4 April 2020, COVID-19 Narrative Sixteen

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


By Dr David Nabarro and John Atkinson

Containing the pandemic

The COVID-19 pandemic is a global emergency caused by a new coronavirus that requires a coordinated global response. Accelerating rapidly, doubling in size and scale every few days, it impacts nations all across the world with profound implications for healthcare, economies and wider society. The first death was reported in China in early January. By Mid-March over 10,000 people had died. In the next six days, that figure doubled. By the end of the next three days, it had trebled.  Large-scale outbreaks have led to many needing hospital-care.  As health care workers are struggling to cope with the rapidly accelerating demands on them whilst trying to keep themselves safe, hospitals are quickly overwhelmed.

The virus spreads as outbreaks of the disease ignite and expand. Extraordinary efforts are underway to limit outbreaks by interrupting transmission from person to person. This involves detecting and isolating those with the disease, so they are not able to infect others.  Small outbreaks require prompt action at the community level and are much easier to suppress than those that have become intense with widespread community transmission.  Outbreak management also involves reducing opportunities for transmission of the virus from person to person by restricting people’s movements through lockdowns.  These are now in place within more than 70 countries and territories: they are affecting more than one-third of the world’s population.  If outbreaks are being detected early through community-level public health action, the lockdown will be a short and sharp shock to society.  Containing larger outbreaks may call for several weeks of enforced physical distancing and varying degrees of lockdown: this will lead to a longer and more drawn-out process. 

Managing lockdowns

Governments do appreciate that lockdowns have consequences for people’s livelihoods – especially poorer people – and place additional demands, especially on women.  For billions of people, especially in poorer nations, the consequences of long lockdowns could be simply catastrophic.  They are already prompting anxiety, despair and civil disturbance.  They leave people, institutions and businesses confused and anxious. All are prepared to make sacrifices and tolerate the necessary impositions for some days but will want to be sure that their sacrifice is not in vain.  Small and medium enterprises, as well as larger businesses, will struggle to keep going. The daily-waged and self-employed are particularly hard hit. They seek whatever protection they can get: most governments are not able to cover needs, and hardship is inevitable. 

People want clarity on when and how the privations they face will end.  At the same time, governments do not want to lift lockdowns until they have clear evidence that the outbreaks are being contained.  They want to protect any undetected build-up of transmission that leads to more intense outbreaks, hospital overload and increased deaths.  That means they will also want to ensure that robust defences are in place to identify and quickly suppress any recurrences of the virus.  Governments are navigating the challenges of managing lockdowns in ways that defend public health while minimising adverse consequences for people, societies and economies. 

The new normal

Will life return to normal after the pandemic has subsided?  As governments navigate the pandemic, making incredibly difficult choices on behalf of their people, we are all coming to realize that life will not be resuming as it was before.  For the foreseeable future the world in which we live must be ‘COVID-19 ready’.  That will apply to ourselves and our households, our communities, our public health services, hospitals, local authorities, governments and international organizations.  All must be prepared to act rapidly and effectively in response to reports of a person suspected with the disease, or a chain of transmission.  The return of the virus must be prevented in ways that are humane, without discrimination and respecting human rights.   Governments are exploring ways to enable social and economic recovery in this light even now, as they advance their response strategies, exploring just what the new normal means in practice. 

We need leadership that embraces complexity and offers direction, is inclusive of all and leaves no-one behind, while learning lessons and being guided by the best available science.

A fundamental challenge for all leaders is to enable the different sectors of society to combine the new reality of ‘COVID-19 readiness’ with in-country and cross border economic activity.  They debate how best to prepare for this new reality.  In the short term, there will be multiple restrictions on movement until there is confidence that nations can stay on high alert and respond rapidly. 

Taken together, the efforts to contain the pandemic, manage lockdowns and emerge from the response involves managing complex interacting forces: it is an epic struggle but one that – we believe – can be won through drawing on the strengths that exist within our communities, institutions, enterprises, governments and multilateral system.  But it needs leadership that embraces complexity and offers direction, is inclusive of all and leaves no-one behind, while learning lessons and being guided by the best available science. It also needs to connect with people and recognize the extraordinary strength of the human spirit when faced by adversity.  The needs of people impoverished as a result of lockdowns will be acute and there will be an urgent requirement to restore their incomes.

Global Solidarity

The leaders of the G20 met on 26th March.  Their declaration indicates their acute awareness of the multiple challenges being experienced everywhere as a result of the pandemic and the responses needed to contain it.  They committed to global action, solidarity and international cooperation: to taking all necessary health measures and to seek to ensure adequate financing to contain the pandemic and protect people, especially the most vulnerable. To safeguard the future, they committed to strengthen national, regional and global capacities for responding to future outbreaks of COVID-19 and other dangerous pathogens by substantially increasing spending on epidemic preparedness. They agreed to work swiftly and decisively with the front-line international organizations, notably the United Nations (UN), World Health Organization (WHO), International Monetary Fund (IMF) and the World Bank (WB), to address gaps in the collective response.  Their statement[1] signals a determination for global action.

To safeguard the future, they [G20] committed to strengthen national, regional and global capacities for responding to future outbreaks of COVID-19 and other dangerous pathogens by substantially increasing spending on epidemic preparedness.

The WHO, under its existing mandate, is directing and coordinating international health work and establishing and maintaining global health responses. Its messages are clear, unambiguous and the best source for expert advice and support. The UN system is focused on the impacts of this pandemic that have implications beyond the fight to maintain health.  It concentrates particularly on the plight of poorer people and poorer nations who have so much less margin for manoeuvre.  The IMF and the WB are working with multilateral and regional development banks to deploy robust, coherent, coordinated, and rapid financial support packages.  It is important that the efforts of all multilateral organizations are joined together and that – together – they develop and implement strategies that enable societies everywhere to get ahead of the pandemic, mitigate adverse impacts and prepare the new normal. 

Leadership for Equity

Nimbly navigating this Global Pandemic Emergency, with interlinked challenges that will be with us for at least the next three months, requires a unified and responsive global effort.  It must enable all nations and their people to combine their priorities for public health, economic recovery and social cohesion.  This calls for a coordinated worldwide approach with universal principles that can be adapted over time in different settings.  It should be pursued in ways that help leaders find their way through the emergency and manage a range of difficult choices. 

A high-level Pandemic Emergency Coordination Council should be established now.  At its core would be the heads of UN, WHO, IMF and WB.  It would be connected to leaders of the G20 and other nations, as well as to platforms that bring together leaders from local authorities, business, civil society, and beyond.  It would meet frequently and should be established now.  It would report to all UN Member States. 

The Councils remit would be to shape the global response to the pandemic, mitigate the impact of containment on the global economy and societies (with a particular focus on the most vulnerable) and contribute to the emergence of a post-pandemic ‘COVID-19 ready’ world. It should do this in ways that take account of all nations’ interests and give emphasis to the needs of those who are poorest. Focus should be on enabling the protection of health workers, ensuring equitable access to protective material, managing the adverse societal effects of lockdowns, coordinating strategy and implementation, and establishing the parameters for the economic activity that emerges in the new reality.   It should be ready to chart ambitious pathways with audacious solutions that are both authentic and accountable to all people everywhere. 

The Pandemic Emergency Coordination Council is needed now.

Time is just not on our side.

The virus waits for no-one.

[1] G20 Leaders’ Statement Extraordinary G20 Leaders’ Summit Statement on COVID-19 (accessed 04 April 2020)

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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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