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CHOLERA EPIDEMIC - Sanitation Improvements

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CHOLERA EPIDEMIC - Sanitation Improvements

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For the purpose of stopping the spread of cholera, sewage systems and clean water sources have to be improved. Providing access to clean drinking water and appropriate waste disposal were part of this.

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The Impact of Water, Sanitation and Hygiene Interventions to Control Cholera: A Systematic Review

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Cholera remains a significant threat to global public health with an estimated 100,000 deaths per year. Water, sanitation and hygiene (WASH) interventions are frequently employed to control outbreaks though evidence regarding their effectiveness is often…

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The COVID-19 pandemic and the cholera epidemic both highlight how crucial public health infrastructure, hygienic practices, immunization, and international collaboration are in the fight against infectious illnesses.

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Modern epidemiology was pioneered by physician John Snow's work during the London Broad Street cholera outbreak, which revealed evidence of waterborne transmission.

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John Snow's Investigation of the Cholera Outbreak

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John Snow's Investigation of the Cholera Outbreak

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John Snow, Cholera, the Broad Street Pump; Waterborne Diseases Then and Now

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Cholera was a major global scourge in the 19[th] century, with frequent large-scale epidemics in European cities primarily originating in the Indian subcontinent. John Snow conducted pioneering investigations on cholera epidemics in England and particularly…

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Over time, a number of cholera vaccines, including oral vaccines, have been developed. These have been essential to the fight against and prevention of cholera.

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Cholera remains endemic in many parts of the world, particularly in regions with poor sanitation and limited access to clean water. Periodic outbreaks continue to occur.

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In December 2019, a novel coronavirus—later known as SARS-CoV-2—was found to be the source of a number of pneumonia cases in Wuhan, China.

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Lockdowns, travel bans, and social distancing policies were put in place in numerous nations to stop the virus's spread, which had an effect on daily life and economies.

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Rapid progress was made in the development of multiple COVID-19 vaccines, some of which were authorized for emergency use and approved for distribution in multiple nations by late 2020 or early 2021.

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Investigations into the virus's epidemiology, therapies, and vaccinations are still ongoing. There are also continuing immunization drives and public health initiatives aimed at lessening the pandemic's effects.

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Study about Cholera Epidemic & the COVID-19 Pandemic

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Network of the National Library of Medicine [NNLM]

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Lessons from History: A Study of Information during the Cholera Epidemic & the COVID-19 Pandemic

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Campaigns for public health aimed to inform the public about good hygiene habits, such as washing hands with soap and water, especially before handling food and after using the restroom.

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COVID-19 Pandemic - Social Distancing & Mask Mandates

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COVID-19 Pandemic - Social Distancing & Mask Mandates

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Social distancing techniques were used to lessen the virus's ability to spread from person to person. This included wearing face masks, keeping a physical distance from people in public areas, and restricting the number of gatherings. Physical separation, or keeping a minimum of one meter between people and avoiding crowded areas and gatherings, aids in preventing the transmission of COVID-19. Defend both other people and yourself. Cut off the transmission line.

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Physical distancing helps limit the spread of COVID-19 - this means we keep a distance of at least 1m from each other and avoid spending time in crowded places or in groups.

Protect yourself and others.​ Break the chain of transmission.

When sharing, please include accompanying text to complete the message.

Be a hero and break the chain of COVID-19 transmission by practicing physical distancing.

This means we keep a distance of at least 1m from each other and avoid spending time in crowded places or in groups.

We do not always know who may be sick with coronavirus.

That's why it's important to stay home and practice physical distancing. If we must go out, e.g. to buy groceries or for medical reasons, we should stay at least 1m away from others.

Staying at home as much as possible is the right thing to do now.

Limiting gatherings with people outside your household - like group activities and religious events - can reduce the spread of COVID-19.​

Protect yourself and others. Do your part. Stay home.

Even small group activities can lead to COVID-19 spreading.​

Staying home and connecting with friends and family through a call or video chat is a smart choice.​

Protect yourself and others. Do your part. Stay home.

If you've been asked to self-isolate or self-quarantine, there is a good reason for this. No one wants to be responsible for making other people sick.

Protect yourself and others. Do your part. ​Break the chain of COVID-19 transmission.

Physical distancing is new for all of us, so it can feel strange. But it's the smart choice.

We can stay socially connected while physically distant - through video, call or text.​

What are some of the ways you stay socially connected while physically distant? Share your ideas with us!

You may like going to the gym, playing a group sport or participating in an exercise class, but these activities bring us into close contact with others.

Try to stay active in your home or outdoors while keeping a distance of at least 1m from others.​

Protect yourself and others. Do your part. Practice physical distancing.

Some of our common habits, like greeting each other with a hug or handshake, put us in close contact with others and can cause COVID-19 to spread.

Let's keep a distance of at least 1m from one another - even when saying hello!​

Protect yourself and others. Do your part. Practice physical distancing.

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COVID-19 advice - Physical distancing | WHO Western Pacific

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Physical distancing helps limit the spread of COVID-19 - this means we keep a distance of at least 1m from each other and avoid spending time in crowded places or in groups. Protect yourself and others.​ Break the chain of transmission. When sharing, please include accompanying text to complete the message.

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COVID-19 Pandemic - Lockdown & Movement Restrictions

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COVID-19 Pandemic - Lockdown & Movement Restrictions

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To stop the COVID-19 virus from spreading, several nations implemented travel bans, stay-at-home directives, and the closure of non-essential companies.

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COVID-19 Pandemic - Testing & Contact Tracing

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COVID-19 Pandemic - Testing & Contact Tracing

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To stop the spread of the virus, contact tracing initiatives and COVID-19 testing assisted in identifying and isolating infected people and their contacts. Numerous locations carried out large-scale testing initiatives.

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Because of its higher transmissibility and severity than cholera, the COVID-19 pandemic required more extensive testing, vaccination campaigns, and unprecedented social distancing measures. Nevertheless, both epidemics required similar public health interventions, such as surveillance and promotion of hygiene.

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CHOLERA EPIDEMIC - Authorities responded 

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CHOLERA EPIDEMIC - Authorities responded 

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The authorities locate volunteers across several regions to support the local health workers in tracking the disease's spread. They may locate the infected person with ease using this kind of procedure. They are able to stop the infection from spreading over the entire population in this way.

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Responses to the cholera epidemics - Industrial Britain and the people’s health, c.1750-c.1900 - OCR B - GCSE History Revision - OCR B - BBC Bitesize

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Learn about and revise health in industrial Britain, c.1750-c.1900, with BBC Bitesize GCSE History - OCR B.

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CHOLERA EPIDEMIC - Combating the Cholera

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CHOLERA EPIDEMIC - Combating the Cholera

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In the fight against cholera, the global public health community and the government collaborate to accelerate the infection's global spread. It is a preventative measure to stop the infection from spreading.

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Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it. People who get cholera often have mild symptoms or no symptoms, but cholera can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

The cholera bacterium is usually found in water or in foods that have been contaminated by feces (poop) from a person infected with cholera bacteria. Cholera is most likely to occur and spread in places with inadequate water treatment, poor sanitation, and inadequate hygiene.

Cholera bacteria can also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of infection. Rarely, people in the U.S. have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

A person can get cholera by drinking water or eating food contaminated with cholera bacteria. In an epidemic, the source of the contamination is usually the feces of an infected person that contaminates water or food. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The infection is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

Cholera infection is often mild or without symptoms, but can be severe. Approximately 1 in 10 people who get sick with cholera will develop severe symptoms such as watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

It usually takes 2-3 days for symptoms to appear after a person ingests cholera bacteria, but the time can range from a few hours to 5 days.

Persons living in places with unsafe drinking water, poor sanitation, and inadequate hygiene are at the highest risk for cholera.

If you think you or a member of your family might have cholera, seek medical attention immediately. Dehydration can be rapid so fluid replacement is essential. If you have oral rehydration solution (ORS), start taking it immediately; it can save a life. Continue to drink ORS at home and while traveling to get medical treatment. If an infant has watery diarrhea, continue breastfeeding.

To test for cholera, doctors must take a stool sample or a rectal swab and send it to a laboratory to look for the cholera bacteria.

Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution (ORS), a prepackaged mixture of sugar and salts that is mixed with 1 liter of water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt appropriate rehydration, fewer than 1% of cholera patients die.

Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk factor for becoming ill.

Be aware of whether cholera cases have recently occurred in an area you plan to visit. However, the risk for cholera is very low for people visiting areas with epidemic cholera when simple prevention steps are taken.

All visitors or residents in areas where cholera is occurring or has occurred should follow recommendations to prevent getting sick:

Drink only bottled, boiled, or chemically treated water and bottled or canned beverages. When using bottled drinks, make sure the seal has not been broken. Carbonated water may be safer than non-carbonated water. Avoid tap water, fountain drinks, and ice cubes.

To disinfect your own water, choose one of the following options:

Boil it for 1 minute, or

Filter it and add either ½ an iodine tablet or 2 drops of household bleach per liter/quart of water, or

Use commercial water chlorination tablets according to the manufacturer's instructions.

Wash your hands often with soap and clean water, especially before you eat or prepare food and after using the bathroom.
If no water and soap are available, use an alcohol-based hand sanitizer with at least 60% alcohol.

Use bottled, boiled, or chemically treated water to wash dishes, brush teeth, wash and prepare food, and make ice.

Eat foods that are packaged or that are freshly cooked and served hot.
Do not eat raw or undercooked meats and seafood, or raw or undercooked fruits and vegetables unless they are peeled.

Dispose of feces in a sanitary manner to prevent contamination of water and food sources.

A single-dose live oral cholera vaccine, called Vaxchora (lyophilized CVD 103-HgR), is approved by the U.S. Food and Drug Administration for people 2-64 years old who are traveling to an area of active cholera transmission. Three other oral cholera vaccines are approved by the World Health Organization (WHO) - Dukoral, ShanChol, and Euvichol-Plus/Euvichol. These vaccines are not available in the United States, but may be available at your travel destination or if you're living outside the United States. Check CDC's Travel Health Notices website to identify areas with active cholera transmission. Visit a doctor or travel clinic to talk about vaccination if you will be traveling to or living in one of these areas.

Visit CDC's global immunization website to learn more about CDC's global work with cholera vaccines.

Cholera was prevalent In the United States in the 1800s but water-related spread has been eliminated by modern water and sewage treatment systems. Very rarely, people in the U.S. get sick with cholera after eating raw or undercooked shellfish from the Gulf of Mexico.

However, U.S. travelers to areas with epidemic cholera (for example, parts of Africa, Asia, and Latin America) can be exposed to cholera bacteria, and might develop illness after arriving home. Some travelers have brought contaminated seafood home from abroad, resulting in cholera.

U.S. and international public health authorities are working to enhance surveillance for cholera, investigate and respond to cholera outbreaks, and design and implement preventive measures across the globe. The Centers for Disease Control and Prevention (CDC) investigates epidemic cholera wherever it occurs at the invitation of the affected country and trains laboratory workers in proper techniques for identification of Vibrio cholerae. In addition, CDC provides information on diagnosis, treatment, and prevention of cholera to public health officials and educates the public about effective preventive measures.

The World Health Organization (WHO) and the Global Task Force on Cholera Control (GTFCC) along with partners and various stakeholders launched Ending Cholera - a Global Roadmap to 2030, which is an unprecedented initiative to fight and reduce cholera transmission globally. This comprehensive plan identifies priorities to reduce cholera deaths by 90% and stop transmission in up to 20 countries by 2030. The Centers for Disease Control and Prevention (CDC) supports the global strategy by participating in task force working groups for water, sanitation and hygiene (WASH), case management, epidemiology and surveillance, laboratory, and oral cholera vaccines.

The U.S. Agency for International Development sponsors some of the international U.S. government activities and provides medical supplies, and water, sanitation and hygiene supplies to affected countries.

The Food and Drug Administration tests imported and domestic shellfish for V. cholerae and monitors the safety of U.S. shellfish beds through the shellfish sanitation program.

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Cholera is an acute, diarrheal illness caused by infection of the intestine with the toxigenic bacterium Vibrio cholerae serogroup O1 or O139. An estimated 1.3 to 4 million people around the world get cholera each year and 21,000 to 143,000 people die from it.

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The government imposed limitations, particularly on travel within and outside of the Philippines, during the COVID-19 pandemic. In order to stop the virus from spreading, they also implement a community quarantine. This is similar to how the authorities responded during the cholera outbreak, where volunteers were sent to every city to help those who were afflicted and to accelerate the infection's spread.

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As a library, NLM provides access to scientific literature. Inclusion in an NLM database does not imply endorsement of, or agreement with, the contents by NLM or the National Institutes of Health.
Learn more: PMC Disclaimer | PMC Copyright Notice

Abstract

Low- and middle-income countries (LMICs) with weak health systems are especially vulnerable during the COVID-19 pandemic. In this paper, we describe the challenges and early response of the Philippine Government, focusing on travel restrictions, community interventions, risk communication and testing, from 30 January 2020 when the first case was reported, to 21 March 2020. Our narrative provides a better understanding of the specific limitations of the Philippines and other LMICs, which could serve as basis for future action to improve national strategies for current and future public health outbreaks and emergencies.

The Philippine health system and the threat of public health emergencies

Despite improvements during the past decade, the Philippines continues to face challenges in responding to public health emergencies because of poorly distributed resources and capacity. The Philippines has 10 hospital beds and six physicians per 10 000 people. (1, 2) and only about 2335 critical care beds nationwide. (3) The available resources are concentrated in urban areas, and rural areas have only one physician for populations up to 20 000 people and only one bed for a population of 1000. (4) Disease surveillance capacity is also unevenly distributed among regions and provinces. The primary care system comprises health centres and community health workers, but these are generally ill-equipped and poorly resourced, with limited surge capacity, as evidenced by lack of laboratory testing capacity, limited equipment and medical supplies, and lack of personal protective equipment for health workers in both primary care units and hospitals. (5) Local government disaster preparedness plans are designed for natural disasters and not for epidemics.

Inadequate, poorly distributed resources and capacity nationally and subnationally have made it difficult to respond adequately to public health emergencies in the past, as in the case of typhoon Haiyan in 2013. (6) The typhoon affected 13.3 million people, overwhelming the Government's capacity to mobilize human and financial resources rapidly to affected areas. (7) Failure to deliver basic needs and health services resulted in disease outbreaks, including a community outbreak of gastroenteritis. (8) Access to care has improved in recent years due to an increase in the number of private hospital beds; (5) however, improvements in private sector facilities mainly benefit people who can afford them, in both urban and rural areas.

In this paper, we describe the challenges and early response of the Philippine Government, focusing on travel restrictions, community interventions, risk communication and testing, from 30 January 2020 when the first case was reported, to 21 March 2020.

Early response to COVID-19

Travel restrictions

Travel restrictions in the Philippines were imposed
as early as 28 January, before the first confirmed
case was reported on 30 January ( Fig. 1a). (9) After the first few COVID-19 cases and deaths, the Government conducted contact tracing and imposed additional travel restrictions, (10) with arrivals from restricted countries subject to 14-day quarantine and testing. While travel restrictions in the early phase of the COVID-19 response prevented spread of the disease by potentially infected people, travellers from countries not on the list of restricted countries were not subject to the same screening and quarantine protocols. The restrictions were successful in delaying the spread of the disease only briefly, as the number of confirmed cases increased in the weeks that followed. (11) Fig. 1b shows all interventions, including travel restrictions undertaken before 6 March, when the Government declared the occurrence of community spread, and after 11 March, when WHO declared COVID-19 a pandemic.

Community interventions

The Government declared "enhanced community quarantine" (ECQ) for Metro Manila between 15 March and 14 April ( Fig. 2a), which was subsequently extended to the whole island of Luzon ( Fig. 2b). The quarantine consisted of: strict home quarantine in all households, physical distancing, suspension of classes and introduction of work from home, closure of public transport and non-essential business establishments, prohibition of mass gatherings and non-essential public events, regulation of the provision of food and essential health services, curfews and bans on sale of liquor and a heightened presence of uniformed personnel to enforce the quarantine procedures. (12) ECQ - an unprecedented move in the country's history - was modelled on the lockdown in Hubei, China, which was reported to have slowed disease transmission. (13) Region-wide disease control interventions, such as quarantining of the entire Luzon island, were challenging to implement because of their scale and social and economic impacts, but they were deemed necessary to "flatten the curve" so that health systems were not overwhelmed. (14) While the lockdown implemented by the Government applied only to the island of Luzon, local governments in other parts of the country followed this example and also locked down. The ECQ gave the country the opportunity to mobilize resources and organize its pandemic response, which was especially important in a country with poorly distributed, scarce resources and capacity.

Risk communication

The Government strengthened and implemented national risk communication plans to provide information on the new disease. The Government conducted daily press briefings, sponsored health-related television and Internet advertisements and circulated infographics on social media. Misinformation and conspiracy theories about COVID-19 were nevertheless a challenge for a population that spends more than 10 hours a day on the Internet. (15, 16) These spread quickly and became increasingly difficult to correct. Furthermore, the Government's messages did not reach all households, despite access to health services and information, resulting in limited knowledge of preventive practices, except for hand-washing. (17)

Testing

Testing is key to controlling the pandemic but was done on a small scale in the Philippines. As of 19 March, fewer than 1200 individuals had been tested, (11) as only the Research Institute for Tropical Medicine located in Metro Manila performed tests and assisted subnational reference laboratories in testing. (18) No positivity rates for RT-PCR tests were reported until early April 2020. Because of the limited capacity for testing at the start of the pandemic, the Department of Health imposed strict protocols to ration testing resources while ramping up testing capacity. Most tests were conducted for individuals in urban areas, where the incidence was highest. (19)

Conclusions

At the start of the COVID-19 pandemic, the country's initial response lacked organizational preparedness to counter the public health threat. The Philippines' disease surveillance system could conduct contact tracing, but this was overwhelmed in the early phases of outbreak response. Similarly, in February, only one laboratory could conduct reverse transcriptase polymerase chain reaction (RT-PCR) testing, so the country could not rapidly deploy extensive laboratory testing for infected cases. In addition, the primary care system of the Philippines did not serve as a primary line of defence, as people went straight to hospitals in urban areas, overwhelming critical care capacity in the early stages of the COVID-19 pandemic.

In response to the early phase of the pandemic, the Government of the Philippines implemented travel restrictions, community quarantine, risk communication and testing; however, the slow ramping up of capacities particularly on testing contributed to unbridled disease transmission. By 15 October, the number of confirmed cases had exponentially grown to 340 000 of which 13.8% were deemed active. (11) The lack of pandemic preparedness had left the country poorly defended against the new virus and its devastating effects. Investing diligently and consistently in pandemic preparedness, surveillance and testing capacity in particular is a lesson that the Philippines and other LMICs should learn from COVID-19.

References

3. Phua J, Faruq MO, Kulkarni AP, Redjeki IS, Detleuxay K, Mendsaikhan N, et al.; Asian Analysis of Bed Capacity in Critical Care (ABC) Study Investigators, and the Asian Critical Care Clinical Trials Group. Critical Care Bed Capacity in Asian Countries and Regions. Crit Care Med. 2020. May;48(5):654-62. 10.1097/CCM.0000000000004222 [[ PubMed] [ CrossRef] Google Scholar]

7. Santiago JSS, Manuela WS Jr, Tan MLL, Sañez SK, Tong AZU. Of timelines and timeliness: lessons from Typhoon Haiyan in early disaster response. Disasters. 2016. October;40(4):644-67. 10.1111/disa.12178 [[ PubMed] [ CrossRef] Google Scholar]

11. Updates of novel coronavirus disease (COVID-19). Manila: Department of Health; 2020. Available from: https://www.doh.gov.ph/2019-nCov, accessed 16 October 2020.

16. Nicomedes CJC, Avila RMA. An analysis on the panic during COVID-19 pandemic through an online form. J Affect Disord. 2020. November 1;276:14-22. 10.1016/j.jad.2020.06.046 [[ PubMed] [ CrossRef] PMC free article] [ Google Scholar]

Articles from Western Pacific Surveillance and Response Journal : WPSAR are provided here courtesy of World Health Organization, Regional Office for the Western Pacific

# data[].attributes.attachment_link.title
Early response to COVID-19 in the Philippines

# data[].attributes.attachment_link.description
Low- and middle-income countries (LMICs) with weak health systems are especially vulnerable during the COVID-19 pandemic. In this paper, we describe the challenges and early response of the Philippine Government, focusing on travel restrictions, community ...

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The Philippines' availability of the COVID-19 vaccination was declared by the government on March 1, 2021. One method to optimize and assist the citizen in fighting the infection is through vaccinations. It is one of the government's initiatives following their collaboration with the Philippine Department of Health.

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Interrogating COVID-19 vaccine intent in the Philippines with a nationwide open-access online survey

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To mitigate the unprecedented health, social, and economic damage of COVID-19, the Philippines is undertaking a nationwide vaccination program to mitigate the effects of the global pandemic. In this study, we interrogated COVID-19 vaccine intent in the ...

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The cholera restricts an individual's ability to earn a living and support their family. The government has prohibited individuals from going to work during cholera in order to prevent infection.

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Comparing sociocultural features of cholera in three endemic African settings

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Cholera mainly affects developing countries where safe water supply and sanitation infrastructure are often rudimentary. Sub-Saharan Africa is a cholera hotspot. Effective cholera control requires not only a professional assessment, but also consideration ...

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The income of rural residents is more negatively impacted during COVID-19. Since the Philippine government imposed a community quarantine, Filipinos living in rural regions are losing their opportunity to make money to meet their daily needs. A lot of people lost their job and the economy is very affected.

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How COVID-19 impacted vulnerable communities in the Philippines

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How COVID-19 impacted vulnerable communities in the Philippines

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The community is deeply affected by the COVID-19 pandemic; many people experienced the loss of loved ones during that period. The community comes to a halt and numerous regulations are put in place; employees, students, kids, and others are impacted during this period. The pandemic made everyone stressed, and the community—including the food industry—has its limits.

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The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work. The economic and social disruption caused by the pandemic is devastating: tens of millions of people are at risk of falling into extreme poverty, while the number of undernourished people, currently estimated at nearly 690 million, could increase by up to 132 million by the end of the year.

Millions of enterprises face an existential threat. Nearly half of the world's 3.3 billion global workforce are at risk of losing their livelihoods. Informal economy workers are particularly vulnerable because the majority lack social protection and access to quality health care and have lost access to productive assets. Without the means to earn an income during lockdowns, many are unable to feed themselves and their families. For most, no income means no food, or, at best, less food and less nutritious food.

The pandemic has been affecting the entire food system and has laid bare its fragility. Border closures, trade restrictions and confinement measures have been preventing farmers from accessing markets, including for buying inputs and selling their produce, and agricultural workers from harvesting crops, thus disrupting domestic and international food supply chains and reducing access to healthy, safe and diverse diets. The pandemic has decimated jobs and placed millions of livelihoods at risk. As breadwinners lose jobs, fall ill and die, the food security and nutrition of millions of women and men are under threat, with those in low-income countries, particularly the most marginalized populations, which include small-scale farmers and indigenous peoples, being hardest hit.

Millions of agricultural workers - waged and self-employed - while feeding the world, regularly face high levels of working poverty, malnutrition and poor health, and suffer from a lack of safety and labour protection as well as other types of abuse. With low and irregular incomes and a lack of social support, many of them are spurred to continue working, often in unsafe conditions, thus exposing themselves and their families to additional risks. Further, when experiencing income losses, they may resort to negative coping strategies, such as distress sale of assets, predatory loans or child labour. Migrant agricultural workers are particularly vulnerable, because they face risks in their transport, working and living conditions and struggle to access support measures put in place by governments. Guaranteeing the safety and health of all agri-food workers - from primary producers to those involved in food processing, transport and retail, including street food vendors - as well as better incomes and protection, will be critical to saving lives and protecting public health, people's livelihoods and food security.

In the COVID-19 crisis food security, public health, and employment and labour issues, in particular workers' health and safety, converge. Adhering to workplace safety and health practices and ensuring access to decent work and the protection of labour rights in all industries will be crucial in addressing the human dimension of the crisis. Immediate and purposeful action to save lives and livelihoods should include extending social protection towards universal health coverage and income support for those most affected. These include workers in the informal economy and in poorly protected and low-paid jobs, including youth, older workers, and migrants. Particular attention must be paid to the situation of women, who are over-represented in low-paid jobs and care roles. Different forms of support are key, including cash transfers, child allowances and healthy school meals, shelter and food relief initiatives, support for employment retention and recovery, and financial relief for businesses, including micro, small and medium-sized enterprises. In designing and implementing such measures it is essential that governments work closely with employers and workers.

Countries dealing with existing humanitarian crises or emergencies are particularly exposed to the effects of COVID-19. Responding swiftly to the pandemic, while ensuring that humanitarian and recovery assistance reaches those most in need, is critical.

Now is the time for global solidarity and support, especially with the most vulnerable in our societies, particularly in the emerging and developing world. Only together can we overcome the intertwined health and social and economic impacts of the pandemic and prevent its escalation into a protracted humanitarian and food security catastrophe, with the potential loss of already achieved development gains.

We must recognize this opportunity to build back better, as noted in the Policy Brief issued by the United Nations Secretary-General. We are committed to pooling our expertise and experience to support countries in their crisis response measures and efforts to achieve the Sustainable Development Goals. We need to develop long-term sustainable strategies to address the challenges facing the health and agri-food sectors. Priority should be given to addressing underlying food security and malnutrition challenges, tackling rural poverty, in particular through more and better jobs in the rural economy, extending social protection to all, facilitating safe migration pathways and promoting the formalization of the informal economy.

We must rethink the future of our environment and tackle climate change and environmental degradation with ambition and urgency. Only then can we protect the health, livelihoods, food security and nutrition of all people, and ensure that our 'new normal' is a better one.

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Impact of COVID-19 on people's livelihoods, their health and our food systems

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The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge to public health, food systems and the world of work.

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SECTION 288

Ashley Kate Baral

Raya Nicole Salao