimpactuponcivilliberties,societiesandtheeconomy.Thisisespeciallyimportantforcountrieswithweakerhealthsystems,socialcapitalandeconomicreserve.Eveninhigh-incomecountries,thenumberofpatientsrequiringintensivecaretreatmentisestimatedtobe30timesthatcomparedtoavailability.
Estimatedproportionofhospitaladmissionsandfatalityrates,includingcriticalcarerequirementsperagegroupbaseduponHighIncomesettings
Evenwithmitigationeffortssuchassocialdistancingandcommunityquarantine,curfewsandsociallockdown,thepeakinintensivecarerequirementsarelikelytobe10-foldmorethanavailability.Theabovetable,fromtheImperialCollegemodelling,providesdataforcountriestoestimatetheiranticipatedhealthsystemresponse.
Astheepidemicunfolds,precioustimeshouldbeutilisedtoestimateandscaleuptherequiredhealthsectorresponse,includingthefollowingareas:
Triagesystems:withonlinewebsitesandemergencyhelplineswithsyndromicchecklistsandsymptomsrequiringhospitalization.Ideallythesesystemscollateanonymousdatatoinformdemographicandgeographicaltrendsaspartofthesurveillanceandmonitoringoftheoutbreak.
Surgecapacity:Needstobeestimatedfortheworkforce(includingtheimpactofsickness),forexamplebybringinginretiredhealthcareprofessionalsandstudents,securityforcesandvolunteers.Creatingmakeshifthospitalsandbeds,forexamplebycreatingtent-hospitals,commandeeringhotelsandprivatesectorfacilities;andscalingupthedevelopmentandavailabilityoftests,respiratorsandprotectiveequipment.
ProtectHealthandCareWorkers:ProvidePersonalProtectiveEquipmentandestablishphoneanddigitalconsultations.EnsuredailysyndromicscreeningandprioritiseCOVID-19testsforhealthandcareworkers,inordertoprotecttheirhealthandthatofthepatientstheyaretreating.Additionally,testhouseholdcontactswithsymptoms–andquarantinehealthandcareworkersfor14days-unlessthehouseholdcontacthasanegativetest.
Note:Theincubationperiodmeansthatanegativetestforahealth-workerlivingwithasymptomaticpersondoesnotmeanthattheywillnotsuccumbtotheillness,andastheperiodofhighestinfectivityisearlyon,theycouldstillposeriskstopatients.TestingforantibodiesinHealthandCareworkersprovidesusefulinformationonwhethertheyhavehadtheinfectionandarethereforelikelytoberesistant,aswellasposingalowrisktopatients.
ClinicalProtocols:Shareandlearnfromsuccessfulcountriesthathaveintervenedearlywithclinicalresponsesthathavereducedthedeathrateandavoidpatternsthathaveledtohighfatalityrates.Createethicalguidelinestoenablecompassionatedecisionsandcare.Communicateaboutearlysuccessesregardingtheapplicationofestablishedtreatmentstothatofcoronavirus,withafocusonearlyinterventionsthatpromoteimmunityandlimitthemoreseverehealthoutcomes.
WHOinformationonclinicalguidelines:
ProtectandPromoteMentalHealth:thepandemiciscreatingsignificantstresstodifferentsectorsofthepopulation–ensurethathelplines,web-resources,healthandcareworkers,mentalhealthservicesandcommunity-wideapproachestoaddress:
MortuariesandFuneralServices:Basedupontheanticipatedmortalityrates,scaleuptheprovisionoftemporarymortuaries.Developguidancetoenablecontinueddeliveryofcompassionatefuneralservices,whilstmaintainingsocialdistancing,forexample,byholdingoutdoororon-lineservicesfollowedbyplansformemorialservicesinthefuture.
DeliverDigitally:Inordertoprotecthealthworkersaswellasotherpatients,thepandemichasinmanysettingsresultedinafasttransformationtoscalingupdigitalhealthresponses.Forexample,byprovidingremoteconsultations,viatelephone,onlineorviavideoconsultations.Thiswillpotentiallyenablethemorewidespreaddigitaltransformationfordeliveringhealthsystemsinthefuture.
Clinicaloptionsandoutcomes:Currently,themainclinicalresponseisthroughsupportiveandcriticalcaremeasurestoaddressrespiratoryandmultipleorganfailure.Anti-viralmedicationsandthosethatenhanceimmunitymayalsobebeneficial;whilstotherroutinemedicinesmayexacerbateclinicaloutcomes.Curesorpreventativemeasureslikevaccinesdonotasyetexist.ThebelowfigureprovidesasummaryfromtheexperienceoftheoutbreakinChina,withtheestimatedclinicalprogressionandoutcomesovertime.
LessonsfromChina–Outcomesofclinicalmanifestationsandhospitalrequirementsovertime
Note:therelativesizeoftheboxesfordiseaseseverityandoutcomereflecttheproportionofcasesreportedasof20February2020.Thesizeofthearrowsindicatestheproportionofcaseswhorecoveredordied.Diseasedefinitionsaredescribedabove.Moderatecaseshaveamildformofpneumonia.
Usingavailablepreliminarydata,themediantimefromonsettoclinicalrecoveryformildcasesisapproximately2weeksandis3-6weeksforpatientswithsevereorcriticaldisease.Preliminarydatasuggeststhatthetimeperiodfromonsettothedevelopmentofseveredisease,includinghypoxia,is1week.Amongpatientswhohavedied,thetimefromsymptomonsettooutcomerangesfrom2-8weeks.
Inresponsetothestrictsocialcontrolmeasuresthatneedtobeappliedtoslowandstopthespread,itisimportanttoemphasiseourresponsibilitiestowardsotherpeopleinourcommunity.Moreover,callinguponthegoodnatureofindividuals,communitiesandorganisationscanassistintransformingtheexperienceofthispandemictooneofaninfringementoffreedoms,tothatofthecreationofcompassionatecommunities.
Protectvulnerablepopulations:Identifyhigh-riskgroupstoisolate,includingolderpeopleandthosewithchronicconditionssuchasRespiratorydisease,DiabetesandCardiovasculardisease,orwithsuppressedimmunesystems,forexampleduetocancertreatments.Additionally,malnutritionorobesityislikelytoincreaserisk.Establishethicalguidelinestoensurecompassionateresponsesexistforvulnerablegroups.Inparticular,targetinterventionssuchasvolunteering,telephoneoronlinesupport,tothoselivingontheirownandforthosewhosementalhealthmaydeteriorateduringextendedisolationtocontaintheoutbreak.
LessonsfromChina–HighRiskGroupstoProtect:
Mortalityincreaseswithage,withthehighestmortalityamongpeopleover80yearsofage(21.9%).Themortalityrateishigheramongmalescomparedtofemales(4.7%vs.2.8%).Whilepatientswhoreportednocomorbidconditionshadamortalityrateof1.4%,patientswithcomorbidconditionshadmuchhigherrates:13.2%forthosewithcardiovasculardisease,9.2%fordiabetes,8.4%forhypertension,8.0%forchronicrespiratorydisease,and7.6%forcancer.
CommunityConnection&Support:Governmentsandcommunitiescanfacilitateapositiveresponsebyemphasisingthat‘weareallinthistogether’andcallinguponneighbourstosupporteachother,aswellasorganisingvolunteerprogrammes.Forexample,theUKhasmanagedtorecruitover500,000volunteerstosupportthehealthservicesandprovidecommunityresponses.Additionally,theprivatesectorcanenablefamilies,friendsandcommunitiestostayconnectedbyenhancingaccesstodigitalandinternetservices.
Publicevents&spaces:LearningfromthesuccessesofChina,anumberofcountrieshavepostponedpubliceventsandclosedpublicspaces,includingshopsandthegatheringofgroupsinordertominimizethespreadofthecoronavirus.Instigatingsuchmeasuresearlyonwithinacountry’sepidemicpotentiallyprovidesvaluabletimetoallowcountriestoslowthespread,aidedbyrigorouscontacttracingandtestingtocontaintheoutbreak.
Socialdistancing:Themainprinciplebehindsocialdistancingistoreducethenumberswhoareinfectedandtoslowandstopthespread–withaparticularfocusonprotectingvulnerablepeople.Recommendationsforsocialdistancingvaryfromkeepingadistanceof1-2metresbetweenpeople.Ensurethatsuchcontrolmeasuresareproportionatetothespiritoftheprinciplesrequired.Somecountriescontinuetoallowdailywalksorexerciseneartotheirhomes,aslongastheyobservesocialdistancingrestrictions,inordertopromoteamoreresilientandhealthierpopulation.Whenappliedatscale,thiscanbeaveryeffectivemeasureforcontrollingthespreadoftheepidemic,asvisualisedbelow:
LessonsfromtheSpanishFlu:
Attheeveofthe1stWorldWar,in1918,theSpanishFluemergedandspreadrapidlyaroundtheworld.Intotalanestimatedonethird(500million)oftheworld’spopulationbecameinfectedwithdeathratesestimatedat50million–morethanfromWWIitself.Therewerethreemainwavesoftheepidemicoveran18-monthperiod.Atthistime,thepopulationwasvulnerablefrommalnutrition,vaccinesandmedicinesdidnotexist,andhealthserviceswereminimal.Toprotectthemselvesandlimittheimpact,somecommunitiesweresuccessfullyabletoapplyarangeofPublicHealthmeasures,includingisolation,quarantine,hygiene,andlimitationsofpublicandsocialgatherings.
ActSwiftlytoMinimiseAvoidableHarm:Themorethattheepidemichasbeenallowedtospreadwithinacommunity,themoredraconianthemeasuresoftenneedtobe,includingstrict‘lockdowns’andcurfewstokeeppeopleintheirhomes.Thelatersuchmeasuresareimplemented,andthemoretheepidemicisallowedtospreadwithinacommunity,thelongercommunityquarantinesandlockdownshavetotakeplace.Notonlydoesthisinfringemoreuponhumanrights,butalsoadelayedresponseincreasesthelikelihoodoftheoutbreakreturninginfurtherwavesoncethelockdownislifted.Moreover,delayedresponseswillmoresignificantlyimpacttheeconomy,socialstabilityandwillneedlesslyresultinlargernumbersofpotentiallyavoidabledeaths.ThesewillresultfromtheCoronavirusitself,aswellasanincreaseinadditionalrisksrelatedtoreducedaccesstohealthcarefornon-coronavirusillnesses,aswellasincreasedstressorsrelatedtothesocio-economicdisruptioncaused.
Akeyresponsibilityofgovernment-istoensuresecurityacrossitspopulations,includingmaintainingthestabilityofessentialservices.Inparticular,creatingalockdownsituationforaprolongedperiodoftimehasthepotentialtonegativelyimpactuponincome,foodandhousingsecurity,economicgrowthandsocialsecurity.Asidefromtheincreasedlevelsofworryaboutthecoronavirusitself,asignificantproportionofanypopulation,willsufferfromunduestressandanxietyregardingthesefundamentalfactorsrequiredfordailyliving.
Communicatingclearlyandregularlyabouttherationale,keyprinciplesandtheanticipatedexitplan,areimportantelementstocreateasenseofcertaintyandstability.Additionally,thisneedstobereflectedinsecuritymeasuresthatareproportionateformaintainingtheseprinciplesanddeliveredinawaythatencouragesasenseofgoodwillandcommunityresponsibility.Heavy-handedsecuritymeasuresduringalockdownpotentiallyrisksignificantdisquietandunrestwithinapopulation,alongwithbreakingdowntrustandinstillinganegativerelationshipwiththeGovernment.
Byensuringasenseofsafety,stabilityandhope,willalsobekeytotheresilienceofcommunitiesandtheirabilitytopulltogetherandrecoverinapositivewayfromthispandemic.Belowprovidesanoutlineforareasthatneedparticularconsiderationformaintainingasenseofsecurityandstability.
EssentialServicesincludingFoodSecurity-Establishamulti-sectorgrouptoidentifyessentialpublicandprivateservices,mapfordeliverycontinuityprocessesandpotentialriskstoabreakdownacrosstheseoften-interrelatedsystems.Payparticularattentiontoessentialservices,includingfoodsupply,waterandsanitation,energy,essentialtravelandcommunications.Establishregularfooddeliverysystems,includingfreefoodandfoodbanks,targetedatpopulationsthataremostvulnerabletotheimpactsofalockdown.Considerrationingoffoodtominimizepanic-buyingofsuppliesandtoensureafairandevendistribution.Identifykeyworkersacrossthepublicandprivatesector,andputinplacemechanismstoallowbusinesscontinuity,withanemphasisonsupportingthehealthsector.Engagevolunteersandyoungpeopleinagriculturalactivitiesandharvestinginordertomaintainfoodsecurity.
StabilityofEducation,IncomeandtheEconomy–Thispandemichasledtotheclosureofschoolsandeducationalinstitutionsinmanycountriestoreducethespreadoftheinfection.Inordertolimittheimpactuponfutureopportunitiesforyoungpeople,itisimportanttomaintaincontinuityofdistanteducation,forexamplethroughpublicradio,televisionorthroughonlinelessonsandwebinars.Identifyfiscalmeasurestostabilizetheeconomicimpactforthecountryaswellasforindividualsandcommunities.Forexample,putinplacepostponementsystemsfortaxes,billsanddebts;createrapidloansforBusinessesandSmalltoMediumEnterprises;andprovideincomesupportforworkersnolongerreceivinganincomeandthoseonlowerincomes.Forexample,somecountriesareprovidinguniversalcredits,handoutsorup-to80%ofpriorincometopreventhouseholdsfallingintopoverty.Theprivatesectorcanbeactivelyengagedtodevelopsolutionsandputplansinplace,whichcanalsofacilitatetherecoveryprocess,asoutlinedintheexamplebelow.
LessonsfromKenya–Engagetheprivatesectortostabiliseeconomicimpacts
TheKenyanGovernmentaimstokeepaheadoftheepidemiccurve.Therefore,withinthefirst12daysofitsfirstcase,ithasannouncedaseriesofmeasurestoreducefearandenhancestabilityandsecurity.Theseareinadditiontoinstigatingbasicpublichealthmeasurestostopthespreadofinfection.Theyincludemeasuressuchasincomesupport,taxrelief,andbenefitstovulnerablepopulations.Additionalfundingisbeingreleasedtorecruitfurtherhealthworkers.Withinthecontextofastrongculturalethosofeveryonepullingtogetherinacrisis,theKenyanPrivateSectorAlliancereleaseddetailedplanstomitigatetheeconomicimpactsoftheoutbreak,aswellastosupportmaintenanceofessentialservices.Thishasbeendevelopedintoamanagementframeworkbaseduponthebelowprinciples:
EconomicManagementFrameworkfortheCOVID-19Response–keyprinciples:
Source:TheKenyaPrivateSectorAlliance-KEPSA
HousingandSocialSecurity–Targetthoseatmostrisk,forexamplethoselivinginslumsandcrowdedhomes,forexample,somecountrieshaveprovidedwatersuppliestoslumareas,hotelaccommodationforhomelesspopulations.Adoptrapidlegislationtoprotectdefaultsonrentsandmortgagepayment,sothatpeoplearenotmadehomelessduetolackofincome.Ensurebasicwastedisposalandsanitationservices,targetingcrowdedpopulationsbyprovidingsoap,wateranddisinfectants.
SecurityServices–Providerapidprotocolsandtrainingofthepoliceandarmy,toenablethemtoenforceemergencylegislationandactassurgecapacityformanagingtheemergencyresponse.UtiliseCCTV,socialmedia,communityandneighbourhoodreportingtoactswiftlyonemerging‘scams.’Establishspecialistteams,withtelephoneandonlineresourcestoaddressanticipateddomesticabuse(whichrosethree-foldduringthelockdowninChina).Wherenecessaryreleasenon-dangerousprisoners.Drawuponretiredandreserveforcestoexpandtheworkforcetosupportandprovideessentialservices.
Research:Continuousevaluationandresearchduringthepandemicisakeypartofhowwecanconstantlyimproveuponresponseandshareeffectiveoutcomes.Therefore,ensureinformationcollatedfromthesurveillanceandmonitoringprocessislinkedtodemographic,geographicaldetailsandhealthoutcomes,toenhanceresponsivenessandimpact.Researchinstitutionscanalsoinformthegovernmentexpertgroupwithriskscenariosandfutureprojectionstoinformplanningandemergencyresponses.ResearchandevaluationsarebeingcollatedbytheWHOtofacilitatesharedlearningduringthecourseofthepandemiconthebelowweb-link:
Wherepossible,investinnationalandinternationalresearchprogrammestofindsolutionstoaddressthecoronavirus.Forexample,throughpreventativemeans,suchasanewvaccine,anti-viralmedicines,curativetreatmentsandrespirators.Additionally,researchinstitutionscandesignandevaluatetheeffectivenessofdeliveringatscale,lowcostaspectsforTestingandProtectiveEquipment.Rapidinternationalevaluationsontherelativeeffectivenessofdifferentcountrystrategiestothepandemiccanalsoinformfutureresponsesandrecoveryprocesses.
Vaccinesandnewmedicinesarelikelytotake12-18monthstoidentify,developandtestforsafety,beforetheyaremadeavailableatscale.Inthelonger-term,weneedtotakegreaterheedofpriorresearchrecommendationstoenhanceourpreparednessforfuturepandemics,includingtheWHOresearchrecommendationsof:
In2016,theCommissiononaGlobalHealthRiskFrameworkfortheFuturerecommendedanacceleratedapproachtoResearchandDevelopmenttoprepareforPandemics.TheCommissionestimatedthatanadditional$1billionayearisinvestedintoprojectsindrugs,vaccines,diagnostics,personalprotectiveequipment,andmedicaldevices,aswellasindefiningprotocolsandpracticalapproaches.
Recover:Earlyonintheresponseprocess,itisrecommendedtoestablishamulti-sectorRecoveryCommitteetofeedintotheNationalEmergencyCommittee.Ideally,seniorleaders,whoarenotdirectlyinvolvedintheemergencyresponse,willheadthisup.Thiswillallowforstrategicthinkingtoshapetheresponseduringaperiodofanylockdownorcommunityquarantine,developexitstrategiesandthelonger-termrecoveryresponse.Possibleexitstrategiesincludethebelow:
RecoveryandtheLengthofLockdown:TheexperienceofChinareleasingitslockdownafter3monthsdurationwillhelptoinformtheresponseinmanycountries.Alateresponseleadingtowidespreadcommunityinfectionislikelytorequirealongerperiodoflockdownwithamoreextensiveandcostlyrecoveryplan.Forexample,theWHOpandemicpreparedness-monitoringgrouphasestimatedadropby5%ofGDPresultingfromapandemicofthissort.Morerecentestimatessuggestthatthelongeralockdown,themoresignificanttheeconomiclosses,asbusinessescloseandunemploymentrises,andalonger-termrecession.Laterespondersarealsolikelytoexperiencerecurrencesofcommunityinfections,withfurthercyclesofoutbreaksandlockdowns.Thiswillespeciallyoccurincountriesthathaveundertakenminimaltestingandarethereforeunabletotargettheircontainmentresponses.
LessonsfromChina–PlanningRecovery
Chinaisalready,andrightfully,workingtobolsteritseconomy,reopenitsschoolsandreturntoamorenormalsemblanceofitssociety,evenasitworkstocontaintheremainingchainsofCOVID-19transmission.Appropriately,ascience-based,risk-informedandphasedapproachisbeingtaken,withaclearrecognitionandreadinessoftheneedtoimmediatelyreacttoanynewCOVID-19casesorclustersaskeyelementsofthecontainmentstrategyarelifted.
Theperiodofrecoverywilldependupontheswiftnessofeliminatingtheepidemic.Inthosecountrieswhichenhancebasicpublichealthmeasuressuchastesting,contacttracing,quarantineandsocialdistancingatspeedandscaleattheoutset,thentheperiodofsocialandeconomicinterruptionislikelytobealotshorter.Forexample,earlypublichealthinterventionsacrossSouthKoreahaveresultedinasmallpeakofcasesanddeaths,withminimalsocialandeconomicdisruption,forarelativelyshortduration.
SDGContinuity:ConsiderationsneedtoincludethepotentialimpactuponprogresstowardstheSustainableDevelopmentGoals,includingtheeconomy,societyanduponhealth.IncludeGovernment,publicandprivatesectorrepresentatives,aswellasprocessestoengagewithcommunities.Identifypotentialandworst-caseriskscenarios,inconsiderationwithestablishedgovernmentriskassessmentplanssothatsolutionsarenotdevelopedinisolation.Inpastrecessions,countriesthathaveinjectedsignificantinvestmentstoboosttheeconomyandpublicserviceshavetendedtorecovermorequickly.Thisinvestmentcanpotentiallybedirectedtodevelopagreenanddigitallytransformedeconomyinordertoensurelonger-termsustainabledevelopment.
BuildBackGreen–andconnectcommunitiestocreateanewfuturetogether:
Akeyopportunitythatarisesfromanycatastropheofthissortisthatduringtherecoveryprocess,thereisthepossibilitytocreateabetterfuturetogether.Forexample,thispandemiciscreatingasignificantandrapidsocial,economicanddigitaltransformationinthewaythatwedothings.Itisalsoenhancingvolunteeringandcompassionateresponses,withcommunitiespullingtogetherforacommongood.Thepeaceandquietcreatedbymasslockdownsalsoallowtimeforreflectionandhasbeenshowntoreducetravelandpollutionlevels.
Additionally,itisgeneratingcreativityandenhancingasenseofglobalandcommunityconnectivitythatcouldhelpusrecoverfromthispandemic,aswellastofindsolutionstoourwiderglobalchallengessuchastheclimatecrisis.ForExample,NatureBasedSolutionshavethepotentialtocreatemoreresilientcommunitiesthatcouldalsoreducetheriskofemerginginfectionscrossingoverfromanimalstohumans.
Moreover,inordertorespondtothepandemicandsupportrecovery,theWorldBankGrouphasrecentlycommittedUS$160billionoverthenext15monthstohelpcountriesprotectthepoorandvulnerable,supportbusinesses,andbolstereconomicrecovery.
Reflect:Atthetime,thelessonsfromtheEbolaoutbreakwereseenasaglobalwake-upcall–toaddressthemultipleperceivedfailurestoaddresssuchoutbreaks.AlthoughtheEbolaoutbreakwaseventuallycontained,itwasonlyafterenormouseffortsbythenationalandinternationalcommunities,withsubstantiallossoflifeandeconomiccosts.Boththecostsandlossoflifecouldhavebeensignificantlyreducedifthefollowinghadbeeninplace:
FollowingtheEbolaoutbreak,in2016,theCommissiononaGlobalHealthRiskFrameworkfortheFuturereviewedtherisksforpandemics,maderecommendationstoenhancepreparednessandestimatedcoststodoso.Inparticular,theyrecommendedstrengtheningglobalco-ordinationandcapabilitiesalongwithenhancinghealthsecurityasaglobalpublicgoodandmakingpublichealthafoundationofhealthsystems.Manycountrieshavefragmentedhealthsystemswithminimalinvestment(oftenonly3-5%)oftheirHealthSectorbudgetsspentonbasicpublichealthmeasuressuchaspreventativeandhealthprotectionservices.Theyalsorecommendedthedevelopmentofaglobalframeworktocounterinfectiousdiseasecrises.Tofundthis,theymadethecasetoinvestapproximately$4.5billionannuallyforpandemicpreparedness.WiththesignificantlossintheglobaleconomyandcostsincurredtorespondtotheCOVID-19pandemic,thiscanbeseentobeaminimalcosttopayforourhealthandglobalsecurity.
SimilarrecommendationswerealsomadebytheWHOGlobalPreparednessMonitoringBoardAnnualReportin2019,aspartofthedeliveryfortheSustainableDevelopmentGoals.Thiscalleduponleaderstoinvestintheirresponsibilitiesinpandemicpreparedness,includingthefullimplementationoftheInternationalHealthRegulations.Greaterglobalandnationalmulti-sectorco-ordinationwasrecommended,includingforriskassessments,preparednessplanningandresponse.Therewasalsoarecommendationthatfinancialinstitutionsincorporatepandemicpreparednessintotheirriskassessments,andthatdonorsenhanceinvestmentintopandemicpreparedness.
InresponsetotheEbolaoutbreaktheInterActionCouncil,agroupofformerheadsofgovernmentandstate,convenedaseriesofhigh-levelexpertgroupmeetingstoidentifythelinksbetweenglobalsecurityandthekeyhealthrisksthatthreatenus.Inourincreasinglyglobalisedworld,thereisanincreasingriskfromemerginginfectiousdiseasesandpandemics.
Additionally,theimpactsofourclimateandenvironmentalcrisisappeartoactasdriversfortheemergenceofnewinfectionsandglobaldiseaseoutbreaks.ThisresultedinthedevelopmentofaCharterforOneHealth,whichemphasisestheimportanceoflinkingthepreventionofdiseaseoutbreakswiththeurgencyoftakingactiontoaddressourplanetaryhealthemergency.TheCharterwasendorsedbyformerleadersattheInterActionCouncilPlenarysessioninDublin,in2017.
ThemainrecommendationsfromthisCharter,inrelationshiptotheCOVID-19pandemic,areevenmorerelevanttoday,andincludetheactionsinthetablebelow:
TheInterActionCouncilActionsintheCharterforOneHealth(2017):
AstragicasthisPandemicis,itrevealshumanity’svulnerabilitiesaswellashowinterconnectedweallare.Ultimatelythough,wewilllookbackonthiscatastropheasawake-upcallofourglobalresponsibilitiestopreventfuturepandemics,aswellasinrespondingatspeedtoourimpendingclimateandenvironmentalcrisis.
Thissentimentisreflectedintheletterbelow,developedincollaborationwiththeClubofRomeandthePlanetaryEmergencyPartnership,andbuildsupontheInterActionCouncil‘ManifestotoSecureaHealthyPlanetforAll–aCallforEmergencyAction.’
OpenLetter:Emergingfromtheemergency–OnePlanet,OneHumanity,OneHealth
Itistimetoharnessourfears,buildhopeanddriveactiontobuildresilientsocietiesonthelongerterm.
Theworldhasbeenplungedintoanextraordinarycrisis.WeshareadeepconcernforthehumancostCOVID-19isinflictingandexpressaprofoundsenseofsolidaritywiththemostvulnerablecommunities.Wefullysupporttheemergencymeasuresneededtosavelivesandprotecttheeconomy.
Thispandemicisteachingushowmuchwedependoneachotherforourhealthsystems,foodsystemsandsupplychains.Weareallonthisplanettogether.Andtheplanetisinthemidstofadeeperandlonger-termcrisisrootedinanumberofinterconnectedglobalchallenges.Humanityhascrossedplanetaryboundaries.Internationalcooperationisthebestoptiontoresolvefutureexistentialthreats.LikeCOVID-19,climatechange,biodiversityloss,andfinancialcollapsedonotobservenationalborders.Thesethreatsmustbemanagedthroughsystemicandcollectiveaction.Countriesarestrongertogether.
Howleadersdecidetostimulatetheeconomyandallocatecapitalinresponsetothecrisiswilleitheramplifythesethreatsormitigatethem.Theriskismakingnear-sighteddecisionsthatincreaseemissionsandcontinuetodegradenature.Itistimetoinvestinnature,phaseoutfossilfuels,movetoacirculareconomyandacceleratethetransitiontoresilientlow-carboneconomies.
Wecallonleaderstohavethecourage,wisdomandforesighttoseizetheopportunitytomaketheireconomicrecoveryplanstransformativeforpeopleandnature.Insodoing,theywillsecureapathtonetzeroemissionsby2050tomeettheParisAgreement,transformourfoodsystemsandrebuildourrelationshipwithnature.Thatiswhyitissoimportantthatclimateandbiodiversitystayatthetopoftheagenda,andthatleadersleverageeveryopportunitytokeepupmomentumandmakeprogressattheUnitedNationsnature,climateandbiodiversitysummitslaterthisyear.
Thisisthemomenttorisetothechallengetoemergefromthisemergencywithaglobaleconomicreset.Ensuringthehealthandprosperityofpeopleandtheplanetispossibleifwemakebolddecisionstodaysothatfuturegenerationscansurviveandthriveinabetterworld.
IsagroupofformerStatesmenestablishedin1983bypoliticalworldleaders.Itconsistsofover40formerHeadsofStateandGovernmentandispresentlyco-chairedbyHEPresidentOlusegunObasanjofromNigeriaandHEBertieAhern,formerPrimeMinisterforIreland.Itcreatesrecommendationsandproposalsforactiononitsmainpriorityareasof:
TheInterActionCouncilprovidesseniorlevelstrategicrecommendationsandguidance,convenesregionalandinternationalmeetingstoadvocateforpriorityareasandfacilitatecountryengagement.Keypublications,communiquesanddeclarationsarecirculatedtoheadsofgovernment,seniorpolicymakers,opinionleadersthroughouttheworld,aswellastointernationalinstitutions.
Overthelastfewyears,theInteractionCouncilhasfocusedonglobalhealthsecurityinresponsetotheEbolaandZikaoutbreaks,withaviewtoidentifyingpolicyresponsesthatstrengthensustainablehealthsystemsandaspartofawidercontributiontoglobalsecurity.Therelevanceofhealthtotheclimatechangeandsustainabledevelopmentagendahasalsobeenexploredaspartofthisagenda,withaseriesofexpertmeetings.Theculminationofthisworkhasledtothedevelopmentofthe‘DublinCharterforOneHealth’,endorsedbytheInteractionCouncilinJune2017,followedbythe‘ManifestotoSecureaHealthyPlanetforAll–ACallforEmergencyAction’in2019:
Annex2:ComparativeSymptomsChartforCOVID-19:
Annex3:COVID-19andtheSustainableDevelopmentGoals:
ThisFrameworkisendorsedandsupportedbythefollowingorganisations: