5 March 2020, COVID-19 Narrative Three

By Dr David Nabarro, Strategic Director of 4SD, Special Envoy to the 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

Business Is a Player, Not a Spectator

The World Health Organization would like everyone everywhere to be ready for COVID-19 outbreaks. As members of the public confront the spread of the new Coronavirus, they seek greater clarity on the risks they can expect to face and how best to minimise them. They search for reliable information from trusted sources. They depend on senior health professionals who have responsibility for public health (in the US this is Dr Robert Redfield, the Director of the CDC in Atlanta, GA). They listen to their medical practitioner or home care nurse. They supplement what they are hear, searching the internet, tuning in to public service announcements and speaking with friends and relatives. They want to know as much as they can about what is going on.

Businesses make a vital contribution to economic and social continuity. They do what they can to maintain profitable operations through uncertainty. They want their valued employees to be well informed and able to keep safe. Most have an interest in their customers being fit and well. It is in the interest of businesses for their customers to access reliable, science-based information and to help them adapt the information to their own circumstances. In the current COVID-19 situation, businesses could – together – help make this information available through product promotion and labelling, and support help-lines staffed by trained public health personnel – as a public service. They may well have significant reach.

The disease caused by the new Coronavirus (COVID-19) is not like influenza or SARS. The COVID-19 virus has only been known about for three months. As the World Health Organization gets to know the virus and its disease better, it is developing updated guidance on how COVID-19 outbreaks can best be contained, delayed and then managed. Outbreaks develop quickly and with dramatic effect because the virus is easily transmitted: one person can infect up to three others (and in rare cases many more). The risk of transmission seems to be highest in unventilated locations.

COVID-19 is respiratory disease: the virus is spread by the microscopic droplets we produce when we cough or sneeze. That is why it is important that the nose and mouth are covered when coughing and hands are washed with soap or sanitizer frequently. We can become infected if we are close to someone who has COVID-19: to avoid infection we need to stay about two metres away.

The symptoms at the start are ache in the joints, then a day or so later, high fever and cough. Runny nose (as happens in a common cold) is not one of the early signs. Around 20% of those infected become severely ill, usually with pneumonia, and between one and two percent will die. The most vulnerable are those over 65, as well as those with underlying ailments such as hypertension or diabetes. Children seem much less vulnerable.

The first COVID-19 outbreaks were in the city of Wuhan, in Hubei Province, China, was intense. When the significance f this disease became clear, authorities and people mounted an intense containment operation. The Hubei outbreak is diminishing, and outbreaks in other Provinces in China are being contained. Meanwhile Government and people are vigilant because it is always possible that outbreaks can restart. In the last two weeks there has been a steep rise in the number of people with COVID-19 outside China. There are now outbreaks, with community transmission, in South Korea, Japan, Northern Italy, and Iran. In the last 24 hours we have seen reports of an outbreak in Washington state, in Kirkland (a suburb of Seattle).

Outbreaks can be contained if they are tackled early. The task is much harder if there is a delay of some days. Public health authorities must be ready to respond quickly to any person suspected of having COVID-19. Once infection is confirmed in an individual, he or she should be isolated promptly in order to prevent transmission to others. Care must be taken to identify those with whom the infected person has been in contact and to keep them under surveillance in case they turn out to be infected. There may be a decision to keep them quarantined while this surveillance takes place.

Once the severity of this new disease was evident to the government of China, a massive operation (involving the whole of government as well as communities and enterprises) was mounted which has had extraordinary results. These are described in the report of a WHO-led joint mission to China (February 2020) which documented the early Chinese experience.

The outbreak of disease in Wuhan is being limited as a result of the involvement of people’s organizations, with support from a reinforced community health workforce that checks on disease spread. Every effort is made to enable people with symptoms to get themselves checked and to access hospital care if needed. The Chinese government has repurposed health services, establishing dedicated treatment facilities for people with COVID-19 infection (with lots of spare capacity): this enables other hospitals to maintain the everyday business of medical and surgical care for the population (including cancer care or treatment of injuries)

There is a key role for business in assuring stable supplies of food, access to energy, transportation services, banking and the maintenance of law and order. Divisions between different levels of government, as well as political position taking and point scoring, can interfere with effective responses. All – businesses, civil society and government – have vital roles to play in keeping life going despite the virus.

In some outbreaks the numbers who are newly infected seems to double every five days. This means that the global situation evolves rapidly. New scientific studies of the disease are emerging all the time. Hence situation assessments, as well as guidance on optimal responses, are being updated every few days. That means companies will have to be prepared to adapt what they do in the light of changing circumstances and to update their key stakeholders regularly

As they learn about COVID-19, people everywhere have many questions and often wonder as to the best sources of guidance. Both the WHO and the US CDC are offering science-based assessments. However, the actual decisions about what should be done in the face of threats are best made locally. People have multiple concerns and seek authoritative information to help them make choices about what they should do in the home, community, residential institution, workplace, church, sporting event and so on.

People tend to ask:

Should I be worried? Are we all at risk? Will we run out of food, water, fuel? What about people who are poorer than us? What about the elderly, sick or disabled?

What can I do to keep safe at home? What about members of my family and my pets? Should I wear a mask to protect myself? Should I go to gatherings?

What is happening to the healthcare system? Will hospitals be overloaded with COVID-19? Will people with other conditions be able to receive the care they need? How will hospital services keep going in the event of an outbreak? Will health workers be able to stay safe? 3

Are there helplines that we can use? What if our local MDs are overwhelmed? With whom can we share our anxieties and discuss our fears? Where is the nearest COVID dialogue group? Should I set one up myself?

Companies are responding to employees’ concerns by encouraging COVID dialogues where issues can be openly debated. Such openness requires an authentic effort at meeting employees where they are. It is best if the CEO is the chief listener, consistently. The CEO’s personal presence is vital to credibility.

People should do their best to follow advice from the World Health Organization, the national health authorities and local care-givers. Those who take decisions about work-related journeys and attendance at conventions, as well as holiday travel and visiting with family, should respect national guidelines and interpret them in the local context.

As of now there is no requirement for all of us to change behaviour. But we must get the mindset right: as soon as the first person with COVID-19 is found in a community we should care for them (they did not ask for it), treat with dignity and isolate them in a comfortable place. We must do all we can to stop spread and contain quickly. This calls for a collective effort. As we get ready, we should learn and practice cough etiquette: we should remember to wash our hands super-often and well and use sanitisers when there is no water and soap. We should learn to keep a distance from each other. When decisions are made about whether to continue with, or modify, sporting events or conferences we should evaluateeach situation based on local, up-to-date information. We need to know about risk of infection, the capacity of local health services and the parameters of national guidance. Remember: things can change very fast, and guidance may alter at any time.

The key lesson from countries that are successful in handling COVID-19 outbreaks is the need to involve the populace. Enlist them as partners in tackling the disease. Disinformation needs to be countered firmly by business, government and community organizations.

Business leaders could contribute greatly if they keep up to date with national and international guidance (especially from WHO); connect and communicate often with employees, customers and suppliers: communicate frequently, clearly and positively; being open to concerns and respond to them. It may be especially helpful if paid advertising slots are made available for transmitting public service announcements about how people can be safer in the face of COVID-19.

Please keep being positive: do all you can to avoid life coming to a standstill. Prevent livelihoods from collapsing. Make the care, safety and well-being of your employees the highest priority.

The World Economic Forum, the Edelman company, the World Business Council for Sustainable Development and the Wellcome Trust are working on a communications plan that involves more than 500 companies. The chairman and founder of the WEF is arranging a weekly update for CEOs and establishing a platform so that companies know what others are doing on employee information, as well as travel, conferences, and office closure.

In the coming weeks it is important that people everywhere are enabled to act for their own and for the public good. They should be able to depend on science, not fantasy, as the basis for their decisions. Businesses can lead for the good of all through connecting people with the science, helping them to stay up to date, and encouraging all to consider “what does this science mean for us”. No-one is finding it easy, but those who depend on reliable information for their survival and growth can make it an awful lot easier for us all.


On 21 February 2020, Dr David Nabarro, Strategic Director of 4SD and Co-Director of the Imperial College Institute of Global Health Innovation at the Imperial College London, was appointed as a World Health Organization (WHO) Director-General Special Envoy on COVID-19. In this role, David and five other special envoys are providing 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. David joins special envoys Professor Dr Maha El Rabbat, former Minister of Health of Egypt; Dr John Nkengasong, Director of the African Centres for Disease Control and Prevention; Dr Mirta Roses, former Director of the WHO Region of the Americas; Dr Shin Young-soo, former Regional Director of the WHO Region of the Western Pacific and Professor Samba Sow, Director-General of the Center for Vaccine Development in Mali in this collective effort.

Please visit: https://www.who.int/emergencies/diseases/novel-coronavirus-2019 for official guidance from the World Health Organisation on the virus. These Narratives are being written and shared by David for those who want more information and to help raise awareness and readiness of all actors.



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