This document is a part of a series of discussion notes addressing fundamental questions about the COVID-19 crisis and response strategies. These documents are based on the best scientific information available and may be updated as new information comes to light.
Written by Adelaida Sarukhan, Elisabeth Cardis and Liudmila Liutsko (ISGlobal), Deborah Oughton (CERAD), Pascal Croüail (CEPN) and Friedo Zölzer (University of South Bohemia in České Budějovice, the document addresses how many of the recommendations that were developed for improving health and well-being of populations affected by nuclear accidents can be directly implemented or adapted to the current COVID-19 crisis (or future disease outbreaks).
In 2015, we launched SHAMISEN, a European project that brought together experts from across the world to examine lessons learned from the nuclear accidents of Chernobyl and Fukushima, and derived a series of recommendations to better prepare for future accidents and better survey the health of affected populations.
Two key general recommendations are particularly relevant to bear in mind when managing this or any other crisis involving affected populations:
- Do more good than harm.
- Encourage a strategy that targets the overall well-being of the population. .
The first general recommendation of SHAMISEN can be translated directly to the SARS-CoV-2 situation and is particularly relevant. It refers to the fundamental ethical principle of doing more good than harm, which should be central to all decision-making processes during this and any other crisis that involves affected populations.
As an example, the strict lockdowns imposed in some countries, where going to parks was discouraged or prohibited, may have had a deleterious effect on the mental and physical health of people living in urban areas, particularly children. Similarly, the social cost of closing schools in areas where viral transmission was relatively low may have been higher than the benefit in terms of infection control, particularly in children from less affluent families.
Along the lines of “doing more good than harm”, recommendations 2 and 3 stress the need to encourage an infection control strategy that considersthe overall well-being of populations and respects the autonomy and dignity of affected populations. Examples include contact tracing apps and other procedures, that need to be explicit about how and for how long personal data will be shared and stored.
Preparedness Is Key
One of the main lessons drawn from Fukushima and Chernobyl is the importance of planning “in times of peace”. The COVID-19 pandemic has been a grim reminder that the world was ill-prepared to respond to an infectious disease pandemic, in spite of multiple warnings by the scientific community and public health experts over the last two decades.
Once an infectious disease outbreak is detected, a quick and coordinated response is key to contain its spread. In fact, a recent study estimates that, given the initial transmission rate of SARS-CoV-2, governments had just 20 days from the first reported cases to implement stringent non-pharmaceutical interventions to reduce the Ro to below 1.1.
Thus, infection control protocols and criteria must be planned ahead of time, together with adequate resource allocation mechanisms. These protocols should span the early, containment phase (testing, contact tracing, quarantine, isolation) as well as the mitigation phase (expansion of hospital capacities and ICU beds, protocols and criteria for shelter at home orders, etc). The greater the participation of all actors involved in helping establish these, the higher the chance they will be successfully implemented.
Another valuable lesson drawn from SHAMISEN is the need to communicate in a timely and transparent manner with the affected populations, and to empower them to make their own decisions. Again, the COVID-19 crisis has underlined the importance of providing clear, timely communication, and, importantly, on acknowledging the uncertainties linked to a new virus and a new disease. This can only be done if early response and communication protocols and channels are established in advance, and the impact of these will largely depend on the degree of public trust in science and in the authorities.
It is therefore urgent to (re)build public trust in public health authorities, scientists, and multilateral organisms such as the WHO. Providing appropriate training and education material and resources to first line responders (nurses, healthcare workers, contact tracers, etc), is also key to enhance preparedness.
Need to engage citizens in the response
One important lesson drawn by SHAMISEN was the need to engage- and empower- local communities in the decision-making process during the later phases of the response: use local facilitators (such as community leaders, nurses and teachers) who serve as a “bridge” between experts and the population, consider the needs and preferences of people living in affected areas, and foster their participation in infection control strategies.
Community engagement takes time and patience, but has been crucial in the control of previous epidemics such as HIV and Ebola, and is key for the collective response to COVID-19, from compliance with lockdown to individual behaviour when easing restrictions.