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ABSTRACT
ABSTRACT
At the end of 2019, a new virus named SARS-CoV-2 emerged in China, provoking coronavirus disease 2019 or COVID-19. Self-isolation and quarantine as key strategies to overcoming the spread of the disease have had major, micro, and macroscopic consequences. This commentary, therefore, seeks to review critical factors impacting the COVID-19 pandemic through the spectrum of levels, categorising effects in the WHO’s ecological framework (individual, relational, community, and societal aspects). We further describe the management of the crisis at each level to help guide health personnel, communities, governments, and international policymakers in understanding how their actions fit into a larger picture as they seek to manage the crisis.
Introduction
In recent years, epidemics- SARS-CoV in 2003, H1N1 in 2009, MERS-CoV in 2012, Ebola in 2014, and Zika in 2015 – emerged as critical concerns (Cascella et al., 2020). At the end of 2019, a novel human coronavirus, currently recognised as SARS-CoV-2, emerged in China, provoking a disease named coronavirus disease 2019 or COVID-19, which swiftly became a global pandemic (Weston & Frieman, 2020; Yang et al., 2020). The pandemic has had not only medical and medical system consequences but has also caused remarkable psychological, sociological, and economic concerns worldwide (Yang et al., 2020). In late January 2020, the COVID-19 pandemic was declared as a ‘public health emergency of international concern’ by the World Health Organization (WHO) where countries with susceptible healthcare systems could be at unreasonable risk (Tabari et al., 2020a). Apart from the direct consequences of the virus, there are some indirect outcomes brought by this unprecedented situation. These effects might include having been left without healthcare due to the exclusive allocations of hospital wards to COVID-19 patients, as well as deaths affected by untimely care because of transportation limitations (Regan & Chi, 2020). Barry Pakes defined a Complex Humanitarian Emergency (CHE) as a kind of calamity which originates from and results in a set of medical, social, and political contexts, and for which external aid and assistance are required (Arya, 2019). CHEs are often linked to multiple factors, including war and natural disasters, poverty, overpopulation, human-made environmental destruction and modification, and may themselves be a source of conflict (Agbedahin, 2019). The, 2020 COVID-19 pandemic might be a CHE; this time, the impact is global and there is no unaffected external actor, meaning that action must be collective and global, comprehensive, and multi-faceted.
The heart of management, as we seek the possibility of a drug or vaccine, is to ‘flatten the curve’. Specified policies (e.g. testing, isolation, contact tracing, and quarantine) are traditional, beneficial measures that can be implemented in any population (Ridenhour et al., 2014) to modify the value of R0 (R-naught or basic reproduction number) to a significant degree, to overcome epidemics (Yang et al., 2020). In public health, R0 is used to estimate the rate of virus spread in a community, the number of contacts that an affected individual infects. To illustrate, for the 2003 SARS pandemic, epidemiologists had initially estimated the original R0 to be approximately 2.75. Months later, the effective R0 fell beneath one, due to activities including significant testing, contact tracing, quarantine, and isolation (Eisenberg, 2020).
This commentary, therefore, seeks to review critical factors impacting the COVID-19 outbreak, categorising effects based on the WHO’s ecological framework (individual, relational, community, and societal aspects). We further describe the crisis at each of the levels, hoping to guide health personnel, communities, governments, and international policymakers in understanding how their actions fit into a larger picture as they seek to manage the crisis.
Individual level
The physical effects of the disease have recently been well documented, and management is based on clinical manifestations. However, research on self-isolation and quarantine also demonstrates adverse psychological effects such as confusion, anger, and post-traumatic stress disorder (PTSD). Insufficient supplies, inadequate information, and financial breakdown may also emerge, causing more negative effects (Brooks et al., 2020) alongside other health-related issues such as limited exercise and dietary restrictions. Students, more specifically medical students, may also be among those who feel the considerable negative effects of this era, physically, mentally, and educationally (Rastegar Kazerooni et al., 2020; Tabari et al., 2020b; Tabari & Amini, 2020).
Generally, suspected or confirmed cases of COVID-19 and their loved ones often suffer mental consequences of SARS-CoV-2. Symptoms of infection and potential adverse effects of treatments may also cause anxiety and mental distress (Xiang et al., 2020).
In the initial phases of social isolation, expressing empathy, and signalling understanding can be helpful (Galea et al., 2020). In the context of mental care, the WHO Department of Mental Wellbeing and Drug Use has established the principles to be utilised to promote psychosocial well-being in target populations such as healthcare workers, team leaders or managers in health facilities, caregivers of children, older adults as well as people with underlying health conditions and their care providers, and people in isolation during the epidemic (WHO, 2020a). Keeping up physical activities and other measures for self-care are important. Non-traditional communities can offer mental and psychological assistance, and instructing the public to support each other. With the difficulties in providing direct support for the financial, emotional and spiritual challenges of crises, the volunteer sector and new technologies may be helpful. Since, even with the best of management, mental issues will arise, individuals should not be quarantined for a longer period than is required (Brooks et al., 2020).
Interpersonal and relational level
Family relationships play a fundamental role in individual health. Such relationships can boost self-esteem, alleviate stress, and modify lifestyle and behaviour, which can positively lead to a higher sense of well-being (Thomas et al., 2017). During this period, people remain at home, spending long days with other family members, diminishing or eliminating physical contact with the outside community. Schools are shut down, sporting events are cancelled, playgrounds are closed, and offices provide the ability for staff to work remotely. Despite the obvious advantages of being with family, many disorders mentioned above, including frustration, anxiety, low mood, and depression, manifested during the prolonged self-isolation and quarantine period can affect interpersonal relations (Ribeiro, 2020). Some lawyers even anticipate a rise in the divorce rate due to self-isolation in the COVID-19 outbreak duration (McKeever, 2020). Increased calls to police and shelters have been documented in some instances, perhaps representing an increase in domestic violence (Michigan Radio, 2020). Further, some people do not have a family with whom they can isolate, and some may have the opposite issue, less ability to find private time.
Many strategies have been offered to get through interpersonal aspects. Having open discussion about fears and concerns; as much as possible, preserving routine life structures while accepting a new lifestyle; engaging in some joint pursuits while respecting individual alone time; staying in touch with other people in the community; and using the pandemic experience as an opportunity for growth could be considered some solutions to retaining relational health during this unprecedented time (Ribeiro, 2020).
Community context
Social cohesion describes the concept of solidarity and propinquity among societal groups. A cohesive society is the one with shared moral support, absence of undiscovered social discord, and the existence of powerful social connectedness. Social capital includes specifications that ease people’s activities within that society (Kawachi & Berkman, 2014). Appropriate management of epidemics results in a reduction in the risk of illnesses, which can correlate with social cohesion (Zelner et al., 2012). However, many measures to achieve this represent a threat.
Lessons for communities currently may be derived from the Ebola outbreak in West Africa in 2014, which presented some similar risks. Strictly enforced policies related to human movement, social practices, and quarantine contributed to a dramatic increase in community apprehension and skepticism during the Ebola pandemic (Plan International, 2015). Community unity was threatened when survivors, health personnel, and burial staff were stigmatised by Ebola and dismissed by their societies (International Labour Organization, 2015).
A strong sense of connection at the community level, reliable lines of communication, and trust between diverse parties of the health care system were identified as critical factors of confronting that crisis which might lead to community cohesion (Alonge et al., 2019). Collaborative activity within populations can steer response efforts from other branches of the health system to the whole community. To respond to this critical situation, United Nations International Children's Emergency Fund (UNICEF) held healing ceremonies in order to regain community cohesion (James, 2015).
When populations are more vulnerable to day-to-day survival threats, they are more susceptible to shock with large-scale traumatic events such as a deadly disease pandemic or conflict. Thus, fostering community resilience is useful. It is essential to identify and describe the nature of shock in concern since approaches to enhance community resilience differ for various shock categories (Alonge et al., 2019). When a quarantine is mandatory, social messages, reminding the public about societal responsibilities, particularly towards the most vulnerable, as well as providing sufficient supplies for people is helpful (Brooks et al., 2020). With the COVID-19 pandemic, communities worldwide have worked together to find solutions, financially and logistically. Volunteer drivers transport health personnel between home and work. Communities have provided survival packages consisting of food, bottled water, hand sanitiser, and toilet paper. Some factories have temporarily re-jigged their manufacturing capacity to develop sanitisers and Personal Protective Equipment (PPE). Technology has also been used: Geographic Information System (GIS) facilities to gather people of specific expertise; apps to link overworked health personnel to help meet their basic needs of meals and accommodation providers; websites for children and child care, and platforms posting and offering job positions to unemployed individuals. These are merely a handful of examples of community responses to the outbreak (Monbiot, 2020).
Societal factors
National and international collaboration
The Ebola crisis had the potential to cause more general societal breakdown, contributing to the exacerbation of conflict, violence, and adverse behaviour which, in turn, could increase the dissemination of the virus (Pellecchia et al., 2015). In the fight against outbreaks of infectious diseases, national and international collaboration is necessary to prepare and respond. With the occurrence of a major outbreak, vital information should be gathered in order to develop coordinated scientific analysis to allow the global community to respond rapidly, to prevent where the disease has not struck and to deal with future outbreaks (Federal Ministry of Education and Research, n.d.). For centuries, information sharing among countries has widely been applied in infectious disease outbreaks (Mahoney & Le Duc, n.d.). The quick spread of Severe Acute Respiratory Syndrome (SARS) in 2003 illustrated the importance of multinational coordination to confront the outbreak. That may have been the first outbreak where detailed real-time electronic information could be shared widely. International Health Regulations (IHR), such as passenger screenings in airports, were demonstrated to be successful in outbreak control. Eventually, SARS was contained within four months (Arya et al., 2009; Mahoney & Le Duc, n.d.).
On the other hand, the initial international response to the Ebola outbreak across West Africa lacked coordination, funding as well as limited skilled personnel and equipment (Mahoney & Le Duc, n.d.). Because international cooperation alone is not enough to curb the spread of infectious diseases, countries should implement local response systems while strengthening global coordination (Schwartz & Yen, 2017). It is also essential that world leaders promote preparedness, particularly in low-and middle-income countries. They can employ effective global action by utilising conventional and more novel techniques and organising global resources to upgrade healthcare facilities and provide equipment to combat the infection (Qian et al., 2020). Governments on their own should also introduce beneficial policies and implement prompt and serious initiatives to slow down the progression of the disease, which may include monitoring and case detection policies as well as management strategies of social isolation, quarantine, and flight suspensions (Tabari et al., 2020a). The WHO argues that every single person being infected from the virus can be a threat to the whole humankind. Therefore, a global collaborative effort is required to be implemented to speed up development, production, and fair access to diagnoses, treatments, and vaccines of the COVID-19 (WHO, 2020b).
Financial panic and unemployment
Among the main hurdles for those who are locked-down is the loss of income and employment both during and after quarantine, respectively. Hence, governmental strategies for extending support for quarantined people and promoting community solidarity through employment security and salary substitution assurances are of high priority. Considering the experiences from previous outbreaks such as SARS, one might conclude that maintaining a successful and thriving response requires not only governmental and official demand orders of quarantine or social isolation, but also the consideration of economic and financial issues of individuals through income replacement or assuring work security (Rothstein & Talbott, 2007).
Although medical practitioners, particularly those working among more affluent populations, might consider the main challenge to be finding the right vaccine or drug, governments need to view their responsibility much more broadly. Since people living in poverty may be willing to take unreasonable risks, prioritising livelihood over life, financial support measures are necessary to protect them as well as others. Such policies enable citizens to pursue self-isolation and social distancing; otherwise, they might prioritise more immediate threats of starvation and poverty (Krishnakumar & Rana, 2020).
While in most countries, businesses can lawfully boost their prices concerning demand during a crisis, many consider such activities unethical and even vampire-like, possibly resulting in public dissatisfaction and panic. In this case, the governmental sector sometimes must regulate prices. New Zealand has enacted laws that forbid fraudulent and dishonest behaviour and misleading claims and obliged businesses to justify massive increases in price (Consumer Protection, n.d.).
Additionally, the economic slump created by lockdown was inevitable, and has resulted in great suffering, as we have seen in the United Kingdom, China, and the United States (U.S.) (Fox, 2020; France 24, 2020; Inman, 2020; Krugman, 2020). The COVID-19 outbreak, with enforced travel restrictions, has blocked various global commercial activities, affecting trade and the movement of labour. The tourism, hospitality, and retail sectors each have suffered tremendously from the pandemic. Many economists believe that the global impact of this viral outbreak on the worldwide economy will be unprecedented (Ayittey et al., 2020). Generally, economic instability and uncertainty may trigger a long-standing financial recession, decreasing employment, and people’s livelihoods. To address the threats, the development of an integrated and responsive economic system is required; something that poses less harm to the well-being of employees and the general public. Strategies should provide not only welfare services but also guarantee congruence between appropriate business activities and social, environmental, and healthcare needs that emerge during the outbreak period (Lucchese & Pianta, 2020).
As coronavirus cases continue to grow, and many businesses experience bankruptcies, millions of people around the world have filed for unemployment insurance (Krugman, 2020). In the beginning of the outbreak, the stock market was quite unstable with panicked sell-offs and buying, paralleled by similar panicked buying of toilet paper in supermarkets. Industries with substantial financial leverage and limited cash flow have been increasingly negatively affected since then. Besides, the daily boost in the number of COVID-19 confirmed cases and deaths could be correlated with plummeting global stock indices (Al-Awadhi et al., 2020; Okyere et al., 2020). This highlights how a health problem can transform into a possible financial catastrophe (Wagner, 2020), which in turn has more adverse health consequences.
The consequences may be much more severe for low- and middle-income countries with health personnel in particular danger, owing to a shortage of PPEs. Additionally, there would be an insufficient supply of the required services for treating patients, and unfortunately, the outcome may be a life-threatening disaster considering the adverse effects in these countries (Bong et al., 2020).
Gender inequality
Men and women usually experience differential power in making decisions, accessing healthcare facilities, and approaching financial supplies. This was apparent during the Zika and Ebola outbreaks (Wenham et al., 2020). Women seem to be more susceptible than men during the COVID-19 pandemic too, and they will be more negatively affected by its unintended consequences- mentally, physically, and financially (Ryan & El Ayadi, 2020). On the other hand, the global health community must also tackle the pandemic-related threats faced by men, particularly those where men’s issues affect the health of women, including the surges in occurrences of domestic violence across the globe. A tactical approach to gender will also be essential to minimise the negative effects of the pandemic and ensuring the equitable and successful implementation of upcoming vaccines and medications (Betron et al., 2020).
Vulnerable populations
Vulnerable populations may lack the right or ability to make informed decisions regarding their health and social conditions and encounter major obstacles in receiving treatment under the best of the situations. These problems are compounded in a pandemic period, especially as people pose a greater probability of being sick and the higher possibility of having more severe disease than others (American Medical Association, 2020). The COVID-19 pandemic underlines the necessity of maintaining the opportunity of all citizens of a community to benefit from public health initiatives. Health equity will remain unreachable and would affect any member of society unless governments devote the resources required to tackle the underlying causes of reduced health and poverty in a comprehensive way (Benfer & Wiley, 2020). Developing equitable policies to protect vulnerable populations as well as recommending additional precautions might be beneficial for society as a whole.
Residents of nursing homes and assisted living facilities
During the COVID-19 crisis, there have been reports regarding the increased probability of death in care homes and long-term care facilities in several countries (Lai et al., 2020McMichael et al., 2020a; McMichael et al., 2020b). For example, data from the United Kingdom illustrated that the death toll might be much more than government estimates (Blackall, 2020). In U.S. states such as Washington and Florida, the situation in such facilities was critical (FOX 13, 2020). Due to the increased prevalence of underlying chronic diseases, residents of nursing homes, and assisted living facilities are among populations at the highest risk of being affected by the SARS-COV-2. Considering the high probability of the virus spread in these settings, many protective strategies should be employed to safeguard residents, visiting families, and health care personnel. Strategies to deter COVID-19 spread and avoid COVID-19 from breaching the facility include detecting pathogens rapidly, assessing and optimising PPE supply, and detecting and addressing serious disease (Centers for Disease Control and Prevention, 2020a, 2020c). National guidelines and regulations are required regarding infrastructure, personnel required, training, isolation capacity, testing, and PPE to deal with any infectious disease outbreaks as private facilities often may cut corners to be bottom lines and shareholder concerns (Main, 2020).
Homeless
Homeless people are another vulnerable cluster of society whose probable exposure to COVID-19 can devastate their physical and mental health. This population often is already afflicted with such health issues and has often had concerns in accessing health care services. Lockdown, isolation, and other measures in curbing the virus spread, including mandatory hospitalisation and detention in a few countries, would probably be detrimental to these people’s health and well-being (Tsai & Wilson, 2020). Some strategies to diminish -if not halt- the virus spread within these populations are offered by the U.S. Centers for Disease Control and Prevention (CDC) and the United Kingdom National Health Service (NHS). CDC offers guidance to support the best responses that can be provided by health officials and associated organisations. Providing meal services and day/overnight shelters are among these response plans (Centers for Disease Control and Prevention, 2020b). The NHS plans to establish COVID-CARE and COVID-PROTECT facilities for this population, based on the HOMELESS COVID-COMMAND structure, before transferring to these sites. Homeless people would be triaged into three cohorts: the symptomatic group, the asymptomatic group at increased risk of severe illness, and the asymptomatic and low-risk group. Each group of people will then be transferred to a suitable facility or continue using the current service provision (The United Kingdom NHS, 2020).
Migrants
To follow basic recommended isolation and sanitation to reduce coronavirus transmission is impossible in contexts such as Cox’s Bazaar, the world’s largest refugee camp located in Bangladesh. In this gruelling context, refugees are rightly concerned and stressed about COVID-19, where visiting health care workers can also be a source of outbreaks (Vince, 2020). Migrant workers and political, economic, and climate refugees might also be affected by the outbreak. In some countries, specific governmental policies such as denying health coverage to undocumented migrants have resulted in public health concerns. Additionally, they can encounter safety issues and ultimate poverty (Page et al., 2020). Since the preservation of life regardless of race and ethnicity should be a priority in pandemics, governments and health officials should guarantee equal access to health services, including prevention, testing, monitoring, and therapy for migrants, as much as for local populations. This may require external financial support from international economic organisations in some contexts (IOM, 2020).
Apart from the mentioned issues, considering the susceptibility of migrants and inequity in delivering health care, there is a critical concern in social behaviour towards this group of people. There are many reports around the world on stigmatising groups considered at higher risk or possibly infected with COVID-19 often due to their nationality or ethnicity. For instance, in the Central African Republic, the diagnosis of the first positive COVID-19 citizen was a Catholic priest, resident in the country for several years and had just come back from a trip to Italy, contributed to written and verbal assaults on the person, and foreigner, particularly Catholics, were commonly regarded as disease vectors. While many COVID-19 patients were citizens who had arrived from foreign countries, pervasive stigma from the first case exacerbated by social media, and the public has ingrained by the press that foreigners and immigrants are the vectors of the disease (Somse & Eba, 2020). In general, xenophobia is not a recent concept, and there have been many incidents worldwide that have led to harassment and offense against immigrants (Shah, 2020).
The incarcerated
Prisoners are at significantly greater hazard of infections than other populations. Highly contagious jail environments are exacerbated by their overpopulation, inadequate health facilities, high-risk activities, and valuing security rather than public health issues. It has been reported that more than 10 million individuals are imprisoned worldwide. Therefore, health care for prisoners and prison personnel needs to be improved, and great financial support for appropriate care and preventive initiatives is required. Interactions should also be improved between the jails and national medical services during the outbreaks (Yang & Thompson, 2020). The advent of COVID-19 once again addressed the topic of jails as infectious disease incubators, underlining that ‘prison health is public health’, as prisons cannot be isolated, and with guard visitors and others moving in and out prisons can be a source of seeding in the general population. Further, urgent measures need to be implemented to deter COVID-19 outbreaks in the jails and safeguard people in detention, workers and the broader community. This is particularly important for overcrowded jails; over half of all countries worldwide have jail population rates that surpass their officially reported capacity. This overpopulation is correlated with negative health effects and infection dissemination. In consideration of such susceptibility to infectious illnesses, people detained in jails and other correctional centres should be regarded as part of the broader public health solution to COVID-19 (Simpson & Butler, 2020). ‘Social distancing’ is a strategy for diminishing viral transmission and ‘flattening the curve’ of cases. However, this preventive policy is highly challenging in these environments (Akiyama et al., 2020). In fact, limited funding in prison health, significant overcrowding and stringent security procedures hinder diagnosis and therapy in these environments. Many countries are now considering increased funding to improve conditions, and releasing people during a pandemic and reflecting on whether such high rates of incarceration are indeed so necessary. In general, custodial facilities can be considered as an essential part of public health response to the pandemic (Kinner et al., 2020).
Children
Children’s sense of security and normality of life have been altered during this uncommon situation brought to them by the COVID-19 crisis. They may face their parents’ unemployment, their grandparents’ susceptibility to the disease, and the fear of losing their family members, being isolated from their friends, uncertainty of their school lockdowns, and the unease of physical distancing from any individuals (Weaver & Wiener, 2020). There are some strategies that might lead to lessen the mental burden on children. Workplaces can offer family-friendly plans such as having flexible job schedules to support families (UNICEF, 2020a). Parents themselves can also play a key role in this case. They might try several strategies, including discussing this unprecedented situation, playing games, telling stories, spending more time with children and maintaining family harmony in the house (UNICEF, 2020b).
Apart from psychological impacts on them, children may experience greater suffering from their families’ financial instability during pandemics and quarantine periods. One of the most critical responses of COVID-19 would be the nourishment of children from underprivileged families, sometimes dealt with by school nutrition programmes. Even short term food deprivation may result in permanent cognitive effects on such children. In this unparalleled current situation, the length and number of school shutdowns will be unknown. Policies that guarantee children's nutritional security are highly required in this pandemic (Dunn et al., 2020).
Information flows
The provision of reliable information is a critical consideration during the time of a pandemic. Delivering false information can cause panic and other psychological concerns within a society (Organization for Security and Cooperation in Europe - OSCE, 2020). Key explanations regarding the broadcasting of misinformation in periods of crises, cultural causes, a high degree of request for knowledge during the crisis, swift distribution of information via social networks, marketing opportunities, and inadequate legal regulations of internet-based contents can be considered as the important factors of delivering misleading information (Bastani & Bahrami, 2020).
In this particular crisis, a new challenge to appropriate communication and optimal decision-making can be exaggerated or turn into false information (Ioannidis, 2020). Unprovable theories and misinformation about the COVID-19 outbreak regarding etiology, pathogenesis, diagnosis and treatment have been disseminated on social media at an increasing pace, sometimes targeting the vulnerable above (Kouzy et al., 2020). As the epidemic evolved into a global public health issue, numerous hypotheses regarding the nature of the virus have arisen on the internet, each premised on a common theme that a hostile government with predefined agenda developed the virus intentionally in a laboratory. With no reliable evidence, such rumours were propagated across social media (Mian & Khan, 2020). Furthermore, some political leaders, public health authorities, infectious disease experts deliberately or unintentionally have given contradictory, ambiguous, and at times transparently misleading advice or have personal behaviour which contradicts public messaging about PPE (e.g. masking) or social distancing (Schreiber, 2020).
In general, governments and media should employ credible professional expertise, e.g. the CDC and WHO, to convey information, sensibly and reliably, not to trigger public hysteria. The emergence of this virus offers an incentive for the public and medical health practitioners to battle this widespread danger in harmony. If health institutions plan, inform and answer the needs of the public properly, there is a potential to overcome the degree of skepticism that has emerged as a consequence of anti-science campaigns (Mian & Khan, 2020). In addition, there are also some suggested approaches for coping with misinformation-related problems, which include the efficient involvement of health practitioners and officials on social media and long-term enhancement in public health literacy (Bastani & Bahrami, 2020).
Enhancing the WHO framework for responding to the COVID-19 pandemic
Since the first cases were detected in Wuhan in December 2019, the WHO has played a pivotal role in handling the COVID-19 pandemic and has been extremely active in responding to this outbreak.
With preparing the ‘Strategic Preparedness and Response Plan’, the WHO aimed to enhance the level of readiness and reaction of each country, speed up research, and arrange region-wide cooperation to evaluate, react and minimise the potential risks (WHO, 2020c).
Alongside its many achievements, we recommend that the WHO enhance its ecological model incorporating political forces, pressures, and controversies that have adversely impacted the global health response. This may include political leadership’s initial response to deny any concern-considering it more of a public relations issue, to undermining their own public health recommendations, to proposing unproven alternative treatments, citing timetables with electoral rather than safety considerations, to defunding collective and collaborative responses, to allowing market-driven considerations to increase internal competition and leave optimal care out of the hands of the most vulnerable.
For example, at a national level, Brazilian President Jair Messias Bolsonaro termed the new disease as the little flu and declared his objection to the WHO's administrative measures and regulations (Ortega & Orsini, 2020). Brazil was not the sole country that showed the signs of discord. The U.S. also complained about the WHO's management strategies in the case of the COVID-19 outbreak and decided to halt the organisation’s funding since April 2020 (Restuccia, 2020).
The WHO, as a critical worldwide organisation for health-related subjects, must take these national and international contradictions into account in order to fully respond to the unprecedented situations and prevent these political divergences from hindering the best reactions. This is best achieved through multilateral negotiations with the countries with conflicting opinions to come to more practical decisions, even prior to a pandemic situation when soberer heads can prevail.
Conclusion
In this commentary, we have sought to review some vital considerations in the COVID-19 pandemic based on WHO’s ecological model in four different categories of individual, relational, community, and societal aspects. Though the greatest investment of international attention is dedicated to medical care, a more holistic approach is prudent for better outcomes. Although preventive strategies can place a financial burden on nations, this problem may be alleviated by allocating economic funds to more susceptible countries through global health and financial institutions. Generally, a feasible global coordinated plan of enforced isolation and quarantine is part of the solution to deal with such critical circumstances. This decision should be made by responsible international officials to overcome the pandemic. National governments sometimes need to implement extreme measures not just to halt the spread, but also to mitigate its direct and indirect consequences. It is also important to consider the implications of financial panic and the crashing global economy and to suppress consequent adverse effects by suitable planning.
According to WHO, no country can fight this outbreak alone and communities should act in solidarity collaborating internationally. Apart from policymakers’ and governments’ duties, in this case, people need to be made psychologically resilient and cope with the current crisis. Supporting people mentally and emotionally at an individual level is critical, but so is preparedness for the massive changes in lifestyle necessitated by the measures above to create a truly improved society. Overall, by describing the management of the crisis at each of the mentioned levels, health personnel, communities, governments, and policymakers can be assisted in perceiving how their measures in managing this pandemic can have considerable impacts on responding to this pandemic.
Disclosure statement
No potential conflict of interest was reported by the authors.
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