27 March 2020, COVID-19 Narrative Twelve

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

Tuning into Local Reality

By Dr David Nabarro and Julien Delemontex


Dr David Nabarro writes:  In order to delay and limit the spread of an intense COVID-19 outbreak it is necessary to reduce opportunities for the virus to be transmitted between people.  This means asking people to make major changes in the way they behave and helping them do this by limiting both their mobility and their opportunities to gather.  Each of us has visions of how different people live and decide what they will do.  As we encourage widespread physical distancing between people we need to tune in to the reality of what this means and reflect this in local, national and global discussions on response strategy and implementation. 

Here is a report shared by Julien Delemontex.  It reflects on the reality of COVID-19 containment in a rural French Commune with two ski resorts in the Northern Alps.

Challenges

One has to keep in mind that local authorities are often composed of good, willing but non-professional political leaders, especially when crises occur at the beginning of a political cycle (like now in France with the ongoing process of local elections). In big cities, the public service workforce can partially compensate for this lack of experience but in small towns (which are the vast majority of the 35 000 French “communes”), this is not the case.

During a time of crisis, local leaders have both to keep managing existing services and to respond to new challenges. They have to cope with the dilemmas associated with implementing the general guidance provided by national or international authorities and deal with any of the consequences.  They must respond to the expectations and fears among the population and address the effects of crisis measures on pre-existing patterns of behaviour (for example: impact of long-term lockdown on domestic violence).

That is why local level leaders who are on the fighting front of the crisis need to be empowered through support from central or regional governments.  This is all the more important as during times of crisis, people have a tendency to turn towards local officials to get information about all kinds of topics.

Needs

Proper narratives: people are not always familiar with the expected roles of officials within the different layers of public authorities.  When they meet the mayor, they expect him or her to be able to explain the reasons behind measures being taken by national government. If they fail to provide these explanations, their credibility as local officials will be questioned. This will undermine their future ability to take part in crisis management effectively. It is important that central authorities make a strong effort to disseminate their directives. They should also provide explanations to local leaders that can be conveyed to the public through effective messaging. This will ensure people’s trust. The COVID-19 pandemic evolves rapidly and rapid shifts in tactics will be necessary often with little warning. If the shift is to be synchronous directives must be disseminated thoroughly with a clear indication of direction and principles for working. 

During a 10-day period the French government’s COVID-19 response strategy intensified.  Some of the subsequent decisions appeared to be inconsistent with the change. 

  • On Thursday 12th March, the President announced the closing of schools, creches and universities for the following Monday, urging fragile people to stay at home but confirming that local elections 1st round will take place on Sunday, as initially planned.
  • On Saturday 14th March evening at 7.00 pm, the Prime Minister announced that bars, restaurants and establishments open to the public will have to close (enforcement of this measure at midnight the same day).
  • The following Wednesday 18th March evening, the government decided that the second round of the elections and the entry into function of the mayors elected during the 1st round (which is the case of 30 000 / 35 000 “communes”) would be postponed to May 15th (best case).

For local leaders, the situation was complicated: up to the middle of the week, the incumbent mayors were not sure if they would stay in charge or if they would have to pass the responsibility to their successors. In the meantime, they had to manage in 48 hours the closing of ski resorts (making sure that hotels and flats were empty and that restaurants and bars respected the closing order). During this process, they had to manage the dissatisfaction of all tourism actors who were afraid of the consequences of the brutal end to this tourist season (unforeseen losses, stock management, especially for food and beverages, firing of seasonal workers, and so on).

A single point of contact: under the pressure of events and people, local leaders have little spare capacity to make sense of the different directives received from various central government departments.  They do not have time to spare for identifying the proper point of contact to get things done. In times of crisis, the responsibility chain of central government has to be as simple as possible to ease the tasks being faced by local actors. The usual organization model of central government (specialized departments with different interlocutors to manage) is not appropriate to crisis management.

  • in France, local leaders have to interact with at least two tiers of government. The “administrative” tier is led by the “Préfet” who has a responsibility for most of the local services of the central government in a sub-regional “département”. 
  • The health tier implements services that are the responsibility of central government through the “Agence régionale de santé”.  
  • In the commune, as the consequences of the pandemic are being managed, it is not easy to separate clearly the issues that need to be handled through the public health and the administrative tiers. In practice the work of the two tiers could have been even more coordinated in the early stage of the crisis.
  • The administrative tier gives instructions to local authorities about closing shops and restaurants before the public health tier provides proper narrative about the virus spreading. Consequently, it is very hard – within the commune – to provide a clear explanation about the necessity for closing shops and restaurants in ways that ensure people’s cooperation.

Accurate and understandable information on crisis evolution: locally you need continuous access to up-to-date and reliable information on the crisis to be able answer people’s expectations, to fight the effects of “fake news”, to be able to shape a crisis management operation at the local level and to take proper decisions. Moreover, communication should not be too technocratic. For example in French government communication, the phases 1,2, 3 of the crisis are characterized only in medical terms (spreading speed, number of infected people,…) without being associated with description of concrete consequences on daily life (at which phase are the restaurants closed, the containment implemented, etc…).

  • The Medical Services of the Commune received limited guidance from the Agence régionale de Santé. The staff of the service made their own assessments of the situation and recommended to the mayor that the outdoor markets be closed.
  • Three days after, the Government released norms indicating that outdoor markets food stores and stalls can be open if they have permission. Consequently, trade unionists representing these shopkeepers threatened to sue the municipality for its closing decision.

Accurate information on whether existing provisions can be adapted and whether additional means are available: to implement the most urgent measures, local authorities need to have a clear sense of the extent to which they are able to adapt existing provisions and any logistical support they will receive.

  • Human resources: To enforce the containment measures, local police have to patrol the entire territory of the municipality which is huge and mountainous. Many people prefer to go hiking rather than stay at home, especially when the weather is nice. But, the municipality has only 4 local policemen. The mayor has to know if he is temporarily allowed to hire extra staff and the procedures he should use.
  • Priority personnel:  The municipality has a home meals delivery service for elderly and isolated people. To maintain it during the COVID-19 crisis, the agents in charge should wear masks to avoid putting the most fragile at risk. But they are not considered as “priority personal” in the list provided by the government. As a consequence, the pharmacist is not allowed to deliver masks to the agents and the home delivery service is at risk…

Conclusion

In conclusion, Dr David Nabarro writes: These notes reflect the reality of the effort to contain an unfolding disease pandemic that is affecting people in our towns and villages. The success of the response depends on how people behave within their communities and the extent to which healthy behaviours are facilitated by officials from both central and local government. 

Locally elected officials bear a huge responsibility.  We would be wise to remember that they are just local people who have volunteered to give up a huge amount of their time and energy in order that they might make their localities better places for all to live, work and play. They are not relief professionals, and they have limited resources to cover local response costs.

We struggle to find enough people who are willing to give up their time, so generously, for their communities.  We salute you for your commitment and impact.

If you feel your community leaders need support, now is the time to step up.

And, we must remember to be grateful to those amongst us who are prepared to shoulder such challenges on our behalf.



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 – 65, as of 10:00 CET 26 March 2020

→ WHO Risk Assessment Global Level VERY HIGH
→ 462,684 confirmed cases (+49,219 new in the last 24 hours)
→ 20,834 deaths (+2,401 in the last 24 hours)
→ 3 new countries/territories/areas has reported cases of COVID-19 in the past 24 hours (Saint Kitts and Nevis, Guinea-Bissau, Mali)
→ UN launches US$21 billion COVID-19 Global Humanitarian Response Plan
→ WHO Director-General mentions key issues and action steps, including maintaining physical distance, not social distance
New guidance for health services and on cross-border collaboration
→ Maintenance of precautions on droplet and contact for healthcare workers and use of PPE


1 Comment
  1. In Africa we have to stress on the issue of cross border and the quarantine system to be in place!
    Food security and sanitary equipment will be a major cause of concern.
    Social distancing in Africa is questionable because of culture and other tribal practices.
    Community and Religious leaders should be involved in educating properly the community
    Vidya Charan
    Executive Director
    Family Planning Association of Mauritius

    Reply

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