TABLE 3

Proposed Actions at the Local and Community Level

A. Country Support and Preparedness
• Comply with WHO recommendations on prevention and containment of new severe epidemics.
• Align all action with the motto expressed in the Helsinki statement “Health in all policies: framework for country action”.
• Focus on the effective implementation of guidelines, regulations, and instructions with relevant authorities.
• Ensure full regional ownership of nationally coordinated actions.
• Ensure adequate national co-ordination and integration of activities with clear overall objectives, focused goals and measures, in a prioritised way.
• Ensure an updated, practical and real notion of each country's critical preparedness and readiness for preventive and response actions to Covid-19 and other, future severe pandemics, not only in terms of health care infrastructures, institutional capacity and skills but also regarding other institutions and the community at large.
• Adequately identify strengths and weaknesses in countries’ global strategy, as well as in health care and community settings regarding CRDs in the context of severe pandemics, as well as limited resources that may hinder adequate approaches.
• Strive to develop community capacity regarding CRDs and severe epidemics, integrated into a national strategy and policy.
• Ensure adequate planning of risk communication regarding pandemics and CRDs, as well as community engagement in actions that may be both global but also tailored to the specific level of health literacy and cultural context of each population, aiming at reducing health inequalities.
• Ensure all actions are inclusive of vulnerable population groups, and their needs are prioritised when appropriate.
• Ensure that there is adequate accessibility to healthcare and medication for patients with CRD, during the pandemic.
• Endeavour to have adequate monitoring of all actions integrated into countries’ policies and strategies regarding CRD management in the context of severe pandemics.
• Endeavour to have actions guided by the “One Front, Many Actions” approach, with integrated, articulated, complementary, necessarily supervised and multiple-level organised actions impacting upon management of CRDs in the context of COVID-19 and other future pandemics, not only within each country but also in collaborative efforts among different countries, as has already been initiated by CPLP (Portuguese-speaking countries), in terms of a common webpage hyperlink to country-level dedicated epidemiological statistics and other relevant information on COVID-19 (www.gard-cplp.ihmt.unl.pt/index.html).
B. Surveillance, Research, Environmental Health and CRDs
• Follow-up (short and longer-term, clinical as well as functional) of infected patients regardless of age (infants, children, adolescents, adults and elderly) is important to monitor disease and symptom severity and treat accordingly, as well as identifying possible long-term consequences.
• Use objective measures for monitoring including pulse oximetry, and where possible, spirometry, CO diffusing capacity, impulse oscillometry, and lung clearance index.
• Support surveillance (testing, screening, diagnosing, contact tracing, treating, and following-up) and reporting of COVID-19 disease burden and epidemiology by countries/regions which will help understand the differential impact attributable to geographic variations.
• Access reliable dashboards (e.g. WHO, www.who.int/emergencies/diseases/novel-coronavirus-2019, European Center for Disease Prevention and Control www.ecdc.europa.eu, Johns Hopkins www.coronavirus.jhu.edu/map.html, GARD www.gard-breathefreely.org/covid19/ etc.) on pandemic surveillance and statistics.
• Keep abreast of the pandemic locally and worldwide in order to act accordingly.
• Ensure COVID-19 surveillance of vulnerable populations in low and middle income countries (LMICs), particularly in areas of high prevalence of HIV, malaria and tuberculosis (TB).
• Ensure that public health surveillance is not just diverted towards COVID-19 but is also kept, together with accessibility to adequate treatments, in other infectious diseases (namely TB, HIV and malaria) and chronic respiratory diseases, particularly in LMICs.
• Partner with respective government agencies to enforce the ongoing fight against air pollution and climate change.
• Include in pre-graduation curriculum (medical, nursing and allied health sciences): catastrophe health care management, as well as preparedness, with an emphasis on epidemics, pandemics and global security.
• Support and provide resources for efficient and effective local surveillance systems.
• Use/support continuing medical education programs to update knowledge on new infectious disease.
• Support investment in training health care professionals and the public in understanding risk, how tests are used, and in risk communication to avoid unnecessary alarm and/or complacency in uncertain times.