COVID-19 Urban Management & Recovery Agenda

This document outlines an agenda for managing and recovering from the novel coronavirus (COVID-19) in urban settings. It includes sessions on emergency management plans, simulation exercises, gap analysis, and feedback for city leaders and technical experts. The agenda emphasizes preparedness and response in city environments to address the evolving situation of the pandemic.

• COVID-19
• Urban management
• Recovery
• Agenda
• Emergency

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1. NOVEL CORONAVIRUS (COVID-19) URBAN SETTINGS CITY NAME Date and location MANAGEMENT & RECOVERY

2. Agenda ***Sample Agenda. Adjust accordingly.*** 1100 Short break (10 min) 0900 Welcome (City representative or facilitator) 1115 TTX session 3 0910 Introduction to the day (facilitator) 1200 Coffee break (10 min) 0925 Overview of city Emergency Management Plans and relevant SOP s 1210 TTX Session 4 1300 Lunch 0935 Overview of SimEx TTX (WHO facilitator) 1400 TTX Session 5 0940 TTX session 1 1500 Debrief: GAP analysis (WHO facilitator) 1010 Coffee break (10 min) 1550 Feedback & way forward (WHO facilitator) 1020 TTX session 2 1630 Closing/Lunch

3. Welcome & Background Insert Welcome Message Here Insert Context/background and Urban plans & SoP activated

4. Simulation Exercises Simulation Exercises (SimEx) A simulation is an event which reproduces aspects of a real situation, to test existing procedures and awareness of actions and needs of preparedness and response. Its practical nature encourages participation and improves learning. A Tabletop Exercise is a type of simulation exercise which uses a progressive simulated scenario, together with series of scripted injects , to enable participants to consider the impact of a potential event on existing plans, procedures and capacities. A TTX simulates a situation in an informal, stress-free environment. The TTX will discuss broad concepts and ideas and to encourage forward planning of the situation rather than simple day to day case management.

5. Introductions & Target Audience ****Facilitator to introduce each exercise staff present and their role, Participants introduce themselves and their role/function.*** The Purpose of this exercise is to discuss critical issues in urban environments Target audience are City & community leaders, urban policy makers & technical experts from different sectors, including; Health Social and economic Faith-based organizations Finance Logistics Urban Planning Security & Emergency Services (fire, ambulance & police) Public communications & Media relations

6. Latest WHO Situation Report The situation is evolving rapidly. Present the Latest WHO or MoH Situation Report

7. COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN - 30 March 2020 All countries are at risk and need to prepare for and respond to COVID-19. Each country is encouraged to plan its preparedness and response actions in line with the global Strategic Preparedness and Response Plan. COVID-19 STRATEGIC PREPAREDNESS AND RESPONSE PLAN - Country Preparedness and Response Status for COVID-19 as of 30 March 2020

8. Critical Forward Thinking Critical issues that need to be explored in managing cases: What is the effect of long term shut down on mental and physical health including livelihood and the economy Immediate impacts at the primary (individual) level, including food, nutrition, shelter, livelihoods Variations in health service capacity within the state/region Major cities vs outlying satellite or rural health services Ensuring that routine care, particularly elderly care and vulnerable people can continue. Plan for other routine health services such as management of long term conditions such a cancer, heart disease and other critical conditions as well as neonatal and maternity care. Accounting and caring for affected people at the margins of society (undocumented, homeless, uninsured, etc.) No one size fits all; global guidelines/measures need to be adapted to fit social norms and practices Other Critical issues related to COVID-19 to be looked at mid/long term could include; Preparing for a second/third/fourth wave and supporting surge capacities Preparing flexible transition strategies including transitioning between public health measures. This could include loosening and reapplying restrictions depending on how the situation evolves Restarting economic activities important for livelihoods and businesses Managing emerging pockets of disease Preparing vaccine strategies

9. Purpose, Scope and Objectives Purpose To discuss critical issues in urban environments as the pandemic develops into an established infectious disease that may have periods of increased spread and number of persons affected. Scope This exercise will discuss different public health strategies that relate to managing spread in areas of high population density and will look at some of the key public health challenges that communities and local authorities are facing moving forward, including the management of measures and restrictions and the impact this has. Specific Objectives The exercise will provide a safe platform to discuss; 1. Comprehensive Public Health Measures, 2. Maintaining health services and critical infrastructure, 3. Risk communications including the management of inaccurate and malicious material 4. Limiting social and economic impacts 5. Easing of restrictions and moving towards recovery

10. Description of the Exercise 1. Participants 2. Exercise team Facilitators Technical advisors Support staff 3. Narrative and Discussion 5 sessions with questions/tasks to be discussed 4. Debrief & action plan Accept the scenario, do not fight the scenario

11. TTX Process Debrief Exercise Gaps, Opportunities and Lessons Learned Action Plan

12. How to Play Rules Use your existing public health plans including SOPS to inform your responses Play yourself (your own daily role) Work as a team Focus on solutions Remember The exercise is designed to discuss critical issues in urban environments. The exercise does not test or evaluate individual participants.

13. Questions?

14. COVID-19 Summary A pneumonia of unknown cause detected in Wuhan, China was first reported to the WHO Country Office in China on 31 December 2019. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020. On 11 February 2020, WHO announced a name for the new coronavirus disease: COVID-19. On the 12th of March 2020, WHO declared COVID-19 a global pandemic. Since early March countries around the globe have been introducing more severe measures in an effort to control the spread of the disease. Measures have included physical distancing, closing schools, restricting travel, restricting imports, and in many cases restricting people to their homes. Almost all countries in the world have reported cases, with a total of around 2,5 million confirmed cases globally*

15. Session 1a: Comprehensive Health Measures Many Urban areas are experiencing community transmission, particularly in places with high population density. Countries and cities around the world have put in place measures to try to limit or prevent urban spread. At the core of the public health response to COVID-19 WHO strongly advocated five main pillars: Find, Isolate, Test, Treat and Trace. Testing of suspected cases wherever possible so that cases are promptly isolated (and treated when necessary) and contacts isolated for the duration of the incubation period (in the case of COVID-19 for 14 days), is critical to break chains of transmission while at the same time protecting crucial social and health care functions. Besides finding, isolate, test, treat & trace, a number of additional interlinked health strategies can be considered, including: Directing the use of individual precautions everywhere, including personal protective measures such as frequent hand washing, cough etiquette and maintaining 1 - 2 meters distance between people. Other public health measures such as Mobile hand washing stations, sanitizing stops in or near those businesses that remain open and guidelines and public advisories have been put in place. Rapidly engage all sectors and communities to ensure all of society ownership of and participation in the response Slow down community transmission through context appropriate time-limited physical distancing measures (see next slide) Banning or restricting mass gathering events that could be the basis of accelerated spread

16. Session 1b: Physical Distancing Many countries and urban areas have imposed various physical distancing measures to try to limit the spread of the virus. Measures have varied from advisory recommendations to legally enforceable measures. These have included: 1. Immediate closure or adaptation of workplaces and schools and use of online working and/or distance learning where possible 2. Measures to avoid crowding in any public or private space, stay-at-home orders and other movement or travel restrictions (essential personnel only),. There are fines in place for non- compliance 3. Closure of non-essential facilities, (exceptions are supermarkets & Pharmacies) 4. Restricting access to important milestone events, such as births and funerals 5. Shielding and protection for vulnerable groups such as restricting access to care homes This has caused a spike in unemployment and large numbers of people; particularly urban poor depending on daily income are struggling to obtain cash and essential supplies. Some countries have tried easing restrictions only to experience further outbreaks. Economies globally are suffering with a major recession likely to exceed that of the 2008 financial crash.

17. Task 1: Health Measures - Key Questions or Tasks 1. Discuss the approach that your region/city is taking towards containing the outbreak and the reasoning of this approach 2. Describe how global guidelines/measures are being customized to fit the local context and the pros and cons 3. How are decisions been undertaken and how do you see the situation developing? 4. How are you communicating this to the public and what role are the media (both traditional and social) playing in this case? 5. Are you ensuring that everyone has the practical possibility to implement physical distancing measures? Are people without secure housing - including those living in homelessness and informal settlements - being provided with adequate temporary or emergency accommodation? ( adequacy can be assessed by reference to WHO Housing and Health Guidelines and SHERPA Tool for Sustainable Housing Projects ) Are you mitigating the risk of people becoming homeless thereby exacerbating the health threat for them and the entire community? (e.g. bans on evictions, suspension of mortgage payments, etc.) 6. What difficulties are you facing in both physically implementing your strategy and communicating the strategy to the public? 7. How are you ensuring that the most vulnerable in society are being supported? 8. Discuss the issue of long-term physical distancing. How long do you think it can remain in place without long term socioeconomic issues? How do you support vulnerable poor groups that are dependent on daily income? How can you manage the situation but prevent the spread of COVID-19? Is there a stepped system that could be employed (such as opening some aspects of normal life)? How will people who are alone and isolated be supported? How will people in urban slums who are unable to effectively self-quarantine be supported? How will people with mental health challenges be supported? Is there a social welfare package available and activated? 9. How can you effectively communicate your decisions to a skeptical public? 10. At what point will you be able move to the recovery phase and start to reopen schools and other key institutions?

18. Session 2a: Maintaining Critical Health Capacity Major urban health facilities are stretched to capacity. Key highlights are: 1. Rapid expansion and repurposing of health services for life-saving measures focused on care for the majority through simple treatments such as providing oxygen 2. Increasing testing facilities, such as test kits and the associated laboratory capacity and Rapid Diagnostics Tests 3. Demand of essential equipment is likely to outstrip supply, e.g. PPE, ICU units, ventilators, O2 cylinders 4. Rural and regional hospitals might be less affected and have capacity but there is reluctance to move people in case the infection spreads. 5. Demand of trained health care workforce; Lack of trained doctors and nurses to operate ICU wards and patients 6. Elderly care can be severely hampered and fatality rates are very high once the infection takes hold within one of these facilities. There may be concerns that vulnerable, elderly people are only receiving minimal care 7. As the pandemic progresses there has been a severe spike in ICU units and deaths and mortuary capacity may be exceeded. 8. Temporary health facilities are being constructed but these come with additional unforeseen costs. 9. Ensuring that sufficient financial resources are in place It is critical to ensure not only that patients with COVID-19 are able to rapidly access safe and effective health services, but also that essential health and social services and systems are maintained as much as possible. It is critical that heath and social services staff are working in safe conditions that minimize risks to their health and wellbeing.

19. Task 2: Health Service & Critical Infrastructure Describe your health service capacity and the challenges being faced. 1. How are you managing the current situation? 2. Do you have facilities available for surge? Are you moving people to other facilities and do you have temporary facilities? 3. How are you managing the regular caseload (accident and emergency, births, other illnesses) 4. How are you managing staff load. Ventilators require specially trained staff to operate. Are there sufficient staff? 5. Is senior management taking a lead role and are their systems in place to support senior management and cover staff absenteeism? 6. How are you managing care of vulnerable people? 7. How are you managing mortuary capacity? What plans do you have for coping with excess deaths? 8. Do have adequate ICU beds, ventilators and oxygen to care for the severe and critical patients Critical infrastructure 1. What critical infrastructure is essential to keep your wider operations functioning? Do you have a comprehensive Business Continuity plan in place with a reliable risk assessment. 2. How are you obtaining critical care items and are there sufficient supplies? 3. Does your ordering system have standardised equipment or do you get different types of equipment (such as PPE and ventilation equipment) from different suppliers

20. Coffee/Tea break

21. Session 3: Risk Communications The media, both traditional and social, continue to have a lot of influence over the general population and providing clear guidance is challenging. Several media that have been traditionally critical of the current government have relentlessly published stories about insufficient testing, poor management and deaths of patients and health workers while at the same time ignoring successes that have been achieved. This has led to an erosion of confidence in the government approach and fueled online speculation. Social media is alive with scare stories, fake news and pseudo cures. Many media pundits have little public health training and simply latch onto stories that they feel have the greatest mileage. There have been some successes. The government health advisors are well regarded in the scientific and public health community and are able to get some facts and clear messaging out. Value of communicating with communities community engagement. This not only a health led issue community engagement has a critical role, as people are part of managing the outbreak. Community groups, faith based institutions and other community lead programmes can assist or hinder reliable messaging and require engagement.

22. Task 3: Risk Communications Describe your approach to risk communication 1. Describe your community engagement strategy 2. How can you ensure media outlets undertake balanced, factual reporting? 3. How can you reduce hostility in the press? 4. How will you improve engagement on social media? 5. How do you support factual reporting by supporting reliable information sources? Key messaging 1. What are your key messages? 2. How are they being transmitted to the public? 3. Are you using enforcement for instance Stay in doors or we will prosecute you or are you using a more socially based system such as encouraging individual responsibility and peer pressure or a combination of both? 4. Faith based institution have been successful in accurate messaging (South Korea religious groups changing practice, remote services over Easter, closure of holy sites in Saudi Arabia and limiting of mosque attendances through video conferencing) or have led to increased transmission (US churches who have declared themselves exempt from physical distancing). How are you engaging with these to ensure good practice?

23. Session 4: Limiting Social and Economic Impacts With physical distancing and movement restrictions in place, the general population were initially welcoming the measures as they felt that something was being done. There were reports of people singing from balconies and standing out the front of houses to clap for medical staff. However, these measures also cause significant stress to individuals, communities, and societies by bringing social and economic life to a complete stop and can only be sustained for a limited time In some places the mood is slowly shifting People are starting to flout regulations as incomes and savings begin to dry up and people become tired of the constant closures. Cases of domestic violence have increased, and mental health services are stretched. Police and officials trying to enforce physical distancing have been attacked and in several cases gangs of people have broken into local shops. Some people have been traveling outside their towns , heading for rural areas where they have weekend homes or relatives, often to areas with minimal health care facilities that would be easily overrun by a large number of cases. In other places, people without work have moved back to their home villages and towns to be with family. When authorities have tried to prevent this they have been attacked or people have found ways around blockades. People on low incomes, minorities groups and those living in informal settlements are particularly badly affected as are people who have high levels of income insecurity. Organized crime is likely to infiltrate the supply chains of goods and medicines, particularly in marginalized and vulnerable communities in times of crisis. This may lead to increased demand and supply of non scrutinized goods and meds, posing additional health threats.

24. Task 4: Limiting Social and Economic Impacts The situation is is likely to deteriorate as people become tired of physical distancing and become concerned about livelihoods and looming poverty 1. What can be done in the situation? 2. Examine benefits vs harm of continued physical distancing 3. At what point can physical distancing be relaxed and what are the likely outcomes? 4. How can livelihoods be protected and ensured? 5. How would law and order be maintained? 6. Are there extra steps that must be legislated to put in place to allow wider use of the military for support across all sectors (logistics and supply, security, emergency field hospitals, etc)? What key elements can assist the situation. Discuss: Supporting incomes through Social welfare packages; e.g. does the national-local regulatory framework allow for quick and emergency extension of social protection to the vulnerable communities and individuals? Does it include housing? Support businesses and entrepreneurs Food distribution or cash transfers for vulnerable people (e.g. urban slum dwellers) What is the impact of failing to do this? Support to communities to prevent unnecessary movement and preventing unrest and organized crime

25. Session 5: Recovery and Easing of Restrictions There is an urgent need for countries that have implemented physical distancing measures to plan for the transition away from these measures in a manner that will enable the sustainable suppression of transmission at a low level whilst enabling the gradual recovery of the economic and social life. Also when numbers of cases are beginning to fall, but the virus continues to circulate in the community, the need to remove physical distancing measures will become louder. Some countries have re-imposed such measures at short notice when a spike in cases has been detected. There are three most likely outcomes being discussed: 1. Gradually relax physical distancing & movement restrictions using a traffic light approach; Gradually remove physical distancing measures and then attempt to isolate clusters as they arise (e.g.2-day work week, re-opening of some services) 2. Relax physical distancing in geographic areas with low or no cases while keeping other parts with stricter restrictions (Note this may cause tension between inhabitants of different areas) 3. Keep physical distancing in place in all parts with the associated economic and social risks (such as social unrest) and wait for medical intervention (such as a vaccine) Managing points of entry and resuming global movement of people. Countries that are major transport hubs may face increased transfer of cases (places such as Singapore, Hong Kong, Dubai, Bangkok, London, Frankfurt, etc) and will need to prepare a management policy

26. Task 5: Recovery and Easing of Restrictions Describe your strategy for removing physical distancing measures What are the likely challenges while removing such measures? How will you manage the inevitable clusters of COVID-19 that emerge? How will you communicate these measures and explain to the public why you are making these decision? How will you support the economy at this time, particularly Urban poor and people who have fragile employment and are in a poor financial position? How will you ensure that the people who require support are able to get such support? How will you ensure that medical support continue to be available to all members of the community? How will you ensure that people provided with emergency and temporary housing do not return to inadequate and unhealthy housing conditions, in particular homelessness? Discuss options

27. Debrief (40 mins) TASKS: Review strengths & gaps 1. In groups, divide a piece of paper into three sections. 2. Review the five sessions and strategies discussed and the notes from your TTX Check assumptions 3. Discuss and write your points in each of the sections to answer: What worked well? (Achievements) Propose ideas to enhance your systems, plans & Procedures What was challenging? (Challenges) Recommendations? (and prioritize, to identify your top 3) ACTION PLAN

28. Feedback (10 mins) Your feedback will assist us to maintain and improve the quality and relevance of future simulation exercises.

29. THANK YOU! For SimEx technical support, please contact your WHO or UN Habitat country office or regional office focal point WHO RESOURCES WHO COVID-19 Emergency webpage More information on coronavirus Scan or Click Scan or Click Scan or Click Scan or Click https://www.who.int/emergencies/diseases/novel-coronavirus-2019