3 April 2020, COVID-19 Narrative Fifteen

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

A COVID-19 READY STATE

By Dr David Nabarro and John Atkinson


I have been focusing on the rate of acceleration of the pandemic especially in Europe and North America. I have been tracking the exponential increase in numbers of cases and the impact of the disease and containment measures on societies everywhere.  I have concentrated on the ways in which rapid rises in case numbers challenges hospital services and the extent to which lockdowns slow the rate of acceleration.  I am constantly asking “Is there evidence that the rate of increase is slowing? Are the lockdowns working despite their extraordinary impact on people’s lives and livelihoods? Are we starting to see a flattening of the outbreak curve?” Some of the intense outbreaks that were experienced in South-East Asia have now been reduced.  There are early signs of reducing intensity in Europe associated with strengthened public health action combined with lockdowns.  I am thinking about how life will be as we move forward. Our journey away from peak infection rates will be long and neither smooth nor swift; we are all in for bumpy rides. 

Why?  As I see it, COVID-19 is not going to go away any time soon. It may be many months before we have a vaccine that is shown to be effective and safe, and available in sufficient quantity for widespread administration.  Enabling everyone who needs it to gain access in every country will take time.  It will be a challenge to ensure that no-one is left behind.  The virus will continue to be transmitted, hopefully with lower intensity, in some locations. There will be a constant risk that new outbreaks of COVID-19 will appear as people return slowly to more normal ways of living and working and seek to travel once more between countries and communities.  We may well not know where it is until we detect clusters of people with disease. 

Populations, health systems and businesses will have become wary of the need for further suspensions of activity.  Requesting localities to go back into repeated lockdowns will stress people alongside many ways of living and working.

Getting COVID-19 ready is the key to our longer-term security in the face of an ongoing threat.

When outbreaks are intense, Governments use their power and resources to the full.  In health systems extra staff and equipment are being rapidly sought. Health services for non-COVID cases are stretched.  Planned surgical operations are being cancelled as hospitals prepare to manage huge demands on their capacity. And staff are getting infected too, placing even greater strain on already overstretched systems. Financial rescue packages are being put in place for large and small businesses and individuals, putting pressure on national finances. Local authorities are diverting resource to care for the vulnerable.  All of these challenges provoke strains in our systems: stress among staff, personal anxiety, financial challenges and logistical difficulties.  All will need to be relieved.  

This flurry of activity now, and the choices being made, means our capacity to prepare our readiness and cope with the potential for further outbreaks in coming months is extremely limited. But getting COVID-19 ready is the key to our longer-term security in the face of an ongoing threat. Our lockdowns do reduce opportunities for transmission.  Those with the disease have fewer contacts to be traced.  The burden on hospital services is reduced.  Lockdowns buy us time. And we need to use that time wisely if we are to return to a normal world safely.

We need to be planning now for how we will live in a world where COVID-19 is a constant reality. Those places and organisations that do this well will arrive at a new normal more quickly and minimise suffering. Those that don’t, those that are affected by repeated outbreaks and all the interruptions they bring, will be hit hard.  People will be wary of living in places that they perceive are not COVID-19 ready.  Businesses won’t want to invest there.  Your ‘COVID-19 Ready State’ will define your future. 

I think a ‘COVID-19 Ready State’ has the following components; 

  1. Public Health. The ability to swiftly mobilise rapid and widespread virus testing, contact tracing and isolation. There is a need for constant and regular messaging on hygiene, case identification and individual responsibility. Access to treatments and vaccines needs to be established as they become available. 
  2. Hospital care. A capacity to rapidly scale up through identified call-in procedures for extra staff, equipment levels (eg ventilation) and stocks of PPE. 
  3. Local authorities. Clear protocols are needed for introducing lockdowns and the means of enforcement of restrictions need to be carefully rehearsed. Plans for supporting the vulnerable particularly the elderly and maintaining basic services. 
  4. Security. Police and civil enforcement need to have deployment plans in place. Parameters need to be established for tracking and surveillance measures for those infected in ways that take account of people’s human tights and entitlements. 
  5. Business. Small medium and large businesses will have resilience plans in place including addressing reserve policies and the capacity for remote working. 
  6. Community. Neighbourhood groups, virtual and real, provide the weave that connects people together, ensuring those who need help get it, messaging is spread and understood, and morale and well-being is maintained. 

These components can be organised on many spatial levels. Depending on the country they might be organised at national, regional or city level. And there is a cost to this. Although it should be seen as an investment that protects future well-being, many countries simply have neither the finance nor the resource to sustain this. If we don’t wish COVID-19 to continually surface around the world with devastating effect, then there needs to be a global response along these lines. This will be key to facilitating movement within and between countries. 

I anticipate that people seeking to travel from places that are not COVID-19 ready, and where outbreaks are still occurring, will face impediments to their movement to those that have invested in COVID-19 readiness.  It is likely that people will find it easier to move between places that have demonstrated they are COVID-19 ready.  Governments will look to the WHO, World Bank, IMF and other institutions within the United Nations system, to ensure there is capacity to support countries that need help to establish their COVID-19 ready state.  There may well be other funds available given the evident link between a society being COVID-19 ready and the potential for economic recovery. 

If we are to return to somewhere near normal, 

having a ‘COVID-19 Ready State’ is in all our interests

Download Narrative Fifteen as PDF
English (54kb)



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 to the 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 – 74, as of 10:00 CET 3 April 2020.

→ WHO Risk Assessment Global Level VERY HIGH
→ 972,303 confirmed cases (+75,853 new in the last 24 hours)
→ 50,322 deaths (+4,823 in the last 24 hours)
→ 1 new country/territory/area reported cases of COVID-19 in the past 24 hours (Malawi)
→ Dr Hans Henri P. Kluge, WHO Regional Director for Europe releases statement about supporting and protecting older people.
→ South-East Asia Director holds regional meeting with Ministers of Health
→ Pan American Health Organization (PAHO) launches an appeal for funds.
→ New online interactive courses provide guidance on managing ill travellers


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