21 April 2020, COVID-19 Narrative Twenty

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

COVID-19 will not go away in the foreseeable future: it will remain a threat to us all and we need to find ways to live with it. Every company needs to think now about how to do more physical distancing, and how to manage requests for sick days for those who feel ill. It is a huge mistake to delay preparations until the local authority decides that it is safe for staff to return to work. The time to get ready for new ways to work and to discuss them with each other is now. 

Communication matters: do not go silent.

The release from lockdown in society will be phased and dependent on certain conditions being in place. There is no hard and fast judgement on when it is appropriate to release lockdown and for whom. This will be a political decision that balances the health risk, the needs of the economy, social responsiveness and the capacity to detect and react to any re-emergence of the disease.

Effective locality defences against COVID.

Localities that have effective defences against COVID-19 will be familiar with the following sequence of activities and everyone will understand the importance of following it to maintain a reasonably normal life in the presence of the disease.

  • SUSPECT – if you think you might have the disease…
  • ISOLATE – isolate yourself immediately
  • REPORT – your suspicions (through an app or call centre)
  • TRIAGE – get triaged by trained staff (such as a dedicated telemedicine centre)
  • TEST – get tested (assuming a virus test is available)
  • TRACE – your close contacts from the day before symptoms started (maybe with an app)
  • ISOLATE – ask them to isolate themselves and be tested if they have symptoms
  • PROTECT – people who are vulnerable, especially older people and those with chronic illnesses

If someone is seriously ill, they will need quickly to be referred for medical care. This may occur suddenly in vulnerable people.  

How this impacts on business

Businesses based in localities where this is not in place have a high risk to business continuity. Localised infections can very rapidly turn into significant and dangerous outbreaks if cases are not identified and chains of transmission broken swiftly. These are some things business might consider;

  • Trust – where staff report as self-isolating you will need to ‘trust by default’ that this is an honest response. There may need to be a cultural shift in attitudes to sickness and absence.
  • Support – self-isolating staff will need to know the expectations the business places on them and the support they will receive in terms of pay and contact from line management.
  • Temperature – taking people’s temperature at the entrance to workplaces or simply asking how they are feeling against a checklist of symptoms helps early identification of cases
  • Test – where testing can be carried out in the workplace it may give reassurance to staff that they and their colleagues are clear, it may reduce the likelihood of significant local business interruption through early identification of cases at work and it supports the locality defence effort by widening the access to testing. Making testing readily accessible in the workplace would be a significant advantage.
  • Trace – businesses can support the tracing process by identifying recent contacts for self-isolating staff.

Things for businesses to consider

There are number of other things that businesses might do to reduce their risk level and safeguard their employees.

  • Travel to work – public transport places people in close proximity for a significant period of time. Providing collective travel to work can reduce the range of contacts employees will contact each day and so reduce anxiety.
  • Work from home – lockdowns have shown just how much work doesn’t require physical proximity. Staggered working days and hours for staff who must physically attend a place of work can reduce the numbers of people who come into contact with each other. Re-examining the need for some staff to attend a physical place of work at all might now be more appropriate.
  • Physical distancing – many logistics and production processes need not place people in close physical proximity. Office environments may be more difficult. Consider leaving empty desks between people; EasyJet have announced they will leave the middle chair empty on their flights when they reopen for business. How will you manage people sharing elevators or mixing at the coffee machine or photocopier?
  • Hot-desking – include a hygiene practice for cleaning workspaces at the end of a hot-desking session. Look at booking processes to stagger occupation of desks so people are not placed in close proximity. Examine cultural practices where people ‘cheat the system’ to ensure they get a spot; consider ‘allocation’ rather than ‘booking’.
  • Face-coverings – providing face-covering for all staff such as masks minimises transmission and ensures good practice is followed in the workplace.
  • Self-certification – consider a protocol or ‘etiquette’ for being ‘Covid-Ready’. Include handwashing, covering when coughing, wearing of PPE, revealing if you have the symptoms of covid-19, reporting who you have been in close contact with. Ensure staff read it and sign to say they are following it.

Responding to events

In each country or locality, the process of release from lockdown and hence return to work may vary. Businesses will have to plan for various eventualities and communicate effectively with staff.

  • Have a COVID-19 working group that is constantly monitoring intelligence locally, nationally and globally about the disease and can therefore give advice and guidance to decision makers on the situation and what others are doing.
  • Engage staff in decision making either directly or through their representatives in order to gain maximum compliance with any new practices or requirements.
  • Create a regular COVID-19 briefing process that keeps staff informed as to events and any changes in working practices. Make sure there is a two-way communication channel so intelligence can quickly spread.
  • Establish clear protocols for reporting and responding to any suspected outbreaks.


The combination of all these measures will allow business leaders to feel into the pace at which they start to open their workplaces, the new rhythm of activity and the ‘COVID-Readiness’ of their business. Using transparent and robust principles will create a sense of reassurance and security that will build solidarity necessary to return to work safely.

Now is the moment for business leaders to take these matters forward.  They need to discuss these reforms with staff, their representatives, HR, suppliers and contractors so that everyone understands what is necessary to go back to work safely and without regret.

Fear is insidious; we need to be clear about the extent of changes and the deep commitment to the precautionary principle. We will then be able to achieve the trust of our colleagues in a return to work.

Download Narrative Twenty as PDF English (89kb)

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 – 91, as of 10:00 CET 20 April 2020.

→ WHO Risk Assessment Global Level VERY HIGH
→ 2,314,621 confirmed cases (+72,846 new in the last 24 hours)
→ 157,847 deaths (+5,296 in the last 24 hours)
→ WHO publishes brief on a brief on the use of non-steroidal anti-inflammatory drugs
→ WHO publishes updated strategy to guide the public health response

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