18 May 2020, COVID-19 Narratives

By Dr David Nabarro, Strategic Director of 4SD, Special Envoy of World Health Organization Director-General on COVID-19 and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London

MY REFLECTIONS AS THE WORLD HEALTH ASSEMBLY BEGINS

By Dr David Nabarro


Across the world, the nations that are getting ahead of the virus know that economies and societies can thrive if they implement comprehensive action to keep it at bay. Yet, not all the nations represented at the Assembly are implementing the COVID-19 containment policies that have been continuously advocated by the World Health Organization (WHO) since late January 2020.

The recommendations include:

  1. making it hard for the virus to move from person to person – physical distancing, face protection and hygiene;
  2. disrupting transmission from person to person when it occurs – high index of suspicion, detect the disease (ideally with virus testing), separate those with the disease from others quickly and effectively, trace their contacts, separate the contacts and do it with respect…;
  3. containing outbreaks as they develop robustly and rapidly – localized movement restriction, separating those who are infected and their contacts, stopping transmission;
  4. protecting lives as those most at risk are poorer people, especially those who work and live in confined places, as well as those whose occupations lead to high exposure, and those who receive residential care – older people, prisoners and their carers;
  5. sustaining livelihoods, especially those that are put at risk through movement restrictions;
  6. reinforcing community health services and hospitals so that they support all these functions, protect all health and other close-contact workers. 

Countries that get ahead of the virus know that it does not go away during lockdowns: transmission is slowed but the virus is still there and will spread quickly when movement restarts unless comprehensive defence strategies are in place. Virus testing is very helpful as it enables authorities to know where the virus is however this is a struggle in densely populated settlements.

Societies are undergoing widespread behaviour change that need to be supported, promoted and reinforced by local and national authorities, employers, institutions and more.  If it is to work, it has to be accompanied by open dialogue in order to encourage sense-making everywhere.  The aim should be to establish communities that are free of the virus, supported by means to keep things that way.

Many countries are implementing courageous strategies (including but not limited to Ethiopia, Mali, Uganda, South Africa, India, Costa Rica, Liberia – building on the Ebola experience) but, countries with fewer resources will face constant challenges if wealthier countries are unable to get their virus defences in place and working.

The knock-on effects on employment, food systems, child nutrition, tourism income, women’s status and so much more will continue until high-income countries do what is needed to contain outbreaks within their own borders.

Constant learning

We continue to be reminded that there are perils of underestimating this virus – COVID-19 may cause lengthy and disturbing illness in younger people. There have been reports from China and Italy of whole-body weakness, shortness of breath after any level of exertion, fatigue, persistent coughing and irregular breathing.  I hear the same from colleagues and family members in the UK and here in France and Switzerland.   This is tough for many, especially when exercise has an important role to for physical and mental health. 

After-action reviews will show how things could have been handled differently with less loss of life. They are, and should always, be done after an outbreak. Nations do not always act on the reviews, for example, the additional funding for WHO recommended by after Ebola 2015 reviews has not been as great as anticipated.

The Assembly

As attention focuses on the Assembly, I send courage and strength to all my WHO colleagues as they continue to work relentlessly to tackle the global catastrophe that is unfolding before our eyes. I extend this same sentiment to all working hard for global coordination be it in government or across inter-governmental institutions.

The sniping and verbal violence I have seen against efforts for global public health, in my view, are grotesque. We, as global citizens should all be concerned about this and as much as possible, discourage this in every society, on every platform, in every forum.

There is an ongoing narrative that the choice is between public health and the economy. In my opinion this is a false dichotomy. The world urgently needs more leaders to step up and bring the human family together to act on the reality that economies can only thrive if public health capacity for all, is in place.

Humanity is challenged as never before. I believe that our collective ingenuity and compassion will prevail for the good of all, to benefit humanity and the natural environment on which we all so depend.

Download Narrative as PDF English (184kb)



There are many great sources of advice for governments and healthcare systems and the people who work in them, particularly the World Health Organization website. This is the trusted source for clinical information. Please bookmark it and keep checking it as it is updated.


On 21 February 2020, Dr David Nabarro, Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London and Strategic Director of 4SD, was appointed as one of six Special Envoys of World Health Organization (WHO) Director-General on COVID-19.

In this role, David provides strategic advice and high-level political advocacy and engagement in different parts of the world to help WHO coordinate the global response to the epidemic.

The COVID-19 Narratives are being written by David and peers to share with those who want more information about the situation and to help raise awareness and readiness of all actors.


Snapshot from WHO COVID-19 Situation Report – 119, as of 10:00 CET 18 May 2020

→ 4,618,821 confirmed cases (+93,324 new in the last 24 hours)
→ 311,847 deaths (+4,452 in the last 24 hours)
→ The 73rd World Health Assembly opens and is available online
→ WHO signs an agreement with the International Olympic Committee to promote health and physical activity with a special focus on non-communicable diseases


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