 Good morning afternoon and evening colleagues. My name is William Shemani, I'm with the Global Protection Cluster, and I would like to welcome you to our discussion this afternoon on approaches to isolation, quarantine and prevention measure, including shielding or what's referred to as shielding of vulnerable individuals in humanitarian setting. I'm very glad that we have many of you from all over the world, despite being a Friday, knowing that it's Ramadan for many of us, and I thank you for your attendance today. Today we have with us experts from the World Health Organization and UNHCR and UNICEF to facilitate a conversation on how we deal with such approaches, what are we doing now in the field, what do we know about what's right and wrong, and create a space for exchange with the operations on the ground to hear from you what you're doing and in which areas we need to engage more and create guidance and tools to take your projects forward. I'm very glad that we have with us today first Teresa Zacarilla from the World Health Organization. Teresa is a health emergency officer and has been heavily engaged in the process of developing guidance on the measures that needs to be taken during COVID-19. That includes protection dimension to them. We have also with us Daniela Raiman, the global coordinator of CCCM who has also been followed. Can I, sorry, can I ask everyone who's not speaking to me because there is echo. Sorry, we still have a couple of questions. Thank you again. So we have as well with us Daniela Raiman, the global coordinator of the CCM cluster who has been also following up with several operations dealing with the measures that I mentioned before. Brett Moore, the global shelter cluster coordinator has joined us and Masumi Yamashina from UNICEF, from the Child Protection AOR, a child protection expert who will also engage with us. The way we'll structure the conversation this afternoon is we'll start by short presentations, starting with Teresa, then Brett, then Daniela and Masumi and open the floor for interventions from field operations. What we would like to hear from the operations is two things. One is what are the practices that you are doing and the kind of good examples that you have managed to accomplish so far. As well as key challenges you are facing that would require further discussion or clear answers to share from the global experts as well from other operations who are on the line with us. So without further ado, I would like to kick off the conversation with presentation by Teresa. So Teresa, please start the conversation for us by first helping us to clarify what are the differences between these approaches and what's the right narrative we have to carry about them. Over to you, Teresa. Thank you very much. And good morning, good afternoon, good evening, dear colleagues. So thank you to the three clusters for this opportunity to have this interaction with you. I'm conscious that this is a topic that is very much alive in many parts of the world and in different settings. So it's great to have this opportunity to have a discussion on what we mean when we talk about isolation quarantine as well as the preventive measures that we aim for particularly vulnerable individuals, those who have risk factors for complications and poor outcomes of the disease. So for the admin colleague who is helping with the presentation, can you please move to the next slide? Okay, so this is just in the glance until the 30th of April yesterday over 3 million cases have been reported and this is from 212 countries or states and or territories. And over 200,000 deaths have been reported from these cases. I think this is just a couple of figures that everybody's aware of, but good to bring these back into perspective. Now, importantly, what we have learned so far, as interventions that are actually successful in slowing down transmission, it's really to the basic principle is really to find all those who are sick with COVID-19 and then isolate them from the healthy population. And this is the best way to slow down transmission. And so in order to build to do this, then we need to have sufficient capacity to actually test those who seem to have COVID-19. So the suspect cases and then to isolate and treat all of them, including those with mild diseases because they too can be infectious to others. And then because normally each case would have close contacts potentially exposed to the virus, it is equally important as well to then list trace and monitor all of these contacts and quarantine them for a period of 14 days, which is the incubation period of the disease. And so the aim is really to stop cases from just a couple of them sporadic from becoming clusters and from clusters to evolving into wider and out of control community outbreak. But then so what do we mean when we talk about isolation? So what's very important is that isolation is for sick people. We isolate people who are sick to keep the rest of the healthy population safe. Quarantine is not for sick people. So quarantine is for those individuals who are not sick, but who may have been exposed to the virus. And as soon as they become sick, they would then need to be isolated. So that's quite a significant difference. So quarantine, we normally hear the term quarantine used, especially for travelers at airports or even goods. I think I'm hearing background use. Okay, so let me continue. So quarantine, we normally hear quarantine when we talk about plants or animals being exported or imported from one country or another or travelers being quarantined. But quarantine is a public health intervention in at those who we think may have been exposed to a pathogen to a disease, but who is not sick yet. So it goes way beyond what is being done at points of international points of entries. So it is true that to be able to test all suspect cases, to be able to treat all of the cases, even those with mild diseases, and to do contact tracing properly, a lot of resources are needed. And humanitarian settings are particularly challenging to be able to where these measures can all be implemented. So there are indeed adaptations that need to be done, but we also need to very much rely on the basic public health principles behind these interventions that we need to follow if we really want to bring this outbreak into containment and even to stop it. So next slide please. So this is just very briefly. The adaptation process itself for the public health and social measures that are recommended to control the outbreak need to be very much based on the characteristics on the context and and every setting is different even within the humanitarian affected countries and areas there's a lot of difference between one setting to the next. So we need to be mindful of these characteristics in order to adapt our measures and include over the conditions of shelter, how crowded the setting is, whether it's in a camp or other types of setting, whether clean water and sanitation are available. How do people live day to day? What type of livelihood activities are they engaged in? Whether there's, what's the status of food security in the setting, whether there's a lot of malnutrition prevalent in the areas. And these humanitarian when I speak here about humanitarian settings obviously we also include the humanitarian camps, but also the illegal settlements and maybe even some of the urban slums where we see a lot of displaced people also coming to find refuge. And then the characteristic of health systems in these areas are normally quite quick beat on delivery of essential services on financial protection on these capacities to respond to COVID. And also there is the capacity of the health system to respond to everything else because obviously there is the outbreak of COVID-19, but there are also a lot of prevalent morbidities, a lot of important diseases for which essential health services need to be sustained at all prices. Next slide, please. So then important assumptions that we need to take into consideration when we want to adapt these measures for isolation for quarantine and other prevention for vulnerable groups are do we actually know what are the biomedical factors, the risk factors for complication and poor outcomes in this type of settings? The data that we have up until now shows that age, older age, especially those above the age of 60, the presence of hypertension, diabetes, cardiovascular diseases are important contributors to risk factors to the development and the progression of the disease. But then these are very different settings. We have received most of our information from China and from high resource settings. Now, specifically for humanitarian settings collectively, we're still lacking information on what additional risk factors can determine the progression of COVID-19. For example, malnutrition or tuberculosis or malaria are there correlations between these diseases that we see much more frequently in humanitarian settings with the ultimate outcome of COVID-19? At least we don't have sufficient information yet and we hope so this is something as well that WHO and partners are all aiming to monitor closed issues. We need to have a better understanding on the manifestation of this disease in humanitarian settings and in low resource settings in general. We need to know whether the same risk factors are as pertinent or there are other diseases, other conditions that we need to be aware about. Another important assumption is that due to the overcrowding and perhaps inadequate shelter and lack of access to safe water, we believe that in humanitarian setting, once the virus is actually introduced inside the setting, it is very likely that it will spread rapidly and potentially the entire setting would be exposed even though not everyone would become sick. And then the next assumption is on the difficulty that we anticipate already on being able to implement the prevention and control measures that are so popular in high resource setting, the confinement, the lockdowns. What are the basic principles to this and how these would impact negatively or positively in humanitarian settings and therefore what adaptations are needed? But on the other hand, we also know that even in camps, humanitarian camps, there's a lot of strong community ties and structures with influencers and trusted chains of communications. Meaning that if measures can actually be agreed bottom up, then the likelihood of it actually being implemented is higher. The success rate may become higher if everybody is actually engaged. Next slide please. So at the moment, many organizations are working together to develop an interagency standing committee guidance for the adaptation of these public health and social measures for COVID-19 for low capacity and humanitarian settings. So what we try to do collectively is to identify and list all the important public health and social measures that are applicable and important everywhere. And then how these could then be adapted to low capacity and humanitarian settings and what key actions we need to sustain or to implement even in the poorest resource setting. Now, what we have learned together collectively in the development of these messages on the key actions is that most of the time the public health principles cannot be compromised. We still need to actually put in efforts, for example, for hand washing, there's nothing really that could replace hand washing. But because there are humanitarian and development actors in many parts of the world, then it is also then our collective duty to continue pushing to make sure that safe water is available to make sure that hand washing supplies are available and to make sure therefore that people can access and use hand washing facilities. Next slide please. So you, we hope to be able to publish this interim guidance next week. And so as soon as it is published in the ISCA website, I'm sure then all the cluster coordinators would be circulating it widely to all partners. So then coming back to the issue of isolation. As I've mentioned earlier, this is a critical measure to make sure that we can contain the outbreak. It is important to separate those who have COVID-19 from the rest of the population. Now how isolation is done, ideally in health facilities. But as we know, even in the richest country, it has been very difficult to find enough hospital beds to accommodate everybody who has the disease, especially if we want to extend the care and in hospitalization to those with mild diseases. And therefore the usage of community structures, including the setup of new temporary tents for the purpose of isolation is extremely important. So the key message from this slide I would like to highlight is really the hierarchy of isolation. If health facilities are not available, in most case, I understand that it would be the situation locally. Then we still need to make efforts to make sure that there are some community facilities. Now, these community facilities would then need to be equipped with staff or trained, of course, and with supplies and also with the support required for those who would be isolated during their isolation time. And there needs to be also sufficient space for cohorting individuals according to severity. So we cannot be mixing those with severe cases with moderate cases and those with moderate cases with mild cases. Understanding that testing capacities may be limited as well in these areas, we have all agreed that once you know that the virus is circulating in the setting or in the country, then syndromic surveillance, so the characterization or taking the decision to treat somebody as a COVID-19 case can be made just based on signs and symptoms, even without lab capacity. So this is an important step as well to make sure that we are not late in detecting cases, that we're more conservative in trying to detect cases. If, and in most situations, health facilities will not have sufficient capacities, then the next step would then be to identify and operate these designated community structures. It can be buildings, it can be community houses, it can be, we want to avoid schools as much as possible. And then other community town halls, for example, other structures that could be used for isolation purposes. These may then be mobilized for the purpose or new structures could also be erected for the purpose. And then as a last resort, one can isolate, especially the mildest cases at home, but this can only be done once an assessment has been done in the household to make sure that some IPC, basic IPCs can be put in place, for example, by adding a physical barrier, a handmade separation, even just from a carton board, but any type of physical barriers that could then be placed to make sure that the sick person can be isolated from the rest of the household. I mean, there are various ways that could be identified to make sure that these three types, this is a hierarchy of isolation and treatment can actually be done. But then there's no one recipe for all, of course, and the best solution really needs to come from a, from a collective discussion and decision making with the people we work with, with the people we serve. Next one, please. So that was for isolation and meaning it's for cases. Now, the quarantine of contacts. So because quarantine is meant for individuals who are not sick, but who may have been exposed to the virus. Then it's intended for contacts and contacts are individuals who have been in touch with sick with COVID-19 cases. They may be COVID-19 cases because they were tested positive. They may also be COVID-19 cases because they have all the signs and symptoms and it has been decided that these individuals will be treated as COVID-19 cases. So contacts in this case is applicable for contacts of probable cases who we could not test as well as confirmed cases. The incubation period of COVID-19 is at the maximum 14 days. And that is why quarantine should also be implemented for a period of 14 days starting from the time or the day of the last contacts. Now I have lost my slide on the screen, but I think I should be able to continue. So ideally we also want in settings where there are abundant resources, we also would like to see contacts quarantined separately because they may have been exposed to the virus. And so it is likely that during the period of 14 days, some of them may become sick and may become COVID-19 cases. And so to be extra cautious, we would like them to be quarantined in separate facility. But understanding as well that in most situations, even in rich countries, it would already be difficult to find sufficient community structures to treat the cases. Therefore, there is a little bit more flexibility on where a contact could be quarantined. And also understanding that in many situations, contacts would still need to go to work because they may be the only breadwinner of the household. Then for as long as they're not sick and for as long as daily monitoring could be assured, this is still allowed. So while a case isolated should not go anywhere, contacts under quarantine can still perform their essential duties for as long as a strict monitoring system is in place. So now the last part which is the prevention measures for at-risk individuals. It is extremely logical that we want to protect those whom we know might develop complications from the disease. As far as we know at the moment, their age, hypertension, diabetes, cardiovascular diseases, but in low capacity and humanitarian settings, it is extremely probable that there are other risk factors that we are yet to find out that may result in complications. And therefore, it is safest if we protect everybody in the same way. Prevention measures should be made available for everyone to begin with. Now, in certain locations, there may already be collective accommodations, operating, for example, retirement homes. These may already exist and these facilities may already have residents. In these situations, if family members could re-accommodate their loved ones, that is an option. Otherwise, then it is extremely important that collective accommodations are monitored closely and that their measures for infection prevention and control are actually very, very strictly implemented. We have seen in Europe and in North America how the disease has actually managed to infiltrate retirement homes and kill many in the thousands without people really realizing or realizing very late. And these are facilities in high resource settings where we know people are trained, the caretakers are trained. There are doctors and nurses for each facility and people take precautions. So in resource poor settings and humanitarian settings, we may not be able to ensure that these control measures are in place and therefore to actually place people whom we know would be at risk of developing complications and poor outcomes is extremely dangerous. Because if the virus is actually introduced into this collective facility, then the likelihood of it actually spreading even faster and killing even more is extremely high. So our recommendation is if you would like to shield, meaning prevent or strengthen the prevention measures for individuals whom we want absolutely to make sure that they don't catch the disease. It needs to be done at the household level with the support of the family and not in a collective site somewhere else. The reason is because first, as I mentioned, if the virus is introduced into a collective facility, the consequences will be very dire. Secondly, if we then allocate resources to actually build these shielding facilities, we take away resources from the measures we know work, isolation and quarantine. So if we can allocate resources to set up shielding facilities, we should be able also to set up isolation facilities. And also for how long would these at risk individuals that need to be shielded is a big issue. How long can we sustain running a green zone or a shielding facilities. So our recommendations remains the same is that we need to focus on detecting and isolating cases, quarantine in contacts and monitoring them. And then any strengthening of prevention measures should be done at the household level. And this is my last slide. Thank you very much. Thank you very much. This was very good to set the right definitions and put the whole issue of quarantine and shielding in perspective. Let me now turn to you, Brent. Of course, shielding or quarantine in any other country has to happen in the physical space. Often, starting in the sometime adoption. So what's the experience from the chapter cluster and what are some of the best addresses you can give us? Thanks, thanks very much, William, for the introduction and thank you, Teresa, for the presentation. It was really rich with content. So thanks very much. Certainly on behalf of the shelter cluster and the shelter implementing agencies. It's been, of course, a challenging time to understand exactly what can be done. So as mentioned by Teresa, initially a lot of the guidance that came out was for high resource settings. And for many of us listening here today, it may be somewhat easier for us to kind of follow the general guidance of stay at home and wash your hands. But for many of us, and clearly for those living in displaced contexts, specifically camps and camp like settings, it's very hard. Next slide, please. So at the global shelter cluster, what we did, we've got a dedicated page. I'm sure many of you have visited already. We've got a lot of cluster colleagues online. Now, we've prioritized the key resources online coming from WHO, that coming from the ISC, and also that coming from the field clusters. Now, this is an important point that we have to try to find the right balance between the high level guidance and then something that can be applied at the detail level. And because shelter practitioners, they have to calculate numbers and requirements and any kind of building provision as part of the response to this health issue. So in the end, a lot of the shelter colleagues, they really need the details. So we have to strike the right balance between the general principles and then enough information so that details can be provided that are right to any context. Now, we've distilled what we see as the key multi-sector messages down to these five key elements. The first thing is really the material assistance. Now, when there's existing NFI programs, what we do is try to maximize that. And of course that's applicable largely through local procurement. We're also very aware that international supply chains have been threatened or broken down. A lot of airports are closed. So lengthy international procurement processes that we would often rely upon when it's a large response clearly can't happen. And of course, this is not just a humanitarian issue. This is a whole other society issue. So we've had to try and place these kinds of messages within any other larger national context. Now, the second element that you can see is that adequate shelter is really critical for protection outcomes and for health outcomes more generally. That doesn't even really matter if it's a humanitarian context or not. There's clear evidence from all kinds of sources for really decades now that people that are living in poor conditions suffer poor health outcomes. So there's a large and strong determinant on the public health and shelter relationships. So shelter has a very, very big impact on how people live. So what we're trying to do is really give clear guidance for two particular perspectives. One is on living within the shelter, say density at shelter level, and one is at the settlement level. So what we're trying to do is provide clear pathway where people can plan interventions at the household level and at the settlement level. So at the household level, the key issues are really around understanding density. What is too dense? How many people in one shelter or how many people in a settlement is considered too much and tends to exacerbate the risk of COVID-19 transmission? Now, this is hard. We don't have clear indicators about this because it largely depends upon people's behaviour. As many of you would know, the guidance which we have universally applied for quite some time now is the sphere standards. And many agencies, of course, have their own accompanying standards, but really 3.5 square metres of space per person is how we've planned a lot of shelter interventions for many, many years. Now, does that metric actually have an impact on COVID-19 spread or not? Well, the answer is we don't know. If you've got a 17.5 square metre house that is minimum adequacy for a family of five, what difference does it make if you have an 18 square metre house or a 20 square metre house or 25? We really don't know. But the general rule of thumb is that people that are living in higher density conditions will, of course, have a higher risk of spreading COVID-19. So what we need to do is mitigate density concerns at the household level and the settlement level. And then the third element there you can see in the infographic is really around provision of adequate space and infrastructure for the health requirements. So it's reframing our shelter approaches to meet health outcomes. Next slide, please. So what we've got, we've got a series of guidance online and we're just in the process of developing something a little bit more specific to guide practitioners at field level. Now, of course, as I mentioned, trying to understand what are the density conditions in the household and what are the density conditions in a settlement actually require some assessment. So, of course, cluster and agencies have many different kinds of assessment formats, but what we've tried to do is distill down the key elements that help for a rapid assessment at the settlement level and the household level. So I've just taken a screenshot there of a part of the guidance and we hope with consultation with partners and with our co-lead IFRC to develop something that's quite universally applicable. We know that many field cluster coordinators have already developed guidance that's appropriate locally in conjunction with local health authorities and close collaboration with protection, WASH, CCCM and community. Because, of course, whenever we're developing guidance for a specific displacement context, it doesn't make any sense if the host community around don't have the same kind of regime applied because where we have quite fluid contexts, you can't have two kinds of social order prevailing without consistency. So you'll see there the settlement density guidance really is looking at the current population of a camp, the total population of a camp, and if the current population is greater than the total capacity, we've got some density issues. So of course, in consultation with health colleagues, we can who can identify the numbers of people of concern, and that is largely defined as Theresa mentioned by age and co-morbidities, but of course other locally applied selection criteria. And then we know the proportion of the population that we need to provide additional assistance for at the settlement level. Now of course, like any settlement, there might be pockets that are more dense than others. So density reduction might occur in only one part of the settlement, depending on what the result of this rapid assessment process is. In the section down below at the household level, we really go back to the basic principles of how many members in a household and of course we prioritise for those households which have the highest density first. Certainly need to look at simple local solutions, provision of local materials, cash for shelter approaches. So as I mentioned, avoiding time consuming and lengthy international processes because we need some quick wins. So once the assessments complete, we want to prioritise something that's feasible at a local scale without relying on something that might require two or three months to implement. Next slide please. So just a simple graphic of what that might look like for the household level assessment. You can see something on the left which shows a very simple outline of what a shelter might be. Of course the first option is to extend existing. Now that is when you might have some simple materials available and the second option is for when you might need to construct a separate dwelling. Now that is only appropriate if the plot of land you have available allows that. If you're on a very small plot of land, a second dwelling may not be possible. But of course the first one is for an internal separation and that provides an additional amount of space aligned with the recommendations that Theresa outlined. And secondly, when you have to have a household level isolation and you've got room for a second dwelling, the third option there is what might be mostly applicable. So the main thing is just to make sure that you concentrate on what's between locally through a locally procurable process. You'll also see online that we have selection of health infrastructure in response to COVID-19. So that's using our most standard NFI kit and seeing what's easily available. Now we've also linked through to the CDC infection control guidelines for how to quickly clean and disinfect so you can make sure that you're keeping the space healthy. Next slide, please. Now when the data comes through, you look at the settlement level. So after you go through the rapid assessment, you can see that there's several planning options available within an existing settlement. Sometimes if you have additional land and you go through a series of questions to see whether additional land is available, you can construct additional dwellings there if the density calculation of the overall settlement was found to be too high. This kind of analysis also allows us to allocate land for the health facilities. So health facilities as Theresa outlined may likely require additional capacity, which will require an extension. In many cases, it is shelter offices and others that are involved on the ground in these kinds of construction activities. For example, in UNHCR, we've used refugee housing units. We've used larger tents, MSF tents and so forth. So there's a variety of prefabricated options that may be available already on site. Otherwise, there's construction of additional ward space. And as Theresa mentioned, we need to pay careful attention for those that are only mildly affected versus those that are more severely affected and separate the categorization of each of the caseloads. So we can see here the kinds of information available and seeing how you can identify land, what is the calculation method for understanding how much land to select and how should you plan that land out, the spacing between units and certainly the extension requirements for the health facility to make sure you're providing spaces that are adequate for isolation or adequate for the health facility. Now, of course, we don't want to promote isolation or any kind of shielding. It's not a recommended approach. If you cannot do it safely and if you cannot do it without having a leaky effect as they say, so if it cannot be done with adequate separation, you may be putting people at greater risk. So follow the health guidance and understand the protection risks before deciding to go on any additional site development process. And then I just go on to the last slide, please. Now, of course, when we're planning out a facility, we need to, as I mentioned, separate, confirm from suspected cases. And with any kind of principles for infection control, they have an architectural manifestation. So what I mean by that is that we normally try to separate patients, visitors and staff. There's three kind of pathways for human movement within a health facility. So this is just a schematic diagram that's been developed from the SARI guidelines, that is severe acute respiratory infection facility guidelines, but bringing it down to a very, very simple level. So our next step really is to finalize the guidance with partners to field test it with our cluster of colleagues and technical staff on the ground and see if it's broadly applicable for the range of contexts that we find ourselves in. So that's really it from my side. These are some kind of reasonably achievable measures that we have a lot of guidance out there. The guidance that we have so far is more working at the conceptual level and what are the principles we're trying to work out. So the purpose of this guidance was to take it down to the next level and have it applicable in a technical sense so that field colleagues can move forward with interventions. Certainly well in advance of risk arising, we would hope. So thanks everyone. That's it from my side. Thank you very much, Brett for the visual and clear and concise presentation. For the colleagues who are asking how to get full of the PowerPoints, we will share them with the recording of the webinar just after the webinar. But also Teresa and Brett, if you have any links to guidance you have referred to you want to drop in the chat box, please feel free to do so. We'll also put them when we upload the recording of the webinar. I have already several questions in the chat box. Please, colleagues continue putting in questions. We'll take them after the third presentation coming up from Daniela CCM. I would also encourage colleagues who would like to speak and present what you're doing in your operations to kind of mark that in the chat box. So I encourage cluster coordinators in the operations to do so. And then I will take give you the possibility as we're going for now. Now let's move beyond the immediate physical dimension that Brett presented to the specific case of camps and settlements with Daniela has been working with other colleagues on these issues and several operations. So Daniela, where do we stand in our practices in this and what can we tell the colleagues in operations over to you. Thank you very much. Welcome everyone and apologies if you have some background noise. That's what teleworking means. Apologies for that. So when it comes to the camp management and CCM cluster, there has been a lot happening. And if I could ask you for 30 seconds, sorry, I need to go and deal with my family situation. I'll be back in 30 seconds. Thank you. Okay. Thanks. Thanks, Daniela. I really appreciate the situation. We're all in similar contexts. Maybe just while waiting for Daniela, I want to direct one specific question to you, Teresa. That came from Yona Stanley. Teresa, Yona asks that the validity of testing for cases versus cleaning before determining who should isolate, how does that work actually? Is that really valid? And even assuming that adequate isolation is possible in camps and camp-like setting, is that the right assumption? Maybe what do you have to say to that? And then we proceed with Daniela. Over to you, Teresa. Thank you. And thanks for the question. The only way we can actually, the only method of confirming the presence of the virus in the body is through the molecular test, so PCR. Serology test does not do that. PCR test is also important to guide the clinical management. A body would only develop antibodies detected through serology tests later in the disease. The amount of virus actually that are excreted through our upper respiratory tract is highest when we first become sick. So during those very early days of becoming symptomatic, and the only way to detect the virus is through the PCR test. Also, when you mentioned screening, from the surveillance perspective, when we say screening, we want to do a symptomatic screening. So screening would involve a detection of signs and symptoms that are suggestive of COVID-19. So temperature measurements and then an evaluation of whether there is a history of fever or dry cough or sore throat and any other symptoms that we would list in our case definition. So screening, the more you have little capacity to test, meaning to do PCR test of suspect case, the more you need to strengthen your screening capacities, because you would like really to detect all those individuals who are symptomatic, who have the signs and symptoms of COVID-19. Now, we can have a separate discussion on how the screening could be done and also the diagnosis of exclusion, because we want to make sure that other potential causes of the signs and symptoms similar to COVID are also analyzed and then removed, right, or treated if they're present. But so screening, we would even put, encourage cams or slums areas to set up screening posts at the entrance of the community and even at the entrance of important sites where people would need to still go to even in the strictest confinement, such as, for example, the market places, right? So that's screening and testing. So testing PCR is needed to guide our clinical management. Serology is only afterward to see whether somebody has been exposed to the virus or not. It cannot be used to guide how a patient is going to be treated. Now, if you don't have PCR testing, then go for screening of signs and symptoms and detect your COVID cases based on signs and symptoms, even without any laboratory test. And so now on the isolation facilities, I'm sorry, but I forgot the question. Could you kindly repeat it? Thank you. On the isolation facilities, even if we're assuming that adequate isolation is possible, sorry, are we assuming that adequate isolation is possible in camps and camp like setting? And maybe I use this opportunity, Teresa, to return back to Daniela, and then we can tackle this issue should Daniela haven't really captured it in her presentation. So thanks a lot, Teresa, and Daniela, back to you. Okay. So welcome again, everyone. Thank you for the flight. And thank you very much for the presentation. They pretty much encompass a lot of what's happening. And the global disease in the cluster has been very much working on especially focusing on this particular setup, meaning isolation and quarantine facilities, because they require some sort of management or they are set up in camps. So there's a very direct link. So even if you might have settlements and sites, which under normal circumstances could be run smoothly, when it comes to setting up these kind of facilities and programs, it gets more complicated. Now, there are also a few things I wanted to mention before going into camp management or management of sites, collective sites at this moment, and then specifically when it comes to isolation and quarantine facilities and then address briefly also the shielding concept. There are huge parameters to be considered. One is the formality of the sites, because many of the things you've been hearing and many of the various measures which are being taken are easier implemented in more formal sites. So if you have formal camps, if you have large sites where you can, where you do have structures where you have some sort of organization, etc. Many of the public health measures and the measures taken to prevent them to fight COVID-19 spread can be added to already existing measures and can be kind of easier implemented. But you have many, many contexts where you would have hundreds of informal sites and settlements where there are a few dozen of people living in very precarious conditions. They might also have difficulties with their land and property and kind of placing restrictions, etc., being in very regular situations. So how do you then do some of these measures? How do you, for example, isolate? How do you quarantine in such a situation? So that's one thing that also the CCCM is looking at. Another part is the stage at which we are because, for example, in Europe or in several countries in the world, by now the virus spreading has been quite advanced. In Europe, the discussions right now are about already starting to be confined and etc., which also means that in many countries where we have a large proportion of displaced populations, the virus is only arriving or it's only starting to be increasing. And so we had a window of opportunity over the past month or two to be able to prepare for it. And a lot of the activities in the various collective sites were focusing on the preparedness on what can we do in order to actually prevent or limit to the extent possible the propagation of the COVID-19. Next slide, please. So what is the role of camp management and how does it link to COVID-19? Well, first of all, there is one of the major advantages of having a well, an existing camp management or a site management agency or a service in any given site is the fact that there is already a lot of data which is available for the site. Which means you would have data on population profiles, which would include possibly their mobilities. You would have data on the demographic of the population on the vulnerability, etc., which is already for preparation purposes, allowing you to look at which are the populations or which are even individuals who might be more experienced, where the attention should be more focused. The other aspect is that the vast majority of, especially formal sites, but also informal sites, do have some sort of site monitoring, which includes having systems for monitoring of various services. So again, there would be a wealth of data to reduce the COVID-19, which allows for assessing how well are the services available. And I'm specifically talking about health services, wash services, so having regular updates and regular friends. So when it comes to preparedness space, when a number of companies, these data have been used to prepare, to actually single out and to prioritize specific collective sites, which might be more at risk and where more attention should be paid. Additionally, the community engagement, the communication and mobilization, that has been a large part of what the camp management agencies have been arguing. And it's very important when it comes to implementing public health measures such as quarantine and isolation, because the population needs to know what's happening. They also need, they need to know what's happening, they need to know what is expected, what they are expected, they need to know where is it going, what are the timelines. In many places, additional volunteers are being used to actually help with communication and to help with public messaging. The other role, the referral pathways in national protocols. Again, the camp management is usually ensuring that referrals within the camp or within the site function. But in addition, when it comes to COVID, there is the national protocols which might come into play. And so in several countries, the national authorities have introduced measures, which might not have been there otherwise. And it was important to ensure that these measures would be compatible and would be kind of introduced without adverse consequences to the population of the sites. Site improvement and maintenance. Brad has been talking about setting up of isolation and isolation centers and quarantine facilities. But this is also something, site improvement and maintenance of the existing structures is important to be able to use them if necessary. Use of infrastructure and crown control, especially when it comes to trying to, for example, close in camps and sites to make sure that people are moving in one direction and not another one. And then it's also extremely important when it comes to the shielding concept, which I will come in a second. Another part is coordination of services. Now that's a normal part of work of camp management. But when we are talking about setting up particular facilities in camps and or in sites, isolation, quarantine facilities, and then let alone the possibility of re-drone, people even discussing that, they need to be serviced. The population who is in these facilities need to have access to all the possible services that they require to stay there. And their stay must be also sustainable. So that was one of the goals for camp management agencies. And then obviously the camp management business continues. Travel restrictions and movement restrictions are nowadays a reality. And it's getting, it will probably be even getting worse. There might be the need to actually not to completely isolate or to completely stop movement into camps. And that's already a reality in many operations. And so how do you ensure that activities will continue? And in particular, how do you ensure that you can cater for the needs of isolation centers and current facilities set up in camps if the movement of management staff and possibly even the nationals, including health staff, is severely restricted? Next slide, please. So now the different settings and the relevance. The quarantine, as Teresa explained, it's something which is being, it's not for confirmed cases. It's for cases who have some suspicion of exposure, who might be coming from places where there has been a known transmission of the virus. And in the context of camps and camp-like settings, this is very much true for either new arrivals or returns. So in a number of locations, in order for the new arrivals, in order not to prevent new arrivals entering camps and entering camps, quarantine has been introduced in order for them to be able to enter to the camp, but then having separate zones where they would be able to spend those 14 days compulsory to see whether they would develop the symptoms or not. And then they can join the rest of the population in the camps. So quarantine part is, and it also will be valid for possible contacts of suspicious cases and camps and camp-like settings. It would mostly, at least, and colleagues who are online would know much more about this. But there are, in some places, quarantine is recommended. In some places, it's made compulsory, including production, production of clients, or kind of being implemented through law enforcement measures. Then there is the question of isolation, which is isolation for suspicious and or confirmed cases, mostly mild and moderate. And as Theresa explained, ideally, they would be in a dedicated facility, and then in low research settings, in camps, camp-like settings, it would then, if that's not feasible, they would need to be isolated within the camp. And if even that's not possible, then the last option is actually taking some measures for home isolation. And so from a camp management perspective, often when isolation is possible in national hospitals or government facilities, these facilities will be mostly outside of the camp or the site. So that would be easier, that would be more the transfer of the people into these facilities, but for camp management, that wouldn't necessarily directly impact other than making, keeping the link between those who are going to these facilities and family members who might be staying in the camp, making sure that their arrangements are done for people who might need such children as we will be probably hearing later on, etc. So, isolation facilities are also being set up in camps. And there it's either existing, there might have existing isolation facilities, especially for example, in countries such as BRC, where previous Ebola outbreak might have led to actually establishment of such facilities. Building of new ones and Brad has been talking about what kind of facilities could be set up. And then re-purposing of existing facilities. Now, the slight advantages that because of the preventive measures for COVID spreading, many of the common facilities in camps have been closed because of the mass gatherings kind of restrictions. So they can be re-purposed for being to be used as isolation facilities. But there is still a need to be assessing whether that such re-purposing is really meeting the purpose of isolating and it doesn't do some other harm for not having that kind of a facility used for their original purpose. And then, especially when it's about collective centers, for example, we have a situation where whole collective centers were closed, for example, reception facilities. Because some cases have been identified or have been suspected, and the authorities have closed the whole reception facility to be now used as an isolation place or kind of quarantine that then transformed into an isolation place with all people who are with all the residents inside. From a camp management perspective, especially isolation facilities, they do remain a specialized facility for medical people. And so when it comes to managing them, it will be done by the health authorities, by the health partners with possible technical support from camp management agencies and actors, but not necessarily directly managed by CCCM actors. But there is still, there's the remaining issue of service provision and taking care of the family members who remain outside of those isolation facilities. And finally, the last point on the shielding, which, and I know that very often it's being used as one of the measures. Now, it's not really one of the measures currently in isolation, that's something that is being implemented in any case. It's a public health measure and it's been implemented for cases who are confirmed or who are the attribution of having COVID-19. When it comes to shielding, the other way around it, as in some operations I've heard the expression reverse shielding, reverse isolation, which means how do I protect those who don't have the virus yet to make sure that they don't get it or that they are less likely to contract the virus. And in that sense, and as Teresa was mentioning, it's a very controversial concept, it would be very, very difficult to implement even under ideal circumstances. There are some operations in some companies where they are trying to keep pilots, or the five pilots, one which is currently ongoing is in Yemen. But as Teresa explained, the shielding part is very much focusing on household level or extended family or extended household. Anything larger than that, the risks might very much outweigh the advantages. Especially in humanitarian settings, in camps and camp-like settings, which was not successful all along. Johanna Ali, can you please mute? Johanna, please proceed Damien. So when it comes to shielding, there are many, many challenges to it, which includes the fact that as already physical delimitation of the place, sustainability of it, maintaining such a setting for a longer term. At a family level, that's what all our families are doing in any case. I mean, I think every family who has some high risk individuals are trying to shield them one way or another so that they would have limited contact with the outside world. But anything that goes beyond the household or the kind of extended family size would be very, very complicated. And from a management perspective, from the no contact perspective, it probably brings more risks than it would do good. Except it's a consideration considering that you might have a choice, we do that, or we do nothing, and we know that the health services are not sufficient. Next slide please. And our last slide, the challenges. So there are a few challenges for any of, I mean, for all the public health measures to be implemented in camps and camp-like settings. One of them is other where you need to be making choices between if this measure is sufficiently important that I invest into this one with my limited resources. Or should I be trying to do something else which might actually better address or have a more of an impact. Now, I'm not talking about the very basic public health measures we can possibly, but anything else, I mean, from a management perspective, you are trying to really focus on those that you know will have the highest success rate. And the unknown exposure, that's another difficulty in many of the contexts where you would not really know if you might have the virus already and who might not. You need to behave as if everyone would have it, but then that makes it so much more complicated to continue to operate in camps. Another issue here is the maintenance of services. And that means that that means both if you do for isolation facilities, for quarantine facilities, how do you maintain provisional services, respecting all the public health measures to ensure that there is no provisional transmission of virus? How do you ensure services are maintained if there is limited or restricted access to the camps? How do you ensure that all the various initiatives which are happening at a camp level are well coordinated? There are many of the interventions which require certain sectors or certain classes, but sometimes it's complicated to make sure that everyone who needs to be around the table is present and can actually coordinate those interventions. And it's the only way how all these measures can actually make sense, led by the health authorities and led by the health colleagues. In terms of public engagement, many of the measures that need to be taken, you need to be able to understand what are the consequences, how long it will take, and they need to be able to express what they can do. And that's part of those solutions, because that's the only way how they would have a buy-in. And how many of the measures, for example, quarantine in isolation would be expected. And how do you ensure management and monitoring, which is another challenge when it comes to restriction of movement, and how to make sure that all these services, including them, running of the isolation facilities in quarantine and monitoring what's happening in facilities, can be done with the restriction on an actual presence of many, many workers. So that's why sustainability, quarantine and isolation is needed for 14 days. Amman, can you also kindly mute? Thank you very much. Please proceed. If you would be considering, or even at the smallest scale shielding, that might be much, much longer, because the present needs to remain as long-class as the virus is present in the environment, or in the community. And so how long do you maintain, what do you need to maintain without compromising all the other services, without compromising all the other activities that are happening at the camp level? This will be the main point for management. Finally, Daniela, maybe I ask Dianna, his sock to mute. Dianna, can you please mute? Thanks a lot. Go ahead, Daniela. This would be kind of a very brief overview of the various considerations for camp management, and I know, and I've seen there are many, many colleagues online who are actually implementing these measures, who are working in camp management, in situations where there are, including, looking at shielding, but also in particular looking at how to deal with isolation, how to deal with quarantine upon entry to the camps, so I think it would be great to hear from them. Thank you very much. Thank you very much, Daniela. It's quite a job, I think, dealing with the situation in camps and settlement settings. Before I turn back to the questions, I would like to call on a colleague from Libya and Marie. I want to brief us quickly on how is the context in your operation, and what kind of solutions are you seeking to have? Can you hear me? Yes, I can hear you. You can hear me. Okay, William. Thank you. Please proceed. I have a brief update on how we're sort of thinking about isolation and quarantine in Libya. Right now, the Ministry of Health has not actually established full-on quarantine or isolation sites. They've identified a few for medical isolation, but as for quarantine facilities, those are being done at home, or having partners doing protection monitoring in the communities that we know have been impacted by COVID. So how we're looking at going forward, though, is we've been working in close collaboration with the Global Protection Cluster on creating tools for monitoring sites, particularly ones that we're looking at that are co-located with military objectives. So this is the biggest constraint in our mind, is that a lot of the isolation sites that the Ministry has identified are in fact co-located with military locations. So this is something that I would like to highlight potentially as a topic for conversation, is how do we ensure that protection principles and humanitarian principles are able to be upheld in these sites. So I'm wondering if any of the speakers have insights on to that. But as for the rest of the monitoring that we're doing, I think it very much mirrors the work that is being done in other operations where we've established community networks to provide inputs and feedback on information. Information about COVID as it's spreading, and also about sort of the information that communities have about what they need to do to isolate or quarantine themselves. So Ober from my side, thanks so much. Thanks a lot, Anne-Marie. This is quite handy and useful. So now I'd like to launch a bit of the challenge to the panelists. I would like to direct some questions we've received to you by name, and I would like to challenge you to answer every question with one minute answer so we can have a quick fire round of keeping the questions coming through the chat box and redirecting them to you. So I would like to go back full circle to you, Teresa. There is a question coming from Michelle to you that she's seen estimation from one organization that if we consider underlying health issues, the percentage of the population that might need shielding of some kind might be up to 80%. What would be your advice on that approach in that kind of setting? Over to you, Teresa, one minute. That's a very spot on question and this is actually what we need to bear in mind may happen because we don't understand fully yet what are the other risk factors for complications and poor outcomes in humanitarian settings. So yes, I mean, you're making that assumption rightly if other risk factors exist and it would increase the number of the proportion of the population requiring shielding. This is also even more reason why all the public health and social matters really need to be implemented for everyone because we never know who else might be vulnerable. Are we targeting the right group or are we missing others who may even be more vulnerable to complications and poor outcomes? And that is why we're not so supportive of collective accommodations for those who are seen as individuals at high risk for complications. That's a lot, Teresa. I would like to turn to Sophia. Is there any specific, that's the question, is there any specific dimensions that we have to look on specifically for children, the context of our discussion. Sophia, can you hear me? Yes, thanks a lot, William. Yeah, a couple of considerations that needs to be taken into account when looking at child protection in isolation and quarantine centers. First of all, I think it is very important that there are clear policies or rules that ensures that home-based isolation is guaranteed so that children are isolated at home with their primary caregiver. And if they have to be in quarantine centers that they are also there together with their caregivers. The second key recommendation is that child safeguarding measures are in place in these isolation and quarantine facilities. By that we mean that health workers who are running the centers needs to have basic training on child protection and need to be able to refer cases to protection practitioners if need be. We also mean that mental health and psychosocial support should be available, that the minimum recreational facilities and activities needs to be also available. So very importantly that the design of these centers are such that they can mitigate the risk of GBB and sexual abuse, for example, by separating, making sure that children are separated from adults, but there's lights and separated wash facilities. In addition, when we encounter unaccompanied children, either because they were separated because of displacement or if their caregiver is also isolated in another center, we need to have a basic family tracing capacity to try to identify either the kinship who can take care of the child or prepare for alternative care solutions once the unaccompanied child is released from the isolation or quarantine center. Finally, it's also important to ensure that there's a very good coordination between health and protection sector or cluster, that there are clear SOPs put in place for the registration and sharing of data pertaining to the children and the family. And it's really, again, very important that health staff, that there is at least a health focal point that is kind of a referral in the center for child protection and can provide basic support to children, but also ensure referral to child protection services and actors if needed. So I think these are the key considerations that needs to be looked at when dealing with isolation or quarantine center. Thanks, William. Thanks a lot, Sofia. That's important dimension to keep in mind. Brett, we have a question from Jenny Ma, saying that she has many teams in the Asia region asking for support on how to adapt the future evacuation centers to be adapted to the pandemic. This is in response to the season that is uncoming in terms of cyclone and monsoons. Are there any discussion, steps, guidance, practical ideas on how to deal with that? Brett, over to you one minute. Thanks, William. Thanks to, I think it was Jamila that answered the question. So it's around adaptation of evacuation facilities here. So, I mean, we still don't know a huge amount of details around the architecture and the epidemiological relationship. In many other contexts where you have building designers and planners working to reach health outcomes, it's based on a lot of science, and I'm thinking to kind of a past life when I had to do quite a few TB clinics for the Global Fund. There's really been a decade of research there around the role of adequate ventilation, for example, in treating TB cases and reducing transmission. I don't know if that is also reasonably similar for COVID-19 or not, but at least some of the information that we've been reading, and that the general principles of severe acute respiratory infection is that adequate ventilation is really important. So, spacing of patients, adequate ventilation, and also categorization. Now, of course, these are not always easy to achieve when we have to repurpose an existing building for a new function. It's always easier the other way around. We see what the human need is, and then you design a facility for that. But repurposing, of course, other way around is a bit complicated. Now, back to the understanding of who are you creating or modifying the facility for? Is it for known cases? Is it for isolation? Is it for suspected? So, if you know who the facility will be used for and what the calculation is from the health colleagues, from the health authorities, of how many beds to cater for, that's the first step. Now, looking at the SARI guidance from WHO and guidance for management of acute respiratory cases and the infrastructure selection, we have some clear understanding of how to lay out a facility and the spacing between beds. So, you can easily look at the square meter surface area of your existing building and roughly calculate how many patients could be accommodated in that. But bearing in mind, as I said, knowing the caseload, is it for confirmed? Is it for suspect? And is it for those requiring higher care versus just basic care? So, your health authorities and health colleagues will help determine the caseload, and then the shelter colleague can help determine the surface area of the existing facility and what modification might be required. Ventilation, as I mentioned, is very important, especially in low resource contexts where we don't have possibilities for negative pressure rooms or mechanical ventilation, so adequate natural ventilation that is big windows, shaded verandas, very, very important. Just a couple of rules of thumb. Thanks. Thanks a lot, Brett. That's a very precise and accurate help page. Alicia, Robert, you raise an important point in the chat box. If you can hear me, it would be great if you can make a quick intervention on the issue. Alicia? Yeah, I hear you. Can you hear me? Loud and clear. Please proceed. Perfect. Yeah, I mean, just really, I think it's pretty straightforward what I put there in the box, but we were asked to review from HealthBage some standing operating procedures that were being put together in Lebanon. It was taking into account those that have caregivers, which were children, unaccompanied children, but also older people and people with disabilities. And so we would say that it's really important to understand that the situation of caregiving might also apply to older people and people with disabilities. And we need to be really conscious of the fact that it's important where it all possible to keep people with caregivers to not separate them unnecessarily in instances of quarantine or isolation. And so we would be happy, I think, to share those guidelines. We've asked for a final copy to come back to us after the review. So we'd be happy to, once we get our hands on those, to share them back to you so they could be circulated more widely if that would be helpful. It's a lot. It would be very helpful. And then we will make sure also to circulate it on our different websites for the tools share. Teresa, I want to get back to you on a topic that hasn't been touched upon a lot coming from the epics. He's asking, how are safe and dignified burials planned and handled? Are there, do we have clarity of roles and responsibilities, especially in those situations where there is limited or no access to additional land? I guess this issue come up with you. I know that the ICRC has just been launching a campaign on the issue and issued some guidance, but over to you. Thank you very much. So I was actually looking at the technical guidance page of the literature. So there's actually a technical guidance under infection prevention and control on burials. So it is important to remember that this is a respiratory disease, as far as we know at the moment. And so we're not talking about burials for Ebola cases, for example, which is different. Now, the biggest issue with burials of COVID-19 cases is actually in the gathering, because, as we know, keeping safe distance, avoiding unessential movement is of extreme importance. So that's the, so there's a lot of discussions and planning that needs to be done with people in charge, community leaders and whoever, to actually make sure that ways could be put in place for this public health and social measure. So I don't really give specific details. I mean, some, I think, have mentioned even a recorded or broadcast of a funeral that could be watched from different locations and therefore then physical distancing could be assured. So it's mostly in the ceremony, ceremonial part, that that would become a problem. No, on the land for burials, I don't think I'm the right person to say anything about it. I'm sorry. I could try to, it's not really an area of strength of WH to be able to answer to that. So perhaps other colleagues could chip in on the land for burials. What I can do is also send you the link to the burial guidance right after. Thanks. Thanks a lot. Colleagues were reaching almost the end of the time. I want to extend for five more minutes to cover a couple of more questions. I hope you can stay with us. This is Daniela. Why is the principle of separation of all mild and moderate cases in designated facilities is clear as asked by Scales. Has this been achieved and maintained in any operations where we can learn from to your knowledge? Is this question related to if you don't have a possibility of actually, there are two things. One is whether those moderate and mild cases, you can send them to a separate facility within the camp or outside depending on the context. Another thing is indeed, if you cannot have them in a separate context, then you need to actually do home isolation and home might mean a few pieces of plastic sheeting. And so in that case, one of the possibilities is to repurpose certain areas of the camp or of the site where that requires a bit more kind of thinking and a more, more looking into what is feasible. But that is one of the options where instead of therefore everyone being and isolating at home, if that's really the only option that is available in the camp, there would be kind of, if you wish, isolation zones created. It's not ideal, but it might be the only option you would have where you would then be able to have some sort of, some sort of more kind of buffer between the population who is not infected and those who are. You would also need, and this will be led by health obviously, where you would also then need to make sure that all the health measures that need to be put in place would be available to people to those who are sick and who are isolating in their zone. I think that's the position from the services, thinking about family relations, ability of their family relatives to be visiting or at least to be able to make some contact with those family members who are being in isolation. I don't know if that brings an answer to the question. Thanks. Thanks a lot. I think that's, that's a spot on. Okay, follow up question from Yasin in Syria. So in relation to the rehabilitation of preparations for quarantine units. This seems like an issue observed in many operations. There is one approach. For example, government public buildings are used for quarantine facilities, or if they're not there, there is a kind of checklist of issues and standards that have to be met. Is there, does the IAC guidance cover this? Do you have in your guidance any directives for this that can be shared over to you. And I just see a little bit more additional information on this issue in the chat box there from Jane. And this is consistent with our guidance as well that, and it's across the sphere status to that we should avoid using schools for isolation or screening or treatment facilities of any sort, unless it's a last resort. Okay, and that would need to be done in consultation with the educational authorities and cluster and so forth. In terms of the public buildings, I mean public buildings can be many, many things they could be, they could have been repurposed storage buildings. They may be government buildings or not government buildings if they're existing owned government buildings. Certainly the government will be the authority to say what can and can't be used. I think when they're within camps, and you do have, you know, situations where if you have, for example, a reception centre or a transit centre that has been depopulated and has been sterilised according to same methods prescribed by the CDC with a bleach solution. You can also use commercially available cleaners but they do have different effects on plastic surfaces. Now, that's all available on the CDC website where you see two kinds of information. One is for disinfection of public buildings and the other is for disinfection of domestic buildings. And the guidance is very straightforward how to prepare locally available option for bleach solution course disinfecting disinfecting is not the same as cleaning. You have to do regularly disinfecting is required every time there's a change of patient. So I'm saying this in relation to once a building is identified what kind of preparation would be needed and I answered that kind of in the previous question. But then the importance of regular cleaning and disinfection as well, especially between patients. Separation of categories is possible and the sorry guidelines give you some methods to achieve that. It can be as basic as plastic sheeting, but of course the more rigid you make the separation that is a solid screen of some sort that would help prevent aerosol contamination. Because the predictions that are going on now is that you need at least two meters between people, but preferably more because when anybody coughs or sneezes, the aerosol circulates in the air. That's the other reason why we don't want to cross populate the severely sick with the mild cases. So the selection of the buildings is important. Now if it's public, the government have to be involved. And as I mentioned, the basic repurposing is possible, but any other kind of building in the camp or onsite can be used, especially for low risk and sorry, you know, low category patients. Those that require greater care should be located within or beside the health facility and extension. Other facilities can be used for low risk or for isolation. But as mentioned, you know, when you have isolation at home, at least there is family level care available when there's isolation that's separated from the existing family dwelling. And there's a lot of issues that arise there is Daniela and the other colleagues have mentioned around protection and support and, you know, feeding of the elderly and feeding children. So that then limits the effectiveness of the isolation in the first place. Okay. Thanks a lot. So, I have a final question to Daniela. Then I will turn to all the panelists for a closing remarks where I would like you to highlight where can all the participants seek more information and how they can reach out to you or your teams in the end. But before the final round, Daniela, the congestions of camps and settlements have come up a couple of the presentations. Any quick direction, you can give our participants on where to look for good examples and tip sheets that they can use, be inspired by for their operations over to you Daniela. Well, I'd take another with the back because if it comes to actually physically moving people within that would be something which site runners will have to be very heavily involved. And so, so I would say that both the guidance could be front on the shelter cluster website which has been provided and also some then, and then some implications and especially preparations for the condition, especially when moving people requires a very strong community engagement. So that because they might have their already existing land, they they or they might have their existing houses where they have lived for a very long time, the congestion will be perturbed will be disrupting their daily life. In addition to already the measures which are being taken for COVID prevention. So it's something we definitely have to be very strongly consulted with the community and explained. I'm looking also at whom would you want to be moving first because in some, in some context, it might be actually one of the ways how you would protect your most vulnerable would be to taking them. If you are having the possibility of the congestion that you would actually moving first those who are at high risk and placing them into individual housing or placing them into into a more into an area where more space is available. You would actually be doing a measure which is feasible but you will be prioritizing who should be moved from those areas which are most overcrowded over. Thanks a lot. Daniela. Thanks a lot colleagues. In this order, Daniela and Teresa. I would like you to take the floor and hammer your message that no one should miss out on and then offer of continued support in a clear way where can you be contacted. So Brett, go. Okay, thank you. Thank you. Thank you for that point. Two key messages. One is at the household level and the settlement level. There's a key relationship between living conditions and transmission risk. So reduce density of the household level, reduce density of the settlement level if it is deemed as being too dense. Not as a single gesture, but with the appropriate hygiene and health inputs as well and the consultation which we've just discussed within this WebEx. All resources are available online and there's more coming. If you need to reach out, reach out to your cluster coordinator in your relevant country. If there's not a cluster coordinator there, reach us at the global level on our general email list. Or you can directly contact myself, Brett Moore at UNHCR or Alasadaralu at IFRC. Okay, thanks very much. Excellent, Brett. Perfect example of hammering the point. Daniela, can you do the same? Yes. When it comes to camp management, the main consideration for isolation and quarantine centres and facilities would be to make sure that not only services and things are provided in these facilities, but that the population and the residents and the family members who are staying in the camps, who are staying outside of these facilities are being serviced with what they need as well, that they can be in touch with their family members and that there is a real thinking around sustainability of any interventions and unintended consequences that some health measures might have on human rights and on the daily life of the people. And when it comes to support CCCM cluster, UNHCR or IOM, or reach to us through the global website which I posted. Thank you. Thank you so much, Daniela. Teresa, the floor is yours. Thank you. So two key messages. The first one is all prevention measures for COVID-19 is really based on the mode of transmission. And so all the public health principles behind these measures is based on how, again, one can contract the disease. It's extremely important that we remember these principles because then we are more free to contextualise or to adapt the measures according to resources available and according to the context. But then, so it is not important to actually follow by the lens, everything that is written in the technical guidance that may not be applicable, but please remember the public health principles behind it and then work around the context according to this principle. So if we really want to contain this outbreak, then we need to detect, isolate and treat cases. And we need to put in all efforts to do it. I mean, in the context of the Ebola outbreak, we were eventually able to mobilise enough resources to establish enough treatment centres to establish enough testing capacities. So there is a lot that can be done if you really want to do it. Shielding, for example, may be an alternative that looks much more feasible with low resources, but then it won't solve the problem of containing the outbreak. So please remember what the most important interventions are to really bring this outbreak to an end. Thank you. Thank you very much, Teresa. Colleagues, thank you so much for a very lively discussion, a lot of questions that have been answered. A lot of questions that are yet to be answered as we're navigating this challenge in the coming weeks. I would like to thank our three panellists. I would also like to thank our colleague from Libya and Sofia from the Global Protection cluster team, presenting also the Child Protection AOR in this context for the intervention. This is an important issue for us from the protection sector. My one conclusion from this meeting is for all protection coordinators, the protection implications of any of these measures seems very significant. However, we can't make any moves regarding any of these measures without full support and backing for the health actors, for the temp and settlement managers and the shelter people. This is a challenge that requires a lot of discussions and agreement in the field and hence a lot of patience and willingness to reach an agreement and consistency in messaging with government counterparts and partners. So with this, I would like to close this first episode of this discussion. I promise to have a follow up based on the questions that you have asked to dive more in some of them in following webinars. With this, I wish you a very good weekend and have some rest if you can and take care. Bye bye.