The Upstream Response to COVID-19
Version 2 - 7th April 2020
Author: Simon Duffy
The COVID-19 crisis has hit the world like a Tsunami. It is very likely that it will change the world; but at the moment we cannot spend too much time thinking about a post-COVID world. We are inside the wave and our priority must be to ensure that as many people as possible survive the impact of the virus.
This paper is a working paper. It began as a joint piece of work between myself and Cormac Russell. However Cormac’s mother has just died and so I have agreed with Cormac, due to the urgency of the issues we’re discussing, to publish this article on my own now and to revisit this with Cormac when the time is right.
Thanks also to Lizzie Peck who has been gathering examples of good practice from the internet and to all those who have spoken to me or shared information on the global Zoom call organised by Cormac or the national Zoom call we organised recently. We hope to maintain some of these conversations over the coming weeks.
In a nutshell
This is a long and imperfect piece and it is work in progress. I publish it now - with all its imperfections - because I think urgent action is better than perfect analysis. For those who have too little time to read the whole article here are my main conclusions in a nutshell.
From our learning so far I think the main action points for every community are to ensure:
- Everyone knows how to stay safe and has what they need to be safe
- Every home is in touch with at least 2 others to help as needed
- Every street (or block within a street) has at least one champion
- Every community has a network of communication and coordination
- Volunteering starts with supporting our neighbours
- People and organisations must have security and the chance to contribute
- Central coordination must be clear and empowered to act
We have also tried to capture these ideas in one image below, you can view and download the pdf in your browser here.
In what follows I will provide some analysis, details and examples of good practice and problems to be solved. But most importantly - if you see a way of improving this model or sharing better examples please do get in touch:
The severity of the challenge
Part of the challenge we face with the COVID-19 crisis is that it demands we integrate expertise and wisdom from multiple fields at a time when there is not enough time to consider all our options. The severity of the crisis really hit me on 11th March after I returned from an event in Madrid that was cancelled because of the crisis. While I do not understand why the UK Government has been so slow to react to the COVID-19 crisis, I do understand what it means to be slow to see the wave coming towards us and to think that maybe it won’t be so bad when it finally arrives, for it certainly took me some time to wake up to how serious this crisis was going to be.
I am no epidemiologist nor a public health official. There is much we still don’t know about COVID-19 and maybe some of my assumptions are faulty but from my initial research several things struck me:
- COVID-19 seems very dangerous and we should all avoid being infected.
- COVID-19 is especially dangerous to the elderly and disabled people and care homes will be at special risk.
- COVID-19 is even more deadly when hospitals reach full capacity and when there are insufficient specialist resources, beds, ventilators, trained staff or essential supplies.
- If you can test and re-test people, track contagion and contain outbreaks then you will save lives.
If this is right then the case for urgent action, especially in places like the UK, is very clear and it is very frightening when those in power seem unwilling to act to prevent the crisis. Delayed lockdown and the failure to do sufficient testing seems likely to ensure that the impact in the UK will be much worse than in most countries (expect perhaps the USA) and on top of that the UK is already at higher risk for a variety of systemic reasons:
- The UK has very few hospital beds. Countries like Japan have 13 beds per thousand people the UK has 2.5 (less than Spain and Italy).
- The UK has high numbers of people congregated in residential and nursing homes (many more than in Italy or Spain).
- Local government, social services and the voluntary sector are very weak, having been hit by eleven years of cuts, the most severe cuts in Europe, alongside Greece.
- The UK is hyper-centralised and the capacity of local communities to self-organise is very low compared to most countries.
- The UK is highly unequal and poverty and income insecurity are very high. The UK’s recovery from the 2008 depression has been one of the worst internationally and slower than our recovery from the Great Depression.
- The UK has an extreme Right-wing government who have persisted with policies that have already led to increased rates of death, mental illness and suicide.
- The independent media in the UK is dominated by a handful of wealthy individual owners and the state-funded media often seem highly subservient to central government.
Everyone needs to be concerned and to act with a sense of urgency. But this is even more so in a country like the UK where the Government has a long track record of failure and heartlessness. Given the failings of our central government the urgency to organise at a community level is even greater.
The need for community
At first the need for community action may not seem obvious. Certainly in the UK the main emphasis from Government, when it woke up to the severity of the threat has been to:
- Encourage social distancing - which is a rather odd way to describe the need to stay physically apart - and which would have been much better called safe distancing.
- Focus on the NHS or hospital response and recruiting 750,000 people to volunteer for the NHS - creating an enormous coordination task nationally, when the needs are actually local.
- Create a package of economic measures to help businesses and the self-employed - but which will leave millions of people still lacking basic economic assistance.
There has been no emphasis on the community response to COVID-19 from central government and it would be easy to think, if you focused only on official news media, that such matters were not important. But the community response to COVID-19 is a vital matter of life and death and it requires just as much attention as the response by the NHS or by local services - although it requires a different kind of thinking. Not command and control - but encourage and enable.
We need each other and at time like this, when normal public services will be stretched to breaking-point, we will discover that the community plays a vital role in protecting public health - a role for which there is no professional alternative. For example:
- We will need to find out if everyone on our street is okay and if they are not okay we will need a plan about what we need to do so that they can be okay.
- We will need to be able to safely provide regular practical help with shopping, collecting prescriptions, helping people have social contacts and even fun.
- We will need to lend a hand, fix the plumbing, do some gardening, help people go to vital appointments - especially when we want to avoid putting pressure on public services that are needed elsewhere.
- We may need to do some things that are very challenging: help taken in children whose mother has to go to hospital, help people who are sick at home, help people who may want to die at home.
- We may sometimes we will need testing, protective equipment and medical and hygienic supplies in our streets and houses.
And we will have to do all of this safely, breaking down social distance, while trying always to be at a safe distance. The community is the upstream response to COVID-19. If we can help people avoid contagion, avoid putting pressure on services, avoid going to hospital then we can help save lives.
This challenge exists for every community and some communities may struggle to take up that challenge. Some people assume that it will be the better-off communities that are best equipped to face these challenges - but I am not so sure. It is many of my friends who live in poverty who I see best equipped to overcome these challenges. I doubt that money will be the most important variable here. A minority may try to buy their way out of the crisis, but even they will struggle to find a way out by using money alone.
The real barrier before us is that many communities have lost the habits of community life and it will take real courage to step up and act like a citizen, rather than a consumer.
The emerging response
One bit of good news amidst the crisis is that as the COVID-19 wave has begun to hit we are discovering that people, citizens, neighbours - whatever we want to call ourselves - are ready to step up to the challenge of being good neighbours. There has been an amazing uprising of genuine civic life orientated towards the places where we live - our communities:
- Groups have been forming within small local areas, using systems like WhatsApp
- Community groups are using shared video-conferencing platforms like Zoom
- Groups for different levels of community have been organised, using Facebook
- People coming together to sing, play music or thank health-workers
- People are doing online learning and sharing skills togetherPeople are sharing pictures, leaving presents, helping with chores
- Some are creating community games (e.g. like hanging jokes from trees, with punch lines on the WhatsApp group)
- People are making telephone calls and talking to each other across the street
This seems to be happening first in places where communities are smaller, power is local, and where the habits of community life have been nurtured and protected. For example:
- Local authorities, like Leeds, Wigan and Barnsley have been organising to support citizen action and local community initiatives for many years now.
- Some places, like Derby have used Local Area Coordination systems to solve problems in local communities before they become crises requiring service solutions.
- In places like Ludlow in Shropshire there is a functioning town council which can work with local GPs to organise a community response.
If you have identifiable communities, where people know each other well, where there are strong habits of community life, clear and effective democratic structures for finding out information, making decisions and organising collective action then community action will be easier. However many communities lack these local democratic structures:
- Formal democratic leadership roles are remote
- Boundaries and communities are obscure
- Communication systems are weak
- The habits of community life are lacking, social isolation is common
- There are no mechanisms for collective decision-making
- Public services are bureaucratic and dislocated from real communities
I am sad to say that my city, Sheffield, is one of those places that is going to find community organising more challenging. Sheffield is a large city in the North of England with a population of about 600,000 and with 230,000 homes, in 7,000 streets, with about 60,000 people living on their own. The city is broken into 28 wards and there are 142 geographical communities within the city (see Appendix 1), but there are no clear political or democratic structures linked to these communities. Public services are largely funded and controlled by central government (e.g. the NHS and schools).
The people of Sheffield love their city, and many will also identify with their local community, but democratic involvement is minimal and there are no formal structures below the city council to coordinate community action. There are lots of great people and great voluntary, community and social enterprises - but they exist in an uncoordinated patchwork, often focusing on particular groups or issues - not on the capacity of the citizens and communities themselves.
Positive work has now begun and the fact that it’s harder in Sheffield doesn’t mean Sheffield can’t make up the ground it has lost over the last decades. But the challenge is greater where there is no expectation for leaders or communities that communities can and must be part of the solution.
Taking a strategic approach
Too often communities have been ignored, under appreciated or allowed to wither and decline. Some communities thrive, but they are disconnected from power and people may be unaware of what they can really achieve and what the current crisis demands. We need a strategic response to try and accelerate the growth and resilience of the community response. It is for this reason Cormac Russell and I have tried to draw out some of the lessons we see being learned around the world and to think about what framework might help people to best organise their community response to the COVID-19 crisis.
We have developed the graphic above as a way of representing the structure of the challenge. We understand that every community is different and that many communities will have different strengths to build on, but we hope that this framework may offer food for thought and creative action in most cases.
Broadly speaking our response needs to be based on an understanding that society has different and distinct elements, and each has their own logic. In the context of COVID-19 we are distinguishing three different parts of society, each of which offers us some kind of defence to COVID-19:
- Community - the things we do as free citizens, neighbours, friends and family
- Services - local government, businesses, charities and organised groups
- Healthcare - hospitals, doctors, nurses and all the additional supporting staff
To begin with it is important to remember that if people can live safely, get their needs met, avoid the virus and stay at home then the virus will not spread, will not lead to people going to hospital and will not kill. There is nothing inevitable about death from COVID-19 and if the community is organised properly it will reduce the number of deaths; the community is the first line of defence against the spread of COVID-19.
It is also worth remembering that congregated care services and hospitals are essentially dangerous and that they should only be used when absolutely necessary. If someone goes into a care home they will risk spreading the virus and the whole population of the care home is at risk. If someone goes into hospital with the virus they risk spreading it; if they go in without the virus they risk catching it - and spreading it further.
Strengthening the community response to COVID-19 is the upstream response to the crisis and dealing with problems upstream is more efficient and effective than dealing with the downstream. The more we empower and strengthen the community response the safer we will all be and the more people will survive this crisis. Looking at what we’ve learned so far we’ve identified 7 key strategies to enhance the community response to COVID-19.
1. Everyone knows how to stay safe
The messages we have received from Government have been confusing and have changed. Some people may not have been listening, may not speak English, may not have understood or don’t know how to convert that guidance into reality. We all may not be working with the best advice.
In France my father tells me that the advice is that food deliveries should not be handled for three hours (for the virus cannot survive that long). If this is true everybody should know it and we should build it into our own habits and the way we help people. This is not a minor issue - having the best possible advice saves lives.
In one city of Canada the local council provides all residents with a daily email briefing containing all the latest information, best practice and what people need to do to stay safe. There is a briefing for Sheffield - but it is not daily and I’m not sure how many people it reaches, it is also rather complex to sign up. Getting important information regularly through emails, social media, local news outlets and door-to-door delivery is very important.
For people in our communities that are most likely to miss out on important information these other strategies will also help:
- Work through existing community groups to make sure they spread information to their members and networks.
- Share information online and help people get access to the internet and internet enabled devices.
- Share information in accessible formats and in different languages.
But the most important thing to do - and the only reliable way of knowing everyone has been reached is to develop street champions and to ensure everyone in the community is part of an active neighbourhood group. This may take time - one Italian community organiser said it took four weeks before the most retiring member of the community began to engage with their group. But going to people to where they live, making sure they receive information and making sure we all stay in touch at that local community level is the only reliable way of getting universal coverage.
My father, who lives in France describes the approach in their neighbourhood:
"There are about 20 houses in our vicinity and at 20.00 we come to our windows or balconies. The children dance in the street and the adults shout at each other across the street. It lasts 5 to 10 minutes then we all go back indoors. It reinforces our community at this difficult time and it enables us to thank the two nurses and the two doctors who live in the street and we all get to know each other that much better. The people there are tiny tots to 80 year olds."
2. Every home is connected to two or more others
The simplest way to help people to stay safe and connected is to make sure everybody - but particularly people who have the virus, are self-isolating or those who are very vulnerable to the virus are in contact with at least two other other local homes and know people from whom they can get support.
Most help does not need much formal organising if people can get into regular habits of thoughtful neighbourliness and know how to be in touch with each other. It will also save a lot of energy for street champions if people get into these habits, so a good early task, while establishing some kind of local list of neighbours, is to make sure everybody has contact details for at least a couple of people and to establish patterns like agreeing that everyone will at least ring a couple of their neighbours regularly. Thanking people, encouraging people and gently reinforcing these norms will quickly establish new patterns of normal everyday neighbourliness.
3. Every street or block has at least one champion
There seems to be no doubt from the international experience so far that communities will cope best if there is at least one (ideally two people working together) street champion for every street. When we listened to community leaders, including those from Italy and Singapore who were already deep in the wave we heard this advice:
- If the street is too long break it into blocks (say 10 homes) and establish champions for these blocks.
- Get a list of everyone on the street and make sure you have contact details for every home.
- Make sure that every home knows folk from at least 2 other homes.
- Encourage people to make small acts of kindness rather than heroically overreach.
- Focus on what children will need and follow people’s source of joy.
- Be brave, don’t doubt yourself
- It may take time to break down resistance, but gently persist
- Keep politics out of it
- Start to prepare for when services can no longer cope and there will be even less external assistance.
Of course street champions will need to establish their own networks of support, particularly with other street champions.
4. Every street is connected into the network
It will help street champions to be connected into the formal help systems organised by local government and the community sector. Many places, like Sheffield, are organising community hubs based around churches or established community groups. However the real challenge is to focus on establishing a structure for the city which is connected to every home and every street. That can seem challenging - but in fact it is largely a matter of breaking down a large city into progressively smaller units:
- Sheffield has about 600,000 citizens living in 230,000 homes
- The city is already broken into 28 wards containing an average 21,500 citizens in 8,200 homes (each ward has 3 councillors who are elected by the ward).
- People themselves identify with 142 communities of on average 4,225 citizens in 1,600 homes (this means there are about 5 communities per ward). Interestingly there are almost exactly the same number of communities as primary schools in Sheffield.
- Often it may make sense to identify a neighbourhood or a small collection of connected streets within each community. So there might be about 1,500 neighbourhoods of 400 citizens in 150 homes (that means there’s about 10 neighbourhoods within an average community).
- Sheffield has 7,000 streets with an average of 85 citizens living in 32 homes (that means there’s about 5 streets in a neighbourhood).
- If we break down streets into blocks of about 10 homes then there are 23,000 blocks with an average of 27 people in 10 homes (this about 3 blocks per street). Obviously this would vary depending on street size or whether people lived in a block of flats.
If we do break the city down like this we could have a way of realistically being in touch with almost all 600,000 citizens living in 230,000 homes. Of course we have to reach out to those who are homeless, although clearly the number one priority is to help people get a home. Also there are visitors, students and the traveller community to consider, but most of these groups can be reached by working through the relevant community groups, landlords or local services.In our communities we need now, as a matter of urgency, to establish coordinators who can break down the community into its relevant component parts and negotiate this with emerging leaders.
This is an entirely do-able task for a named person or a small team if they use a spreadsheet and start communicating out through the emerging networks, priorities may include:
- Develop a list of wards, communities, neighbourhoods, streets and blocks and start to assign names to coordinators at every level.
- Where there are gaps reach out the existing community structures, use social and official media channels to make people aware of the gap.
- Use mapping technology to highlight all the areas, streets and points of coordination.
All of this may challenge some assumptions about privacy - but local communities need to start evaluating the relative risks and the real duty of care. If we do not discover or create a community structure that guarantees universal coverage then we will increase the risk of unnecessary deaths.
There is a particularly important role here for people who are part of pre-existing ‘horizontal’ communities. For example there are diverse ethnic, faith and language communities. There are also people connected by shared interests: music, sport, art, dance, disability, love of nature, passion for justice and education. There are also many businesses, social enterprises, charities and informal associations. Organisations like Voluntary Action Sheffield and Sheffield Chamber of Commerce act as advocates for these communities. These groups will have members in every geographical or vertical community and they can therefore help people establish points of leadership and coordination at every level.
Once these structure are created they become the essential means for communicating needs, information and advice. Once these structures start to be used people will be able to:
- Find out how to help a neighbour in extreme need and get access to protective equipment or find out what to do if none is available
- Learn about good practice, useful resources and creative ideas in your local community.
- Get information from the central point of coordination in the city about urgent needs or information that everybody needs to know
This network is the nervous system that allows the whole community to operate, cooperate and react to the COVID-19 wave. Without this network many people, families and neighbourhoods will miss out on support and may end up in crises. Establishing this network is the point where self-organising communities must meet up and work with the local government and community leadership.
5. Volunteering starts in our neighbourhoods
One strength that the UK has is that it has a dedicated and well organised system of medical care. The NHS is not well funded by international standards and it has a low number of beds and intensive care beds. However its funding is secure and there is no nonsense about private insurance or making people pay for treatment. Its staff are valued by the community and we know that they will do all they can amidst this crisis. The challenge is to grow the capacity of the NHS and volunteers may be able to supplement what the NHS can do.
In the last few days 750,000 signed up to be NHS volunteers. This tells you a lot about the level of community capacity and good will that exists in our communities. However there are serious questions about what untrained volunteers can do. Many of the tasks that the volunteers have been asked to do are actually tasks that could be better organised at a community or a local government level. For example the four main tasks for NHS volunteers identified by the Government are:
- deliver medicines from pharmacies
- drive patients to appointments
- bring people back from hospital
- make regular phone calls to check on people at home
Most of these tasks could be achieved more efficiently if they were organised at a street or neighbourhood level. Community organisation of this kind of volunteering is much better because it increases:
- the use of local resources, shops and services and reduces travel times, pollution and cost
- neighbourliness and grows local knowledge, creativity and understanding
- the chance people will pick up on problems and avoid crises down the line
This is also true at the level of community services, although there are different kinds of volunteer roles already within our community services and these will need support and reorganisation. For example:
- Sheffield’s Citizen Advice network had to move to home working and it includes many vital volunteers who can provide specialist advice on benefits.
- Some community groups will have access to people who are at extra risk of falling through the gaps, people who are homeless may have had no access to information about COVID-19, asylum seekers will need extra support to get the right information and assistance.
- Some community groups are embedded in geographical communities and can play a big role in helping local communities get organised. This is where the idea of a community hub can be very useful.
Local leaders need to be having conversations with central government, the NHS and local services and comparing the volunteering capacity with what is going on in communities. Some communities, like Wigan are sending out a clear message:
If you want to volunteer start in your own local community, be a street champion or talk to your existing street champion to find out what you can do.
6. People and organisations are secured
One of the most important features of the current crisis is that it reveals the degree of unnecessary control and insecurity built into our social and economic system:
- Community groups controlled by meaningless contracts - many of which can no longer be completed according to the normal rules
- Disabled people and families told they can only use their direct payments on things they now can’t purchase rather than what people know themselves know they need
- People stuck in the Universal Credit Misery Machine made to jump through meaningless hoops, assessed, re-assessed, endlessly polishing CVs and applying for jobs that make no sense
- People and business in debt, paying taxes and struggling to survive from week to week, while giant corporations gather vast cash reserves and avoid any social responsibilities
This economic crisis has revealed that the system doesn’t work, it doesn’t trust people and it doesn’t provide people with the basic economic security we all need. The Centre for Welfare Reform has been one of the many groups arguing that now is the time to embrace the principles of basic income, but these issues are even broader and at this time there are other things local and central government should be doing to make sure people are free and secure so that people are properly enabled to give of the best of themselves in this crisis.
Interestingly the crisis reveals that the only people with secure jobs are people in the public sector. This security should be broadened to as many groups as possible:
- Local authorities need to send a clear message that all contracts will be protected - and then work out with their partners how they will use the energy that this releases to help businesses and charities focus on our urgent needs.
- Most people receiving social care or extra support are at home and they need to be able to create solutions that are safe, working within safe distancing rules and often this will mean families or others that people live with doing what is needed. People need to know that they will be trusted to do what they need to do and are free to use funds as they see fit. Even systems of monitoring should be closed down during this crisis - they merely create fear and unnecessary work.
- We need people to be secure in the knowledge that neighbourliness will not be punished; you don’t need insurance to help people; you won’t be liable if things go wrong in a crisis like this.
- All the rules of conditionality and control associated with the benefit system need to be turned off. No longer should people fear that they can’t do volunteering because they should be looking for a proper job - at the moment volunteering is the most important job out there.
- Demands for Council Tax and all other bills should be put on hold wherever possible.
- Wifi and internet equipment should be made available to everyone.
Business should be supported, especially local businesses. They should be pulled into the system of local neighbourhood coordination. Conversations should be had about how the business can use its staff, its building or its other resources and every effort must be made to ensure people can help out rather than feeling they lay staff of. There are important unanswered questions at present about whether the Chancellor’s deal is really helping communities do the right thing. [e.g. If I lay myself off we may get some funding, but if I lay myself off can I help out if my job is to try and develop community solutions.]
Civic leaders need to be strategic and treat the whole community as part of the necessary solution, from individual citizens and families to charities and organisations. It must be unacceptable to add the worry of economic insecurity on top of the worry that we may not live through this crisis. It must be unacceptable that organisations profit from this crisis. It must be unacceptable that resources, skills and capacities go unused because we lacked the will or insight to find out how to mobilise them.
7. Clear and empowered central co-ordination
Local leaders need to be brave and clear in their leadership and coordination. There needs to be a central point of control for each local authority, a named person and a team around them which means they can communicate with all of the key resources in the community:
- Who is representing the NHS and communicating their needs and resources?
- Who is representing social care and other local authority staff?
- Who is representing the voluntary sector?
- Who is representing the business sector?
- Who is representing the community and street champions?
After this crisis communities will be judged by their competence, their clarity and their ability to coordinate actions across the city. Mistakes will be forgiven; refusing to lead and failing to trust communities will not.
Many of us have been working towards establishing systems of neighbourhood democracy as part of a renewed constitutional settlement in the UK. Now is the time to behave like we have one - even though we don't - as we establish new habits of community life we must also begin to ask how we create the democratic structures to protect them in the future.
We will be adding to this text in the coming days and we would welcome feedback and examples of good practice we can share, please email: firstname.lastname@example.org
The publisher is the Centre for Welfare Reform.
The Upstream Response to COVID-19 © Simon Duffy 2020.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.
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