at Dadhaleh Institute

Compounding crises undermine ethical, equitable COVID-19 response

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh The strongest cyclone ever recorded in [ ... ]

A new study in Science demonstrates the need for a coordinated approach for countries in Europe to lift lockdown measures in order to prevent subsequent outbreaks of cases. The research team from WorldPop highlight the significant impact of actions by countries that are populous, well-connected and with strong interventionsin place – which include France, Germany, Italy, Poland and the UK. The study produced over 1,200 exit strategy scenarios, using publicly available epidemiological data as well as anonymized mobile phone data to map population movement in 35 European countries. A notable finding of the study is that premature and uncoordinated easing of control measures by some countries could accelerate the resurgence of COVID-19 outbreaks across the entire continent by up to five weeks. The simulations furthermore show that synchronizing intermittent lockdowns across countries would lead to half as many necessary lockdown periods in order to achieve an end to community transmission in six months.

Compounding Crises of COVID-19 and Super Cyclone in India and Bangladesh

The strongest cyclone ever recorded in the Bay of Bangal (with maximum sustained winds up to 265km/h) is expected to hit India and Bangladesh on Wednesday. Millions of people are being forced to evacuate north-east India, while only 12,000 shelters have been prepared in Bangladesh to house the nearly five million people in the expected path of Cyclone Amphan. The impact is likely to be hardest on those living in low-lying flood prone coastal areas, as the Needs Assessment Working Group of Bangladesh estimates that up to 14.2 million people in coastal districts are likely to be affected, displacing 1.4 million people and damaging up to 600,000 houses.

Vulnerable communities affected by COVID-19 outbreaks and lockdown will also likely be impacted, including the approximately 1.2 million Rohingya refugees that live in over-crowded camps in Cox’s Bazar in Bangladesh. In collaboration with humanitarian partners, including UNICEF and UNHCR, the IOM is constructing a COVID-19 treatment centre in Cox’s Bazar along with cyclone preparedness effort (alerting the community, reinforcing critical infrastructure and prepositioning emergency items before the cyclone makes landfall).

COVID needs in Humanitarian Emergency Settings

The UN High Commissioner for Refugees made an appeal for US$745 million for preparedness and response to outbreaks of COVID-19 among the more than 71 million refugees and forcibly displaced people that remain acutely vulnerable. While no major outbreaks have been reported in large refugee and IDP settlements, UNHCR is rapidly scaling up efforts in 134 refugee-hosting countries that are reporting local transmission. There is also widespread evidence of deep economic impacts on refugees, as 70% of refugees surveyed admitted to skipping meals, and this is most acute among refugee women.

Médecins Sans Frontières has outlined five key priorities for the international community in order to protect migrants and vulnerable populations in humanitarian response locations. These include:

Ensuring COVID-19 is not used as an excuse to enforce restrictive migration control policies and evade international obligations towards refugees, asylum seekers and migrants;
Governments must not use COVID-19 emergency measures to target refugees, asylum seekers and migrants, and measures should be proportionate and limited in duration, respect human dignity, and based on scientific evidence and not applied arbitrarily;
Lockdowns and mass quarantining cannot be cut-and-pasted or discriminatorily applied;
Direct humanitarian evacuation corridors for displaced people at risk (including people above 60 years and those with respiratory conditions, diabetes, or other health complications); and
Safeguarding access to healthcare for all (ensuring border closures do not prevent the mobility of people, essential supplies and aid workers, particularly in humanitarian response locations).

EU is Creating Humanitarian Air Bridges to enable the COVID-19 Response

The European Commission has allocated 10 million Euro to support a humanitarian air bridge amid travel shutdowns. In the absence of commercial air travel, the air bridge will allow humanitarian staff and supplies to be delivered across 30 routes deemed important for the COVID-19 response, with the first flight launched last week from France to the Central African Republic with 60 humanitarian workers and 13 metric tons of humanitarian cargo.

Build Back Better After COVID-19

The International Recovery Platform developed a toolkit of existing guidelines and tools to support countries and communities when they are ready to recover from the COVID-19 pandemic crisis. It supports recovering communities to “build back better” towards more resilient health systems, economies, and more just societies. The Compendium of Tools and Guidelines are organized according to four categories: Health Sector Recovery; Private Sector and Livelihood Recovery; Inclusive Recovery; and Disaster Recovery Governance. The IRP is a joint initiative of UN, international finance institutions, national and local governments, and NGOs engaged in disaster recovery and sustainable development.

A paper commissioned by the Swedish International Development Cooperation Agency provides analysis and guidance on to inform the design, implementation and adaptation of conflict sensitive humanitarian and development responses to COVID-19.

Lancet Papers Decry the lack of Ethical global leadership on health inequities around COVID-19

A paper in the Lancet calls for greater ethical global leadership on health inequities during the COVID-19 pandemic. The authors reference widespread reports of the disproportionate impact of the pandemic on vulnerable communities around the world, while pointing to “unconscionable stockpiling by wealthy countries” and even attempts to extract profits from the crisis through economic speculation.

Another paper in the same issue highlights how social inequalities in health profoundly, and unevenly, impacting COVID-19 morbidity and mortality. Among the social determinants of health, the authors identify emerging findings on the correlation of the pandemic with poverty (including homelessness), physical environment, and race or ethnicity. The paper also notes how physical distancing measures are significantly more difficult for vulnerable and marginalized populations, while school closures have increased food insecurity for children living in poverty, exacerbating physical and mental health. The authors urge policymakers to emphasize the mitigation of social determinants, including improving housing and reducing overcrowding as well as improving access to health services and income support. The paper also calls on social determinants of health to be an essential part of pandemic research priorities, public health goals, and policy implementation.

Preventing a COVID-19 Related Global Food Crisis

The Food and Agriculture Organization made an appeal for US$350 million to scale up efforts to address hunger and livelihood-boosting efforts in contexts vulnerable to food crisis. As part of the broader UN Global Humanitarian COVID-19 Plan, the appeal will include supporting farmers’ access to fields, seeds and other inputs to plant or buy feed for their animals in order to avoid the cascading impacts of missing planting seasons such as drops in output. The FAO also advocates proactive efforts for stronger emergency livelihoods interventions to avoid famines.
The WEF also reports how the pandemic has amplified the risk of worldwide food-price spikes, urging greater coordination across governments to avert disruptions to food supply chains, including through food protectionism. While lockdowns have led to a collapse in demand for discretionary goods and services, the opposite is true of food as panic buying and food hoarding has proliferated. On the supply side, global grain stockpiles could be quickly depleted as the virus disrupts production and distribution, compounded by the worst locust outbreak in 70 years that have left countries in East Africa acutely vulnerable. In Kenya, for example, the price of staple foods has risen by 60% since last year.
ICRISAT published a new report that outlines four key strategies to protect the lives and livelihoods of farming communities in Eastern and Southern Africa. These include:
1. Diversification of farming systems for improved resilience and profitability (including technologies suitable for sustainable intensification);
2. Enhancing access to seed at scale of grain legumes and dryland cereals (through community seed banks that also supports grain aggregation);
3. Building capacity of partners to promote technologies in a participatory manner (including governments, community organizations, local leaders and women); and
4. Gender integration and empowerment to engage actively in agribusinesses (including livelihood-strengthening activities like climate-smart agriculture)

CommunityFirst COVID-19 Roadmap

This week, SeeChange Initiative and Ilisaqsivik Society, in partnership with the Association of Médicos Sin Fronteras in Latin America, and the Dahdaleh Institute, launched the CommunityFirst COVID-19 Roadmap, a planning tool to empower communities in developing local strategies to organize, prepare and respond to COVID-19. The Roadmap is available in English, Spanish and Inuktitut, and also includes an Emergency Readiness Checklist. Last month, the Executive Director of SeeChange and a Steering Committee member of the CommunityFirst Roadmap published an article in the Lancet on local efforts among Inuit communities to address COVID-19 and TB. The role of community-based responses to the pandemic was also highlighted in STAT.

Webinar Resources

COVID-19 in Humanitarian Setting: Magnifying Gender Inequalities? (JHU)
- Wednesday, May 20, 2020 (8-9am EST)
Digital Solutions to Covid-19 and Urban Challenges in Sub-Saharan Africa (CSIS)
- Thursday, May 21, 2020 (9-10am EST)
Humanitarian Operations During Covid-19: A Conversation with UNHCR (CSIS)
- Monday, June 8, 2020 (9:30-10:15am EST)

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The doubling rate of confirmed COVID-19 cases dropped to once every 21 days from a high of once every 7 days on April 1. As some countries experience stabilizing or declining national death tolls, it has prompted attempts to loosen lockdown measures. This includes France, Italy and Spain, three of the world’s hardest hit countries (accounting for 20% of cases and a third of all COVID-related deaths worldwide). Germany is begun to relax lockdown measures, as face masks have become mandatory in public. The National Health Service of the United Kingdom set out a six-week plan to ‘return to normal’ following projections that the U.K. has ‘likely survived the first wave’ of the pandemic and will get close to testing targets. Despite a record daily increase in confirmed cases,South Africa restarted some mining operations, as India has also begun to ease lockdown measures following a drop in reported

As some Asian-Pacific countries such as Singapore experience major outbreaks in the second wave of transmission, hospitals across Europe have raised concerns. The WHO noted that many states also do not have adequate testing capacity needed to support a safe reopening strategy that can detect, trace and isolate new COVID transmission. China has meanwhile provided a guide on how countries can prevent a second wave, including compulsory masks in public, fines for failure to exercise public hygiene practices, as well as public markings for social distancing lanes.

The LSHTM is gathering data on hundreds of intervention measures from around the world to determine factors contributing to disease outbreak as well as relative effectiveness of control strategies. For example, to date, Hong Kong’s swift surveillance, quarantine and social-distancing measures – such as the use of face masks and school closures – helped to cut Coronavirus transmission with only 4 deaths in a (urban) population of 7.5 million. The LSHTM platform is being developed to support the WHO’s technical support to member states, and includes more than 1,100 volunteers, multiple universities, public health organizations and non-profits, including ACAPS which analyses humanitarian crises.

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Ten countries have now confirmed more than 1,000 COVID-related deaths, with 14 countries reporting more than 10,000 cases. With less than 17% of all confirmed cases globally, Italy and Spain continue to account for more than 35% of all reported deaths (21,645 and 19,130, respectively). Both countries are experiencing a slow-down in the rates of transmission, however, and while Spain is beginning to relax control measures, Italy has extended lockdown measures until May.

Sweden (12,540) is the latest country to exceed 10,000 cases, as the number of deaths doubled in less than a week, which has been blamed on its controversial voluntary public health measures. France (147,863) and Turkey (69,392) continue to experience significant daily increases in confirmed cases and deaths, while the U.K. is expected to see a drop in new cases and hospitalization, despite surpassing 10,000 deaths and approaching 100,000 cases. The U.K. Prime Minister Boris Johnson was moved out of Intensive Care over the weekend, noting “I owe (NHS staff) my life.”

Transmission rates in Russia have also raised concerns, as daily reported cases continue to surge 20% for a second consecutive day, approaching 28,000 cases and 232 deaths. As the number of COVID-related deaths in Belgium surpass China, Germany is reporting an increase of COVID-related outbreaks in nursing homes and hospitals, where the elderly account for only 17% of cases but 86% of all deaths.

Many European countries are also reporting high CFR near or above 10%, including Italy, Spain, France, the U.K., Netherlands, Belgium, and Sweden. This has been partly attributed to selective testing strategies, as a paper this week in BMJ suggests early and widespread testing may be contributing to Germany’s relatively low CFR (2%). The European CDC has recommended that countries scale up testing and surveillance systems to guide and monitor the escalation and de-escalation of mitigation strategies.

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During this unprecedented global pandemic, U.S. President Trump announced his intention to suspend funding to the WHO over accusations of mismanagement. The move has been roundly criticized by many governments and the EU, global health experts as well as the UN Secretary General. The U.S., meanwhile, has raised questions about its own handling of the pandemic, as it remains the epicentre with almost a third of all worldwide cases (644,806) and over 20% of all COVID-related deaths. The five worst affected countries (U.S., Spain, Italy, Germany, France) account for over 60% of all cases and almost 80% of deaths globally.

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April 9 marks the 100th day since the WHO was notified of the first case of “pneumonia of unknown cause” in Wuhan, China.

As of April 12 at 10am EST, the total worldwide deaths from COVID-19 has surpassed 110,000, as confirmed cases approach 1.8 million. The actual number of dead and infected worldwide are believed to be much higher, but testing shortages, different counting practices and concealment by some governments limit detection and reporting.

The U.S. is the current global epicentre with over 530,000 confirmed cases and over 20,000 deaths, while the five worst affected countries (U.S., Spain, Italy, Germany, France) account for over 60% of all cases and almost 80% of deaths globally.

Community transmission is spreading, and the rapid increase of cases across low- and middle-income countries has become a critical global issue, as over 20 developing countries are reporting more than 1,000 cases. The number of African cases increased approximately by 40% over the past week, with all 55 countries reporting cases and 8 African countries seeing exponential rise. South Africa’s border controls and lockdown over the past two weeks have significantly reduced the number of new cases.

The economic fallout from the global pandemic could push 500 million people into poverty (8% of global population), according to a UN University report. This would be the first time that poverty has increased globally in over thirty years. The World Bank and IMF have scaled up and accelerated efforts to provide emergency funding to countries, while the UN Office for the Coordination for Humanitarian Affairs (OCHA) issued a US$2 billion appeal for a Coordinated Global Humanitarian Response Plan, which as of April 8, is only 20% funded.

As governments confront the dual challenge of containing the viral pandemic and economic crisis, public health experts warn countries that premature re-opening could lead to a second wave of outbreaks, echoed as well by modelling projections in a recent Lancet paper. Oxfam has urged world leaders to contribute to the $2.5 trillion economic rescue plan set out by the UN to “keep poor countries and poor communities afloat.” Mounting job losses and disruptions to global supply chains are also expected to result in chronic food shortages, as countries are urged to keep trade open and to protect farmers.

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The total number of cases continue to increase by at least 10% for a second day to 1,039,158, and 55,000 confirmed deaths, as of 3 April 2020 (9:25am EST).

Although the U.S. and Europe constitute over 70% of confirmed cases, the rapid increase of local clusters across low- and middle-income countries has emerged as a major concern.

CFR figures (in order of countries with the highest number of deaths)

Italy (11.4%)
Spain (8.7%)
Iran (6.5%)
U.K. (8.2%)
France (6.8%)
China (4.1%)
US (1.9%)
Netherlands (8.3%)

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Countries are increasingly adopting the WHO’s main advice to “test, test, test,” with total number of tests performed increasing 42% over the past week, as of April 1. Limited availability of diagnostic kits and laboratories in many low- and middle-income countries remain a critical concern and is almost certainly masking more widespread local transmission.

Similar to prior pandemics, high initial Case Fatality Rates for COVID-19 are expected to trend downwards over time as countries adopt more wide-spread population testing (i.e. recording those dying with as opposed to from the virus). This is reflected in these CFR figures (in order of countries with the highest number of deaths), as of 3 April: Italy (12%), Spain (9.1%), U.S. (2.4%), France (7.1%), China (4.1%), Iran (6.3%)

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The pandemic continues to grow exponentially. As of March 25, It took only 6 days for the global case number to double from 200,000 to over 400,000 (and 2 days from 300,000 to 400,000).

At least 650,567 cases and 30,299 deaths have been reported in 199 countries as of March 28 at 2:30pm EST. Europe and the U.S. account for almost two thirds of all cases globally. There is growing alarm, however, as case reports are increasing in many low- and middle-income countries.

Select Case Fatality Rates (for countries with at least 50 deaths)

Worldwide: 4.7%
Italy: 10.6%
Spain: 7.9%
Iran: 7.1%
China: 4.1%
France: 6.1%
US: 1.6%
South Korea: 1.5%
Canada: 1.2%
Germany: 0.7%

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A new study in Science demonstrates the need for a coordinated approach for countries in Europe to lift lockdown measures in order to prevent subsequent outbreaks of cases. The research team from WorldPop highlight the significant impact of actions by countries that are populous, well-connected and with strong interventionsin place – which include France, Germany, Italy, Poland and the UK. The study produced over 1,200 exit strategy scenarios, using publicly available epidemiological data as well as anonymized mobile phone data to map population movement in 35 European countries. A notable finding of the study is that premature and uncoordinated easing of control measures by some countries could accelerate the resurgence of COVID-19 outbreaks across the entire continent by up to five weeks. The simulations furthermore show that synchronizing intermittent lockdowns across countries would lead to half as many necessary lockdown periods in order to achieve an end to community transmission in six months.

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