Coronavirus Disease 2019 (COVID-19) is arguably the biggest international public health and emergency management challenge faced in a generation.
As we move into our sixth week of nation-wide lockdown, data released by NHS England and NHS Improvement (NHSE/I) suggests that the UK is now over the peak of the first wave. Organisations, resilience forums and partnerships have begun to look at elements of recovery, whilst hopefully recognising that we will remain in a response or quasi-response phase for some time, amid any release of social distancing and lockdown measures that may be a precursor to a second wave.
History teaches us that we should give parity to our preparedness and concerns for subsequent waves as we do for the first. Analysis of the 1918 influenza pandemic indicates that nations documented between one and three waves, with the majority experiencing two distinct waves during October 1918 and February 1919 (Morens, Taubenberger, Harvey & Memoli, 2010). Notably, the second and third waves were ultimately more impactful that the first.
Whilst subsequent waves are not with absolute certainty inevitable, the likelihood of organisations needing to remain in a posture of response, whilst juggling the activities of recovery, restoration, transformation, and learning is plausibly high. Throughout this period we must remain mindful of the risk of other incidents occurring. We are in the midst of a global crisis, but this does not prevent concurrent disasters. Furthermore, once social lockdown measures are relaxed and the transience of society increases, the likelihood of certain anthropogenic incidents increases.
Work-effort in the emergency planning sector is broadly driven through risk assessment, with all manner of events, incidents and occurrences subject to qualitative and quantitative analysis at national and local levels. Resultant risk registers provide us a basis to understand our landscape of risk and potential consequences, but rarely do these take into account the prospect of society being simultaneously in the midst of a global pandemic.
Figure 1: Example of potential concurrent incidents as illustrated by the UK National Risk Register (Cabinet Office, 2008).
Exercises mapping capabilities against known risks that are then quantified against the COVID-19 characteristics are beneficial in identifying gaps in preparedness during this period. For example, the required capabilities in response to a Chemical, Biological, Radiological and Nuclear (CBRN) incident include Personal Protective Equipment (PPE), some of which is an assured capability (e.g. hospital and ambulance PRPS stocks) and some of which is not (e.g. general PPE). When combined with the current global pressure on PPE, a concurrent incident of this nature would clearly bring an element of increased risk associated with the capability of PPE delivery.
Figure 2: Example of capability mapping for a CBRN incident for which each element can subsequently be assessed against the impacts and ongoing activities associated with COVID-19. This example only reflects a small number of associated CBRN capabilities.
On the contrary, incidents arising in mass casualties usually require a proportion of bed stock release in order for receiving hospitals to provide treatment. However, in our current posture hospital capacity across the country is much lower than it ordinarily would be and therefore the capability is currently more assured and available more expediently.
This type of exercise is also beneficial in identifying the interaction between information flows, processes and actors currently engaged in COVID-19 response. Many organisations currently have established Incident Coordination Centres (ICCs) and rostered Strategic (Gold), Tactical (Silver) and Bronze (Operational) Commanders. Most if not all Local Resilience Forums (LRFs) have established their Strategic Coordinating Group (SCG) structures and many have established Tactical Coordinating Group (TCG) structures. Furthermore, regions may have a Multi-SCG Response Coordinating Group (ResCG) functioning in addition to provide a broader strategic view of the regional response to COVID-19. Plus as widely reported nationally there are regular meetings of the Cabinet Office Briefing Room (COBR) and various supporting committees such as the Scientific Advisory Group for Emergencies (SAGE).
With numerous actors in play it is important to be clear in how the flow of information in addition to command, control, coordination and communication (C4) for any concurrent incident would be handled and how this interfaces with COVID-19 structures. Will COVID-19 Commanders and ICCs be responsible for discharging concurrent incident activity? Will new ICCs be established for big-bang short-term incidents requiring a distinct short-sharp burst of C4? If so – where will these be, who will staff them, and is the equipment available? For some organisations this is less intensive, but for others it is more arduous given the current response and requires some thought as to the best mode of delivery.
As we experience a post-peak drop in activity and pause to reflect, learn, and ready ourselves for a second wave, now is the perfect time to seek assurance of concurrent incident preparedness within organisations, LRFs, and HM Government alike.
References
Cabinet Office. (2008). National Risk Register. London.
Morens, D., Taubenberger, J., Harvey, H., & Memoli, M. (2010). The 1918 influenza pandemic: Lessons for 2009 and the future. Critical Care Medicine, 38, e10-e20. doi: 10.1097/ccm.0b013e3181ceb25b
NHS England, COVID-19 Daily Deaths. https://www.england.nhs.uk/statistics/statistical-work-areas/covid-19-daily-deaths/