‘COVID-19 feedback exercise’: what happened, and what we learned

Using the Open Space method, a feedback exercise was carried out during the Autumn School on Humanitarian Aid about the different facets of the COVID-19 crisis and how it was managed. The initial part of the exercise consisted of collectively establishing a timeline of the events that took place. The workshop looked at three distinct periods (prior to 15 March, between 15 March and 31 May, and since 1 June 2020), and focused on three areas: what happened; the measures implemented and actions undertaken; what we learned.

This article attempts to describe the ‘timeline’ that was drawn up.

1. Prior to 15 March 2020

What happened

Though a certain number of elements seem to indicate that SARS-COV-2 was already present in Europe in the last months of 2019, it was in January 2020 that things began to gather pace when China sounded the alarm after discovering a form of pneumonia with an unknown source. From 22 January, the 6 million inhabitants of the province of Wuhan were locked down, but contaminated people had already begun spreading the virus on every continent. Fears began to rise when several clusters were found outside Asia (Italy, Iran, etc.) and on 24 January the first three cases were announced in France, all linked to people who had travelled from China. But it was only on 30 January that the WHO declared that the COVID-19 epidemic was a ‘Public Health Emergency of International Concern’.

After this initial period when the situation appears to have been underestimated, a first major cluster was identified in Italy in mid-February, then another in France, and soon after in Spain. After a period of doubt about the seriousness of the problem, monitoring systems were set up at the beginning of March. These quickly helped to assess the scale of the epidemic in Europe. Meanwhile, in the United States, which appeared to have been spared, the situation suddenly deteriorated. The WHO officially declared that COVID-19 could be characterised as a pandemic on 11 March, while the first cases were found in Africa, generally linked to people arriving from China or Europe.

At this time, the epidemic seemed to be gradually coming under control in Asia and many were astonished to see Chinese aid arriving in Italy. It was not until almost every country was locked down that Europe and the majority of the world properly took stock of the situation: the impact of the pandemic on health, but also, and perhaps especially, the measures implemented to control the movement of people and goods that were progressively put in place to stop the virus spreading.

Measures implemented and actions taken

Soon, alerts were issued from numerous sources. Recommendations and protocols began to be sent to the field, notably the Middle East and Africa. Following the internal alert that was issued on 20 January, Médecins du Monde began to produce COVID-19 memos as of 6 February. COVID-19 Task Forces were set up (mid-February for the International Committee of the Red Cross, mid-March for Coordination Sud and OCHA). In France, the Ministry for European and Foreign Affairs set up a crisis unit to advise embassies and begin organising the return of French citizens.

What we learned

At the beginning of March, many organisations began to understand that a major change was taking place. As such, they had to consider withdrawing key staff, develop continuity plans, and establish mechanisms and tools to adapt activities to remote management. Staff also had to be protected, which was made possible by the first instalments of emergency funding. Certain organisations (e.g. Action contre la faim and Médecins sans frontières) set up crisis units to monitor the epidemic and launch initial responses.

At this stage, the availability of equipment was not yet an issue and few experts were mobilised. The response was implemented by staff in the field. In rich countries, women played a major role in trying to control the virus (e.g. as care assistants, nurses, those who made masks, childminders, housekeepers, and domestic helpers), often working without protection. Two major issues emerged: that of anticipation-preparation, and that of protecting carers.

2. Between 15 March and 31 May 2020

What happened

Due to the rapid saturation of health systems, Italy and then France decided to lock down, followed by other countries, in a relatively uncoordinated manner. Europe became the epicentre of the crisis as of 13 March, followed by the United States, and particularly New York State, as of 11 April. European and international flights were halted, and most airports closed. Lockdowns of different kinds were implemented almost everywhere in the world.

It became clear that the COVID-19 crisis would also be a social crisis. The restrictions particularly affected those in the most insecure low-paid jobs who were unable to work from home. Schools were also closed, bringing the risk of deschooling, etc. The situation became increasingly difficult for all those who were no longer able to work, and thos who no longer had access to food due to lockdowns and the slowing down of international and local trade. A new term was coined in France – ‘premiers de corvée’ (roughly meaning ‘those who do the hard work’) – referring to those who work in healthcare, cleaning, the food sector, waste disposal, water supply, electricity, etc., who often are not very visible but who play a crucial role in the functioning of modern societies.

Towards mid-May, lockdown was lifted in a certain number of countries, including France, but people were encouraged to limit their mobility. At the same time there was a serious deterioration of the situation in the Americas (e.g. Brazil, Peru, and the United States), while Africa continued to have few cases, despite initial fears because of the weak capacity of many African health systems to manage epidemics. The international community began to receive more detailed information about the reality of the pandemic in China, which led to a virulent attack against the WHO by Donald Trump.

Measures implemented and action taken

While debates raged within sections of the health sector and the media about treatments and methods of transmission, aid practitioners – who were also locked down – began to review their strategies. Protecting medical staff was one of the first priorities, but withdrawing expatriate staff raised numerous questions about local capacity and the ability to coordinate with expatriates. Organisations began to establish systems for monitoring cases and situations in the countries where they were implementing projects, with maps of each country. With visits by headquarters no longer possible, and concerns about risks for staff, practitioners in the field began to define the due diligence that they should exercise. While it was necessary to put in place systems to protect staff, and particularly medical staff (and equip health ministry staff), many questions were raised about supplies of personal protective equipment (PPE), which became the object of international competition. In April there was a global shortage of PPE stocks, including FFP2 masks, leading to cases where these were requisitioned by the authorities. What is more, the large number of orders for these placed in China showed that many countries, including rich countries, were not prepared for such a pandemic, despite the numerous warnings that there had been in recent years.

At the same time, international aid organisations began to detect cases among their staff, which led to a tightening of lockdown protocols. As a result, staff became increasingly dependent on tools for working and discussing remotely, such as Zoom, WebEx, Teams, Skype, etc. It was the beginning of a long period…

The development of response strategies raised important questions about issues of prioritisation in the health sector (COVID-19 vs. other medical problems), and also about the role of social assistance, and even food assistance. Subsequently, numerous fund-raising campaigns were launched to manage the COVID-19 crisis (26 March: joint appeal by the Red Cross and Red Crescent; UN appeal), a substantial number of technical notes were produced (by WHO, the WASH Cluster, the Sphere project, USAID, etc.), and think tanks and academic institutions began to get involved (at the end of March, Groupe URD launched its COVID-19 Observatory, as did CERAH in Geneva, ALNAP launched its COVID-19 Portal, etc.).

From mid-March, due to the new working conditions, the reinforcement of operational continuity plans became a priority for humanitarian actors: decisions had to be made about adapting human resources, staff repatriation, sending relay staff, and which activities to maintain… Due to limited supplies, some organisations decided to fund the local production of masks and to design shock-responsive social protection projects. In the majority of cases, appropriate protection measures had been established for staff, partners and beneficiaries by the end of March. In April, most major humanitarian donors, as well as development donors, agreed to allow programmes to be adapted both in terms of content (responding to the different facets of the COVID-19 crisis) and methods (working from home, remote monitoring, localisation). In certain cases, organisations established forms of mutual support, pooling their competencies.

Based on the experience of Ebola, the competition to find a vaccine began to heat up. This raised the question of whether there would be equal access to the vaccines, given the risk that certain rich nations might buy them up in advance, and Oxfam launched its ‘Free vaccines for all’ campaign. Another issue was the time that was needed for vaccines to get through the different health security filters before being available on the market. At the end of April, WHO launched the COVID Tools Accelerator (ACT), an international collaboration project that aims to accelerate the development, production and equitable sharing of COVID-19 tests, treatments and vaccines, in order to fight more effectively against the pandemic.

What we learned

This disease-related crisis was clearly now a global crisis, and not only a public health crisis. Advocacy related to economic and social issues increased, as did advocacy in favour of a large-scale response. The major international financial institutions began to respond by setting up specific COVID-19 funds. In terms of operational response, a large number of cash-based emergency food programmes were launched between the end of April and the beginning of May.

It was also at this time that certain thinkers began to look ahead to the world after the pandemic. The connection between the risk of pandemics and environmental degradation began to be understood better and to be more present in public debates.

3. Since May 2020…

What happened

From 22 May, the epicentre of the pandemic swung between Latin America and India. Europe was split between optimism (freedom of movement and the return of economic activity) and the renewed lockdown of certain regions (notably in Spain). The number of cases had still not significantly risen in Africa, even though the situation varied a great deal from one region to another. The deterioration of the economic situation was evident in many contexts both in the Global South and the Global North, and there was a huge increase in inequality.

In addition, due to the ‘infodemic’, and ‘infoxication’, it became difficult to understand how the situation was evolving. The quantity of rumours and fake news grew with tragic consequences: by 15 August, more than 600 violent incidents against healthcare workers/institutions had been recorded in 40 countries.

Measures implemented and actions taken

In May, an original initiative, the European Union Humanitarian Air Bridge, was established involving a network of NGOs, the Humanitarian Logistics Network and two donors (DG ECHO and the CDCS). Within a few weeks, this initiative helped to fly over 1000 people into field contexts. Between May and August, it allowed 785 000 tonnes of equipment to be transported. While staff were gradually returning to their offices, both at headquarters (the ICRC’s ‘Back to office’ plan was implemented in August) and in the field, widespread fatigue was apparent at all levels within organisations. The cancelling of international events involving NGOs (Global Cluster, etc.) and their replacement by video-conferences continued to have an impact on the system. Lockdowns not only affected activities but also contributed exhaustion among staff, bringing psychosocial risks: this fatigue had to be managed, and measures were taken to increase staff resilience and provide those in need with psychological support… This situation led to the need to find replacement staff, and to plan for time off and the financial difficulties this would bring: all of which were expensive measures that were not funded by donors. In France, Coordination Sud’s efforts to raise awareness of the structural impacts of the crisis on NGOs in 2021 highlighted that organisations had used up all their own funds due to the cancellation of fund-raising events and new expenses linked to the pandemic.

In certain difficult or unstable contexts, alternatives to locking down were explored (e.g. by ACF in DRC and Lebanon). Having been in place for a number of months, international directives began to evolve on a number of levels (masks, case identification, cash assistance, etc.). On 3 June, a UN briefing regarding access to the MEDEVAC mechanism was sent to NGO staff.

In August, the first results of studies on the treatment of COVID-19 were published, leading to debate and controversy, particularly regarding chloroquine: only corticoids were recognised as being effective. Serious cases began to be treated more effectively in countries with well-equipped health facilities, reducing the amount of time patients spent in hospital and thus reducing the pressure on emergency services.

More and more attention was given to the issue of vaccination following the GAVI Vaccine Alliance’s call to establish a vaccination fund. There was ferocious competition between the major pharmaceutical laboratories, despite the official messages about international collaboration.

One concern was the effect that the COVID-19 crisis would have on development budgets, a concern heightened by the announcement of cuts to the UK aid budget. Oxfam subsequently launched its campaign calling for multinationals who have made significant profits during the crisis to redistribute their wealth.

What we learned

On a strategic level, taking lessons from previous health crises into account proved crucial in numerous contexts. In contrast, when these were overlooked, the situation became difficult to manage. The results of studies on the social impact of COVID-19 (economy, gender, exile, etc.) began to be published, with inequalities increasingly evident, once again raising the crucial question of social protection. And lastly, many aid organisations began to see the need to integrate COVID-19 and the emergence of probable health crises into their ‘normal’ way of functioning in the field and at headquarters.