Thread by @SWalshEU

When @ossjohnson & I wrote #GettingtoZeroBook on our work on the #Ebola crisis in Sierra Leone, little did we know that we would soon be battling another infectious disease #COVID19, me in #SouthSudan and Oliver in South Africa. Here are some of the lessons we are trying to apply

1. We need to monitor and mitigate the negative side-effects of preventative measures.
Measures aiming to prevent #COVID19 like lockdowns, banning public transport & closing shops, can create unemployment, raise food prices and threaten livelihoods of already vulnerable people.

So each preventative measure must be analysed in terms of its prevention benefit vs. its cost for the population to try to find the best balance. And then we need to try to mitigate the impact on the newly vulnerable people as much as we can.

2. It’s critical to balance addressing the primary and secondary impacts of the virus.
In Sierra Leone we were too slow to address the secondary impacts of #Ebola. We focussed on battling the disease itself but didn't do enough to protect the rest of the health care system.

Ultimately more people died from other diseases due to the collapse in health care than died from Ebola itself. As malaria season approaches in #SouthSudan, we must try to protect the health system & its critical workers from #COVID19 so they can continue to serve the population.

3. Pre-existing vulnerabilities remain & must continue to be addressed.
In #SouthSudan approximately half of the population, over 6 million people, were already facing crisis levels of food insecurity in 2020 before #COVID19 began.

It is critical that we keep the existing humanitarian programmes going, while having measures in place to prevent COVID19. Another difficult but important balance.

4. Context is everything: the virus finds you where you are.

#SouthSudan has 190 doctors which is approximately 1 per 65,000 people in the population. About 1.5% of what WHO says a country needs. Unfortunately this number doesn’t magically increase with COVID19.

And unlike for Ebola we can't bring in many health workers from abroad. We need to work with what exists in country. Creative strategies will be key for us to do the maximum of what is possible to assist #SouthSudan despite shortages of health workers, facilities and equipment.

5. Strong political and technical leadership is essential.
As with Ebola, the COVID19 pandemic is unprecedented, fast-moving and full of uncertainty. This requires strategic political leadership to be combined with robust technical expertise at every level of the response.

The crisis requires a sole focus on the public interest and never personal advantage. Coordination is also vital. The Ebola response was initially plagued by bad meetings – we wasted precious time. Getting meetings right – brief, structured and action-oriented – had a big impact.

6. Community ownership of prevention is critical; the job of the response is to give people the tools to protect themselves.

This is our most critical lesson. We learnt that when people were given the information and the means they created their own prevention strategies.

At first, we focussed on providing info but two-way dialogue and understanding people's specific prevention challenges was key to help overcome them. We often underestimate how difficult the basics are for people living in poverty, e.g. hand washing facilities in slum communities

And finally...
7. An over-militarised approach to enforcing prevention measures will backfire
In Sierra Leone, when the police & army were enforcing strict quarantine measures, people often fled the response, rather than engaging with it. People need to feel cared for.

We hope that these seven lessons have been useful. For more visit gettingtozerobook.org

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