NOTE: This was last updated on 25 Feb 2020 when the virus had only just started to hit northern Italy hard. It is obviously outdated now, but I think it does bear up well against how things have happened. For a more recent view on what I can offer, see Covid-19 Response Consultancy.

Client: Large organisation with HQ in the UK and some operations around the world.

This is a set of notes for a workshop on Covid-19 (novel coronavirus) preparedness. It’s the first in a series of pieces I’m calling “Dr Doug’s Second Hand Fact Emporium”, which is where I take work I’ve done and make it available more widely.

If you want me to facilitate a workshop like this for you, tailored to fit your needs, do get in touch. I’m not a public health expert, but I am well briefed, and very experienced in running this sort of workshop. (There are a small number of people with proper expertise in the disease and public health, but they have other priorities right now, and few of them have experience in working through these types of workshops with a wide range of participants.)

NB These notes are fictionalised to ensure confidentiality. As someone who’s worked on data de-anonymisation, I know that genuine anonymity is very difficult to ensure alongside data accuracy. It’s not as simple as being more broad-brush or leaving out details. Here, though, I am able to cheerfully sacrifice accuracy for security, so as well as glossing some details in {curly brackets}, I have composited some parts of this account from other organisations, and made up some of it entirely.

Workshop title: Covid-19 Preparedness

Workshop aims: To ensure that the organisation is well prepared for any pandemic outbreak, and so is able to {achieve its mission statement in difficult circumstances}.

Workshop philosophy: It is quite likely – and we all hope – that this will turn out to be wasted effort, and there won’t be a serious outbreak of Covid-19 here. However, it makes sense to prepare, because there are things we can do now to be more ready in practical and psychological terms if things to take a turn for the worse. And also, things we do to improve our resilience for this particular scenario will help us be more resilient to other, perhaps more mundane difficulties. Handwashing is a great example: Washing your hands more often and more thoroughly can reduce the spread of Covid-19, and thus the impact on the organisation and on wider society. It can also substantially reduce the spread of common colds, which will also have a positive impact on the organisation and on wider society – if a less dramatic one.

Attendance: At least one person, preferably two, from each of the organisation’s main departments, who are familiar with the whole of that department’s work, and who have the backing of their head of department to be the lead on following up. This includes senior management as a ‘department’. {All are important and need to be there for this approach, but it’s particularly critical to have good attendance and high-level buy-in from IT and facilities/estates, as well as – of course – senior management. I also like the idea of having people from billing and accounts payable, since they will know where the money comes from, and a full list of which suppliers get paid.}

Duration: One day, with shorter followup meeting in one month’s time

Preparation: One person from each department to be ready to give a two-minute in-person briefing on their department, as detailed below. (No slides.) Ideally, all attendees will have paid attention to reliable news about the current situation.

Outline:

• Welcome and introductions
• Ground rules
• Current preparedness in the organisation (short review of roles of each department, briefing on IT business continuity preparedness, note of what has happened already on Covid-19)
• Current Covid-19 situation and official advice (presentation from me on the disease, its spread, official advice, and what may happen next)
• Scenario 1: Mild outbreak (small group work to explore impact of a mild outbreak and possible actions)
• Scenario 2: Severe outbreak (small group work to explore impact of more severe outbreak and possible actions)
• How can we help? (small group work to explore possible actions for the organisation to help the wider community in an outbreak)
• Prioritising Action (collation of possible actions, discussion of and voting for prioritisation)
• Responsibilities and follow-up

Room arrangement: Cabaret style (tables scattered round the room), flipcharts with pens next to each table, presentation screen at the front, flipchart or whiteboard with pens at the front, separate from presentation screen. Post-its and pens on each table. A supply of coloured sticker dots with the facilitator. No set seating plan, but attendees encouraged on arrival not to sit next to people from their own department, and to sit next to people they don’t already know. Morning tea, lunch, and afternoon coffee arrangements {in line with usual practice}. Ensure access arrangements are well in hand (e.g. if microphones are needed, roving mic for presenter, and one per table, or smaller number with a designated ‘runner’).

---

Detailed workshop notes

Here I’ve written out my notes-to-myself for the workshop so that other people can make sense of them. Note that they are all aimed at me, rather than at the attenders. When presenting, I use high-quality PowerPoint slides with minimal text.

Welcome and introductions

• Purpose and outline of the day
• Anecdote on warnings and risk communication: you are ‘ “darned if you do and damned if you don’t.”  You’re only darned if you warn about something that turns out minor.  But you’re damned, and rightly so, if you fail to warn about something that turns out serious.’ [source]
• More on what we know and what we don’t know about Covid-19 later, but we don’t know if this will turn out to be serious here. It is already very serious elsewhere. It makes sense to be prepared. We will be darned – mild grousing – if we do things that turn out to be unnecessary. We will be damned – serious condemnation – if we don’t do things that turn out to be necessary and readily foreseeable. And rightly so, in both situations.
• Our job for today is to do that foreseeing and work out what is necessary. {Quick sentences on how senior management are dealing with it, who is responsible, and what will happen next.}
• Round-the-room introductions: each person to briefly say their name, what they do for the organisation, any other relevant expertise you have, and something about their role that others in the room may not know. All that, briefly!
  (I’m Doug Clow, and I’m an external consultant here to facilitate this workshop. My main expertise is in teaching, technology, and organisational learning, so I’ve run many workshops like this one, although not on this particular subject before. In terms of other relevant expertise, I do have some health background, and I am well briefed on business continuity planning and Covid-19, but I am not a public health expert. And a thing you might not know about my role is that {I did some data analysis for the organisation in the distant past}.)

Ground rules

1. Confidentiality

Confidentiality of this discussion: Recording the entire day and putting it online would be inappropriate. So would all of us going away and never speaking of this to anyone ever again. Where in the middle do we want to be?

[Open discussion, be guided by the culture, watch for any concerns and sensitive points and for people who may dissent; summarise outcome on flipchart and pin up.]

2. Honesty

We’re going to be talking about things happening that don’t usually happen. It may be that you or your department isn’t as well prepared as you think.

{Very specific-to-the-organisational culture stuff about it being Ok to say honestly how things actually are at the moment, rather than how they are ‘supposed to be’. Backed up by senior management in the room.}

{Other specific stuff about what the level of senior management commitment is to the ideas raised here and how they will be carried forward.}

3. Personal wellbeing

We are going to be talking about very serious, very upsetting things, including a major health disaster, and how it would be for us, personally and specifically, in that situation. That will include talking about adults, children and older people getting sick and dying, and about quite extreme measures that might be taken.

So please

• Take care of yourself. If things get more challenging for you, do please feel free to ask for a break, or just slip out.
• Take care of others. Be kind, understanding, and non-judgemental. If someone does just slip out, don’t make a big deal of it. If someone’s obviously distressed by a line of discussion, don’t press it. I’ll be keeping an eye out and I will stop things if they look like they’re anywhere close to going too far – but it’s so much better if we are all doing this and supporting each other

Any questions at this point?

These two messages, I’d like to suggest, are at the core of preparedness: We’re here to look at how we take care of ourselves, but we’re also here to look at how we can take care of others. This also works at the organisational level: how can the business take care of itself to keep itself going, and how can the business help the rest of society?

Current preparedness in the organisation

1. Departmental needs

Someone from each department to give a two-minute briefing on what their department does for the organisation, and what would happen to the rest of the organisation if the department wasn’t able to do it at all for (a) an hour, (b) a day, (c) a month. Obviously, most attendees will know a lot of this already, so it doesn’t need to be at great length.

[Short general discussion: What strikes you about these briefings? Bring out that the impact of outages can be very different for different departments, and also that what is a major operational crisis for a department may not be one for the organisation until later. And general message that although departments are very different in what they are focused on, they are all needed by the organisation – otherwise they wouldn’t be there.]

2. IT business continuity planning

{The IT department has for a long time done explicit work on business continuity and disaster preparedness. This section is a short, high-level presentation from them on that work, and what plans they have for dealing with a range of possible scenarios, highlighting the ones that are particularly relevant to Covid-19.}

{Followed by another short presentation on remote working. The IT department has recently rolled out remote working to all staff in the Australasian office. Remote working has been available for UK staff as part of flexible working, but there had been no business need for it in the Australasian office until now. A great example for the rest of the day from this: the rollout would’ve been way easier and more secure if they’d been able to do some of the setup before there was a lockdown and people couldn’t come to work at all.}

3. What {the organisation} has done already

{Most attention has focused on the situation in the Australasian office, which has been heavily affected. In the UK, advice on foreign travel and return. All-staff messages with general information, and advice about hand-washing, plus increased frequency of cleaning staff checks on soap stocks.}

Current Covid-19 situation and official advice

{A briefing from me on the current situation with Covid-19, and the official advice from the Government, from the NHS, and from Public Health England. Also drawing on advice from the CDC in the US and other public health sources. NOTE THAT THE FOLLOWING ARE NOTES, NOT FINAL PRESENTATION, AND MAY RAPIDLY BE OUTDATED. LAST CHECKED 25 Feb 2020}

1. The disease

1. Terms and basics: viruses vs bacteria, coronaviruses, SARS-Cov-2 (the virus), Covid-19 (the disease it causes).
2. Other coronaviruses: In other mammals. Some very old in humans, circulate generally, cause colds, and rarely more serious esp in young/old/already ill: pneumonia, bronchitis, croup/bronchiolitis in babies. SARS. MERS.
3. Transmission: from human to human, by droplets from breath (esp coughs, sneezes) from people within 2m; some evidence of spread by touch). Incubation ? 2-14 days.
4. Symptoms: fever, cough, shortness of breath; can be pneumonia, acute respiratory distress. It’s like a bad cold or flu. Some evidence of asymptomatic infection.
5. Current estimates of morbidity & mortality: Uncertain, but one analysis of Hubei outbreak says 80% mild form, 14% severe e.g. pneumonia, 5% critically ill, 2% fatal. Worse in older people and people already with conditions like hypertension, diabetes, or cardiovascular disease. [source] NOTE UNCERTAINTY Rates very much depend on how many people are infected, which is hard to tell; some evidence of asymptomatic infection and spread, so could be much lower. But some reports that deaths due to secondary infections not counted, which would make the rate higher.
6. Treatment: Virus so no antibiotic possible. No antiviral treatment. No vaccine. Supportive care for seriously ill people, what that means. Massive research effort on antivirals and vaccine ongoing, but results not likely to be available at scale until 2021.
7. The story so far: Wuhan, China. Diamond Princess, UK evacuations and quarantine arrangements. Daegu, South Korea. LATEST 25 FEB 2020: Lombardy/Veneto, Italy; ?Qom, Iran.

Key prevention recommendations:

• Frequent hand washing with soap and water
• Don’t touch eyes, nose, or mouth with unwashed hands
• Good respiratory hygiene – sneeze and cough in to a tissue then bin it; if no tissue, in to your sleeve, not your hands. Catch it, bin it, kill it [campaign link].
• Try to avoid close contact with people who are unwell
• Clean and disinfect frequently touched objects and surfaces
• Masks not recommended for healthy people: “Employees are not recommended to wear facemasks (also known as surgical masks or respirators) to protect against the virus. Facemasks are only recommended to be worn by symptomatic individuals (advised by a healthcare worker) to reduce the risk of transmitting the infection to other people.” [source: UK Govt, checked 25 Feb 2020]
• If infected or think you might be, stay at home, phone/email to get medical advice and help (NHS 111), wear a facemask in public, extra handwashing/respiratory hygiene, avoid sharing personal items.

2. The response

{Short presentation from me on the response to the disease by various organisations. Key points:

• Focus in the UK at the moment is on containment, with quarantine for all possible infections and full contact tracing for all confirmed cases.
• Chinese response was reportedly slow initially, but then very serious. Closures, travel restrictions, confined to home.
• Containment remains the main strategy, but if there is sustained onward transmission in the UK, delay will become more important.
• Slowing the rate of new cases will stay valuable even if all attempts at containment have failed: it spreads out the outbreak, reducing the peak impact on health systems and on other things. There is also reasonable hope that the spread will naturally reduce in the warmer months, like colds and flu. This would give more time for preparation and for research efforts to pay off.
• ‘Social distancing’ is likely to be important. School closures, events cancelled, workplace/area closures, public transport/taxis curtailed, up to complete lockdown.
• The Government does have very wide powers in law to act in extreme circumstances, and has already enacted specific enabling secondary legislation. “It hasn’t happened here in living memory” is not the same as “it can’t happen here”.

As of Tue 25 Feb 2020, with onward transmission happening in several countries well outside China, it seems very likely that it will be declared as a pandemic soon. However, while this may prove effective in preventing onward transmission in the UK, if there is serious spread in many other countries, it will be very difficult to prevent here.

This is scary, but it’s not so bad we can’t face it.}

3. What should the organisation do?

UK Government advice to employers and businesses: https://www.gov.uk/government/publications/guidance-to-employers-and-businesses-about-covid-19

ACAS https://www.acas.org.uk/acas-publishes-new-advice-on-handling-coronavirus-at-work

CIPD https://www.cipd.co.uk/knowledge/fundamentals/emp-law/health-safety/coronavirus-factsheet

CDC advice: https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/guidance-business-response.html

{Official advice from countries where the organisation has significant presence.}

Example:

“There’s no legal (‘statutory’) right to pay if someone is not sick but cannot work because they’ve:

• been told by a medical expert to self-isolate
• had to go into quarantine

But it’s good practice for their employer to treat it as sick leave and follow their usual sick pay policy or agree for the time to be taken as holiday. Otherwise there’s a risk the employee will come to work because they want to get paid. They could then spread the virus, if they have it.” [ACAS]

This makes the difference between the legal and the moral case very clear. Legally, the organisation could refuse to pay staff who have been quarantined and put them on a disciplinary/PEP/sickness plan. But morally it’d be outrageous! Feelings are likely to run high in this context. We don’t want to be the sort of organisation whose ‘social license to operate’ falls apart in that situation.

Useful messages for pandemic flu: http://www.psandman.com/col/panflu4-1.htm

Key elements

• Risk is currently low in the UK
• Handwashing and respiratory hygiene (tissues for coughs and sneezes, in to the bin)
• Be sensitive to staff concerns
• Give sick pay for staff told not to come to work (e.g. self-isolation, quarantine)
• Ensure contact details and emergency contacts updated
• Ensure staff know how to identify illness, and are up to date on procedures
• Face masks may be appropriate in some contexts, but not routinely for uninfected people outside China
• Review travel arrangements, regularly, on up-to-date advice
• Keep everyone updated and informed

All the advice agrees that organisations should plan what they would do if there were difficulties caused by Covid-19. And that’s exactly what we’re here for today, and what we’re going to do now.

{How this links to how the organisation is managing it at present, and who the key responsible executive is.}

Scenarios

Now it’s your turn to work hard. I’ve set out two scenarios for things that might happen if Covid-19 becomes more serious here. These are not predictions! It may well be that it doesn’t even spread in the UK, or that it does but turns out to be much less serious.

Three steps:

1. What would be the impact? How would the organisation be affected in those circumstances? What would be the most difficult things to deal with? What are we not already prepared for?
2. What could we do about that? Either now, or if did happen, or if it looked likely to happen? What actions can we take?
3. Of those, what are the most important ones to take forward? That’ll come mostly at the end, where we vote on actions.

Remember, the scenarios are not intended to be accurate predictions. They are to help us think through what might happen, not to tell us what will happen. There is a mild scenario, and a severe scenario. Not included: total societal breakdown, because it’s not going to happen.

Scenario 1: Mild outbreak

Staff sickness and absence rate above normal. Travel impossible to certain foreign destinations (e.g. heavily infected places). Supplier problems. Some public containment measures, such as school closures and large public events postponed or cancelled.

1.1 Impact

In your tables, discuss what the impact of this would be. What would happen in your department? What problems would come up? How bad might it be? What would the worst bit be? Don’t worry too much yet about what you would do about it – we’re coming on to actions later. Take notes on the flipchart if you want, and have someone in the group ready to feed back two sentences about your discussion.

[Let them talk, circulate to keep them going and get a sense of the discussion, then quick oral feedback; use Mild Impact Cheatsheet for extra suggestions if needed.]

1.2 Actions

Given that, what should be done? Are there things that we could do now that would be really helpful later? What would we need to do if certain things happen?

We’re going to do this in two stages. First, write your ideas on post-its. At that point, quality still matters, but focus more on quantity: more ideas at that stage. Once you’ve done that, I’ll get you to work on the ideas for action a bit more to shape them up.

So – on your post-its, on your own to start with, what actions might we do?

[Let them write, circulate if anyone appears stuck, slow, or otherwise in need of attention; use Mild Actions Cheatsheet for extra suggestions if needed – my favourite is providing moisturiser widely, to stop people getting dried-out hands from all the handwashing, which discourages handwashing and damaged skin makes infection control worse.]

Now we have plenty of ideas, I want you to share them quickly in your group, and then work together to write up your best ones on the flipchart paper, the actions that are most important. For each one, note what the benefit would be, but also the cost, and make it clear whether it’s something for now or something to do later if something specific happens.

For example, one action might be having a no handshakes policy – nobody embraces or shakes hands when they meet, they just wave. That would reduce the spread of infection, and would be a visible sign of us doing something about it. But it would also be socially awkward and weird, which is a real cost, and more importantly, it would probably create a lot of worry if we did that now. So that might be better introduced only if things got more severe – which we’ll come on to later.

So, in your groups, share your ideas, and work up your best ones on the flipchart, remembering the benefit, the cost, and the timing.

[Let them work, prompt to get them writing up on the flipchart once they’ve had time to work on post-its. Quick oral feedback, but not in detail yet.]

Scenario 2: Severe outbreak

Staff sickness and absence rate severe, some departments have no healthy staff. Travel impossible outside the country (restrictions imposed on the UK), travel restricted within the country (public transport/taxi closures/restrictions). Serious disruptions to suppliers and utilities. Serious public containment measures, such as entire areas locked down, workplaces ordered to close.

2.1 Impact

You know the drill now! In your tables, discuss what the impact of this would be. What would happen in your department? What problems would come up? How bad might it be? What would the worst bit be? Don’t worry too much yet about what you would do about it – we’re coming on to actions later. Take notes on the flipchart if you want, and have someone in the group ready to feed back two sentences about your discussion.

[Let them talk, circulate to keep them going and get a sense of the discussion, then quick oral feedback; use Severe Impact Cheatsheet for extra suggestions if needed.]

1.2 Actions

Given that, what should be done? Are there things that we could do now that would be really helpful later? What would we need to do if certain things happen?

Again, we’re going to do this in two stages. First, write your ideas on post-its. At that point, quality still matters, but focus more on quantity: more ideas at that stage. Once you’ve done that, I’ll get you to work on the ideas for action a bit more to shape them up.

So – on your post-its, on your own to start with, what actions might we do?

[Let them write, circulate if anyone appears stuck, slow, or otherwise in need of attention; use Severe Actions Cheatsheet for extra suggestions if needed.]

Now we have plenty of ideas, I want you to share them quickly in your group, and then work together to write up your best ones on the flipchart paper, the actions that are most important. For each one, note what the benefit would be, but also the cost, and make it clear whether it’s something for now or something to do later if something specific happens.

So, in your groups, share your ideas, and work up your best ones on the flipchart, remembering the benefit, the cost, and the timing.

[Let them work, prompt to get them writing up on the flipchart once they’ve had time to work on post-its. Quick oral feedback, but not in detail yet.]

How can we help?

So far, we’ve focused on looking after ourselves: keeping the organisation going. But we’ve already talked a few times about the importance of looking after others and {this is important to the organisation’s values}. This is a pretty capable organisation. What could we offer?

We’ll do the same as we did before when we were working up actions, but this time focusing on ways in which the organisation could help the rest of society.

So again, we’re going to do this in two stages. First, write your ideas on post-its. What actions might we do?

[Let them write, circulate if anyone appears stuck, slow, or otherwise in need of attention; use Help Actions Cheatsheet for extra suggestions if needed.]

So, in your groups, share your ideas, and work up your best ones on the flipchart, remembering the benefit, the cost, and the timing.

[Let them work, prompt to get them writing up on the flipchart once they’ve had time to work on post-its. Quick oral feedback, but not in detail yet.]

Action prioritisation

Presentation

We [should!] now have lots of ideas for actions: things we could do. We almost certainly have more than we can do, and definitely more than it would be sensible to do. We need to prioritise! We’re going to do this in two stages as well. First in your groups, then as a whole.

In groups: Pick your five best ideas to present briefly to the whole room, using flipchart paper.

As plenary: Each group presents its 5 best ideas. [Or other number if total group size different. If there is overlap/duplication (likely), combine them by moving the flipchart sheets together on one table.]

Voting

Two rounds of voting. Like the French Presidential election: first with your heart, then with your head.

First round: Pick the one you are most personally passionate about, and move over to it. When that’s done, call on each grouping of people to say (briefly!) to the room why that is worth caring about.

Second round: You have 5 sticker dots. Vote for which actions you think are the most important, on dispassionate consideration, for the organisation to do. You can put all 5 on one idea if you think it’s that important, or 5 on 5 different ideas, or three on one and two on another, or whatever you like. The more dots, the more important we’re saying it is. Be aware that no dots may well mean it’s dropped after this meeting, and the one with most dots will stick around as an idea for a while.

Final feedback [some disorganisation likely by here]: Someone by each flipchart calls out its title, and how many votes; I write them up at the front, and then summarise what that suggests overall.

Responsibilities and follow-up

{Review who is responsible for taking these ideas forward, what will happen next, and when the follow-up meeting will be.}

Quick summary of the day, thanks to all for participating.

Abbreviated actions cheatsheets

Note not all appropriate at this time!

• Appoint a Covid-19 lead responsible for ensuring the organisation is up-to-date on the situation and official advice
• Updated contact and emergency contact details for all staff
• Workplace hygiene measures: Handwashing stations, tissues & hands-free bins, regular cleaning of high-touch surfaces
• Reminders of sickness policies
• Reminders of official advice about contact with disease outbreak areas and what to do afterwards (stay at home, ring NHS 111)
• Encourage sick employees to stay at home
• Suspension of normal sickness verification requirements, limits, Bradford scoring
• Supportive measures for staff with unexpected caring responsibilities or movement restrictions
• Remote working
• Flexible shifts
• Social distancing shifts (minimise infection risks)
• Internal communications strategy
• Prepare messages for specific worsening of circumstances, widely consulting
• Cross-training/briefing within depts, and also across
• Knowledge management/business knowledge sharing/documentation
• ‘Procedures in case the entire dept is unwell’
• ‘Virus buddy’ system
• No handshakes policy
• Hands-free door opening
• Increase inventory on key supplies
• Scope out alternative suppliers
• Phased, planned, escalating business closure
• Action plan in case of forced office closure in {places the organisation works in}.