The document discusses key aspects of emergency planning and management for viral pandemics such as Covid-19. It notes that pandemics have occurred throughout history and outlines some of the uncertainties involved in responding to new viruses. Effective emergency management requires careful evaluation of scientific information, regional coordination, clear public communication, and being prepared to adapt health, economic and social systems in response to evolving needs during a pandemic. Learning from both successes and failures in addressing Covid-19 will help improve readiness for future pandemic threats.

1. KEY ASPECTS OF EMERGENCY
PLANNING AND MANAGEMENT
FOR VIRAL PANDEMICS
Prof. David Alexander

2. Pandemics are a consistent part of human history

3. Emerging infectious diseases capable of causing pandemics
Viral:
• non-seasonal influenza (e.g. H1N1)
• sudden acute respiratory syndrome (SARS, e.g. Covid-19)
• HIV-AIDS (acquired immune deficiency syndrome)
• Ebola haemorrhagic fever
• yellow fever, measles, smallpox [eradicated]
Bacterial:
• bubonic, pneumonic and septicaemic plague
• cholera, typhus, tuberculosis, leprosy (Hansen's disease)
Plasmodic:
• malaria
Others.

4. Is non-seasonal influenza
different from a SARS virus?
• yes: influenza has a
faster rate of infection:
testing is not important
• no: the needs generated
by the emergency are
virtually the same

5. The scenario:-
• following SARS 2002-2004
(8,000 infected in 29 countries, 774 died)
• elaborated in papers 2003-2009
• 2005-2013 a period of intense
pandemic planning
• gradually 'flu came
to be feared more
than other viruses
SARS 2002-2004

6. ORDERED UNORDERED
SIMPLE COMPLEX
ESTABLISHED
PRACTICE
EMERGENT
PRACTICE
MORE
PROCEDURE
MORE
IMPROVISATION
PREDICTED
SITUATION
UNPREDICTED
SITUATION
PREDICTABLE
AND ANTICIPATED
UNPREDICTED
AND UNUSUAL
PREDICTABLE AND
NOT ANTICIPATED
COVID-19

7. What we knew beforehand:-
• the basic scenario for a pandemic
- in full except for the recovery phase
• it would have socio-economic consequences that
would be at least as serious as the medical ones
• it would be highly disruptive and cause big
economic problems and shifts in patterns
of demand and supply
• it would cause major behavioural
changes in the affected population

8. Theoretical background

9. How do we define Covid-19 as a disaster?
• not abrupt, no direct physical damage,
plenty of casualties
• not localised or regional but world-wide
• a 'wave' disaster, it ebbs and flows,
it spreads and dilates

10. The Covid-19 pandemic
is undeniably a disaster
and, due to the
interconnected nature
of modern society,
disasters tend to be
cascading events.

11. Primary
cause of
disaster
Impact on
critical
infrastructure
Impact on
housing
Impact on
productive
capacity
Direct
impacts
Indirect
impacts
Impact on
activities
Secondary
impacts
Impact on
livelihoods
Impact on
revenue
Secondary
cause of
disaster
Impact on
well-being
Impact on
safety
Impact on
recovery

12. C
E
E
E
E
C
E/C
E
E
E
E
E
E
E
E
E/C
(a)
(b) C – cause
E – effect
Escalation
points
(a) (b)

13. International vacations,
Summer 2020:
escalation
Cheltenham Festival
(UK) 2020: a simple
escalation point

14. Oldham/Bolton Lancashire, UK:
• high-density habitation (many people in few rooms)
• high exposure (many front-line workers)
• low income, high deprivation rate
• high infection rate
• Covid-19 is probably endemic

15. An exceptionally high sensitivity to
political decisions, especially those with
direct operational consequences.

16. The "egg hypothesis" Disaster
• prima facie causes
• root causes
• vulnerabilities
• dynamic pressures
Context
• general
vulnerability
• poverty
• deprivation
• marginalisation

17. HAZARD or
THREAT
SPECIFIC
VULNERABILITY
HUMAN
CONSEQUENCES
The 'hazardscape' or
the 'risk landscape'
WEAKENING of the
SOCIAL FABRIC
GENERAL
VULNERABILITY
HUMAN
CONSEQUENCES
The 'wreckage
economy'
Health
Employment
Services
• reduced
• rationed
• overpriced

18. SPECIFIC VULNERABILITY
GENERAL (CONTEXTUAL) VULNERABILITY
Long-term causes
(dynamic pressures):
predisposition to disaster
CAUSES EFFECTS
National
cascading
effects
International
cascading
effects
Local
cascading
effects
Direct causes
Practical problems that
contribute to disaster
Root causes:
motivating and
underlying factors
Escalation
factors

19. Disease and infection
• transmissibility
• infection rate
Exposure
• front line workers
• Lock-down, shielding, isolation
Morbidity and mortality
• vulnerable categories
• environmental factors
Economic effects
• reduced commerce
• loss of employment
• business failure
• reduction in tax revenue
Social effects
• solidarity and voluntarism
• social tension
• protest, crime, 'deviant' behaviour
• social polarisation
Psychological effects
• increased mental illness
• depression
• family conflict
Policies, legislation,
communication
Recovery
• a new normal
• legacy
The environment in which
a pandemic occurs

20. Performance of
health system
[or care at home]
Performance of
governmental
system for making
and implementing
decisions
[or ad hoc
decisions]
Performance of
organisations and
their BCM units
[or improvisation and
reliance on other assets]
Performance of
the mass media
[or informal
social networks]
Performance of
family economy
[or kinship networks]
Public
fear and
anxiety
Loss of earnings
and financial
security
Provision
of medical
assistance
Measures
and policing
functions
Business
continuity
and viability COVID-19
elements

21. The Realities of Covid-19 Coronavirus

22. Pandemic virus uncertainties:-
• infectiousness; 'R' reproduction number
• asymptomatic transmission of the virus
• case-fatality rate - how lethal is it?
• will there be other waves?
• impact by ethnicity, gender and age-group
• acquisition of immunity (individual and 'herd')
• how long immunity might last
• relationship of the disease to environmental factors
• efficacy of personal protective equipment
• a vaccine...?

23. Eventual role
of a vaccine:-
• when?
• will it be effective?
• how fast can it be mass produced?
• how will it be distributed?
• will potential recipients accept it?

24. Pfizer Covid-19 vaccine:-
"90% effective"
• claim is not properly substantiated
• needs to be kept at minus 70 degrees C
• distribution requires a massive cold-chain
• Pfizer CEO sold $5.6 mn of shares on day
of announcement

25. Managing the Covid-19 pandemic:-
• political decisions coupled with scientific advice
• in many places emergency planning has been
marginalised, ignored and underfunded
• scientists (and politicians) become risk
and emergency planners and managers
- they are not suited to such roles
• most of the scientific answers are
simple in emergency planning terms:
many boil down to a simple 'yes' or 'no'

26. What we didn't know:-
• how to recover from it
• whether there would be more than
one peak of infections (or 'wave')
• all the details about the virus in question
We sort of half-knew that care homes would be
profoundly affected, but that also depended on
policy regarding:-
• support for care homes and their staffs
• discharge of hospital patients into care homes

27. Leadership in some countries has been:-
• arrogant and denialist
- "it's not a problem"
• ignorant - failing to consult experts
• indecisive or erratic
- lack of attention or a system
• negligent - failing to act on imperatives
• exploitative
- favouring vested
[economic] interests

28. What was done:-
• countries retreated behind their own borders
instead of collaborating in an international
effort to contain and control the disease
• international organisations were marginalised
• first reactions were 'normalcy bias' and
'unconflicted inertia', disbelief
• second reactions were to give priority
to the economy - it could "bite back"

29. What should have been done:-
• recognise the signs and
react quickly to them
• learn quickly from other countries,
study the progress of the disease there
• quickly impose strong measures:
physical distancing, tracking, tracing,
containment, community measures
(it is standard epidemiology)
• use scenario-based planning

30. What was needed:-
• careful evaluation of scientific,
economic, logistical and behavioural
information
• regional and local approaches,
coordinated and harmonised nationally
• clear, consistent, honest, frequent
communication with the public and
interested parties

31. PATIENT
WITHOUT
SYMPTOMS
PATIENT
WITH
SYMPTOMS
LOCKDOWN - CLOSURES - RESTRICTIONS ON MOVEMENT
TEST
CONFIRMED
FALSE
POSITIVE
FREE
RETEST
NOT
TRACED
TRACED
CLOSE
CONTACTS
ISOLATION
PRECAUTIONARY
QUARANTINE
TEST
HYGIENE-PHYSICALDISTANCING
LEVEL OF COMPLIANCE - POLICING OF MEASURES
TRUSTINAUTHORITY

32. The present and future:-
• perpetuating inequality?
• some people made money by
exploiting others during Covid-19
• the need for a greener future, but will it
happen, and will it happen fast enough?
• there will be bigger and worse pandemics
• the next one will be influenza:
wait for the cytokine storm to hit you
• learning to live with contamination and infection

33. Being ready for the next pandemic emergency:
• emergency planning, simulation exercises and
emergency management
• integrated find, test, trace, isolate and support
system
• either stockpiling or detailed high-speed
manufacturing agreements
• ready to absorb massive changes in economy,
society and psychology
• welfare, support and taxation changes

34. New ways of working:
• new pattern of demand for accommodation,
transportation and services
• need to adapt social relations and working practices
New patterns of risk and opportunity:
• altered balance of office and home space
• safeguarding the built and natural environment
What proportion of these changes will be permanent?

35. Economic
recovery
Physical
recovery
Socio-
psychological
recovery
Earthquakes,
floods,
industrial
accidents,
etc.
Indebtedness,
economic
transformation
and adaptation
Challenges
climate change adaptation
stronger disasters
resources and environment
strategic situation
Changes in
society,
politics and
attitudes

36. My take-home message:-
emergency planning and management
(and risk management) hold the key
to the control of pandemics:-
• identify needs in time to
work out how to satisfy them
• involve the public and
communicate well with them
• a clear, well-thought out, precise strategy
• sensitive to evolving needs and situations.

37. LOSS OF
HUMAN RIGHTS
PROXY WAR,
CONFLICT &
POLARISATION
POVERTY &
MARGINALISATION
'WRECKAGE ECONOMY' &
RISE OF THE PRECARIAT
LACK OF
DISASTER
GOVERNANCE
NIHILISM
CORRUPTION &
LOSS OF TRUSTANOMIE
constraints upon life and safety
Anomie (Durkheim 1893) is a condition
of instability resulting from
a breakdown of standards
and values or from
a lack of purpose
or ideals.

38. THANK YOU
FOR LISTENING!
david.alexander@ucl.ac.uk
Report:-
www.ucl.ac.uk/rdr/
resources/irdr-reports