Our @ScHARRSheffield MPH disaster management class recently looked at the topic of post-disaster recovery. Several key points that will be relevant as we look ahead to the coming months. (I know we are in the thick of pandemic response, but never too early to look ahead!) 1/
It needs to be a managed process that starts the moment an incident has occurred. Not just about rebuilding and recovery, but also has to incorporate prevention/risk reduction measures & preparedness for potential further crisis. 2/
Key to this will be the need for multi-sectoral rapid needs assessments. The population's needs will have changed considerably between pre-disaster and post-disaster. So NHS/LA need to start thinking about doing these RNAs to guide next steps. 3/
Central to these will be the need for community engagement. Top-down responses may be appropriate during the crisis, but for recovery we need more bottom up collaborative partnerships with the community. (This is the bit we often get wrong...) 4/
Recovery is a complex, protracted social process. Wide range of stakeholders, recovery needs & coping mechanisms. Process can take years. Best done at the local level using community development approach. 5/
Community approach helps raise awareness in the community where there may be lack of knowledge, strengthens community resilience & capacity to cope, & makes use of expert local knowledge to help guide planning. Community may be more receptive if a bottom up approach is used. 6/
Community engagement also essential to make programmes sustainable. But community groups may need coordination and help interfacing with statutory organisations etc. Local collaborative partnerships key. 7/
Must not forget need for rest and recovery of our staff & services. Failure to do so jeopardizes services over the longer term & harms people. Also beware potential for waning political support & interest (as the next "headline" issue takes precedence). 8/
Lastly, we really must learn lessons from this crisis. I don't mean "identifying faults/lessons" but actually learning where it leads to positive/constructive change in the way we behave, operate, prepare & respond to future challenges.

So start compiling those insights!
Quote from a wise old paramedic: “You’ve got to be v honest with yourself & be v careful you don’t over-estimate your own knowledge & skills. Just because you’ve dealt with this in the past doesn't mean that you’ve done the right thing. It may just mean you’ve got away with it!”
Also if you've not seen @CraigNikolic 's thread on recovery, worth a read.

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More from @andrewleedr

3 Feb
In the past 15+ yrs I've worked as a GP in some of the poorest parts of Sheffield with all the social ills of poverty: debts, joblessness/job insecurity, crime, abuse, domestic violence, mental ill health, disrupted lives, chronic diseases, alcoholism, early deaths, etc... 1/
For many of my patients, poverty isn't an abstract concept you read about. It's their lived experience. It's real. It's pervasive. It wears you down. It kills your hopes & dreams. And they're trapped in a repeating cycle across generations. 2/
COVID has been really bad for them. Difficult to lockdown in rubbish housing, little greenspace, nowhere to go, nothing to do. Having debts & insecure work forces you to work. I feel most for the kids, many who went to school with my kids, but lack the opportunities mine have. 3/
Read 6 tweets
17 Jan
I tweeted last week the link to @ECDC_EU evidence review of EU & international evidence on: COVID-19 in children and the role of school settings in transmission. Just finished reading it in full & it's balanced & comprehensive. (1) ecdc.europa.eu/en/publication…
Reiterates finding that children are very unlikely to have severe illness with COVID19 infection. (2)
Shedding of viral RNA thru upper respiratory tract may be of shorter duration in children than in adults. Associated with age, although doesn't appear to be significant difference in levels of viral RNA detected in nasopharyngeal swabs between the two. (3)
Read 16 tweets
10 Oct 20
The number of COVID19 cases in UK continues to rise, with a trajectory that is worryingly becoming steeper. Hospitalisations up. ICU admissions up. Community transmission & outbreaks widespread. Clearly control of the epidemic in the UK is deteriorating. Deaths will follow.
1/
Worth revisiting @acmedsci 's report in July for their predictions. acmedsci.ac.uk/file-download/…
Their predicted real worst case scenario is looking more likely.
Give or take a few weeks, we're in for a difficult winter. What's less clear is just how bad is going to get...
2/
The UK gov has thrown £billions at the problem, hired loads of private consultants & consultancy firms, been given lots of good scientific advice, done national lockdown plus local variants of lockdown lite. Yet it's not working.
3/
Read 8 tweets
1 Oct 20
The key to better control of the #covid19 pandemic may be in identifying & preventing #superspreading, through backward tracing to identify clusters. Need to rethink our approach.

Good article by @zeynep explaining the rationale.
theatlantic.com/health/archive…
Contact tracing seeks out where the infection has come from (look for source) & where it is going (contacts of the index who may be susceptible). An assumption is that all infections are equal (i.e. every infected person has a similar chance of infecting someone else).

1/n Image
So with COVID19, we assume with R0=2.6, 1 infected person infects 2.6 others. But this is an erroneous assumption if superspreading is a key mode of transmission. Some infected persons are more infective!

2/n Image
Read 13 tweets
18 Sep 20
Musings today:

The problem I think with the current approach to COVID19 is we are approaching it the wrong way round, from the wrong end of the telescope.

1/...
COVID19 is a public health problem that requires a public health approach & solution. Trouble is, we often try to solve public health problems with healthcare solutions from a healthcare perspective.

2/...
If you had cancer, it would be nice to have the best cancer diagnostics & treatments. But wouldn’t it be better not to have had cancer in the first place? What if we eliminated smoking & in doing so prevented thousands of cancers?
Similarly, COVID19 is a preventable disease.

3/
Read 9 tweets
3 Sep 20
#Masstesting especially of asymptomatic individuals for #COVID19 is NOT a magic bullet solution.

There seems to be a lot of clamour for it but we need to consider not just the utility of testing but also the issues with it.
1/...
A few months back a team of public health researchers @FionaBell19 @lliandme @ScHARRSheffield carried out a rapid evidence review on #masstesting. We found the evidence from around the world to be mixed, patchy and limited.
2/...
NO TEST IS PERFECT. PCR tests for COVID19 can’t always tell if it is current infection or past infection, or whether the individual is still infectious or not. Here's where clinical interpretation and judgment is key.
3/...
Read 12 tweets

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