Strengthening Preparedness for COVID-19 in Cities and Urban Settings - Interim Guidance for Local Authorities
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Strengthening Preparedness for COVID-19 in Cities and Urban Settings Interim Guidance for Local Authorities
1 Strengthening Preparedness for COVID-19 in Cities and Urban Settings WHO/2019-nCoV/Urban_preparedness/2020.1 © World Health Organization 2020 Some rights reserved. This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 IGO licence (CC BY-NC-SA 3.0 IGO; https://creativecommons.org/licenses/by-nc-sa/3.0/igo). Under the terms of this licence, you may copy, redistribute and adapt the work for non-commercial purposes, provided the work is appropriately cited, as indicated below. In any use of this work, there should be no suggestion that WHO endorses any specific organization, products or services. The use of the WHO logo is not permitted. If you adapt the work, then you must license your work under the same or equivalent Creative Commons licence. If you create a translation of this work, you should add the following disclaimer along with the suggested citation: “This translation was not created by the World Health Organization (WHO). WHO is not responsible for the content or accuracy of this translation. The original English edition shall be the binding and authentic edition”. Any mediation relating to disputes arising under the licence shall be conducted in accordance with the mediation rules of the World Intellectual Property Organization. Suggested citation. Strengthening preparedness for COVID-19 in cities and other urban settings: interim guidance for local authorities. Geneva: World Health Organization; 2020 (WHO/2019-nCoV/ Urban_preparedness/2020.1). Licence: CC BY-NC-SA 3.0 IGO. Cataloguing-in-Publication (CIP) data. CIP data are available at http://apps.who.int/iris. Sales, rights and licensing. To purchase WHO publications, see http://apps.who.int/bookorders. To submit requests for commercial use and queries on rights and licensing, see http://www.who.int/about/licensing. Third-party materials. If you wish to reuse material from this work that is attributed to a third party, such as tables, figures or images, it is your responsibility to determine whether permission is needed for that reuse and to obtain permission from the copyright holder. The risk of claims resulting from infringement of any third-party-owned component in the work rests solely with the user. General disclaimers. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of WHO concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by WHO to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO be liable for damages arising from its use. Design and layout: ACW, London, United Kingdom
Interim Guidance for Local Authorities 2 Index Acknowledgements 2 Executive summary 3 I Introduction 4 II Target audience and purpose 4 III Why urban settings are unique 4 IV Considerations in planning for urban preparedness for COVID-19 5 V Key areas of focus for urban preparedness for an effective 7 response to COVID-19 1 Coordinated local plans in preparation for effective response to 7 health risks and impacts 2 Risk and crisis communication and community engagement that 7 encourage compliance with measures 3 Contextually appropriate approaches to public health measures, 8 especially physical distancing, hand hygiene and respiratory etiquette 4 Access to healthcare services for COVID-19 and the continuation of 10 essential services VI Preparing for future emergencies 11 Additional resources 11 References 12 Annex 1: Considerations and recommendations for urban areas in 14 preparing for COVID-19 Acknowledgements This interim guidance was developed by Marc Ho, Stella Chungong, Abbas Omaar, Xing Jun, Ludy Suryantoro and Nirmal Kandel of the Health Security Preparedness Department of the WHO Health Emergencies Programme. WHO also wishes to thank the following for their valuable inputs: • Local Authorities: Greater London • WHO Regional Office for Europe Authority, United Kingdom; Local Health (Haris Hajrulahovic, Monika Kosinska, Authority ASL Roma 1; Italy; Local Tanja Schmidt) Authorities of Surabaya and Semarang, • WHO headquarters: Social Indonesia; and a city in Japan Determinants of Health (Etienne Krug, • Government of the Republic Tamitza Toroyan), Health Promotion of Singapore (Faten Ben Abdelaziz, Ruediger Krech); • Norwegian Public Health Institute Environment, Climate Change and (Hinta Meijerink, Siri Hauge) Health (Nathalie Roebbel), Health • Resolve to Save Lives Security Preparedness (Frederik Copper, (Amanda McClelland) Jonathan Abrahams, Jostacio Lapitan, • UN-Habitat: COVID-19 Core Kathleen Warren, Luc Tsachoua Choupe, Coordination Team; Urban Practices Qudsia Huda, Romina Stelter, Stephane Branch; Programme Development De La Rocque); Global Infectious Branch; Geneva Office (Graham Hazard Preparedness (Maria Van Alabaster) Kerkhove, Sylvie Briand)
3 Strengthening Preparedness for COVID-19 in Cities and Urban Settings Executive summary • e nsure adequate housing, reduce risk of homelessness and anticipate outward- Preparedness in cities and other urban migration and mobility; settlements is critical for effective national, • ensure that due consideration is given to regional and global responses to COVID-19. maintaining good mental wellbeing; These settings face unique dynamics that • ensure that measures are rooted in a affect preparedness – they serve as travel robust evidence-base as far as possible hubs, have a higher risk of disease spread due and account for the resulting impact on to high population densities, and many have lives and livelihoods. extensive public transport networks. Diverse subpopulations have different sociocultural In addition to the COVID-19 strategic needs and contain vulnerable groups. Some preparedness and response plan (SPRP)1 live in crowded and substandard housing, lack and the COVID-19 strategy update2, there access to safe water, sanitation and hygiene are four key areas that local authorities of facilities, and those in informal settlements are cities and urban settlements should focus also more often unemployed or dependent on on in ensuring preparedness for a robust informal economies. Cities also have centres response to COVID-19: for advanced medical care and are critical to • coordinated local plans in preparation broader health systems. Local authorities have for effective responses to health risks governance and policy-making responsibilities and impacts; and play an important role throughout the emergency management cycle – from • risk and crisis communication and preparedness and readiness to response to community engagement that encourage and eventual recovery from COVID-19. compliance with measures; • contextually appropriate approaches To be effective, any public health measure to public health measures, especially must be implementable and designed in physical distancing, hand hygiene and a way that will promote willingness to respiratory etiquette; and comply. Urban authorities should: • access to health care services for • adopt a coordinated multisectoral, COVID-19 and the continuation of whole-of-government and whole-of- essential services. society approach; • promote coordination and coherence in During recovery or between epidemic measures across governance levels; peaks, cities and other urban settlements • identify existing hazards and vulnerabilities; should refer to the interim guidance on • identify and equitably protect vulnerable adjusting public health and social measures subpopulations; in the context of COVID-193, in ensuring that the stepping down of measures • consider diverse social and cultural is in keeping with the considerations interactions with health issues, norms described, is balanced against the risk and perceptions; of disease resurgence, and ensures that • consider the extent of reliance on the any escalation of spread can be rapidly informal sector or economy; detected. Urgent actions for COVID-19 • consider the most appropriate means of must set the stage for sustainable capacity communication of information; development for concurrent or future • ensure continued provision of essential health emergencies. Documentation, services; learning and sharing of COVID-19 • ensure that health facilities are prepared experiences will help to inform and build for COVID-19 and identify and mobilize better preparedness for reducing the risks additional resources; and impacts of future health emergencies.
Interim Guidance for Local Authorities 4 I. Introduction III. Why urban settings are unique Cities and other urban settlements are at risk of COVID-19. Many densely Cities, including megacities, are highly populated areas have experienced complex settlements that are regionally high case numbers and deaths, which and globally dependent on each other reflects the ease of introduction and and on neighbouring towns, rural areas spread of the virus in such places. Urban settings face unique dynamics that have and places where migrants come from. a direct impact on the achievement They often serve as subnational, national of preparedness for all types of health and international hubs, with major points emergencies, including COVID-19. of entry (e.g. airports, seaports, ground These dynamics shape the capacity crossings). These transport routes often of authorities to mount an effective serve as foci for transmission. Given response, which further underscores the high population density, the risk of the need to learn from the experiences spread of infectious diseases is often and best practices of others, implement elevated, especially in congested areas appropriate measures for preparedness (e.g. crowded sidewalks, supermarkets, before a public health emergency occurs mass gatherings including cultural, and to adjust them as necessary. sporting and religious events), and their people often rely on extensive and II. Target audience crowded public transportation networks to get from one place to another. There and purpose are also communities with crowded and substandard housing, have shared This document aims to support local authorities, leaders and policy-makers toileting facilities, and that lack access in cities and other urban settlements to safe water, sanitation and hygiene in identifying effective approaches (WASH) facilities. – taking into consideration urban vulnerabilities – and in implementing Urban areas also have diverse recommended actions that enhance the subpopulations and neighbourhoods prevention, preparedness and readiness with different sociocultural needs and for COVID-19 and similar events in vulnerable groups with regards to public urban settings, and that ensure a health emergencies, including COVID-19 robust response and eventual recovery. (see examples in Table 1). Rapid rural– It covers key areas unique to urban urban migration in many parts of the settings, supplements other COVID-19 world has resulted in unmanaged and documents, including the WHO strategic unplanned urbanization, including the preparedness and response plan (SPRP)1 development of informal settlements. A and the strategy update2, and is neither substantial proportion of those living in exhaustive nor prescriptive. such settlements are often unemployed or dependent on informal economies There are many variations in definition to survive. There can also be a great for the term “urban setting”. For the variety of sources of information, purposes of this document, it refers including word-of-mouth, leading to an to areas with a large and dense increased risk of misinformation that can population that may be within certain compound health emergency challenges administrative or political boundaries4. in urban areas.
5 Strengthening Preparedness for COVID-19 in Cities and Urban Settings Table 1: IV. Considerations in planning Examples of vulnerable for urban preparedness groups in urban settings for COVID-19 in COVID-19 outbreaks Optimal preparedness in cities and urban settlements is critical for effective national, • Informal settlements regional and global responses to COVID-19. • Urban poor The strategic preparedness and response • Homeless and people living in plan1; the strategy update2 and critical inadequate housing conditions preparedness, readiness and response • Refugees and migrants including actions5 provide key considerations and labour markets actions that all countries need to take for • Older persons, especially those at COVID-19. To be effective, any public risk of isolation health measure must be implementable • Persons with underlying medical and designed in a way that will promote conditions willingness to comply. As such, in planning for health and other sectors across all • Socially marginalized groups stages of emergency management, urban • Individuals at risk of interpersonal authorities need to additionally undertake violence or self-inflicted harm due to the following. physical distancing measures 1. Adopt a coordinated multisectoral, whole-of-government and whole-of- Cities often have referral centres for society approach to preparedness to tertiary and specialized medical care, harness local resources in ensuring the although some serve large populations effective implementation of measures with poor access to care – at times due (see examples in Table 2). This includes to financial barriers – or have health accounting for the way that public systems at risk of being overwhelmed services are organized and financed when there is a surge in patient demand. locally, and for the roles of civil society These hospitals and health facilities are and the private sector. often critical to the strength of broader local and national health systems. Cities Table 2: also act as points of entry for the arrival of medical and humanitarian aid. Examples of sectors that Collectively, these dynamics call for should be involved in unique preparedness measures for COVID-19 preparedness cities and other urban settlements. The in urban settings presence of pressing health vulnerabilities and social disparities requires that they • Health address the needs of the most vulnerable • Social services / protection populations and build resilience in an • Mental health services inclusive manner. Local authorities • Transport have governance and policy-making • Housing and energy responsibilities that often include some • Education public health or health services and play • Communication an important role in the whole emergency • Water, sanitation, hygiene management cycle – from preparedness • Civil defence, security and readiness to response and eventual • Commerce and economy recovery from COVID-19. This includes • Veterinary and animal health rapidly establishing new governance arrangements and partnerships to address • Parliamentarians the crisis. • … and many others
Interim Guidance for Local Authorities 6 2. Promote coordination and society, and possibly a source of coherence in measures across essential goods such as food and fuel. different levels of governance, Measures that disrupt the informal from national to intermediate (e.g. sector and livelihoods could affect the state) and municipal/ local levels. ability of populations to comply and may compromise access to essential 3. Identify existing hazards and services and lead to increased levels of vulnerabilities that could emerge as crime and insecurity. concurrent health emergencies that may need to be managed alongside 7. C onsider the most appropriate COVID-19. This includes the use of means of communication of local risk assessments, profiles and information, including online and mapping based on epidemiological device access. This includes their use risk, and the anticipated risks that by off-site government teams and may emerge from the implementation other stakeholders in coordinating of public health measures. the response and in interactions with 4. Identify and equitably protect the general public. vulnerable subpopulations at risk of poorer outcomes (see Table 1) and 8. E nsure continued provision identify partners who may be able of essential services including to reach out to these people. This emergency medical and surgical includes considering the likely impact services, sexual and reproductive of the pandemic and public health health services, drug and alcohol measures on mental health and misuse services, vaccination, public introducing safeguards, as well as transport, energy supplies and the continued provision of essential repairs, housing, communication, social services. water, sanitation and garbage disposal with safe management of 5. Consider the diverse social and infectious hazards. cultural interactions with health issues, norms and perceptions in 9. Ensure that existing health facilities subpopulations that may influence are prepared for COVID-19, and the local uptake and effectiveness of identify and mobilize additional public health measures. This includes resources including those owned working with community-based by local government, available in the organizations or ethnic/religious community and other sectors, and media channels that may be trusted that can be repurposed or contribute by certain communities. It is thus to preparedness or response activities important to provide clear public (e.g. faith-based organizations, health messages that are tailored to manufacturing plants). This includes different audiences and communities identifying human resources and and that are transmitted by suitable facilities to supplement health care means. Cultural and religious traditions facilities in anticipation of a surge of are also important considerations in patient demand. Stadiums, convention the management of deaths. centres, hotels, dormitories, military health personnel, logistics and 6. Consider the extent of reliance on engineering sectors, including the informal sector or economy as collaboration with higher authorities an important source of livelihood, at the intermediate/state and especially for poorer segments of national/federal levels;
7 Strengthening Preparedness for COVID-19 in Cities and Urban Settings 10. Ensure adequate housing, reduce V. Key areas of focus for the risk of becoming homeless and anticipate outward-migration and urban preparedness for mobility of population subgroups, an effective response including liaison with the local to COVID-19 authorities at their destinations to contain further spread and ensure There are four key areas that local social protection and basic needs. authorities of cities and other urban settlements should focus on to prevent 11. Ensuring that due consideration is the spread of COVID-19 and to develop given to maintaining good mental resilience to and preparedness for wellbeing. This includes, where events of a similarly disruptive nature appropriate, daily access to outdoor (see Annex 1 for more details). space for exercise and ensuring safe access to public areas such as keeping parks open, with measures 1. Coordinated local plans in to reduce crowding and maintain preparation for effective physical distancing. responses to health risks and impacts 12. E nsure preparedness measures are rooted in a robust evidence-base Cities are at the frontline in implementing as far as possible and account for the measures adopted by national the resulting impact on lives and governments such as the issuance of livelihoods. This includes proactively stay-at-home notices and the closure of searching to determine how similar public areas. These include nationwide urban settings have managed measures or tailored measures in line COVID-19, learning and appropriately with national frameworks. Cities also adapting from their experiences, and complement efforts by addressing sharing evidence with one another. challenges on the ground, for example by Local authorities should build on their introducing targeted measures for specific experiences of COVID-19 to build vulnerable groups. sustainable capacities for longer-term health threats. Each city and urban settlement is unique and should develop, adapt and implement its own local multisectoral and inter-jurisdictional plans to ensure that measures for COVID-19 and similarly disruptive events meet the needs of local populations. Plans must be flexible enough to react to rapidly changing epidemiological situations and account for local contexts and capacities to respond. Local authorities can also learn from similar urban settings that have already had experience of managing COVID-19.
Interim Guidance for Local Authorities 8 Furthermore, coordination between scientific and public health messages different levels of government should be identified11. when responding to health emergencies is essential. Regardless Communications should be paired with of decentralization, cities and urban active community involvement and the settlements need to coordinate with co-creation of solutions, such as the higher authorities in the country6. mobilization of volunteers through civil society organizations, civil protection and Examples: universities for the rapid deployment of • London, United Kingdom, has knowledge and innovation. These can established a Mutual Aid Cell that improve the chances of compliance, deploys volunteers and other public especially among vulnerable populations. health expertise around the system to It may also be challenging for people address capacity needs7. to adhere to stay-at-home orders for • Through a COVID-19 Presidential Task long periods of time, which may have an Force, cities such as Lagos, Abuja and impact on mental well-being12. Cities and Kano, Nigeria, have been able to take on other urban settlements should consider a comprehensive multisectoral approach leveraging their advantage in the delivery to preparedness8. of essential services, including food supply, • The Bloomberg Philanthropies’ WASH, health and social services in densely Partnership for Healthy Cities has populated neighbourhoods, especially for created a learning and sharing network vulnerable groups. Local authorities should for urban COVID-19 response9. also work with organized community • United Cities and Local Governments groups (e.g. micro-credit groups, women’s and UN-Habitat have launched the Live and youth networks, those engaged in Learning series of webinars to allow for informal settlements) to identify the learning and sharing of local experiences most vulnerable within communities, and COVID-19 responses10. combat misinformation and stigma, and enable access to medical and other essential services. 2. Risk and crisis communication and community engagement Examples: that encourage compliance • Singapore city implemented a with measures communication strategy that regularly involved its Prime Minister and a WhatsApp Clear and consistent public health system that transmits the Government’s messages are needed for all segments messages in the four official languages13. of society. This includes communicating local ordinances and other regulatory • Religious leaders in some Africa cities, measures to limit spread so as to such as in Nairobi, Kenya, have been facilitate compliance. Advantage working with local governments to provide should be taken of all the multiple worshipers with information on how to opportunities available in urban settings protect themselves from COVID-1914. to disseminate information that • Municipal police in some cities in Turkey supports preparedness and response have been taking food orders from elderly measures in order to help counter the people and delivering them to their potentially rapid spread of misleading, homes15. Likewise, the Tunis municipality ambiguous, and false information. The has been home delivering essential food right channels and community-based to vulnerable populations to strengthen networks and influencers to promote compliance with the general lockdown16.
9 Strengthening Preparedness for COVID-19 in Cities and Urban Settings • K erala, India opened community while maintaining physical distancing. kitchens and has been delivering cooked This includes operational changes to food at a low price to ensure that no one maintain public transport services for goes hungry during the lockdown17. health and essential workers while • New York City has launched a website avoiding crowding. In some places, to involve residents in the city’s promoting safe active mobility (e.g. response to COVID-19 by self-reporting cycling and walking) that also supports symptoms with a view to obtaining healthy behaviours may help. There may a better picture of where potential also be a need to temporarily convert COVID-19 patients or people in self- narrow vehicular roads to exclusive use quarantine are, and to facilitate the city by pedestrians. government’s communications with those populations18. Those that rely on the informal economy/sector may have difficulties 3. Contextually appropriate in complying with measures such approaches to public health as the mandated closure of non- measures, especially physical essential businesses and restrictions on distancing, hand hygiene and population movement. Such closures respiratory etiquette may also increase job losses, especially in the food sector, and affect producers Timely implementation of public health who rely on these markets. Cities and measures, especially physical distancing, urban settings can explore coordination hand hygiene and respiratory etiquette, with non-profit and private sectors to are important to slow transmission of mitigate losses in food and agriculture respiratory diseases such as COVID-19 while maintaining access to food, and to allow health facilities to cope especially for vulnerable subpopulations. better with patient demand. Given their In addition, ways to link businesses densely populated nature, physical and consumers, such as through the distancing in cities and other urban internet, should be encouraged. settlements may be harder for many to achieve (e.g. multiple families Where possible, cities and urban in a shared space). Where physical settlements should introduce measures distancing in domestic settings is not to enforce physical distancing in public feasible, local authorities should identify spaces, markets and streets without public facilities where people can be closing them entirely. This includes placing quarantined. Local authorities should markings on the ground and restricting provide temporary and emergency the direction of walking. Support by accommodation to those without secure religious leaders should also be sought for housing to enable physical distancing. suspending or modifying observances and Furthermore, extraordinary measures ceremonies. Advice on the use of masks may be necessary to secure the right to in the context of COVID-19 should also housing by implementing measures such be based on the interim guidance that has as moratoriums on evictions, deferring been published19. mortgage payments and suspension of utility costs. Some areas, such as informal settlements, may not have adequate Measures should balance the continued access to safe WASH, which may make provision of essential goods and services it difficult to comply with generic hand-
Interim Guidance for Local Authorities 10 washing recommendations. These 4. Access to healthcare services for challenges necessitate community COVID-19 and the continuation consultation and education, anticipating of essential services and meeting critical economic and basic (e.g. food and water) needs, and Urban settings often have national innovative approaches to improving referral centres and need to be access to wash stations, soaps and prepared to manage surges in demand. disinfectants, including deploying This includes having a plan for case additional WASH infrastructure. This management of COVID-19 in health includes in facilities in public buildings, facilities and the community31,32, ways to health care settings, schools and public increase the capacities of health services transport stations20,21. and transfers between health facilities for load-balancing. Where possible, cities Examples: and urban settlements should project • In Ethiopia and Kenya where soap and surge using modelling and health care water are in low supply, antimicrobial data from affected areas. Barriers to fabric requiring a minimal amount of accessing health care, including testing, water22, water-efficient taps and low- may be amplified during emergencies cost foaming soaps have been tested23. and should be addressed to maximize • Sao Paulo City Hall, Brazil has also installed continued access by all who require sinks with potable water in streets to improve it. Social care plays an important role hand hygiene in crowded locations24. in providing access to healthcare and • The number of passengers allowed on supporting demand management within board a single bus has been reduced in the healthcare system. Essential health Latvia, with passengers only allowed to services for other medical conditions, take every second seat25. In some cities, including vaccinations, must continue to sale of tickets by bus drivers has stopped prevent excess morbidity and mortality33. and passengers are only allowed board Continuation of primary health care through rear doors26. Bogota, Colombia, services is also essential and, where possible, technological solutions such closed streets to cars to create more as telemedicine should be considered. space for people to walk and cycle, Scarce personal protective equipment promoting physical distancing in their (PPE) should also be prioritized for daily commute27. health care workers to ensure sufficient • Morocco introduced measures to help protection while carrying out their work. families and individuals working in the informal sector directly affected by the Ensuring the continuity of essential COVID-19 lockdown28. services beyond health also contributes to • The Municipality of Barcelona, Spain, the prevention and control of COVID-19. finalized an agreement with the Touristic This includes having a clear list of essential Business Association to allocate 200 public services and infrastructure, apartments, originally destined for ensuring prioritization and their continued tourism, as emergency housing for provision, whether provided by local families in vulnerable situations and governments or independent service homeless29. Rio de Janeiro, Brazil has made providers. Essential services include social rooms available in local hotels to host services, including home care, public elderly residents of informal settlements transport, WASH services including waste to enable proper physical distancing30. disposal, and food and energy supplies.
11 Strengthening Preparedness for COVID-19 in Cities and Urban Settings Examples: risk3. This includes assessing the • Private hospitals in Islamabad, Pakistan sustainability and impact of measures, have offered beds, isolation rooms and especially for vulnerable groups. ventilators to increase the city’s capacity in managing COVID-134. Urgent actions taken by cities and • The Jawaharlal Nehru Stadium in New other urban settlements for COVID-19 Delhi, India, has been converted into a must set the stage for sustainable quarantine facility for COVID patients35. capacity development for concurrent or future health emergencies. Funding Madrid, Spain has converted an ice rink for managing COVID-19 should be into a morgue36 and London, United applied in a manner that contributes Kingdom has turned a convention centre to these interrelated objectives, and into a hospital for COVID-19 patients37. actions to respond urgently to the • Both Ministries of Health and of pandemic should transition into longer- University and Research in Italy term actions, anchored in plans and expedited the graduation of final- health systems that can surge to meet year medical students to increase the the needs imposed by other health healthcare workforce at city levels38. emergencies. Special consideration to • Cities in the United States of America these aspects should be given when have rolled out drive-through COVID-19 urban settings are in the preparedness testing sites to reduce demand on health and readiness phase, are moving from care facilities39. response to recovery or are between COVID-19 epidemic peaks. VI. Preparing for Future Cities and urban settlements should Emergencies also document, learn, share and adapt during their COVID-19 experience, In the transition to recovery or to periods including taking proactive steps to between epidemic peaks, cities and collect evidence and advocate for the urban settlements should ensure that the financing of sustainable capacities. phased transition away from measures When appropriate, they may also wish for COVID-19 is conducted in keeping to conduct a formal after action review with the considerations described (AAR). Doing so would ensure that above, and will enable the sustainable progress in emergency preparedness suppression of transmission at a low- made during the current outbreak level whilst enabling the resumption of confers benefits to the wider health some parts of economic and social life, system and helps to inform and build prioritized by carefully balancing socio- better preparedness for reducing the economic benefit and epidemiological risks and impacts of future events. Additional Resources Local authorities of urban settings may find additional information on COVID-19 that is relevant to them at the following website: https://www.who. int/teams/risk-communication/cities-and-local-governments/ Additional preparedness resources can be found at the Strategic Partnership for IHR and Health Security Website: https://extranet.who.int/sph/
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13 Strengthening Preparedness for COVID-19 in Cities and Urban Settings 22. White S, Petz JF, Desta K, Larsen TH. Could the Supertowel be 32. Operational considerations for case management of COVID-19 used as an alternative hand cleaning product for emergencies? in health facility and community. Geneva, World Health An acceptability and feasibility study in a refugee camp Organization, 2020. (https://www.who.int/publications-detail/ in Ethiopia. PLOS One. 2019;14(5): e0216237. https://doi. operational-considerations-for-case-management-of-covid-19- org/10.1371/journal.pone.0216237. in-health-facility-and-community, accessed 24 April 2020). 23. Whinnery J, Penakalapati G, Steinacher R, Wilson N, Null C, 33. COVID-19: Operational guidance for maintaining essential Pickering AJ. Handwashing with a water-efficient tap and health services during an outbreak. Geneva, World Health low-cost foaming soap: the Povu Poa ‘‘Cool Foam’’ system in Organization, 2020. (https://www.who.int/publications-detail/ Kenya. Glob Health Sci Pract. 2016;4(2):336–41. https://dx.doi. covid-19-operational-guidance-for-maintaining-essential- org/10.9745%2FGHSP-D-16-00022. health-services-during-an-outbreak, accessed 24 April 2020). 24. Updates from March 26 to 31, 2020. Sao Paulo City International 34. Private hospitals in Islamabad offer 1,000 beds, 80 ventilators Affairs. 1 April 2020. (https://www.docdroid.net/kSmLieL/ for Covid-19 patients. Dawn. 25 March 2020 (https://www.dawn. covid19-pmsao-paulo-city-april01-pdf, accessed 24 April 2020). com/news/1543497, accessed 24April 2020). 25. Rules for public transport bus use change in Latvia to limit 35. Jawaharlal Nehru Stadium to be converted into quarantine Covid-19 spread. Baltic News Network. 27 March 2020 (https:// centre after Delhi government’s request: SAI. India Today. 30 bnn-news.com/rules-for-public-transport-bus-use-change-in- March 2020 (https://www.indiatoday.in/sports/other-sports/ latvia-to-limit-covid-19-spread-211793, 24 April 2020). story/coronavirus-pandemic-jawaharlal-nehru-stadium- 26. Meeting Report - Extraordinary Meeting of the WHO European quarantine-centre-delhi-governments-request-sai-training- Healthy Cities Network and National Network Coordinators. 19 centres-covid-19-patients-1661501-2020-03-30, accessed 24 March 2020. April 2020). 27. Colombia bans gatherings of more than 50, Bogotá and 36. Goodman A, Maestro LP, Formanek I, Ramsay M, Kottasová I. Medellín declare “calamity”. The City Paper. 16 March 2020 Spain turns ice rink into a morgue as coronavirus deaths pile up. (https://thecitypaperbogota.com/news/colombia-bans- CNN. 24 March 2020 (https://edition.cnn.com/2020/03/24/ gatherings-of-more-than-50-bogota-and-medellin-declare- europe/spain-ice-rink-morgue-coronavirus-intl/index.html, calamity/24114, accessed 24 April 2020). accessed 24 April 2020). 28. Kasraoui S, Hekking M. Morocco announces financial assistance 37. Coronavirus: Nightingale Hospital opens at London’s ExCel for informal sector workers. Morocco World News. 27 March centre. BBC. 3 April 2020 (https://www.bbc.com/news/uk- 2020 (https://www.moroccoworldnews.com/2020/03/297815/ 52150598, accessed 24 April 2020). morocco-announces-financial-assistance-for-informal-sector- 38. Di Donata V, McKenzie S. Fresh out of medical school, young workers/, accessed 24 April 2020). Italian doctors are being fast-tracked to the coronavirus 29. Barcelona dispondrá de 200 apartamentos turísticos para frontline. CNN. 30 March 2020 (https://edition.cnn. alojar a familias vulnerables. El Pais. 20 March 2020. (https:// com/2020/03/30/europe/italy-young-doctors-coronavirus-intl/ elpais.com/espana/catalunya/2020-03-20/barcelona- index.html, accessed 24 April 2020). dispondra-de-200-apartamentos-turisticos-para-alojar-a- 39. Yancey-Bragg N. Going to a drive-thru COVID-19 testing familias-vulnerables.html, accessed 24 April 2020). site? Here’s a step-by-step look at what to expect. USA 30. Agência Brasil. Rio: idosos de comunidades podem ficar em Today. 21 March 2020 (https://eu.usatoday.com/story/news/ hotéis para evitar covid-19. Correo Braziliense. 26 March health/2020/03/20/drive-thru-coronavirus-testing-step-step- 2020 (https://www.correiobraziliense.com.br/app/noticia/ look-what-expect/2873324001/, accessed 24 April 2020). brasil/2020/03/26/interna-brasil,839963/rio-idosos-de- comunidades-podem-ficar-em-hoteis-para-evitar-covid-19. shtml, accessed 24 April 2020). 31. Coronavirus disease (COVID-19) technical guidance: Patient management. Geneva, World Health Organization, 2020. (https://www.who.int/emergencies/diseases/novel- coronavirus-2019/technical-guidance/patient-management, accessed 24 April 2020).
Interim Guidance for Local Authorities 14 ANNEX 1: Considerations and recommendations for urban areas in preparing for COVID-19 Considerations in Objective Recommendations for Urban Areas Urban Areas Coordinated Local authorities • In developing a local COVID-19 response plan, adopt a local plans in may have local multisectoral and multi-stakeholder approach to preparation significant collaboration and coordination, including involvement for effective governance, of local authorities and relevant sectors in preparedness responses to coordination and and response plans. This includes the identification of health risks policy-making supply chains, mobilization of cross-sectoral workforce, and impacts responsibilities that engagement of local institutions, established community may change as the leaders and groups, and professional associations. outbreak evolves • Conduct capacity assessments and risk analysis: to determine potential hot-spots at high risk of transmission, such as marketplaces, public transport lines; to identify infrastructure vulnerabilities including location of vulnerable groups and their access to public services such as health care, WASH and food distribution; and to map local assets and facilities that can support the expansion and continuation of essential services. • Develop a coherent strategy to contain the spread and mitigate the impacts of COVID-19 during different stages of the outbreak. This includes approaches for contact tracing, quarantine for the exposed, isolation for those who are ill, access to food, and support to food systems in urban and outward-migration areas. • Guided by the COVID-19 strategic preparedness and response plan (SPRP) and national plans, determine and implement priority actions that would lead to better capacities to prevent, detect, assess and respond at the local level. Investments are also needed for sustainable capacities for future and concurrent emergencies beyond COVID-19. Local authorities • Establish and test two-way communication with (e.g. municipalities, higher authorities (e.g. subnational/state and national) governorates) need and surrounding local authorities, including regular to coordinate with updates on the local situation and federal/national surrounding and guidance on measures for preparedness and response. higher authorities • Establish and test two-way coordination with to ensure higher authorities and surrounding local authorities, coherent, aligned including access to supply chains and the deployment and effective of resources such as health care personnel, medicines, preparedness and supplies and other logistics. Local measures should be response aligned with nationwide measures or in keeping with national frameworks.
15 Strengthening Preparedness for COVID-19 in Cities and Urban Settings Considerations Objective Recommendations for Urban Areas in Urban Areas Coordinated Cities are highly • Develop, test and implement points of entry local plans in connected to preparedness measures with appropriate and preparation other parts of proportionate restrictions on non‑essential domestic for effective the country and and international travel. Plans should include the use response to internationally of points of entry for the delivery of medical and health risks and via points of humanitarian supplies. impacts entry • Develop measures to manage urban–rural movement and vice versa, to minimize disease spread and ensure support to food systems. The wealth of • Learn from the experiences and adapt relevant experience can actions of similar urban settings that are facing or have be shared with managed COVID-19. This includes the activation of others for better relevant inter-city networks, and through case studies preparedness collated by WHO and circulated through the Global and response Strategic Preparedness Network (GSPN). • Develop a mechanism to document actions on strengthening capacities, experiences and lessons, and share these with other urban settings. Risk and crisis Populations •D evelop, test and implement innovative but pragmatic communication have access to solutions for health risk communication appropriate and community multiple sources to the local context. This includes transparency, clarity engagement of information, and consistency, explaining the rationale of measures, that encourage some of which and the use of traditional, non-traditional and social compliance may lead to media. These messages may change as the situation with measures misinformation evolves and should be in local languages. •M onitor and analyse public perceptions, knowledge and attitudes (e.g. through rapid surveys), including identifying gaps and misinformation. •D evelop, test and implement proactive steps to correct misinformation. • Develop, test and implement health risk communication messages for specific groups of workers that need to be protected while conducting essential services (e.g. in grocery stores and postal services). Vulnerable • I dentify and map vulnerable subpopulations in urban populations areas, develop and test innovative but pragmatic are harder to solutions to reach out to these groups, and disseminate reach and may information, including through civil society partners. have challenges •D evelop pragmatic measures and evaluate their in complying expected impact on lives and livelihoods, especially for with measures, vulnerable populations. This includes considering the especially in areas sustainability of measures and their impact on physical, with housing social and mental health. inequalities [continued overleaf]
Interim Guidance for Local Authorities 16 Considerations Objective Recommendations for Urban Areas in Urban Areas Risk and crisis Vulnerable • Maximize the wide range of available community communication populations resources (i.e. adopting a local whole-of-society and community are harder to approach) for the outreach and implementation engagement reach and may of measures. This includes tapping on community that encourage have challenges leaders, social networks for community engagement compliance with in complying such as grassroot movements and religious leaders, measures with measures, and the private sector. especially in areas • Build on existing community networks used with housing for delivering other health intervention, such as inequalities immunization. Contextually There are • Develop and test possible innovative but pragmatic appropriate large numbers solutions for physical distancing in public places approaches to of people to appropriate to the local context. This includes public health manage, spread measures such as limiting mass gatherings, and measures, may be faster in the selective closure of enclosed public venues. especially congested places, Consider ways to promote physical distancing physical and there are in public spaces that remain open (e.g. green distancing, heterogenous and natural spaces, temporary closure of narrow hand hygiene subpopulations vehicular roads). and respiratory with unique needs • Develop and test possible innovative but pragmatic etiquette solutions to physical distancing in domestic settings appropriate to the local context. This includes home isolation of cases, home quarantine of contacts, and measures to limit movement out of homes while reducing overcrowding within homes. Where this is not feasible, the use of public assets and facilities should be explored. • Develop and test possible innovative but pragmatic solutions to limiting physical contact in social settings. This includes alternatives to handshakes, hugs and cheek kissing, as well as closures of schools, religious centres, entertainment venues, and limiting visits to elderly and chronic care centres and prisons. • Set in place protective measures to facilitate physical distancing measures (e.g. food delivery services, temporary and emergency housing in vacant units or repurposed buildings) and implement extraordinary measures to reduce the risk of homelessness, such as postponing rental and mortgage payments and evictions.
17 Strengthening Preparedness for COVID-19 in Cities and Urban Settings Considerations Objective Recommendations for Urban Areas in Urban Areas Contextually Physical • Engage businesses, associations and corporations in appropriate distancing implementing physical distancing measures, including approaches at centres of encouraging and testing business continuity plans to public commerce and including working from home where possible or necessary health economic activity, and substituting physical shopping with delivery services / measures, that employ options for pick-up. especially large numbers of • Develop ways to mitigate the impact of physical distancing physical individuals, are measures on livelihoods especially for those that dependent distancing, needed on the informal economy (e.g. relief packages). hand hygiene and Health risks • Develop, test and implement innovative but pragmatic respiratory on public solutions for reducing health risks on public transportation etiquette transportation, systems, appropriate to the local context. This includes used for protecting public transport workers. Operational changes movement to maintain services while reduce crowding should be within urban considered. This includes encouraging working remotely and areas, should be travelling during non-peak periods, rearranging routes and reduced the number of public transport vehicles, promotion of safe active mobility (e.g. walking and cycling), as well as cleaning and disinfection procedures. Priority should be given to essential workers who need to continue to travel to work. Subpopulations • Develop, test and implement innovative but pragmatic may not have solutions for personal, hand hygiene and respiratory good access to etiquette in the community, appropriate to the local WASH facilities context. This includes the use of simple and accurate educational materials, installing additional WASH infrastructure and practical alternatives for subpopulations with limited access to WASH facilities. Access to Hospitals and • Establish and test a plan for case management of health care health facilities COVID-19 in health facilities and the community, with services for in cities and the support of an emergency operations centre if possible, COVID-19 other urban including managing a surge in demand, deployment of and the settings are healthcare personnel and additional resources and facilities continuation often national (e.g. stadiums and military health services), and meeting of essential referral centres infection prevention and control needs. services •D evelop and test innovative solutions to increase capacities of health services while ensuring adequate protection for healthcare workers. This includes involvement of private hospitals, mobilisation of qualified volunteers (e.g. retirees, final year medical students), as well as increasing the quantity of medical devices and personal protective equipment (PPE). •P lan for transfer arrangements between overloaded hospitals. This includes between cities within a country or internationally.
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