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Strengthening Preparedness

for COVID-19 in Cities and

Urban Settings
Interim Guidance for Local Authorities
1 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

© World Health Organization 2020
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Interim Guidance for Local Authorities 2

Acknowledgements 2
Executive summary 3
I Introduction 4
II Target audience and purpose 4
III Why urban settings are unique 4
IV Considerations in planning for urban preparedness for COVID-19 5
V Key areas of focus for urban preparedness for an effective 7
response to COVID-19
1 Coordinated local plans in preparation for effective response to 7
health risks and impacts
2 Risk and crisis communication and community engagement that 7
encourage compliance with measures
3 Contextually appropriate approaches to public health measures, 8
especially physical distancing, hand hygiene and respiratory etiquette
4 Access to healthcare services for COVID-19 and the continuation of 10
essential services
VI Preparing for future emergencies 11
Additional resources 11
References 12
Annex 1: Considerations and recommendations for urban areas in 14
preparing for COVID-19

This interim guidance was developed by Marc Ho, Stella Chungong, Abbas Omaar,
Xing Jun, Ludy Suryantoro and Nirmal Kandel of the Health Security Preparedness
Department of the WHO Health Emergencies Programme. WHO also wishes to
thank the following for their valuable inputs:
• Local Authorities: Greater London • WHO Regional Office for Europe
Authority, United Kingdom; Local Health (Haris Hajrulahovic, Monika Kosinska,
Authority ASL Roma 1; Italy; Local Tanja Schmidt)
Authorities of Surabaya and Semarang, • WHO headquarters: Social
Indonesia; and a city in Japan Determinants of Health (Etienne Krug,
• Government of the Republic Tamitza Toroyan), Health Promotion
of Singapore (Faten Ben Abdelaziz, Ruediger Krech);
• Norwegian Public Health Institute Environment, Climate Change and
(Hinta Meijerink, Siri Hauge) Health (Nathalie Roebbel), Health
• Resolve to Save Lives Security Preparedness (Frederik Copper,
(Amanda McClelland) Jonathan Abrahams, Jostacio Lapitan,
• UN-Habitat: COVID-19 Core Kathleen Warren, Luc Tsachoua Choupe,
Coordination Team; Urban Practices Qudsia Huda, Romina Stelter, Stephane
Branch; Programme Development De La Rocque); Global Infectious
Branch; Geneva Office (Graham Hazard Preparedness (Maria Van
Alabaster) Kerkhove, Sylvie Briand)
3 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

Executive summary • e nsure adequate housing, reduce risk of

homelessness and anticipate outward-
Preparedness in cities and other urban migration and mobility;
settlements is critical for effective national, • ensure that due consideration is given to
regional and global responses to COVID-19. maintaining good mental wellbeing;
These settings face unique dynamics that • ensure that measures are rooted in a
affect preparedness – they serve as travel robust evidence-base as far as possible
hubs, have a higher risk of disease spread due and account for the resulting impact on
to high population densities, and many have lives and livelihoods.
extensive public transport networks. Diverse
subpopulations have different sociocultural In addition to the COVID-19 strategic
needs and contain vulnerable groups. Some preparedness and response plan (SPRP)1
live in crowded and substandard housing, lack and the COVID-19 strategy update2, there
access to safe water, sanitation and hygiene are four key areas that local authorities of
facilities, and those in informal settlements are cities and urban settlements should focus
also more often unemployed or dependent on on in ensuring preparedness for a robust
informal economies. Cities also have centres response to COVID-19:
for advanced medical care and are critical to • coordinated local plans in preparation
broader health systems. Local authorities have for effective responses to health risks
governance and policy-making responsibilities
and impacts;
and play an important role throughout
the emergency management cycle – from • risk and crisis communication and
preparedness and readiness to response to community engagement that encourage
and eventual recovery from COVID-19. compliance with measures;
• contextually appropriate approaches
To be effective, any public health measure to public health measures, especially
must be implementable and designed in physical distancing, hand hygiene and
a way that will promote willingness to
respiratory etiquette; and
comply. Urban authorities should:
• access to health care services for
• adopt a coordinated multisectoral,
COVID-19 and the continuation of
whole-of-government and whole-of-
essential services.
society approach;
• promote coordination and coherence in During recovery or between epidemic
measures across governance levels; peaks, cities and other urban settlements
• identify existing hazards and vulnerabilities; should refer to the interim guidance on
• identify and equitably protect vulnerable adjusting public health and social measures
subpopulations; in the context of COVID-193, in ensuring
that the stepping down of measures
• consider diverse social and cultural
is in keeping with the considerations
interactions with health issues, norms
described, is balanced against the risk
and perceptions;
of disease resurgence, and ensures that
• consider the extent of reliance on the any escalation of spread can be rapidly
informal sector or economy; detected. Urgent actions for COVID-19
• consider the most appropriate means of must set the stage for sustainable capacity
communication of information; development for concurrent or future
• ensure continued provision of essential health emergencies. Documentation,
services; learning and sharing of COVID-19
• ensure that health facilities are prepared experiences will help to inform and build
for COVID-19 and identify and mobilize better preparedness for reducing the risks
additional resources; and impacts of future health emergencies.
Interim Guidance for Local Authorities 4

I. Introduction III. Why urban settings

are unique
Cities and other urban settlements
are at risk of COVID-19. Many densely Cities, including megacities, are highly
populated areas have experienced
complex settlements that are regionally
high case numbers and deaths, which
and globally dependent on each other
reflects the ease of introduction and
and on neighbouring towns, rural areas
spread of the virus in such places. Urban
settings face unique dynamics that have and places where migrants come from.
a direct impact on the achievement They often serve as subnational, national
of preparedness for all types of health and international hubs, with major points
emergencies, including COVID-19. of entry (e.g. airports, seaports, ground
These dynamics shape the capacity crossings). These transport routes often
of authorities to mount an effective serve as foci for transmission. Given
response, which further underscores the high population density, the risk of
the need to learn from the experiences spread of infectious diseases is often
and best practices of others, implement elevated, especially in congested areas
appropriate measures for preparedness (e.g. crowded sidewalks, supermarkets,
before a public health emergency occurs mass gatherings including cultural,
and to adjust them as necessary. sporting and religious events), and their
people often rely on extensive and
II. Target audience crowded public transportation networks
to get from one place to another. There
and purpose
are also communities with crowded
and substandard housing, have shared
This document aims to support local
authorities, leaders and policy-makers toileting facilities, and that lack access
in cities and other urban settlements to safe water, sanitation and hygiene
in identifying effective approaches (WASH) facilities.
– taking into consideration urban
vulnerabilities – and in implementing Urban areas also have diverse
recommended actions that enhance the subpopulations and neighbourhoods
prevention, preparedness and readiness with different sociocultural needs and
for COVID-19 and similar events in vulnerable groups with regards to public
urban settings, and that ensure a health emergencies, including COVID-19
robust response and eventual recovery. (see examples in Table 1). Rapid rural–
It covers key areas unique to urban urban migration in many parts of the
settings, supplements other COVID-19 world has resulted in unmanaged and
documents, including the WHO strategic unplanned urbanization, including the
preparedness and response plan (SPRP)1 development of informal settlements. A
and the strategy update2, and is neither substantial proportion of those living in
exhaustive nor prescriptive. such settlements are often unemployed
or dependent on informal economies
There are many variations in definition to survive. There can also be a great
for the term “urban setting”. For the variety of sources of information,
purposes of this document, it refers including word-of-mouth, leading to an
to areas with a large and dense increased risk of misinformation that can
population that may be within certain compound health emergency challenges
administrative or political boundaries4. in urban areas.
5 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

Table 1: IV. Considerations in planning

Examples of vulnerable for urban preparedness
groups in urban settings for COVID-19
in COVID-19 outbreaks Optimal preparedness in cities and urban
settlements is critical for effective national,
• Informal settlements
regional and global responses to COVID-19.
• Urban poor The strategic preparedness and response
• Homeless and people living in plan1; the strategy update2 and critical
inadequate housing conditions preparedness, readiness and response
• Refugees and migrants including actions5 provide key considerations and
labour markets actions that all countries need to take for
• Older persons, especially those at COVID-19. To be effective, any public
risk of isolation health measure must be implementable
• Persons with underlying medical and designed in a way that will promote
conditions willingness to comply. As such, in planning
for health and other sectors across all
• Socially marginalized groups
stages of emergency management, urban
• Individuals at risk of interpersonal authorities need to additionally undertake
violence or self-inflicted harm due to the following.
physical distancing measures
1. Adopt a coordinated multisectoral,
whole-of-government and whole-of-
Cities often have referral centres for society approach to preparedness to
tertiary and specialized medical care, harness local resources in ensuring the
although some serve large populations effective implementation of measures
with poor access to care – at times due (see examples in Table 2). This includes
to financial barriers – or have health accounting for the way that public
systems at risk of being overwhelmed services are organized and financed
when there is a surge in patient demand. locally, and for the roles of civil society
These hospitals and health facilities are
and the private sector.
often critical to the strength of broader
local and national health systems. Cities Table 2:
also act as points of entry for the arrival
of medical and humanitarian aid. Examples of sectors that
Collectively, these dynamics call for should be involved in
unique preparedness measures for COVID-19 preparedness
cities and other urban settlements. The in urban settings
presence of pressing health vulnerabilities
and social disparities requires that they • Health
address the needs of the most vulnerable • Social services / protection
populations and build resilience in an • Mental health services
inclusive manner. Local authorities • Transport
have governance and policy-making • Housing and energy
responsibilities that often include some • Education
public health or health services and play • Communication
an important role in the whole emergency • Water, sanitation, hygiene
management cycle – from preparedness • Civil defence, security
and readiness to response and eventual • Commerce and economy
recovery from COVID-19. This includes
• Veterinary and animal health
rapidly establishing new governance
arrangements and partnerships to address • Parliamentarians
the crisis. • … and many others
Interim Guidance for Local Authorities 6

2. Promote coordination and society, and possibly a source of

coherence in measures across essential goods such as food and fuel.
different levels of governance, Measures that disrupt the informal
from national to intermediate (e.g. sector and livelihoods could affect the
state) and municipal/ local levels. ability of populations to comply and
may compromise access to essential
3. Identify existing hazards and
services and lead to increased levels of
vulnerabilities that could emerge as
crime and insecurity.
concurrent health emergencies that
may need to be managed alongside
7. C
 onsider the most appropriate
COVID-19. This includes the use of
means of communication of
local risk assessments, profiles and
information, including online and
mapping based on epidemiological
device access. This includes their use
risk, and the anticipated risks that
by off-site government teams and
may emerge from the implementation
other stakeholders in coordinating
of public health measures.
the response and in interactions with
4. Identify and equitably protect the general public.
vulnerable subpopulations at risk
of poorer outcomes (see Table 1) and 8. E  nsure continued provision
identify partners who may be able of essential services including
to reach out to these people. This emergency medical and surgical
includes considering the likely impact services, sexual and reproductive
of the pandemic and public health health services, drug and alcohol
measures on mental health and misuse services, vaccination, public
introducing safeguards, as well as transport, energy supplies and
the continued provision of essential repairs, housing, communication,
social services. water, sanitation and garbage
disposal with safe management of
5. Consider the diverse social and infectious hazards.
cultural interactions with health
issues, norms and perceptions in 9. Ensure that existing health facilities
subpopulations that may influence are prepared for COVID-19, and
the local uptake and effectiveness of identify and mobilize additional
public health measures. This includes resources including those owned
working with community-based by local government, available in the
organizations or ethnic/religious community and other sectors, and
media channels that may be trusted that can be repurposed or contribute
by certain communities. It is thus to preparedness or response activities
important to provide clear public (e.g. faith-based organizations,
health messages that are tailored to manufacturing plants). This includes
different audiences and communities identifying human resources and
and that are transmitted by suitable facilities to supplement health care
means. Cultural and religious traditions facilities in anticipation of a surge of
are also important considerations in patient demand. Stadiums, convention
the management of deaths. centres, hotels, dormitories, military
health personnel, logistics and
6. Consider the extent of reliance on engineering sectors, including
the informal sector or economy as collaboration with higher authorities
an important source of livelihood, at the intermediate/state and
especially for poorer segments of national/federal levels;
7 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

10. Ensure adequate housing, reduce V. Key areas of focus for

the risk of becoming homeless and
anticipate outward-migration and
urban preparedness for
mobility of population subgroups, an effective response
including liaison with the local to COVID-19
authorities at their destinations to
contain further spread and ensure There are four key areas that local
social protection and basic needs. authorities of cities and other urban
settlements should focus on to prevent
11. Ensuring that due consideration is
the spread of COVID-19 and to develop
given to maintaining good mental
resilience to and preparedness for
wellbeing. This includes, where
events of a similarly disruptive nature
appropriate, daily access to outdoor
(see Annex 1 for more details).
space for exercise and ensuring
safe access to public areas such as
keeping parks open, with measures 1. Coordinated local plans in
to reduce crowding and maintain preparation for effective
physical distancing. responses to health risks
and impacts
12. E
 nsure preparedness measures are
rooted in a robust evidence-base Cities are at the frontline in implementing
as far as possible and account for the measures adopted by national
the resulting impact on lives and governments such as the issuance of
livelihoods. This includes proactively stay-at-home notices and the closure of
searching to determine how similar public areas. These include nationwide
urban settings have managed measures or tailored measures in line
COVID-19, learning and appropriately with national frameworks. Cities also
adapting from their experiences, and complement efforts by addressing
sharing evidence with one another. challenges on the ground, for example by
Local authorities should build on their introducing targeted measures for specific
experiences of COVID-19 to build vulnerable groups.
sustainable capacities for longer-term
health threats. Each city and urban settlement is
unique and should develop, adapt and
implement its own local multisectoral
and inter-jurisdictional plans to ensure
that measures for COVID-19 and
similarly disruptive events meet the
needs of local populations. Plans must
be flexible enough to react to rapidly
changing epidemiological situations
and account for local contexts
and capacities to respond. Local
authorities can also learn from similar
urban settings that have already had
experience of managing COVID-19.
Interim Guidance for Local Authorities 8

Furthermore, coordination between scientific and public health messages

different levels of government should be identified11.
when responding to health
emergencies is essential. Regardless Communications should be paired with
of decentralization, cities and urban active community involvement and the
settlements need to coordinate with co-creation of solutions, such as the
higher authorities in the country6. mobilization of volunteers through civil
society organizations, civil protection and
Examples: universities for the rapid deployment of
• London, United Kingdom, has knowledge and innovation. These can
established a Mutual Aid Cell that improve the chances of compliance,
deploys volunteers and other public especially among vulnerable populations.
health expertise around the system to It may also be challenging for people
address capacity needs7. to adhere to stay-at-home orders for
• Through a COVID-19 Presidential Task long periods of time, which may have an
Force, cities such as Lagos, Abuja and impact on mental well-being12. Cities and
Kano, Nigeria, have been able to take on other urban settlements should consider
a comprehensive multisectoral approach leveraging their advantage in the delivery
to preparedness8. of essential services, including food supply,
• The Bloomberg Philanthropies’ WASH, health and social services in densely
Partnership for Healthy Cities has populated neighbourhoods, especially for
created a learning and sharing network vulnerable groups. Local authorities should
for urban COVID-19 response9. also work with organized community
• United Cities and Local Governments groups (e.g. micro-credit groups, women’s
and UN-Habitat have launched the Live and youth networks, those engaged in
Learning series of webinars to allow for informal settlements) to identify the
learning and sharing of local experiences most vulnerable within communities,
and COVID-19 responses10. combat misinformation and stigma,
and enable access to medical and other
essential services.
2. Risk and crisis communication

and community engagement
that encourage compliance • Singapore city implemented a
with measures communication strategy that regularly
involved its Prime Minister and a WhatsApp
Clear and consistent public health system that transmits the Government’s
messages are needed for all segments messages in the four official languages13.
of society. This includes communicating
local ordinances and other regulatory • Religious leaders in some Africa cities,
measures to limit spread so as to such as in Nairobi, Kenya, have been
facilitate compliance. Advantage working with local governments to provide
should be taken of all the multiple worshipers with information on how to
opportunities available in urban settings protect themselves from COVID-1914.
to disseminate information that • Municipal police in some cities in Turkey
supports preparedness and response have been taking food orders from elderly
measures in order to help counter the people and delivering them to their
potentially rapid spread of misleading, homes15. Likewise, the Tunis municipality
ambiguous, and false information. The has been home delivering essential food
right channels and community-based to vulnerable populations to strengthen
networks and influencers to promote compliance with the general lockdown16.
9 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

• K
 erala, India opened community while maintaining physical distancing.
kitchens and has been delivering cooked This includes operational changes to
food at a low price to ensure that no one maintain public transport services for
goes hungry during the lockdown17. health and essential workers while
• New York City has launched a website avoiding crowding. In some places,
to involve residents in the city’s promoting safe active mobility (e.g.
response to COVID-19 by self-reporting cycling and walking) that also supports
symptoms with a view to obtaining healthy behaviours may help. There may
a better picture of where potential also be a need to temporarily convert
COVID-19 patients or people in self- narrow vehicular roads to exclusive use
quarantine are, and to facilitate the city by pedestrians.
government’s communications with
those populations18. Those that rely on the informal
economy/sector may have difficulties
3. Contextually appropriate in complying with measures such
approaches to public health as the mandated closure of non-
measures, especially physical essential businesses and restrictions on
distancing, hand hygiene and population movement. Such closures
respiratory etiquette may also increase job losses, especially
in the food sector, and affect producers
Timely implementation of public health who rely on these markets. Cities and
measures, especially physical distancing, urban settings can explore coordination
hand hygiene and respiratory etiquette, with non-profit and private sectors to
are important to slow transmission of mitigate losses in food and agriculture
respiratory diseases such as COVID-19 while maintaining access to food,
and to allow health facilities to cope especially for vulnerable subpopulations.
better with patient demand. Given their In addition, ways to link businesses
densely populated nature, physical and consumers, such as through the
distancing in cities and other urban internet, should be encouraged.
settlements may be harder for many
to achieve (e.g. multiple families Where possible, cities and urban
in a shared space). Where physical settlements should introduce measures
distancing in domestic settings is not to enforce physical distancing in public
feasible, local authorities should identify spaces, markets and streets without
public facilities where people can be closing them entirely. This includes placing
quarantined. Local authorities should markings on the ground and restricting
provide temporary and emergency the direction of walking. Support by
accommodation to those without secure religious leaders should also be sought for
housing to enable physical distancing. suspending or modifying observances and
Furthermore, extraordinary measures ceremonies. Advice on the use of masks
may be necessary to secure the right to in the context of COVID-19 should also
housing by implementing measures such be based on the interim guidance that has
as moratoriums on evictions, deferring been published19.
mortgage payments and suspension of
utility costs. Some areas, such as informal
settlements, may not have adequate
Measures should balance the continued access to safe WASH, which may make
provision of essential goods and services it difficult to comply with generic hand-
Interim Guidance for Local Authorities 10

washing recommendations. These 4. Access to healthcare services for

challenges necessitate community COVID-19 and the continuation
consultation and education, anticipating of essential services
and meeting critical economic and
basic (e.g. food and water) needs, and Urban settings often have national
innovative approaches to improving referral centres and need to be
access to wash stations, soaps and prepared to manage surges in demand.
disinfectants, including deploying This includes having a plan for case
additional WASH infrastructure. This management of COVID-19 in health
includes in facilities in public buildings, facilities and the community31,32, ways to
health care settings, schools and public increase the capacities of health services
transport stations20,21. and transfers between health facilities
for load-balancing. Where possible, cities
Examples: and urban settlements should project
• In Ethiopia and Kenya where soap and surge using modelling and health care
water are in low supply, antimicrobial data from affected areas. Barriers to
fabric requiring a minimal amount of accessing health care, including testing,
water22, water-efficient taps and low- may be amplified during emergencies
cost foaming soaps have been tested23. and should be addressed to maximize
• Sao Paulo City Hall, Brazil has also installed continued access by all who require
sinks with potable water in streets to improve it. Social care plays an important role
hand hygiene in crowded locations24. in providing access to healthcare and
• The number of passengers allowed on supporting demand management within
board a single bus has been reduced in the healthcare system. Essential health
Latvia, with passengers only allowed to services for other medical conditions,
take every second seat25. In some cities, including vaccinations, must continue to
sale of tickets by bus drivers has stopped prevent excess morbidity and mortality33.
and passengers are only allowed board Continuation of primary health care
through rear doors26. Bogota, Colombia, services is also essential and, where
possible, technological solutions such
closed streets to cars to create more
as telemedicine should be considered.
space for people to walk and cycle,
Scarce personal protective equipment
promoting physical distancing in their
(PPE) should also be prioritized for
daily commute27.
health care workers to ensure sufficient
• Morocco introduced measures to help protection while carrying out their work.
families and individuals working in the
informal sector directly affected by the Ensuring the continuity of essential
COVID-19 lockdown28. services beyond health also contributes to
• The Municipality of Barcelona, Spain, the prevention and control of COVID-19.
finalized an agreement with the Touristic This includes having a clear list of essential
Business Association to allocate 200 public services and infrastructure,
apartments, originally destined for ensuring prioritization and their continued
tourism, as emergency housing for provision, whether provided by local
families in vulnerable situations and governments or independent service
homeless29. Rio de Janeiro, Brazil has made providers. Essential services include social
rooms available in local hotels to host services, including home care, public
elderly residents of informal settlements transport, WASH services including waste
to enable proper physical distancing30. disposal, and food and energy supplies.
11 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

Examples: risk3. This includes assessing the

• Private hospitals in Islamabad, Pakistan sustainability and impact of measures,
have offered beds, isolation rooms and especially for vulnerable groups.
ventilators to increase the city’s capacity
in managing COVID-134. Urgent actions taken by cities and
• The Jawaharlal Nehru Stadium in New other urban settlements for COVID-19
Delhi, India, has been converted into a must set the stage for sustainable
quarantine facility for COVID patients35. capacity development for concurrent
or future health emergencies. Funding
Madrid, Spain has converted an ice rink
for managing COVID-19 should be
into a morgue36 and London, United
applied in a manner that contributes
Kingdom has turned a convention centre
to these interrelated objectives, and
into a hospital for COVID-19 patients37.
actions to respond urgently to the
• Both Ministries of Health and of pandemic should transition into longer-
University and Research in Italy term actions, anchored in plans and
expedited the graduation of final- health systems that can surge to meet
year medical students to increase the the needs imposed by other health
healthcare workforce at city levels38. emergencies. Special consideration to
• Cities in the United States of America these aspects should be given when
have rolled out drive-through COVID-19 urban settings are in the preparedness
testing sites to reduce demand on health and readiness phase, are moving from
care facilities39. response to recovery or are between
COVID-19 epidemic peaks.

VI. Preparing for Future Cities and urban settlements should

Emergencies also document, learn, share and adapt
during their COVID-19 experience,
In the transition to recovery or to periods including taking proactive steps to
between epidemic peaks, cities and collect evidence and advocate for the
urban settlements should ensure that the financing of sustainable capacities.
phased transition away from measures When appropriate, they may also wish
for COVID-19 is conducted in keeping to conduct a formal after action review
with the considerations described (AAR). Doing so would ensure that
above, and will enable the sustainable progress in emergency preparedness
suppression of transmission at a low- made during the current outbreak
level whilst enabling the resumption of confers benefits to the wider health
some parts of economic and social life, system and helps to inform and build
prioritized by carefully balancing socio- better preparedness for reducing the
economic benefit and epidemiological risks and impacts of future events.

Additional Resources
Local authorities of urban settings may find additional information on
COVID-19 that is relevant to them at the following website: https://www.who.

Additional preparedness resources can be found at the Strategic Partnership

for IHR and Health Security Website: https://extranet.who.int/sph/
Key elements of multisectoral preparedness coordination 12

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Interim Guidance for Local Authorities 14

ANNEX 1: Considerations and recommendations for urban areas

in preparing for COVID-19
Considerations in
Objective Recommendations for Urban Areas
Urban Areas
Coordinated Local authorities • In developing a local COVID-19 response plan, adopt a
local plans in may have local multisectoral and multi-stakeholder approach to
preparation significant collaboration and coordination, including involvement
for effective governance, of local authorities and relevant sectors in preparedness
responses to coordination and and response plans. This includes the identification of
health risks policy-making supply chains, mobilization of cross-sectoral workforce,
and impacts responsibilities that engagement of local institutions, established community
may change as the leaders and groups, and professional associations.
outbreak evolves • Conduct capacity assessments and risk analysis:
to determine potential hot-spots at high risk of
transmission, such as marketplaces, public transport
lines; to identify infrastructure vulnerabilities including
location of vulnerable groups and their access to
public services such as health care, WASH and food
distribution; and to map local assets and facilities
that can support the expansion and continuation of
essential services.
• Develop a coherent strategy to contain the spread
and mitigate the impacts of COVID-19 during different
stages of the outbreak. This includes approaches for
contact tracing, quarantine for the exposed, isolation for
those who are ill, access to food, and support to food
systems in urban and outward-migration areas.
• Guided by the COVID-19 strategic preparedness and
response plan (SPRP) and national plans, determine and
implement priority actions that would lead to better
capacities to prevent, detect, assess and respond at the
local level. Investments are also needed for sustainable
capacities for future and concurrent emergencies
beyond COVID-19.
Local authorities • Establish and test two-way communication with
(e.g. municipalities, higher authorities (e.g. subnational/state and national)
governorates) need and surrounding local authorities, including regular
to coordinate with updates on the local situation and federal/national
surrounding and guidance on measures for preparedness and response.
higher authorities • Establish and test two-way coordination with
to ensure higher authorities and surrounding local authorities,
coherent, aligned including access to supply chains and the deployment
and effective of resources such as health care personnel, medicines,
preparedness and supplies and other logistics. Local measures should be
response aligned with nationwide measures or in keeping with
national frameworks.
15 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

Objective Recommendations for Urban Areas
in Urban Areas
Coordinated Cities are highly • Develop, test and implement points of entry
local plans in connected to preparedness measures with appropriate and
preparation other parts of proportionate restrictions on non‑essential domestic
for effective the country and and international travel. Plans should include the use
response to internationally of points of entry for the delivery of medical and
health risks and via points of humanitarian supplies.
impacts entry • Develop measures to manage urban–rural movement
and vice versa, to minimize disease spread and ensure
support to food systems.
The wealth of • Learn from the experiences and adapt relevant
experience can actions of similar urban settings that are facing or have
be shared with managed COVID-19. This includes the activation of
others for better relevant inter-city networks, and through case studies
preparedness collated by WHO and circulated through the Global
and response Strategic Preparedness Network (GSPN).
• Develop a mechanism to document actions on
strengthening capacities, experiences and lessons, and
share these with other urban settings.
Risk and crisis Populations •D  evelop, test and implement innovative but pragmatic
communication have access to solutions for health risk communication appropriate
and community multiple sources to the local context. This includes transparency, clarity
engagement of information, and consistency, explaining the rationale of measures,
that encourage some of which and the use of traditional, non-traditional and social
compliance may lead to media. These messages may change as the situation
with measures misinformation evolves and should be in local languages.
•M  onitor and analyse public perceptions, knowledge
and attitudes (e.g. through rapid surveys), including
identifying gaps and misinformation.
•D  evelop, test and implement proactive steps to correct
• Develop, test and implement health risk communication
messages for specific groups of workers that need to
be protected while conducting essential services (e.g. in
grocery stores and postal services).
Vulnerable • I dentify and map vulnerable subpopulations in urban
populations areas, develop and test innovative but pragmatic
are harder to solutions to reach out to these groups, and disseminate
reach and may information, including through civil society partners.
have challenges •D  evelop pragmatic measures and evaluate their
in complying expected impact on lives and livelihoods, especially for
with measures, vulnerable populations. This includes considering the
especially in areas sustainability of measures and their impact on physical,
with housing social and mental health.
inequalities [continued overleaf]
Interim Guidance for Local Authorities 16

Objective Recommendations for Urban Areas
in Urban Areas
Risk and crisis Vulnerable • Maximize the wide range of available community
communication populations resources (i.e. adopting a local whole-of-society
and community are harder to approach) for the outreach and implementation
engagement reach and may of measures. This includes tapping on community
that encourage have challenges leaders, social networks for community engagement
compliance with in complying such as grassroot movements and religious leaders,
measures with measures, and the private sector.
especially in areas • Build on existing community networks used
with housing for delivering other health intervention, such as
inequalities immunization.
Contextually There are • Develop and test possible innovative but pragmatic
appropriate large numbers solutions for physical distancing in public places
approaches to of people to appropriate to the local context. This includes
public health manage, spread measures such as limiting mass gatherings, and
measures, may be faster in the selective closure of enclosed public venues.
especially congested places, Consider ways to promote physical distancing
physical and there are in public spaces that remain open (e.g. green
distancing, heterogenous and natural spaces, temporary closure of narrow
hand hygiene subpopulations vehicular roads).
and respiratory with unique needs • Develop and test possible innovative but pragmatic
etiquette solutions to physical distancing in domestic
settings appropriate to the local context. This
includes home isolation of cases, home quarantine
of contacts, and measures to limit movement out of
homes while reducing overcrowding within homes.
Where this is not feasible, the use of public assets
and facilities should be explored.
• Develop and test possible innovative but pragmatic
solutions to limiting physical contact in social
settings. This includes alternatives to handshakes,
hugs and cheek kissing, as well as closures of
schools, religious centres, entertainment venues,
and limiting visits to elderly and chronic care centres
and prisons.
• Set in place protective measures to facilitate
physical distancing measures (e.g. food delivery
services, temporary and emergency housing in
vacant units or repurposed buildings) and implement
extraordinary measures to reduce the risk of
homelessness, such as postponing rental and
mortgage payments and evictions.
17 Strengthening Preparedness for COVID-19 in Cities and Urban Settings

Objective Recommendations for Urban Areas
in Urban Areas
Contextually Physical • Engage businesses, associations and corporations in
appropriate distancing implementing physical distancing measures, including
approaches at centres of encouraging and testing business continuity plans
to public commerce and including working from home where possible or necessary
health economic activity, and substituting physical shopping with delivery services /
measures, that employ options for pick-up.
especially large numbers of • Develop ways to mitigate the impact of physical distancing
physical individuals, are measures on livelihoods especially for those that dependent
distancing, needed on the informal economy (e.g. relief packages).
hygiene and Health risks • Develop, test and implement innovative but pragmatic
respiratory on public solutions for reducing health risks on public transportation
etiquette transportation, systems, appropriate to the local context. This includes
used for protecting public transport workers. Operational changes
movement to maintain services while reduce crowding should be
within urban considered. This includes encouraging working remotely and
areas, should be travelling during non-peak periods, rearranging routes and
reduced the number of public transport vehicles, promotion of safe
active mobility (e.g. walking and cycling), as well as cleaning
and disinfection procedures. Priority should be given to
essential workers who need to continue to travel to work.
Subpopulations • Develop, test and implement innovative but pragmatic
may not have solutions for personal, hand hygiene and respiratory
good access to etiquette in the community, appropriate to the local
WASH facilities context. This includes the use of simple and accurate
educational materials, installing additional WASH
infrastructure and practical alternatives for subpopulations
with limited access to WASH facilities.
Access to Hospitals and • Establish and test a plan for case management of
health care health facilities COVID-19 in health facilities and the community, with
services for in cities and the support of an emergency operations centre if possible,
COVID-19 other urban including managing a surge in demand, deployment of
and the settings are healthcare personnel and additional resources and facilities
continuation often national (e.g. stadiums and military health services), and meeting
of essential referral centres infection prevention and control needs.
services •D  evelop and test innovative solutions to increase
capacities of health services while ensuring adequate
protection for healthcare workers. This includes
involvement of private hospitals, mobilisation of qualified
volunteers (e.g. retirees, final year medical students), as
well as increasing the quantity of medical devices and
personal protective equipment (PPE).
•P  lan for transfer arrangements between overloaded
hospitals. This includes between cities within a country or
Interim Guidance for Local Authorities 18

Considerations in
Objective Recommendations for Urban Areas
Urban Areas
Access to health Essential health • Establish and test a plan to ensure the continuity of
care services for services may be essential medical services. This includes emergency
COVID-19 and affected due medical and surgical services and vaccinations.
the continuation to diversion of Continuing primary care is essential and where
of essential resources possible, the use of technological solutions such as
services telemedicine should be considered.
Subpopulations • Develop and test possible innovative but pragmatic
may not have solutions for access to COVID-19 evaluation,
good access to testing and contact tracing and prepare healthcare
testing services facilities. This include mobile testing units and drive-in
and healthcare testing facilities.
facilities required • Develop and test possible innovative but pragmatic
for COVID-19 solutions to ensure that populations have access to
medical care for COVID-19, at home or in health
facilities, or remotely through telemedicine when
The number • Develop arrangements for the alternate and
of deaths may temporary management of funerals, burials and
stress or exceed cremations appropriate to the local context. This
existing capacities includes adequate physical distancing at ceremonies.
of the burial
and crematory
There is a need • Define the list of essential public services and
to ensure the basic needs that must be maintained and those that
continuation of can be postponed, and communicate this widely.
essential public • Develop and test standard operating procedures
services beyond (SOPs) and business continuity plans (BCPs) for
the health sector urban areas to ensure the continuation of essential
public services based on scenarios such as workplace
absenteeism, teleworking and limited resources (e.g.
funds, staff, and logistics). These procedures and
plans may include moving services online, freeing up
internet bandwidth, involvement of volunteers and
the private sector where necessary.