advertisement offers a frontline guide for local decision-makers

The COVID-19 pandemic is causing significant disruptions to cities and local communities globally. A group of global health professionals has developed, a guide to provide a decision framework for local leaders to think through what will need to be done to help reduce the impact of the outbreak, both by reducing spread and decreasing the number of cases, but also in responding and supporting communities effectively.

This document is informed by existing guidance from U.S. and global authorities, public health research findings, and lessons observed from countries that have been battling COVID-19 since January 2020. It is intended to complement, but not in any way supplant, advice and guidance from global, federal and local public health and other authorities.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can spread explosively if not rapidly addressed. Different cities will face differing risk profiles and require tailored mitigation strategies, depending on how far the outbreak has advanced in any given location. This document is intended to provide leaders and public officials at state, city, or locality level with a decision support tool to assist in informed strategy and decision-making on how to combat the resulting disease, COVID-19, in their jurisdiction. It is NOT a prescriptive set of instructions; rather it provides context and advice on how to tailor principles of outbreak control strategy, disaster management, and evolving knowledge on COVID-19 dynamics to different local conditions.

Battling a new virus pandemic is a unique public policy challenge: the human and economic costs of daily or weekly inaction grow exponentially. Early in an outbreak, when case counts are low, losing a week of potential action may not dramatically change outcomes.

But as an outbreak begins to spread and accelerate, a 1- to 2-week delay can be the difference between cases in the thousands or cases in the tens of thousands.

Research on the 1918-19 influenza pandemic in the United States has found that early, sustained application of measures like social distancing mitigated community-level impact of the outbreak. It is beneficial to apply strong measures early on rather than to wait, even if those measures feel intuitively premature at the time. Lessons from Singapore, Hong Kong, and Taiwan during the current pandemic likewise affirm that early and disciplined action can limit or prevent explosive spread.

However, state and local leaders must also weigh the public health benefits of disruptive measures against the second-order impacts that those measures may have on the economy, vulnerable populations, and other local factors.

The tool outlines seven initial key actions:

• Activate Emergency Op Center;

• Understand real-time local spread;

• Slow and reduce transmission;

• Protect high-risk groups;

• Reinforce/expand health system;

• Enhance risk communication;

• Mitigate economic and social impacts.

Check out the guide at

The guide's authors are:

• Jessica Bell, MS, Senior Program Officer, Global Biological Policy and Programs, NTI

• Matthew Boyce, MS, Senior Research Associate, Georgetown University, Center for Global Health Science and Security

• Beth Cameron, PhD., Vice President, Global Biological Policy and Programs, NTI, former Senior Director, National Security Council staff, Directorate on Global Health Security and Biodefense

• Jacob Eckles, MPH, Program Officer, Global Biological Policy and Programs, NTI

• Ellie Graeden, PhD., Chief Executive Officer, Talus Analytics

• Rebecca Katz, Ph.D. MPH, Professor and Director, Center for Global Health Science and Security, Georgetown University

• Jeremy Konyndyk, MSFS, Senior Policy Fellow, Center for Global Development; Former Director of Foreign Disaster Assistance, USAID

• Hayley Severance, MPH, Senior Program Officer, Global Biological Policy and Programs, NTI

The contributors include:

• Paul D. Biddinger, MD, FACEP, MGH Endowed Chair in Emergency Preparedness Director, Center for Disaster Medicine and Vice Chairman for Emergency Preparedness, Department of Emergency Medicine, Massachusetts General Hospital, Medical Director for Emergency Preparedness, MGH and Partners Healthcare, Director, Harvard T.H. Chan School of Public Health Emergency Preparedness Research, Evaluation and Practice (EPREP) Program

• James Lawler, MD, Executive Director, International Programs & Innovation, Global Center for Health Security, and Associate, Professor of Medicine, Division of Infectious Diseases, University of Nebraska Medical Center

• Margaret Hamburg, MD, Chair, Board of the American Association for the Advancement of Science, and former Commissioner of the U.S. Food and Drug Administration

• Ashish K. Jha, MD, MPH, Director, Harvard Global Health Institute, K.T. Li Professor of Global Health, Harvard T.H. Chan School of Public Health, Professor of Medicine, Harvard Medical School

• Dan Hanfling, MD, Vice President Technical Staff, In-Q-Tel

• Dylan George, Ph.D., Vice President Technical Staff, In-Q-Tel

• Jennifer Nuzzo, DrPH, SM, Associate Professor, Johns Hopkins Bloomberg School of Public Health, Senior Scholar, Johns Hopkins Center for Health Security

• David Polatty, MA, Professor, U.S. Naval War College Humanitarian Response Program

• Nathaniel A. Raymond, Lecturer, Jackson Institute of Global Affairs, Yale University

• Eric Toner, MD, Senior Scholar, Senior Scientist, Johns Hopkins Center for Health Security

• Juliette Kayyem, JD, Faculty Chair, Security and Global Health Project, Harvard's Kennedy School of Government

• Timothy Manning, Director, Washington, D.C. Operations, PDC Global; former Deputy Administrator

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