Dr Tamorish Kole, describes seven effective polices to disaster response during COVID-19

With heavy monsoon rains, widespread flooding and lethal landslides in India and its neighbours including Bangladesh, Bhutan and Nepal have affected millions of children and families. According to UNICEF, over 4 million children are currently estimated to be impacted and in urgent need of life-saving support, with many millions more at risk. The COVID-19 pandemic and containment and prevention measures add additional complications to the mix of extreme weathers and natural disasters, as the health and social support systems are already on maximum stretch.

Converging crises

The world is facing unprecedented challenges managing disasters while responding to COVID 19 pandemic. When cyclone Harold hit Pacific countries in April 2020 or a flood happened as snow melting in Manitoba Province, Canada; the efforts were made to protect responders from risk of COVID. In Bangladesh, humanitarian assistance and government organisations prepared for cyclones as well as a COVID-19 outbreak in the densely crowded camps in Cox’ Bazar, which shelter Rohingya refugees. 

Compounding climate risks

A series of evidence suggests that climate hazards, which are increasing in frequency and intensity under climate change, are intersecting with the COVID-19 outbreak and public health response. These compound risks exacerbate and be exacerbated by the unfolding economic crisis and long-standing socioeconomic issues, both within countries and across regions. Within few months of the COVID-19 pandemic, several climate hazards have collided with the outbreak itself or jeopardised sensitive public health response. Storms, flooding and droughts are among the most concerning reasons of displacement and disruption within the pandemic. Displaced populations, like those residing in refugee camps, are also uniquely at risk from COVID-19 outbreaks because of living conditions that are incompatible with social distancing and a fragile access to testing or healthcare. 

Strategic frameworks 

Sendai Framework for Disaster Risk Reduction (SFDRR), health emergency disaster risk management (Health-EDRM) framework & the international health regulations integrate infrastructure, climate change, and economic considerations into policies and plans to mitigate the threats to the health of the global population. Health-EDRM refers to the “systematic analysis and management of health risks, posed by emergencies and disasters, through a combination of (1) hazard and vulnerability reduction to prevent and mitigate risks, (2) preparedness, (3) response and (4) recovery measures” (WHO 2019).

Policies for disaster response during COVID-19

Identify the hotspots: The first step in disaster response is to conduct hazard vulnerability analysis (HVA) and identify the hotspots where climate disasters and the pandemic are likely to converge. In South Asia, the most immediate concern must be water-related disasters, (monsoon season of June to September) like flood including urban flooding, landslides, building collapse etc. Sudden flood can also result in displacement and crowding in shelters. These hotspots need to updated regularly based on climate conditions and the evolution of the pandemic. 

Ensure early warning for early action: A composite risk matrix like National Severe Weather Warning Service (NSWWS), UK matrix should be used that takes into account the risk of disaster, and its potential impact, along with the extent of COVID-19 infections to place districts or areas into the appropriate zones. Intelligent risk analytics can also be used for establishing evacuation shelters, which are socially distant, yet functionally active.

Invest in disaster resilient infrastructure: The main climate-related disasters in South Asia are droughts, floods and cyclone which particularly affect the poorest people who live in vulnerable urban or rural areas. While COVID-19 has complicated many activities, it has also resulted in migration of workforce who are now available for infrastructural capacity building. In India under the Mahatma Gandhi National Rural Employment Guarantee scheme, which has around 80 million participants, works on irrigation, afforestation, soil and water conservation, flood protection and watershed development are carried out. 

Customise local solutions: Local adaptation remains as cornerstone of COVID 19 response. For example, to address the twin problems of tackling floods and the coronavirus, the Bihar state government has launched a unique initiative called COVID boat ambulance for many villages in Vaishali district where a boat is the only way for the people to come to the block headquarters and hospitals. This boat has all the facilities similar to a ground ambulance including PPEs. 

Offer universal social protection: COVID-19, both on its own and during other disasters has undermined family-based systems of social protection particularly for the hundreds of millions of migrant labourers who are far from home, and many other daily wage earners and informal sector workers. Moreover, lockdowns and the requirements for social distancing can heighten social isolation. Therefore, National Social Protection Schemes must be augmented specially to support vulnerable populations. In May 2020, The World Bank has approved financing a program called ‘Accelerating India’s COVID-19 Social Protection Response Program’ to support India’s efforts at providing social assistance to the poor and vulnerable households, severely impacted by the COVID-19 pandemic.

Capitalise on regional cooperation: Disasters in South Asia typically span beyond national borders, so do the effective cooperation and response. In the two recent cyclones, sharing of timely and accurate early warnings helped save thousands of lives under a regional cooperation through the WMO/ ESCAP Panel on Tropical Cyclones.

In 2020, locust swarms, another transboundary threat formed in Africa migrated east to the Indo-Pakistan border and beyond. In India, locusts threaten food security and the response was superimposed during the national lockdown, making it extremely challenging. 

Building a green and resilient recovery: South Asian countries are committed to the Sustainable Development Goals by 2030, and to ensuring that ‘no one is left behind’. A holistic approach is needed to break the vicious circle of poverty, inequalities and disasters, while confronting COVID-19 and future pandemics. Rather than simply responding to a disaster or this pandemic; countries will need to take a more coherent approach working with partners at local, national and regional levels to reduce vulnerabilities and systemic risks while ensuring a green and low-carbon recovery.

Healthcare facilities and double jeopardy

In the early hours of August 6, when a massive fire broke out on the fourth floor COVID ICU of the hospital in Ahmedabad, patients died because of lack of ventilation as the four windows in the ICU had been fixed shut with screws. Investigation revealed that the fire was caused by a short circuit, but reportedly, the 22-year-old hospital had no fire clearance. COVID-19 pandemic has not only highlighted the need for general preparedness of the health sector, but also fire safety & disaster preparedness of the hospitals.

National Disaster Management Guidelines for Hospital Safety was issued in February 2016 and in its preface; our honourable prime minister made an appeal to all stakeholders to make our hospitals reliable and disaster resilient. In the introduction of the guidelines (Section 1.2) illustrates a scenario where both community and the Hospital are affected. Such situations obviously exacerbate the challenges posed to hospitals, as they not only need to cater to the existing demand on their facilities but also need to address the sudden increase in demand on their facilities because of the surrounding community being affected by disasters. COVID 19 and hospital fire is one such scenario.

In COVID facilities where movement is severely restricted due to infection control issues horizontal exits must be made available. A horizontal exit implies that the occupants will be transferred from one side of a partition to the other. Essential fire safety provisions for horizontal exits includes (1) Width of the horizontal exits shall be same as the exit doorways. (2) A horizontal exit shall be equipped with at least one fire/smoke door of minimum 2 hrs fire resistance of self-closing type. Further they shall have direct access to the fire escape staircase for evacuation. (3) A refuge area of 15 Sq. Mtr. or an area equivalent to 0.3 Sq. Mtr. per person for the number of occupants in two consecutive floors, whichever is more, shall be provided on the periphery of the floor or preferably on an open air cantilever projection with at least one side protected with suitable railings/guards with a height not less than 1 mtr. (4) Where there is a difference in the level between areas connected by a horizontal exit, ramps not more than 1 in 10 metre slope shall be provided. The steps shall not be used.

At the end… 

COVID-19 pandemic is a global catastrophe. To better prepare for managing such incidents, we can utilise the framework of a disaster management cycle by: reducing the infection risk (mitigation); providing adequate preparation to both healthcare workforce and public (preparedness); dispatching healthcare team to the forefront to combat the infection (response); and facilitating infected patients to recover physically, psychologically and socially (recovery).

(Dr Kole is a Significant Contributor of the National Disaster Management Guidelines for Hospital Safety. Issued by National Disaster Management Authority, Govt of India (February 2016). An alumnus of the International Visitor Leadership Program (IVLP), crisis and disaster management (2013). US Department of State and Chair of the Disaster Medicine Special Interest Group, International Federation for Emergency Medicine (IFEM).)

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