Strengthening Preparedness for COVID-19 in Cities and Urban Settings - Interim Guidance for Local Authorities

Strengthening Preparedness for COVID-19 in Cities and Urban Settings - Interim Guidance for Local Authorities
Strengthening Preparedness
for COVID-19 in Cities and
Urban Settings
Interim Guidance for Local Authorities
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

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Strengthening Preparedness for COVID-19 in Cities and Urban Settings - Interim Guidance for Local Authorities
Interim Guidance for Local Authorities   2

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

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)
Strengthening Preparedness for COVID-19 in Cities and Urban Settings - Interim Guidance for Local Authorities
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
    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.

     Additional preparedness resources can be found at the Strategic Partnership
     for IHR and Health Security Website:
Key elements of multisectoral preparedness coordination         12

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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

      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
                                                          • 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

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

      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).
      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
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