International Case Studies in the Management of Disasters: Natural - Manmade Calamities and Pandemics 1839821876, 9781839821875

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International Case Studies in the Management of Disasters

Tourism Security-Safety and Post Conflict Destinations Series editors: Maximiliano E. Korstanje and Hugues Seraphin Since the turn of the century, the international rules surrounding security and safety have significantly changed, specifically within the tourism industry. In the age of globalization, terrorism and conflict have moved beyond individual highprofile targets; instead, tourists, travellers and journalists are at risk. In response to this shift, the series invites authors and scholars to contribute to the conversation surrounding tourism security and post-conflict destinations. The series features monographs and edited collections to create a critical platform which not only explores the dichotomies of tourism from the theory of mobilities, but also provides an insightful guide for policy makers, specialists and social scientists interested in the future of tourism in a society where uncertainness, anxiety and fear prevail. Tourism Security-Safety and Post Conflict Destinations explores research approaches and perspectives from a wide range of ideological backgrounds to discuss topics such as: • • • • • • • • • • •

Studies related to comparative cross-cultural perceptions of risk and threat Natural and human-caused disasters Post-disaster recovery strategies in tourism and hospitality Terror movies and tourism Aviation safety and security Crime and security issues in tourism and hospitality Political instability, terrorism and tourism Thana-tourism War on terror and Muslim-tourism The effects of global warming on tourism destinations Innovative quantitative/qualitative methods for the study of risk and security issues in tourism and hospitality • Virus outbreaks and tourism mobility • Disasters, trauma and tourism • Apocalyptic theories and tourism as a form of entertainment

International Case Studies in the Management of Disasters: Natural - Manmade Calamities and Pandemics EDITED BY: DR. BABU GEORGE Fort Hays State University, USA

DR. QAMARUDDIN MAHAR Isra University, Pakistan

United Kingdom – North America – Japan – India – Malaysia – China

Emerald Publishing Limited Howard House, Wagon Lane, Bingley BD16 1WA, UK First edition 2021 Copyright © 2021 Emerald Publishing Limited Reprints and permissions service Contact: [email protected] No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters’ suitability and application and disclaims any warranties, express or implied, to their use. British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library ISBN: 978-1-83982-187-5 (Print) ISBN: 978-1-83982-186-8 (Online) ISBN: 978-1-83982-188-2 (Epub)

Table of Contents

About the Contributors Foreword

Introduction Chapter 1 Analyzing Site Security Design Principles in a Built Environment and Implication for Disaster Preparedness: The Case of Istanbul Sultanahmet Square, Turkey Ali Akbulut and G¨okçen Firdevs Y¨ucel Caymaz

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1

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Chapter 2 Local Knowledge in Russian Flood-prone Communities: A Case Study on Living with the Treacherous Waters Kseniia Puzyreva and Nikita Basov

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Chapter 3 Financial Implications of Natural Disasters: A Case Study of Floods in Pakistan Vivake Anand, Kinza Yousfani and Jianhua Zhang

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Chapter 4 Microcase Studies on Managing Tourism Destinations in the Aftermath of Disasters Frank Haas, Jerome Agrusa and Joseph Lema

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Chapter 5 Comparing the Experiences of African States in Managing Ebola Outbreaks from 2014 into 2020 Peter Mameli and Darryl Bobb

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Chapter 6 Kerala Nipah Virus Outbreak 2018: The Need for Global Surveillance of Zoonotic Diseases 131 Smarty P. Mukundan, Ananthi Rajayya and Zakkariya K. A.

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Chapter 7 Managing Visiting Scholars’ Program during the COVID-19 Pandemic Miguel Cordova, Karla Maria Nava-Aguirre and Maria Alejandra Gonzalez-Perez

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Chapter 8 Managing E-commerce During a Pandemic: Lessons from GrubHub During COVID-19 Anil Yasin Ar

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Chapter 9 The Role of Communications in Managing a Disaster: The Case of COVID-19 in Vietnam Lena Bucatariu

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Chapter 10 Passage from the Tourist Gaze to the Wicked Gaze: A Case Study on COVID-19 with Special Reference to Argentina Maximiliano E. Korstanje

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Chapter 11 COVID-19 Outbreak in Finland: Case Study on the Management of Pandemics Sajal Kabiraj and Filip Lestan

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Chapter 12 The COVID-19 Crisis Management in the Republic of Korea Sahrok Kim, K. Praveen Parboteeah and John B. Cullen

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Chapter 13 Empowering Patients through Social Media and Implications for Crisis Management: The Case of the Gulf Cooperation Council Manoj Menon and Babu George

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Chapter 14 Technology in Medicine: COVID-19 and the “Coming of Age” of Telehealth 271 Babu George, Lena Bucatariu and Tony L. Henthorne Index

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About the Contributors

Ali Akbult graduated from Istanbul Gelis¸im University Architecture Department with a scholarship. He is still at the thesis stage of Istanbul Aydın University Architecture master’s program. Also he is still working in Istanbul Parking Facilities, Inc., under the supervision of studies and projects as an architect. Email: [email protected]. Ananthi Rajayya is a prolific author of management case studies with 13 years of experience in management education. She has authored 30 case drafts in various disciplines and has been as resource person for FDPs/workshops on case writing and analysis in more than 10 colleges. She is also passionate about participating in competitions and has won best case awards in various case study competitions at national and international level. She may be contacted at [email protected]. Anil Yasin Ar received his PhD in International Business and MSc in Organizational Leadership from the Southern New Hampshire University. He is currently Visiting Professor in the Department of International Business and Logistic at Tecnologico de Monterrey. His main research interests are international business strategy, corporate social responsibility, and emerging market firms’ innovative capabilities. He is also teaching international business and management classes. He may be contacted at [email protected] or [email protected]. Babu George is Professor of International Business and Associate Dean in the School of Business, Christian Brothers University, Memphis, USA. He is the coeditor of The Changing Landscape of Global Businesses (2019), Strategies for Promoting Sustainable Hospitality and Tourism Services (2020), and Digital Transformation in Business and Society (2020). He may be contacted at [email protected]. Darryl Bobb holds a Bachelor of Science degree in Public Administration from John Jay College of Criminal Justice. He may be contacted at bobb.darryl@ gmail.com. Filip Lestan is an Alumni of International Business at the School of Entrepreneurship and Business, H¨ame University of Applied Sciences Ltd. (HAMK). His research interest includes crisis management, sustainable international business during times of uncertainty. He is a Chief Operation Officer in the small-sized

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About the Contributors

business operating in the Oil and Gas Industry. He may be contacted at fi[email protected]. Frank Haas is President of Marketing Management, a consultancy providing strategic and management services focused on Hospitality and Tourism. He has managed projects for clients in Hawai’i, the US Mainland and Internationally. He has published papers and case studies on Destination Management and Smart Tourism. Email: [email protected]. G¨okçen Firdevs Y¨ucel Caymaz is Associate Professor and Head of Department of Industrial Design Department at Istanbul Aydin University. She received her BArch from Istanbul University, Landscape Architecture Department, and MSc in Landscape Planning Program from Istanbul Technical University. She earned her PhD degree in Landscape Planning Program from Istanbul Technical University. Her major research interests are landscape design, environmental perceptions, and street furniture. She has been an associate editor of A1Arch Design journal of Istanbul Aydin University Architecture and Design Faculty since 2015. Email: [email protected]. Jerry Agrusa, PhD is a Professor of Travel Industry Management in the Shidler College of Business at University of Hawaii. He is well regarded for his expertise in research and teaching in the area of hospitality and tourism management. Professor Agrusa may be contacted at [email protected]. Jianhua Zhang is Professor and Dean in the School of Economics at Huazhong University of Science and Technology, Wuhan, China. Email: jhzhang@ mail.hust.edu.cn. John B. Cullen is Professor Emeritus of Washington State University. He received his PhD from Columbia University. He may be contacted at [email protected]. Joseph Lema, PhD is Professor/Chair in the Food & Beverage and Event Management Department in the Harrah College of Hospitality at the University of Nevada, Las Vegas, USA. Professor Lema’s professional experience includes hospitality industry management in ultracompetitive markets. He is a Fulbright scholar through the US State Department and a US-ASEAN Fulbright Specialist who lectures and conducts research in the area of international hospitality and tourism services. Email: [email protected]. Karla Maria Nava-Aguirre (PhD, MBA, BA) is Full Professor of International Business at Universidad de Monterrey (UDEM) Business School in Mexico. Dr. Nava has participated as a researcher in international projects, conferences, published articles, and book chapters. He is a member of the National System of Researchers (SNI) from CONACYT in M´exico. Email: [email protected]. Kinza Yousfani is Assistant Professor in the Management Science Department of Isra University, Hyderabad, Sindh, Pakistan. Email: [email protected]. Kseniia Puzyreva is a research associate at the Centre for German and European Studies, St Petersburg State University – Bielefeld University. Her research

About the Contributors

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interests include sociology of disasters, sociosemantic network analysis, and coevolution of knowledge structures in disaster management. She may be contacted at [email protected]. Lena Bucatariu is Faculty member in the area of professional communication in the School of Communication and design of RMIT University, Vietnam. Healthcare management in the special context of mental health in Vietnam is one of her major areas of expertise. Email: [email protected]. Manoj Menon brings over 29 years of experience and expertise in strategic information technology planning with special emphasis on the healthcare sector. As CIO of SPOTCHECK, he leads the cutting-edge wellness technology company and introduces innovative solutions to market. Manoj has been credited with Patents. He also has many publications and posters under his name apart from giving numerous presentations at high-profile healthcare conferences. His academic profile encompasses Doctor of Management. He can be contacted at [email protected]. Maria Alejandra Gonzalez-Perez (PhD, MBS, Psy) is Full Professor of Management at Universidad EAFIT, Colombia. She is the regional chapter chair for Latin America and the Caribbean of the Academy of International Business (AIB-LAC) (2018–2021). Dr. Gonzalez-Perez has published 16 books, over 60 academic peer-reviewed papers. Email: mgonza40@eafit.edu.co. Maximiliano E. Korstanje is a leading global cultural theorist specializing in terrorism, mobilities, and tourism. Dr. Korstanje serves as Senior Researcher at the University of Palermo, Buenos Aires, Argentina, and Editor in Chief of the International Journal of Safety and Security in Tourism and Hospitality. In 2015, he was Visiting Professor at the Centre for Ethnicity and Racism Studies (CERS) at the University of Leeds, United Kingdom; TIDES at the University of Las Palmas de Gran Canaria, Spain, in 2017, and the University of La Habana, Cuba, in 2018. Email: [email protected]. Miguel Cordova Espinoza (PhD(c), MBA, Eng) is an Associate Professor of Management at PUCP, Peru. His research interests are Power and Influence, Sustainable Supply Chain Management, and Entrepreneurship. He was a visiting professor at INSEEC Business School in Paris, UDD in Santiago, ESADE in Barcelona, and UDEM in Monterrey. Email: [email protected]. Nikita Basov is a senior researcher at St Petersburg State University and scientific manager of the Centre for German and European Studies, St Petersburg State University – Bielefeld University. His research interests include cultural sociology and sociosemantic network analysis. He may be contacted at [email protected]. Peter Mameli is an Associate Professor in the Department of Public Management at John Jay College of Criminal Justice. He may be contacted at pmameli@ jjay.cuny.edu.

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About the Contributors

K. Praveen Parboteeah is the inaugural COBE Distinguished Professor and Director of the Doctor of Business Administration program at the University of Wisconsin-Whitewater. He may be contacted at [email protected]. Qamaruddin Mahar is Associate Professor of Management at Isra University, Pakistan. He coordinated the Collaborative Research Program between Ball State University, USA, and Isra University, funded by the U.S Department of State (2012-2015). He also served as a book and monograph reviewer for the Higher Education Commission (HEC) of Pakistan during (2017-18). Email: [email protected] Sahrok Kim is Assistant Professor of Management at California State University, Stanislaus. He received his PhD from Washington State University. His research interests include disruptive innovation and the effects of cultural values and social institutions on ethical, crisis management, and other managerial outcomes. He may be contacted at [email protected]. Sajal Kabiraj is a Principal Lecturer of Strategy and International Business at the School of Entrepreneurship and Business, H¨ame University of Applied Sciences Ltd. (HAMK). He has received Best Teacher Award – 2008, 2011, 2014, 2018, Xinghai Friendship Award – 2015 (Municipal Gov’t. of Dalian, PR China), Outstanding Contribution Award – 2018 (DUFE, PR China). He may be contacted at sajal.kabiraj@hamk.fi. Smarty Mukundan is a Member of Faculty, at State Bank Institute of Leadership (SBIL), an apex training Institute of SBI at Kolkata. She has been training and teaching aspiring management graduates, consultants, and technocrats in HR and OB and skills development for the past 17 years. Her research interests lie in Emotional Intelligence, Conflict management, Leadership, and HR analytics and has published several research articles, coauthored a book on analytics, and a peer reviewer for some top international management journals. She may be contacted at [email protected]. Thomas R Panko is Professor Emeritus in the School of Criminal Justice, Forensic Science and Security, at University of Southern Mississippi, USA. His research interests include criminal justice, safety, security, and crisis management. Tony L. Henthorne is currently a professor in the William F. Harrah College of Hospitality at the University of Nevada, Las Vegas, USA. Previously, he investigated emergency management topics in the contexts of the Tsunami that hit the Indian Ocean countries (2004) and the Hurricane Katrina that hit the US Gulf Coast (2005). He may be contacted at [email protected]. Vivake Anand is Assistant Professor in the Management Science Department of Isra University, Hyderabad, Sindh, Pakistan. Email: [email protected].

About the Contributors

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Zakkariya K.A. Professor in Management and the Director of DDU KAUSHAL Kendra (a center for vocational studies) at Cochin University of Science and Technology, Kerala, India, with more than two decades of experience in teaching and research. He has published over 70 research papers in reputed national and international journals and is reviewer of half a dozen top international journals. He has been a member in various academic and administrative bodies of different universities in India. He may be contacted at [email protected].

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Foreword

We live under the constant spell of disasters and they seem to be outpace our abilities to predict them. We were no more cognizant about the emergence of COVID-19 hitting us than the previous generation knew about the devastating arrival of the Spanish flu. Does this mean, the study of disasters is of no practical use? The answer is a resounding “no”. For one thing, certain disasters are truly outlier events and our incapacity to predict them need not be overblown. What matters is whether we are better prepared to deal with it when something of a similar kind hits us. We did learn about managing pandemics from the previous outbreaks and this knowledge is currently being used. Of course, management, even as we term it a scientific process, is also muddled with the compulsions of our political and public administration leadership. These complex equations make it difficult to fully leverage the accumulated knowledge from previous crises with emerging crises. While the COVID-19 pandemic is a current worldwide pandemic mentioned in the same breath as the plague of the seventeenth century in Europe, and the outbreak of influenza in 1918–1919, I have experienced the disastrous wrath of nature in the form of hurricanes. Three remain vividly etched in my memory. While going through the chapters of this book, my own memories of living through those disasters quickly came to mind. I had a scholar’s understanding of these calamities but that alone was insufficient. Betsy hit Louisiana the day I arrived in Baton Rouge in September 1965. I was born and raised in Michigan but had transferred universities. I had no idea what hurricanes were like but found out that night as Betsy tracked through and hammered the state capital. I was holed up in a hotel and can still hear the fury and howling of the storm. The next morning, I went to the top of the state capital and surveyed the damage. Uprooted trees, damage to buildings, and many other reminders left in the storm’s wake. What a reception to my new home!. Camille hit the Gulf Coast in August 1969 with the highest windspeed at landfall ever recorded – worldwide. 190 miles per hour. Devastation on the coast, only an hour’s drive, was horrendous but what really got my attention was the flooding, about three feet of water in my in-law’s home. That water also brought in snakes and swarms of fire ants riding on the water, two critters I can do without. Katrina in August 2005 flooded about 80% of New Orleans. Thousands sought refuge in the Superdome. Category 4 and 5 hurricanes cause so much damage,

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displacement, and death. Official hurricane season is June 1 to November 30 but peak activity occurs from mid-August to late October. Living in the Pine Belt of Mississippi just an hour’s drive from the Gulf Coast provided no escape from Katrina’s fury. A few personal examples: tree limbs from towering pines punched through the roof and into my living room and bedroom. Electric power was out for three weeks (thankfully, I had purchased a generation specifically for such purpose) as was phone service. It took two full days and several eighteen-wheeler truckloads to clear my subdivision’s main street. The physical and social constraints on living are enormous when a hurricane pummels an area. Every crisis is different but, in the end, all people want and need it to be over. As I write, hurricane season has officially opened and there is a tropical depression whose projected cone has Baton Rouge in the center. Although it is not certain whether this will develop into a hurricane, it is predicted to bring large amounts of rain. Its counterclockwise motion will assuredly bring much precipitation to south Mississippi where I reside. Residents living near the Gulf Coast are accustomed to standard hurricane warnings and instructions. Tracking maps are widely available and contain information on safe places if needed. Based on studies and experiences with many previous hurricanes, protocols have been developed for precrisis, crisis, and postcrisis circumstances. Steady PSAs on radio and television advise on a storm’s progress, direction, and strength. As is the case with any disaster, information is key in reducing losses and returning to normalcy. COVID-19 has killed hundreds of thousands of people and put many more in hospitals and other medical settings. The final total is far from being determined. Social distancing, wearing of masks, and self-quarantining are among the coping measures until a vaccine can be developed. Each measure must be closely followed because, contrary to the visible havoc a hurricane can wreak, the coronavirus like the plague, influenza, and other medical afflictions is invisible and does not leave readily observable scars on the landscape. However, the fear of contracting the virus exerts immense psychological pressure. In the end, its “costs” (social, economic, etc.) can be just as great or even more devastating than the physical forces of our world. Our understanding of disasters and coping methodologies is enhanced by studies such as those contained in this book. General, universally valid theories of disasters or their management are neither possible nor feasible. For the best possible practical impact, there is need for developing nuance-laden case studies that touch upon specific disasters, yet presented in a manner as to integrate these with the wider body of literature on disaster management. It is refreshing to see this compendium of case studies taking shape at a time when it most needed. To reassert its timeliness, a substantial number of contributions in it connect with topics related to COVID-19. Case studies on other topics, drawn from a diverse mix of international contexts, make the book worthy of reading for a greater cross section of readership. I am impressed that the contributions in this volume have impacts far beyond academia attributable, in part, to the nature of the topics and also because of the credentials of the contributors. The contributors come from a diverse range of

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disciplinary and practice areas, offering a wide variety of perspectives upon disaster management. They include sociologists, economists, psychologists, geologists, ecologists, technocrats, and business management consultants, among others. This book is significantly interdisciplinary in nature, with management studies as its interlinking element. The disaster preparedness aspect of the case studies will be of most interest to planners and public policy makers. While case studies in rehabilitation part will be of greatest interest to psychologists, those focusing on the economic impacts of disasters will be of more interest to economists. All the case studies, in one way or another, showcase real-world disaster management practices that will be of immense use in planning for and mitigating impacts. I earnestly hope this book will be a valuable reference guide for disaster management practitioners and a supplementary educational resource in the graduate courses in related areas. Thomas R. Panko, PhD Professor Emeritus, School of Criminal Justice, Forensic Science and Security, University of Southern Mississippi, USA Email: [email protected]

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Introduction According to the United Nations Office for Disaster Risk Reduction, disaster refers to a serious disruption of the functioning of a community or a society at any scale due to hazardous events interacting with conditions of exposure, vulnerability, and capacity, leading to one or more of the following: human, material, economic, and environmental losses and impacts. Disaster management has become a major topic of discussion, given the increasing incidents of different kinds of disasters around the world. Greater investments are made in disaster preparedness and in disaster recovery. Best practice case studies are especially being sought out by disaster management practitioners as well as scholarly researchers. Disaster management interfaces various disciplinary and professional areas: Business, Economics, Environment, Ecology, Economics, Tourism, Geology, Culture, Disasters, Technology, Community Development, Policy, among others. It involves theoreticians and practitioners coming from different academic streams and professional practice areas. This includes sociologists, economics, psychologists, geologists, ecologists, technocrats, and business management consultants, among others. The editors were keen to support interdisciplinary research in disaster management, where this was relevant and impactful. Wherever appropriate, we were explicitly committed to helping scholars achieve realworld impact with their work. Thus, case studies with immediate practical applications were particularly welcome. The choice of chapters in this volume was significantly driven by the need for them to be interdisciplinary in nature, with management studies as the interlinking element. While initially floating the proposal, this book was aimed at presenting a diverse range of case studies on how disasters, both natural and manmade, are managed in different parts of the world. However, while the call for papers was being circulated, something totally unexpected and of a global proportion happened – a disaster of a very rare kind, something that most of us have never before gone through in our lifetime. The COVID-19. With this in the backdrop, the call for papers to be included in this book acquired a special dimension. The editors got several researchers expressing interest in writing chapters on managing the COVID-19 crisis. Given the currency and the ramifications both in time and space, we encouraged them to contribute on this theme. As a result, this volume now has several chapters examining COVID-19 from a crisis

International Case Studies in the Management of Disasters, 1–7 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201002

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International Case Studies in the Management of Disasters

management standpoint. That said, we did not exclude papers on various other kinds of crises. So, you would find in this volume case studies on managing flood through famine. In the chapter titled Analyzing site security design principles in a built environment and implications for disaster preparedness: The case of Istanbul Sultanahmet Square, Turkey, the authors offer a critical examination of security enforcement with a special focus on disaster readiness. A checklist is designed to measure the security design process around the building and is tested. It is concluded that, in order to mitigate disasters, vehicular and pedestrian access, parking lots, lighting and trash receptacle designs around Sultanahmet Square need to be improved. Kseniia Puzyreva and Nikita Basov, in their paper titled Local knowledge in Russian flood-prone communities: A case study on living with the treacherous waters, discuss how at-risk communities develop their local knowledge and put it to use as they struggle with adverse impacts of flooding, when the existing flood protection means are insufficient. When it comes to traditional communities that have a long and deeply entrenched history in place, their knowledge is axiomatic and tacit, acquired performatively through daily interaction with their natural and sociotechnical environments. This knowledge cannot be easily codified or generalized for the benefit of external parties. Yet, these authors seemed to have achieved some of these objectives, to some extent. Vivake Anand, Kinza Yousfani, and Jianhua Zhang discuss a similar issue but highlight the economic consequences of the disaster. In the absence of leverageable social capital, communities faced with disasters are often at peril. Financial implications of natural disasters: a case study of floods in Pakistan concludes with lessons for averting a number of mistakes while faced with a disaster of national consequence. This paper also highlights the role of nongovernmental and other community organizations. Frank Haas, Jerome Agrusa, and Joseph Lema gather together a set of succinct case studies each of which highlights disaster management in tourism destinations around the world. Disaster management practices in Vietnam, Hawaii, and Nepal debated. The authors argue that a multidimensional approach to disaster tourism should consider not only the physical destruction but also other aspects such as the social, political, emotional, psychological, and in many instances spiritual perspectives that not only provide a well-rounded experience for visitor but also a transformational learning experience that can last a lifetime. Tourism is often seen as a confounding factor that redirects essential recovery resources, often to the dismay of local residents. The chapter Micro case studies on managing tourism destinations in the aftermath of disasters showcases some of these efforts and associated tensions. In their contribution titled Comparing the experiences of African States in Managing Ebola Outbreaks from 2014 into 2020, Peter Mameli and Darryl Bobb invite readers to a better understanding of successful disease management where public health epidemics are concerned. These lessons have a lot to speak to the current coronavirus scare that we face. This paper concludes that early investment in cultivating disease-specific practices, combined with establishing cooperative

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networks of actors across levels of political response, enables improved mitigation and response during outbreaks. Virus outbreak is scary, to say the least. And, viruses do not know caste or creed. The State Government of Kerala, India, earned laurels for the way it managed the Nipah (NiV) outbreak in 2018. Authors Smarty Mukundan, Ananthi Rajayya, and Zakkariya K. A. narrate this disaster and response. Their paper, Kerala nipah virus outbreak, 2018: the need for global surveillance of zoonotic diseases, also provides a critical analysis of the disease control modes followed. In this paper, the authors discuss the need for transforming public health surveillance and proactive measures that must be taken by governments across the globe to prevent human being and animals from outbreaks of such zoonotic diseases. Mobility has positive and negative definitions. Mass tourism has a lot of negative connotations. Study and research abroad, on the other hand, has a generally accepted positive meaning. The COVID-19 dented even this. For one thing, cross-border travel itself became close to impossible. Add to that the perceived stigma that scholars face as thieves of intellectual property. Focusing on Latin America, the case study titled Managing visiting scholars’ program during the COVID-19 pandemic aims to provide insights about how planned activities related with visiting international scholars suffer major disruptions and how managerial interventions could be geared for success. E-Commerce and e-business are lifelines of financial transactions when people are locked down in their homes and when businesses operate virtually. Anil Yasin’s paper, Managing e-commerce during a pandemic: Lessons from Grubhub during COVID-19, is an account of how Grunbhub, a food ordering service, employed new measures and devised new ways of conducting business to protect its competitiveness. The COVID-19 crisis has forced several companies to innovate and find novel means of doing their businesses. While necessity is touted as the mother of inventions, not everyone could deal with an exogenous force like the global spread of the novel coronavirus. Can Grubhub stay in business during the pandemic and be able to meet expectations of not only its shareholders but also stakeholders? Read this case study to find the answers! Both internal and external communication are critical for organizations faced with a calamity. Infodemic is a cousin of pandemics and it is important that this be nipped in the bud. With Vietnam in context, Lena Bucatariu attempts to highlight the role of effective communications in dealing with COVID-19. Her paper titled The role of communications in managing a disaster: The case of Covid19 in Vietnam investigated the effectiveness of official Vietnam government communications, the sentiment of foreign media reporting on Vietnam, and any challenges. Official government communications were quite accurate, timely, and effective in displaying transparency, employing war symbolism, and shared responsibility, but should more clearly separate between state and expert, offer differing views, and highlight the benefits of compliance. Gaze is important in appreciation and consumption in general. Tourists gaze at objects, including people in destination areas, to consume their appearances and underlying properties. COVID-19 changed this equation. Now, tourists are

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the victims of the gaze. The nature of the gaze has turned wicked, too. The present crisis reveals a new unknown process of feudalization which is here to stay, observes Maximiliano Korstanje in his contribution titled Passage from the tourist gaze to the wicked gaze: A case study on COVID-19 with special reference to Argentina. Hopefully, when the clouds are removed and the skies become clearer, a more sustainable and mutually respectable form of new tourism would emerge. How can a government ensure in an understandable and efficient manner toward the habitants, the importance of the already undertaken emergency measures? Sajal Kabiraj and Filip Lestan delve into the Finnish style of management of disasters. COVID-19 outbreak in Finland: Case study on the management of pandemics is a valuable user manual for public policy officials looking for good and promising practices. Although Finland did not manage it as effectively as several other countries, their style is informed by sound principles of available research. South Korea’s style of managing COVID-19 is in stark contrast. Yet, The Republic of Korea too gained many fans for its disaster management efforts. Evidently, there were ups and downs and the end results are yet to be known. In the case study titled The COVID-19 crisis management in the Republic of Korea, authors Sharok Kim, Praveen Parboteeah, and John Cullen employ a sociological approach, in examining various social institutions and cultural facets to understand how South Korea is handling the crisis while drawing important implications for other countries. The authors hope that Korea’s approach lead to greater international collaboration for better preparedness when such pandemics occur in the future. In the paper, Empowering Patients through Social Media and Implications for Crisis Management: The Case of the Gulf Cooperation Council, Manoj Menon and Babu George highlight the centrality of patient empowerment in managing healthcare crisis situations. As a concept, empowerment is critical to effective engagement between patients and their healthcare service providers. Social media technologies have taken empowerment to a new dimension. It comes with more opportunities for empowerment but also poses threats to true empowerment because of the frictionless flow of misinformation on social media sites and the echo chambers they sustain. This is evident in the COVID-19-related news items being spread through popular social media outlets. On a related theme, the final chapter of this book, titled Technology in Medicine: COVID-19 and the “Coming of Age” of Telehealth identifies the culmination of some logical processes in healthcare that were brewing and simmering over the last couple of decades. The topic of discussion is telehealth. The authors, Babu George, Lena Bucatariu, and Tony Henthorne, argue that COVID-19 provided the final push for telehealth. Even as the infrastructure and technologies were ready for this revolution to take place, it needed a “reason.” This chapter highlights the role telehealth plays in mitigating the tragic consequences of COVID-19. It must be admitted that disasters are of such variety that a book of this scope cannot include all of them. However, it might be beneficial to mention in this introductory chapter some of the key categories and what each of them entail.

Introduction

5

We hope that the topics that we propose here would guide future researchers in their investigations. Hurricanes: Hurricanes, one of nature’s most powerful storms, can bring strong winds, storm surge flooding, heavy rainfall that can lead to inland flooding, tornadoes, and rip currents. Droughts: Drought is the condition when people have not the availability of food, water, and dearth or absence of cultivation of any crops, the state brings lives to high risk that often lead to death. There are numerous reasons of occurrence of drought such as war, natural disaster, climatic change, inaccessibility of water or basic facilities of cultivation, and in some cases poor planning. Volcanic Eruptions: A volcanic eruption transpires after hot constituents from the Earth’s interior are thrown out of the volcano. Lava, rocks, dust, and gas compounds are some of the substances that are discharged during a volcanic eruption. A volcanic eruption can cause damage to human beings, economic goods, livestock, and the overall environment. Floods: A flood is the surplus amount of water beyond its limits that overflow from the normal level of rivers, canals, watercourse and moves to villages, towns, and cities and sink them partially or fully. A flood can destroy human life and cause heavy economic loss and fatalities; in many cases it involves mass migration as well. Earthquakes: Earthquakes are the abrupt trembling under the earth that in many cases cause devastation in different forms like plunging of houses, bridges, and other constructions at a high rate. Often earthquakes claim the lives of hundreds of people in a very short span of time. Tsunamis: A Tsunami is an elongated, high sea wave that may be caused by an earthquake or other changes. Thus far a Tsunami has claimed hundreds of lives and provided heavy economic loss. Tornados: Tornados are fast rotating winds that often cause economic losses and destroy anything that comes in their way. The study on Tornado comprises designing guidelines for protecting people and economic goods from Tornados, methods of measuring the magnitude of Tornados, and forecasting of Tornados. Wildfires: Wildfires are huge, damaging fires that spread in a short span of time. The incidents of wildfires occur in various regions of the world, particularly in Australia, the US, and even some of the Asian and African countries. Disaster management in this situation involves developing technology for extinguishing wildfires, designing human resource training manuals to deal with wildfires, identifying people and places in forests that are at risk in the wildfire, and rescuing people toward a safe place. Avalanches: An avalanche is a heavy piece of snow or rock that drops from mountains often on roadsides, valleys, and residential areas. Such incidents occur worldwide like in Canada, the US, Argentina, Afghanistan, and Slovakia. Avalanches can occur at any time, hence a thorough study and development of protecting tools from avalanches are essential. Industrial Hazards: Every day, enormous manufacturing and industrial operations are going on, where millions of people work in factories, and sometimes

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International Case Studies in the Management of Disasters

their lives are at risk. Hence, they often come across numerous accidents. In the everyday changing situation of globalization, various types of risks prevail in our society that create live hazards such as the danger of use of lethal war weapons that may lead to perilous explosions. Terror situations such as riots, mass shootings, and wars: Terrorism has become a reality of today’s world. Globally various countries have suffered from terrorist attacks that have claimed the lives of thousands of people. Hence, management of victims of terrorism is proposed. The victims of terrorist attacks go through deep shock and severe injuries. Pandemics: The occurrence of contagious diseases in each part of the globe is a common phenomenon these days that make the lives of people unsafe. In the recent era, HIV, Hepatitis, Polio, and other viral diseases are common. Besides, disease is not just a clinical occurrence, but there are various social factors that are associated with the spread and protection of a disease. In this regard, developing management of pandemic is essential. Some of the chapters in this volume touch upon various governmental and nongovernmental disaster management organizations and their roles in disaster management. Globally various government and nongovernment organizations including the United Nations manage disaster situations. Each year million of dollars are spent to rehabilitate victims of floods, tsunamis, and so on. It is important to further expand on some of the following: measuring the effectiveness of disaster management organizations; examining the mechanism of financial support to government and nongovernment organizations; analysis of time scale on how long it takes to bring people into normal positions; the tools and techniques used to rehabilitate victims; gap or flaws in disaster management; and the innovative approaches and tools government and nongovernment organizations apply to bring rapid recovery of people; to list a few items. Likewise, more attention needs to be devoted to case studies on the role of the private sector in disaster management. Although government and nongovernment organizations are doing their best, the magnitude of disasters has been increasing; hence, the private sector is another aspect that provides effective services on a commercial basis. Future researchers must examine the effectiveness of the private sector in managing disaster; for instance, what proportion of services is covered by the private sector in comparison with the government and the nongovernment sectors; and, how the government sought support from nongovernment organizations and private organizations during the disaster occurrences globally. Codifying successful strategies in disaster preparedness and prevention is a great contribution we can pass on to the future generations. “Prevention is better than cure” is an old saying but it still works. Sound preparedness against disaster is essential. Disaster management must involve a proactive strategy that encompasses disaster communication system; forecasting of emergency, type of emergency, the magnitude of emergency expected; guidelines for staff, and people regarding taking essential measures during the occurrence of disasters; a protocol of shifting of people, precious things, and livestock to a safe place; developing protocol of Disaster Management Cell that engages numerous stakeholders such

Introduction

7

as government, public, health department, police, fire brigade, and so on; and developing an effective training manual for staff who manage an emergency. Contemporary analysis of disaster management is incomplete without referring to technologies, particularly social media. The use of technology is inevitable in forecasting of emergency, coping with emergency, reaching out to people stuck in emergency situations, and so on. Hence, further development in technology may take place that handles disaster in a better way. In this connection, both hardware and software applications may be made that can assist in reaching out to support for victims. These include devising applications that forecast the type, magnitude, and time of occurrence of disaster; devising gadgets that give signals to the relevant departments, for example if a person is stuck somewhere they can be reached out through signals; developing applications that guide people on how and where they can find support from the relevant organization; and developing applications that connect people, government, and other humanitarian bodies to seek support and register complains regarding any indiscrepancy. Before concluding this introduction, we would also like to highlight the role of social capital upon community resilience and consequently upon disaster recovery. Coping with disasters is not the responsibility of government or humanitarian organizations alone but everyone in society must take ownership to combat the catastrophes. So, there is a dire need for developing value-based education that imparts a positive sense in stopping the things that bring emergency. Social capital is more effective than economic capital in the revival of affected communities, in many cases. Some of the case studies included in this volume directly speak to the value of shared resources and values held by communities. Addressing certain associated questions are truly valuable. Say, how being a human can we reduce disaster conditions? What sort of organizations and protocol may be made that mitigate emergencies and disasters in human lives? What kind of global networks are needed to mitigate disasters? The scholarly community has studied disasters from various perspectives and we now have a rich knowledge field of disaster management comprised of theories, models, and frameworks. However, less clear is how all these can be applied to specific disaster contexts. In this regard, situationally bound and nuance-filled case studies, particularly those conducted in the aftermath of dealing with disasters, assume importance. There is a dearth of books meeting this need for the scholarly and practitioner communities. We hope this collection of case studies fill some of that void. We encourage readers to take both critical and reflective peeps into these case studies and develop actionable self-awareness on dealing with similar disaster situations. The case studies on COVID-19 are still of a formative nature – the crisis is still with us and we are still not sure how it would fully unfold. Our best hope is that what expands exponentially will also shrink exponentially. With that hope, we invite our readers to continue to read the chapters. Babu George and Qamaruddin Mahar Editors

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Chapter 1

Analyzing Site Security Design Principles in a Built Environment and Implication for Disaster Preparedness: The Case of Istanbul Sultanahmet Square, Turkey Ali Akbulut and G¨okçen Firdevs Y¨ucel Caymaz

Abstract Today, the presence of unwanted activities threatening the safety of the field, which has negative effects on daily life and social psychology, is increasing day by day. There is no doubt that it is inevitable to avoid these threats, but it is possible to take some measures to reduce the destructive power of these threats. Nowadays, increasing terrorist attacks increase the importance of field safety design in urban areas. There is a loss of life in attacks around the world. The subject of this study is to investigate the design criteria related to the built environment and the measures to be taken in the case of bomb attacks in the built environment. In this study, a checklist will designed to measure the security design process around the building. The checklist titles are taken mainly from the “Safety design and Landscape Architecture” series of the Landscape Architecture Technical Information Series/LATIS publications by the American Society of Landscape Architects (ASLA) and the Risk Management Series of the Federal Emergency Management Agency/FEMA (FEMA, 2003, 2007; LATIS, 2016) and others. The checklist created as a result of literature review will be tested in Istanbul Sultanahmet Square. As a result of the study, it was determined that improvements should be made in the areas of vehicular and pedestrian access, parking lots, lighting and trash receptacle designs around Sultanahmet Square.

International Case Studies in the Management of Disasters, 9–46 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201003

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Ali Akbulut and G¨okçen Firdevs Y¨ucel Caymaz Keywords: Defense; street furniture; site security; landscape elements; risk management; public space

Introduction Although fear is not an adequate predictor of crime, it has obvious negative consequences which affect people even in the absence of crime (Nasar & Fisher, 1992). The security of urban spaces is an alarming reality of modern life. In 2006, while Coaffee and Murakami emphasized there was an issue with the increasing importance of security, and a problem related to the communities and cities, they underscored that these impacted the urban spatial planning and also mentioned new design requirements. These new design issues include isolating the structure surroundings from traffic, reducing the distinctions between neighborhoods, and boosting the neighborhood concept rather than residential areas (Glaeser & Shapiro, 2001). A 2017 study published in the Journal of Sustainable Architecture and Civil Engineering reported that terrorism attacks happen mostly in integrated street segments; it determined they occur more frequently in streets with privatesector structures and heavy people traffic (Alasiri, 2020). Architectural objects and urban areas can be classified into two groups: those of “hard” and “soft” targets. Attackers often refrain from attacking hard targets such as government buildings, nuclear power plants, consulates, and military structures. For this reason, they revert to cities with soft targets and historical importance. Today, crowded urban spaces have turned into insecure areas. In terms of security, shopping malls, stadiums, train stations, entertainment venues, parks, squares, religious sites, and other places with heavy foot traffic are in the risk group (Kalvach, 2016). Protecting crowded places in cities is an ongoing issue. The utilization of Crime Prevention (CPTED) design ideas has a long history, whereas implementing CPTED-style security measures dates back to early human settlements. drawbridges, moats, walls, and landscaping designed to control access around Iron Age fortresses and castles were examples of uses implemented in the scope of these measures (Schneider and Kitchen, 2004). The higher the public’s interest in the target, the higher the media interest regarding the attack will be (Coaffee, O’Hare, & Hawkesworth, 2009; HM Government, 2010; McIlhatton et al., 2018; Thackrah, 2013). Therefore, targets will generally be public, administrative and iconic structures, commercial and industrial centers. Once again, attacks carried out with vehicles in crowded urban areas of Berlin, Nice, Stockholm, London, New York, Melbourne have demonstrated the importance of taking security measures or bolstering existing measures in order to diminish the impact of terrorist attacks in high-density public spaces (GCDN, 2018). Due to their ease of access, inadequate protective security, high loss rates in the event of a successful attack, and political impact, crowded spots continue to be attractive targets for attackers (Goodrich & Edwards, 2020; Matijosaitiene & Petriashvili, 2017).

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Urban security planning to combat terrorism is comprised of planning arrangements using advanced technology such as security zones and rings of steel, where access is restricted and surveillance is significantly increased (Coaffee, 2010). Some important studies were made by theorists. One is Jane Jacobs (1961) – Crime Prevention Through Environmental Design – passive measurements involving increased co-ownership and oversight of urban spaces – , the other is C. Ray Jeffery (1969, 1971) and third is Oscar Newman – the region, natural surveillance and modification of existing construction to effectively reduce crime (1972, 1973) – forth is by Kaplan (1973) et al. While Jacobs and Newman emphasize passive measures, new theorists led by Jeffery and CPTED (Crime Prevention Through Environmental Design) have discussed proactive measures, including active surveillance devices, reinforced entry points, and adequate lighting to prevent crime. Among the guidelines for planning and design principles regarding the protection of crowded areas are: the UK National Counter Terrorism Security Office (NaCTSO, 2017) and Australia’s Strategy for Protecting Crowded Places from Terrorism (Australia-New Zealand Counter-Terrorism Committee, 2017), Royal Institute of British Architects (RIBA) paper on designing for counterterrorism (Royal Institute of British Architects, 2010) Crowded Places: The Planning System and Counter Terrorism (HM Government, 2010). Crime Prevention Through Environmental Design involves; (1) Natural Access Control (the use of gates, fences, bushes, and other physical elements), (2) Natural Surveillance – “Eyes on the Street”, (3) Regional Strengthening (fences, sidewalks, sculptures, signs, good care and landscape design), and (4) Management and Maintenance (the neighborhood’s sense of “pride of place” and territorial reinforcement) (Fennelly & Crowe, 2013). In addition to these four criteria, the other four principles that may be required to ensure field safety in the built environment are: (1) Increasing the security distance around the building as much as possible, (2) ensuring protective design of the structure and its components at the first stage, (3) strengthening existing structures, (4) and posi¨ tioning protective elements separately from the structure (Gebbeken, Doge, & Larcher, 2012). Security views should be as inconspicuous as possible and placed intelligently and accurately in urban environments (Coaffee, 2017; National Capital Planning Commission, 2002). Benches, lighting poles, or other street elements installed into the ground function as “hostile vehicle mitigation.” Following the Westminster attack in March 2017, the BBC’s interior correspondent Dominic Casciani stated that the goal of terrorism is not only to kill and maim but also to create a sense of panic and discomfort in a city or country (Casciani, 2017). Managing Director at Marshalls Landscape Protection, Jaz Vilkhu, argues that instead of building concrete defensive barricades, people should consider a holistic approach which focuses on protection and design in order not to feel a constant threat (Eha, 2018). Urban furniture, public art, and trees can all be used to ensure safety while making cities more livable. They can also separate pedestrians and cyclists from the vehicular road and stop them by creating obstacles for a vehicle in motion (Quito, 2016; Securiscape, 2020). For

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instance, one of the busiest and most visited public areas in the United States, Times Square, has been cordoned off from the use of heavy vehicular traffic, having been widely pedestrianized with the use of large concrete blocks (GCDN, 2018). In order to maximize the effectiveness of the built-in security features of cities, municipal officials need to make necessary arrangements to prepare for these shocking urban attacks. It is important to take necessary measures and design requirements in the built environment. For this purpose, taking the CPTED into consideration in this study, principles regarding the field safety process defined by FEMA in particular and considering other international studies on this subject, a comprehensive checklist has been created that can be used to measure the security of all public spaces.

Literature Review Environmental safety elements such as fences, walls, vehicle barriers, water views can hinder vehicles or pedestrians from accessing the area. The conclusion of the 2009 study by Jon Coaffee, Paul O’Hare, Marian Hawkesworth entitled “The Visibility of (In)security: The Aesthetics of Planning Urban Defences Against Terrorism,” indicates that invisible safety, including the use of urban furniture, is more aesthetic and advantageous (Coaffee et al., 2009). In his article entitled, “Architecture in the era of terror: the security dilemma,” G. Zilbershtein underscored security concerns confronting the spread of terrorism today. It should be kept in mind that the problems of perceiving physical conditions of the image and the surroundings affect not only potential criminals and terrorists but also the population at large (Zilbershtein, 2005). The possible threat of terrorism in certain cities manifests the need for additional security design in urban spaces (Coaffee, 2017). Design elements, structural reinforcement, technology and operational policies related to the field can be protective, intimidating, and facilitative in case of a terrorist attack (Coaffee, 2007; FEMA, 2003). The results of Felix and Elhefnawi’s (2020) study, in which examples of attacks that occurred in the Middle East were examined, indicate that a lack of protective landscape elements in the built-up environment increased the number of fatalities, even in cases with a beefed-up military presence. Landscape design and details are used not only as defense tools but also have a positive effect in their environs with cultural, sociological, aesthetic, and accessibility aspects (Felix & Elhefnawi, 2020). The results of a study that Lavy and Dixit conducted in 2010, which included 42 field protection proposal criteria, determined that vehicle and pedestrian circulation, parking lots, infrastructure systems, building, and envelope are important in the process of protecting the site. Topographic changes in field design environments provide opportunities to preserve trees and increase security by facilitating suitable heights for roads, buildings, and car parks, as well as balancing the proportion of excavation and filling in an inconspicuous manner. The effects of the explosion would vary depending on the type of explosive threat and the construction and design of the

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standoff area. While determining the standoff distance, the initial level of protection created is called the “keep-out zone.” In urban situations with spatial restraints, it is possible to expand the area of removal by installing barriers along the sidewalk, by removing the parking lot on the sidewalk, and, if necessary, by sealing the street off to regular traffic (Szantner, 2002). The standoff distance should be closed to traffic and contain other security implements such as landscape, trees, and rocks to restrict vehicular access (Nadel, 2002). The results of Matijosaitiene and Petriashvili’s study on a total of 35 sites in which 14 terrorist attacks took place recently showed the importance of standoff distance, and the presence of medical institutions and security forces as a deterrent to possible attacks (Matijosaitiene & Petriashvili, 2017). In an emergency situation, vehicles can be used as temporary physical obstacles and placed at junctions to mark or guide traffic. The amount and flow of traffic should be evaluated regularly in order to monitor traffic control issues. If possible, one-way circulation of vehicles should be provided so staff can conveniently observe suspicious activities of vehicles and people (CPTED, 2005; FEMA, 2003). Park and surrounding areas should be designed in shapes and forms that provide maximum visibility and easy surveillance, and should be well lit. To minimize the effects of explosions caused by vehicle bombs, vehicle parking and service areas should be away from buildings and sensitive areas (AIA, 2004). Underground car parks will put the building at risk. Positioning the car park away from high-risk buildings and in areas with the least risk for staff should be a high priority. Outdoor parking lots should be located away from building groups or buildings. It has been proven that the use of urban furniture is effective in preventing terrorist attacks to ensure that vehicles cannot approach walkable areas (BarryJester, 2017). City furniture such as bollards, sculptures, walls, fences, topography, fountains, water elements, flower beds, and other landscape elements can be the means to protect spaces and building environments. In some cases, certain types of trees may also be used instead of impact-resistant poles to provide protection (Brower, Dockett, & Taylor, 1983; Commission, 2001). The results of a study conducted by Chambers and Andrews after the 2017 Melbourne attack showed the importance of bollards as a protective element. Barriers installed to prevent vehicular access must meet given parameters based on the estimated speed and weight of a charging car (Chambers & Andrews, 2019). Physical protective limits can be man-made or natural. Some natural restraints include water scenery, changes in topography, use of vegetation, and the creation of rough terrains that are difficult to traverse; some artificial borders include fences, walls, flower beds, border elements, fountains, urban furniture (Lewis, 2002; Speckhardt & Dowdell, 2002). The use of garbage bins should be avoided within safety distances of the buildings. The signs should be descriptive, especially for first-time users, by identifying multiple site entrances, parking lots, and main building entrances. Signs should be placed stating that the area is under control and that no one can enter without prior permission. The number of routing signposts in the area should be kept to a minimum. Although lighting alone does not naturally improve

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safety, it is an important component in an overall field safety plan. They allow the possibility for security personnel to conduct visible checks of the site. Security lighting provides both physical and psychological deterrence. Insufficient lighting creates shadows that provide hiding places for criminals and terrorists. Such lighting may also be a security choice, in that security personnel can view the environs using night vision equipment, with no visibility provided for criminals (Goodrich & Edwards, 2020). Mature trees and thorny plants are potential stopping elements. Instead of structural restraints, the use of low-maintenance, sustainable plant materials can create aesthetic spaces in building environments (Brigham, 2002; Van Oss, 2002). Excessive plant growth and hidden areas are a source of fear in urban landscape for many people (Kuo & Sullivan, 2001; Nasar & Fisher, 1993). It is essential to use plants as hinderance in safe landscapes. The Urban Design and Security Plan for Washington DC provides a variety of examples of how mature trees, king posts surrounded by bushes, and reinforced concrete flower beds can be placed both as a way to bolster buildings against building bombs as well as to beautify street views. Water elements used in public spaces are passive physical barriers that may be used against vehicular terrorist attacks. In addition, as they have the feature to absorb explosion waves against the risk of terrorist attacks with a bomb vehicle they should be used in public places, especially in areas where pedestrian zones are located (FEMA, 2007; Gebbeken et al., 2012). Providing rainwater management with the use of topography and water elements for protection against vehicles are other important issues for field safety (GSA, 2007). Infrastructure systems can be significantly damaged by an explosion that can create serious life safety problems for building occupants. Perhaps more than physical damage to the building’s own structure, critical utility damage can threaten the residents’ urgent safety, making evacuation of the building difficult or impossible. The landscape architect needs to carefully consider the location and route of the landscape architect in order to minimize the potential damage to important infrastructure elements. In addition to infrastructure facilities, electronic surveillance systems such as closed circuit television (CCTV) coverage, combinations of sensors, such as (infrared (IR), thermal, microwave, motion, etc.), electronic access controls, biometrics, etc. should be kept in mind (Sipes, 2002).

Methodology Project Selection Criteria Cities in many parts of the world are exposed to high levels of chronic violence. Historical touristic places, crowded bazaars, and modern office areas of Istanbul render the city susceptible to being exposed to large-scale attacks. Around 223 Istanbulites were killed and approximately 1,288 were injured over the past 40 years (Savitch, 2014). When we look at the terrorist attacks that occurred between 1999 and 2017, 2 of the total 10 attacks took place in the vicinity of Sultanahmet Square (Table 1.1). For this reason, Sultanahmet Square was chosen for the field study.

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Table 1.1. Adapted from List of Terror Attacks in Istanbul (Aljazeera, 2020). Year

Location

Type

1999 2003

A shopping center In front of the Bet Israel Synagogue, S¸is¸li; In front of the Neve Shalom Synagogue in Beyo˘glu; British Consulate General The HSBC General Headquarters in Bes¸iktas¸ Shopping street in the ¨ ¨ oren Gung district, Ba˘gcılar Taksim Square, Taksim A police station in Istanbul’s central Sultanahmet district, Sultanahmet Sultanahmet Square and the Obelisk of Theodosius Istanbul’s Beyo˘glu district in front of the district governor’s Office, Taksim On S¸ehzadebas¸ı Avenue, Fatih Vodafone Arena and Dolmabahçe – Gazhane Avenue, Bes¸iktas¸ Reina Nightclub, Bes¸iktas¸

Bombings and arson attack Trucks fitted with bombs

2008 2010 2015

January 3, 2016 March 2016

June 2016 December 2016 2017

Bombing Suicide bombing Suicide bombing

Suicide bombing Suicide bombing

Suicide bombing Car bombing, suicide bombing Mass shooting

The Case Study of Sultanahmet Square Bordered by Hagia Sophia and Divan Yolu Street in the north, the courthouse in the west, the Blue Mosque in the southwest, and Topkapı Palace in the south, Sultanahmet Square is an area which was completely pedestrianized in June 2010. In terms of historical, cultural, and architectural significance, Sultanahmet Square is the most attractive part of Istanbul. Sultanahmet Square is comprised of four different regions. The first is the basin area between Sultanahmet Complex and Hagia Sophia. The second is the ancient hippodrome area replete with the German Fountain and the Obelisks. The third is the area near the Sultanahmet Complex. There are benches in this area for the audience to follow the audio and visual screens. The fourth is between the Courthouse and Firuz A˘ga Mosque.

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There are ruins of a Byzantine palace in the middle of the park (Cansever, 1991; Kuban, 1998). You can reach the square via bus, metro, tram, train, or even ferryboat (Fig. 1.1; Table 1.2).

Research Questions Which planning and design issues are important in the built-up environment against possible terrorism attacks in urban environments? How can we reduce the impact of an attack through landscape design and urban furniture?

Research Methodology A checklist comprised of a total of 108 criteria has been created to test the security sufficiency of the research area. Aerial photographs, street views, on-site detection and measurements, weekday, weekend, and observations at different times of the day were used to analyze the created checklist. The criteria agreed on the checklist were tested as “Yes,” “No,” and “Neither Yes Nor No.”

Research Analysis As a result of testing the 108 criteria that were prepared to measure field safety in Sultanahmet Square, it was determined that 83 criteria were met, 13 criteria were not met, and 12 criteria were partially met. Overall, the field safely study determined that there are no serious problems (except for the fact that buildings are not

Fig. 1.1.

Sultanahmet Area: Aerial View. Source: Modified from Google Maps.

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Table 1.2. Case Study Area Properties. Location Date of attack Method of attack Purpose of attack Causalties Buildings primary purposes Critical activities take place at the buildings Site’s occupants and visitors Topography Entry Pedestrian Access Axis Utilization Floor Coverings

Vehicular Road Axis Usage

Pavement Asphalt paved Properties

Turkey, Istanbul Istanbul historic Sultan Ahmet district January 12, 2016 Suicide bombing Both political and religious 13 dead/14 injured Museums, Governmental offices, Obelisk of Theodosius, Mosque Tourist attraction site Mostly tourists Generally flat ground Four different entry points, just one exit point West axis linking Beyazıt Square with Sultanahmet Square (Divanyolu ¨ u¨ Avenue), North axis linking Eminon Ferryboat Pier and the square (Million – Hidayet Mosque Course), South axis linking the square and the sea route passing from the south (The Akbıyık line from Kennedy Avenue that opens ˙ to the square the Ahırkapı Iskele Street ¨ uk ¨ and S¸adırvan Street with the Kuç Ayasofya line – Aksakal Street). Heavy Granite parquet stone, concrete, asphalt, granite cubes and locked parquet stone. The historical identity of the square and compatible materials must be used Streets on the left and right path of the hippodrum, in front of Hagia Sophia Museum, in front of Sultanahmet Square Rarely used The Hippodrome is in front of the Sultanahmet Mosque and the pedestrian path leading to the mosque

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Table 1.2. (Continued) Natural stone/Granite parquet stone) Precast concrete elements

Parking lot Sitting elements With concrete feet wooden seats

Barriers Spatial Closure Continuity of Boundaries Material Routing

Lighting

Trash Bins Types Material

Sturdy, Not Permeable, Monotonous, No human scale effect Between Hagia Sophia Mosque and the park with fountain Durable, permeable material, suitable for historical texture, suitable for heavy pedestrian traffic, slip resistant, grouted, human scale effect, dark gray color Sultanahmet Mosque The portion facing the Hippodrome, The Hippodrome is the portion facing the Museum of Islamic Art, the small park on the Divan Road Drainage is problematic, slip-proof, environmentally incompatible, monotonous neutral effect, insufficient surface drainage, gray and red color Above ground parking places Intensive positioning around the park and the central pool Weighted Fixed; for cruise and recreational purposes; Image incompatible with historical texture Nonknitted Wall-like No limiters to define the area. Metal Orientation, information boards, billboards, commercial signs, New generation billboards with light and visual effect ¨ Yerden aydınlatma, Yuksek aydınlatma Beyaz boyalı, Tarihi doku ile uyumsuz. Different types of trash containers Plastic, metallic materials Mostly stationary, incompatible with the environs

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Table 1.2. (Continued) Ground Vegetation

Water Features Alman Çes¸mesi Fountain Pool Stepped Weir Pool Rectangular-Shaped Pool

Infrastructure

Ownership, Maıntenance, and Management

Wide grassy areas, flower beds, a small number of tall plants (Aesculus hippocastanum, Platanus acerifolia, Palm trees, Salix bablyonica), medium and short plants (Cercis siliquastrum, Lagerstroemia indica, Taxus baccata), Flower beds, Limiting elements (Buxus, Euonymus, Juniperus communis subsp. Nana), Conical, circular forms Politically significant, octagonal module, fountain model, cooling function Mosaic coating, 25m diameter circular form, mirror effect, focus creation, sound and light shows Granite coating, sitting function, sprinkler use in top and bottom codes Circular fountains in three different heights, surrounding seating, incompatible with historical environment Maintenance covers, Sewer grates, Tree grates, Fire hydrants Incompatible with historical texture The area between the Sultanahmet Mosque, Hagia Sophia, Hippodrome, and the Basilica Cistern quadrangle is well maintained and safe; Places including the square itself and very near the main axis are neglected and unsafe (poor in terms of pedestrian circulation).

¨ (2005), Çınar & Aktas¸ (2018), Çınar and Çetinda˘g (2009), Turgut (1999). Compiled from Bingol

distributed in the area, and not being near the train station), in the security perception components (except for the presence of a sufficient number of telephone boxes), seating elements at the safe distance in the topography (except they are not stationary), passive protective barriers (except that the standard distance which needs to be between two barriers does not comply with the standards), active protective barriers (except that barriers are partially painted black), in the

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vegetation landscaping (except for the use of thorny plant species), and in the infrastructural facilities (no protection of the facilities, no information on where to report maintenance problems). It was determined that there were no serious problems. On the other hand, it was concluded that improvements need be made in the areas of vehicle and pedestrian access, parking, lighting and trash receptacle design, and improvements need to be carried out in matters of vehicle and pedestrian access, parking, lighting and trash receptacle design. The criteria for vehicular and pedestrian access were partially met. While long, straight vehicular approaches should be avoided as they provide an opportunity for vehicles to speed up rapidly, vehicle approach distances were found sufficient as well as the minimal vehicle entry points. It is determined that loading and transport service entry areas, electricity, telephone, fire systems etc. are located closer than 50 meters to the road, insufficient numbers of speed bumps, and that the five access and entry points should be reduced to two such points. Looking at the car park criteria, it was determined that other than security and police, there was no additional opportunity for emergency assistance in places around the car parks in the vicinity of the buildings deemed high-risk in front of the museum and land registry office located within the square. It has been observed that the urban furniture used in the field was generally of the sort that could not withstand vehicular impact; some of the seating elements and trash receptacles are not mounted into the ground; lighting elements provide insufficient light at the entrance control points; there is no emergency lighting system; and that white halide metal street lamps provide partial lighting at best. It has been determined that some of the trash receptacles do not meet the condition of placement at a distance of nine meters from buildings (Table 1.3).

Discussion As researchers have mentioned, implementing invisible security measures in urban environments will make people feel more comfortable (Coaffee et al., 2009). Coaffee emphasized the necessity of improving urban spaces in the field safety process in many of his studies. Protection measures are inevitable in urban areas, especially in areas of strategic importance with heavy foot traffic. With its heavy pedestrian traffic and strategically important structures, Sultanahmet Square is one of the areas where security concerns are felt at the highest level. In their field safety studies, Coaffee and Bosher argue that it is not only security and public safety concerns that should be included in the planning, design, and engineering of the built environment but also environmental benefits as well, by considering a safe and sustainable design together in one (Coaffee & Bosher, 2008; Meek, 2001). Looking at applications throughout the world, it is seen that crowded areas are pedestrianized and controlled with few entry points for security purposes. They are primarily aimed at facilitating safe distancing through pedestrianization. It is seen that safety distances around the building are generally provided, but entering the area from five different entry points has a negative impact on security control

Table 1.3. Control List (ANZTC, 2017; ASLA, 2019; Atlas, 2013; Briggs, 2005; FEMA, 2003, 2007; GCDN, 2018; Hopper & Droge, 2005; LATIS, 2016). Yes

General Subjects Buildings with functional compatibility and similar threat levels should be clustered throughout the site. There must be physically defined and visible boundaries between public and private spaces. There should be open and visible gathering areas. There should be a place for security zones. Access control design should be sufficient. The area should be higher than the street height. Area should not be near train transportation route. Area should not be near highway transportation route. A medical institution should be nearby for emergency access. The existence of an infrastructure facility around the area should be avoided.

No

N/A

✕ U U U U U ✕ U U U

Table 1.3. (Continued) Yes

Security Perception Components

Source: Authors.

No

N/A

The area’s physical layout design should be clearly comprehensible for users. There should be natural surveillance by people or activities through various land uses. Access to help, e.g., security alarm, emergency telephones, signage, and information should available. Routing in the area should be sufficient for physical access. Security personnel must be present in the area. Access to assistance in the area should be sufficient. The existence of telephone booths should be sufficient. The presence of bustops. Topography

Source: Authors.

U U U U U U ✕ U

Table 1.3. (Continued) Yes

Natural physical barriers (such as water, rough terrain) should be found around the area. Topography should enhance observation of surrounding activities from the within the site. Standoff Distance A clear zone of 15 m. or more should exist between the perimeter barrier and structures within the protected area. A clear zone of 6 m. or more should exist between the perimeter barrier and exterior structures, parking areas, and natural or manmade features. Vehicle circulation, parking, and maintenance areas should be located away from critical building components (emergency building systems, fire control systems, etc.) (This should be “No”) Vehicular and Pedestrian Access

Source: Modified from Google Maps. Source: Authors.

U U U U U

No

N/A

Long, straight vehicular approaches should be avoided as they provide an opportunity for a vehicle to accelerate to a high speed. Controlled entry points should be included. Loading and shipping area service entrances should be located away at least 50 m from electricity, telephone, fire systems, etc. Vehicle entry points must be appropriate. Approach distance to the vehicle should be sufficient. There should be speed bumps (an abrupt change in pavement appropriate for low speeds) or speed humps (a gentler change of elevation used to enforce a speed limit. There should be few access roads and entry points into the area (preferably 2 entrances). Access to private and public spaces should be defined. Pedestrians should be able to get through the protected area in a defined time. Physical space should be sufficient for pedestrian flow. Objects preventing pedestrian access should be vented. Pedestrian and vehicular roads should be separated.

✕ U ✕ U U ✕ ✕ U U U U U

Table 1.3. (Continued) Yes

Parking Areas

Source: Modified from Google Maps. Source: Authors.

No

N/A

Surface parking lots should be located so as to avert potential threats from a building or the interior of a group of buildings. Underground car parks should be avoided. Design the parking lot with one-way circulation to facilitate monitoring for potential aggressors. Provide emergency communication systems (e.g., intercom, telephones, etc.) at readily identified, well-lighted, closed circuit television monitored locations to permit direct contact with security personnel. There should be one-way circulation into the parking areas. Locate vehicle parking and service areas away from high-risk buildings. Restrict parking from the interior of a group of buildings. There must be security personnel for the car parks. There should be passenger loading/unloading zones within the area. The area should be suitable for the rapid and sufficient access of emergency vehicles. The parking area should be designed with adequate lighting levels. Cameras strategically located should be used where warranted to provide formal surveillance and monitoring. Urban Furniture Furniture should be visible day and night (so that its presence will not lead to injury). Furniture forms should be safe (no hazards such as sharp edges). Furniture materials used must be resistant to vehicle collisions.

U U U ✕ U ✕ ✕ U U U U U U U ✕

Table 1.3. (Continued) Yes

Seating Elements

Source: Modified from Google. Source: Authors.

No

N/A

There should be seating elements facing the street. There should be seating elements facing the building. Seating equipments should be hardened. Physical Protective Barriers

Source: Modified from Google Maps. Source: Authors. Passive Physical Protective Barriers The height of the bollard above ground should be taller than the bumper of the vehicle, typically 39–40 inches. The spacing of the bollards should have a minimum clear distance of at least 91 cm (max. 152 cm). King posts must be at least 50 cm high. Surface mounted planters can also be used to provide perimeter security. Topographic order should facilitate separation of pedestrians and vehicles. Water elements should hinder entry into the pedestrian area or vehicle that needs to be protected. Tree and shrub groups should be spaced in a way to prevent vehicle entrance.

U U ✕

U ✕ U U U U U

Table 1.3. (Continued) Yes

Active Protective Barriers The hybrolic king posts and mushrooms in the area should hinder pedestrian traffic with their locations. Kingposts should be placed halfway on the sidewalk at a distance of 2.4 m. Bollards should be hardened. Fences should be painted black for a visible environment image. Signage

Source: Authors.

No

N/A

U U U ✕

Identify all critical resources in the area (fire and police stations, hospitals, etc.). Wayfinding systems should identify entrances and exits. They should not (unless required by regulations) identify sensitive areas that are restricted. Minimize the number of signs identifying high-risk buildings. A significant number of warning signs should be erected to ensure that possible intruders are aware of entry into restricted areas. Install warning signs that are easy to understand along the physical barriers and at each entry point. The warning signs should be posted at all entrances to limited, controlled, and exclusion areas. Parking spaces should clearly marked. The entry point must be clearly marked. Warning signs must use both (or more) languages in areas where two or more languages are commonly spoken. The signs should be posted at intervals of no more than 30 m. Signs should be hardened.

✕ U U ✕ U U U U U U ✕ U

Table 1.3. (Continued) Yes

Lighting

Source: Modified from Google Maps. Source: Authors.

No

N/A

A minimum surface lighting average of four horizontal foot-candles are needed to provide adequate lighting at entry control points. White metal halide lamps provide best color rendering for CPTED. Ensure tree canopy does not interfere with lighting fixture. There should be an emergency lighting system. Lighting should be adequately provided so that a person can recognize a face from a distance of 10 m. Lighting should provide uniform spread and reduce contrast between shadow and illuminated areas. Lighting should not provide too much glare. There should be adequate car park lighting. There must be sufficient pedestrian path lighting. There should be a high lighting presence. Lighting equipment should be hardened.

✕ ✕ U ✕ U U U U U U U

Table 1.3. (Continued) Yes

Trash Receptacles

Source: Modified from Google. Source: Authors.

No

N/A

Trash receptacles (a concealed place that can be used to hide explosives) should be placed at least 9 m away from the building. Trash bins should be hardened. Vegetation Landscaping

Source: Authors.

✕ ✕

Table 1.3. (Continued) Yes

Design landscaping that does not provide hiding places. Plants shorter than 90 cm or taller than 2.4 m should be used in order to provide natural surveillance. Sharp-leaves create natural barriers and repel aggressors. Thorny bushes create natural barriers and repel aggressors. Dense leafy plant species should be preferred as a bordering element. Vegetation should be maintained regularly in order not to form hiding points. Low-maintenance, sustainable materials can be used. Groundcover, flowers, and grass should be used under tall trees.

No

U U U ✕ U U U U

N/A

Water

Source: Modified from Google Maps. Source: Authors.

Table 1.3. (Continued) Yes

Water elements should be limited to a durable material. Infrastructure Systems

Source: Modified from Google Maps. Source: Authors.

U

No

N/A

Utilities should be placed underground or alternatively concealed and protected. Permeable flooring materials (permeable concrete, permeable asphalt) are to be used on pavements. Car parks and vehicle traffic should be routed in a way that keeps them at least 15 m from critical utility systems. The marking of important infrastructure facilities (powerplants, water treatment plants, etc.) should be avoided. Fire hydrants should be visible. Pole-mounted cameras, both fixed and mobile surveillance, can be used. Ownership, Maintenance, and Management The design should provide territorial reinforcement through design features. The design should allow for easy maintenance. There should be signage and information to guide people on how to report maintenance. The management of space should provide maintenance priorities, e.g., removal of offensive graffiti.

✕ U U U U U U U ✕ U

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Ali Akbulut and G¨okçen Firdevs Y¨ucel Caymaz

Fig. 1.2.

Sultanahmet Area: Street View.

(Fig. 1.2). Providing one-way vehicular traffic in general in the square and its surroundings is positive in terms of protection (Fig. 1.4). Considering both security and sustainability together mainly pertains to the development of landscape design systems. The environmental design principles considered to prevent crime can be provided as an example in the use of pools or plants, rather than a physical restraint manifested with concrete or steel bollards (Moore, 2008; Nash, 2003). Looking at the scale of Sultanahmet Square, it can be said that the four different water elements and vegetation that were used meet these principles. The importance of restraints, urban furniture, adequate lighting, and cameras were encountered in many studies (Barry-Jester, 2017; Eckes, 2018; Goodrich & Edward, 2020; Moore, 2008). While these elements, which are used both as seating and vegetation within the square, act as a barrier (Fig. 1.3), the trash receptacle and lighting elements do not serve in this function. The lack of an emergency lighting system as well as entry point illumination in the area, as well as the nonutilization of metal halide lamps which are recommended in standards in lighting, all have a negative impact on safety (Figs. 1.5 and 1.6). CPTED advocates recommend using plants lower than 90 cm or taller than 2.4 m to ensure natural surveillance. These dimensions will leave the middle plane open within the landscape, thus facilitating the chance for natural surveillance as well as reducing hiding opportunities. Meeting this requirement can be

Analyzing Site Security Design Principles in a Built Environment

Fig. 1.3.

Problematic Car Park Area Near the Square: Aerial View. Modified from Google Maps.

Fig. 1.4.

Problematic Car Park Area Near the Square: Street View. Source: Authors.

41

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Ali Akbulut and G¨okçen Firdevs Y¨ucel Caymaz

Fig. 1.5.

Fig. 1.6.

Furniture as a Barrier from the Area: Example 1.

Furniture as a Barrier from the Area: Example 2. Source: Authors.

Analyzing Site Security Design Principles in a Built Environment

43

achieved by using ground cover, grass, and flowers around trees that provide tall shade. Observable surroundings can also be created by pruning shrubs and not planting groups of bushes near each other (Atlas, 2013). The vegetation used in Sultanahmet Square facilitates an environment that allows the chance for natural surveillance and reduces the opportunity to hide. At the same time, users are provided with the chance to sit beneath shady trees. Visible environments are created by maintaining the landscape in the square and truncating the trees.

Conclusion Individuals and businesses need to be aware of the risks and take proactive measures to ensure the protection and safety of their community. As was seen in Paris, Nice, London, and Orlando, targets are generally iconic places, city districts or offices, entertainment venues, and beaches. These targets offer a higher chance of success and more potential to spread propaganda (WSP, 2020). When conducted properly, beyond the effective risk reduction and increasing the comfort of use, security projects will improve the physical environment quality of the space. In order to maximize security, safety, and sustainability in urban spaces, designers need to take into account the existing spatial features in order to take an integrated planning, design, implementation, protection, and defense approach. At this stage, the checklist in this study, which was created by taking into account the important studies previously researched, will be a data resource which can be used in efforts to increase the quality and comfort of field safety.

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Bing¨ol, E. M. (2005). kentsel açik alanlarda kullanilan sert zemin elemanlarinin tasarim ve kullanimi ‘sultanahmet meydani o¨ rne˘gi’ (Doctoral dissertation, Fen Bilimleri Enstit¨us¨u). Briggs, R. (2005). Invisible security: The impact of counter-terrorism on the built environment. Joining forces: From national security to networked security (pp. 68–90). Retrieved from https://webarchive.nationalarchives.gov.uk/20110118174834/http:// www.cabe.org.uk/files/impact-of-counter-terrorism.pdf Brigham, D. (2002). Green guardians: Can plants enhance security? Landscape Architecture, 92(11), 30–32. Brower, S., Dockett, K., & Taylor, R. B. (1983). Residents’ perceptions of territorial features and perceived local threat. Environment and Behavior, 15, 419–437. Cansever, T. (1991). Sultanahmet meydani yayalas¸tirma projesi 1969, Arredemento ˙ Mimarlık, 24, Istanbul. Casciani, D. (2017). London attack: What security chiefs have long been preparing for. Retrieved from http://www.bbc.co.uk/news/uk-39360710 Chambers, P., & Andrews, T. (2019). Never mind the bollards: The politics of policing car attacks through the securitisation of crowded urban places. Environment and Planning D: Society and Space, 37(6), 1025–1044. Coaffee, J. (2007). 7th annual regeneration management research network workshop, Centre for Urban Policy Studies (CUPS), University of Manchester. Journal of Urban Regeneration & Renewal, 1(2), 215–216. Coaffee, J. (2010). Protecting vulnerable cities: The UK’s resilience response to defending everyday urban infrastructure. International Affairs, 86(4), 939–954. Coaffee, J. (2017). Terrorism, risk and the city: The making of a contemporary urban landscape. London: Routledge. Coaffee, J., & Bosher, L. (2008). Integrating counter-terrorist resilience into sustainability. Proceedings of the Institution of Civil Engineers-Urban Design and Planning, 161(2), 75–83. Coaffee, J., & Murakami Wood, D. (2006). Security is coming home: Rethinking scale and constructing resilience in the global urban response to terrorist risk. International Relations, 20(4), 503–517. Coaffee, J., O’Hare, P., & Hawkesworth, M. (2009). The visibility of (in)security: The aesthetics of planning urban defences against terrorism. Security Dialogue, 40(4–5), 489–511. Commission, U. N. C. P. (2001, October). Designing for security in the nation’s capital, Washington, DC. CPTED. (2005). CPTED security, crime prevention through environmental design. Retrieved from www.cptedsecurity.com/cpted_design_guidelines.htm Çınar, H. S., & Aktas¸, N. K. (2018). Searchıng for a successful organization for historical environment: Sultanahmet square-Istanbul. Academıc researches in architecture, engineering planning and design, 9. ¨ ¨ u: ¨ Sultanahmet Çınar, S., & Çetinda˘g, K. (2009). Gorsel algilamada is¸ik ve renk faktor ¨ ¨ gi. I˙ stanbul Universitesi meydani ve çevresi orne˘ Orman Fak¨ultesi Dergisi, 59(2), 103–123. Eckes, A. (2018). Landscape architecture in protection of pedestrian zones against acts of terrorism. Architecture Civil Engineering Environment, 11(2). Eha, L. V. (2018). A new frontline against terrorism. Retrieved from https://www. pbctoday.co.uk/news/planning-construction-news/new-frontline-terrorism/37523/ Felix, M., & Elhefnawi, M. (2020). Landscape design elements as a defensive tool for building security. In Urban and transit planning (pp. 227–238). Cham: Springer.

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FEMA (Federal Emergency Management Agency) (2003). FEMA 426: Reference manual to mitigate potential terrorist attacks against buildings (risk management series). Washington, DC: Federal Emergency Management Agency. FEMA. (2007). FEMA 430: Site and urban design for security: Guidance against potential terrorist attacks, providing protection to people and buildings. Washington, DC: Federal Emergency Management. Fennelly, L. J., & Crowe, T. (2013). Crime prevention through environmental design. Amsterdam: Elsevier. GCDN (Global Cultural Districts Network). (2018). Beyond concrete barriers innovation in urban furniture and security in public space. Retrieved from https://gcdn.net/wp-content/uploads/2018/01/GCDN-Urban-Furniture-StudyA4-FINAL-highres_web.pdf ¨ Gebbeken, N., Doge, T., & Larcher, M. (2012). Safety and security of urban areas through innovative architectural and structural concepts. In Future security research conference (pp. 153–164). Berlin, Heidelberg: Springer. Glaeser, E. L., & Shapiro, J. M. (2001). Cities and warfare: The impact of terrorism on urban form (No. w8696). National Bureau of Economic Research. Goodrich, D., & Edwards, F. (2020). Transportation, terrorism and crime: Deterrence, disruption and resilience. GSA. (2007). The site security design guide. Retrieved from https://www.wbdg.org/ FFC/GSA/site_security_dg.pdf HM Government. (2010). Crowded places: The planning system and counterterrorism. Hopper, L. J., & Droge, M. J. (2005). Security and site design: A landscape architectural approach to analysis. Assessment and design implementation. New Jersey: Wiley. Jacobs, J. (1961). The death and life of great American cities. London: Jonathan Cope. Jeffery, C. (1969). Crime prevention and control through environmental engineering. Criminologica, 7(3), 35–58. Jeffery, C. R. (1971). Crime prevention through environmental design (Vol. 91). Beverly Hills, CA: Sage. Kalvach, Z. (2016). Basics of soft targets protection—guidelines. Soft Targets Protection Institute, p. 45 Kaplan, S. (1973). Book review of defensible space. Architectural Forum, 98(8). ¨ ˙ Kuban, D. (1998). Kent ve Mimarlık Uzerine “Istanbul Yazıları, YEM Yayınları, ˙ Istanbul. Kuo, F. E., & Sullivan, W. C. (2001). Environment and crime in the inner city: Does vegetation reduce crime? Environment and Behavior, 33(3), 343–367. LATIS (Landscape Architecture Techical Information Series). (2016). Landscape architecture and the site security design process. Retrieved from http:// www.wbdg.org/resources/landscape_sitesecurity.php Lavy, S., & Dixit, M. K. (2010). Literature review on design terror mitigation for facility managers in public access buildings. Facilities, 28. Lewis, R. K. (2002). Shaping the city, a resolution to Banish Jersey barriers. Washington Post. Matijosaitiene, I., & Petriashvili, A. (2017). Urban planning and design for terrorism resilient cities. Journal of Sustainable Architecture and Civil Engineering, 18(1), 27–38. McIlhatton, D., Berry, J., Chapman, D., Christensen, P. H., Cuddihy, J., Monaghan, R., & Range, D. (2018). Protecting crowded places from terrorism: An analysis of

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the current considerations and barriers inhibiting the adoption of counterterrorism protective security measures. Studies in Conflict & Terrorism, 1–22. Meek, T. (2001). Quoted in what is the impact of building safety and security issues? Experts consider the future. Architectural Record, 189(12), 22. Moore, J. E. (2008). The economic costs and consequences of terrorism. Edward Elgar Publishing. NaCTSO, N. C. (2017). Crowded places guidance. UK: Crown. Nadel, B. A. (2002). Building for a secure future: Environmental design. New York, NY: McGraw Hill Companies. Retrieved from http://www.constroctioii.com/ NewsCenter/Headlines/ENR/20020325d.asp Nasar, J. L., & Fisher, B. S. (1992). Design for vulnerability: Cues and reactions to fear of crime. Sociology & Social Research, 76, 48–58. Nasar, J. L., & Fisher, B. (1993). ‘Hot spots’ of fear and crime: A multi-method investigation. Journal of Environmental Psychology, 13(3), 187–206. Nash, C. (September 19, 2003). The dawn of lifesaving landscaping. Newsday. National Capital Planning Commission. (2002). The national capital urban design and security plan, Washington, DC. Newman, O. (1972). Defensible space (p. 264). New York, NY: Macmillan. Quito, A. (2016). The secret of anti-terror archtecture: Your city is probably safer than you realize. Retrieved from https://qz.com/733374/counter-terrorism-architecturehow-cities-prevent-attacks-without-looking-like-theyre-trying/ Royal Institute of British Architects. (2010). Guidance on designing for counterterrorism. Savitch, H. V. (2014). Cities in a time of terror: Space, territory, and local resilience. London: Routledge. Schneider, R. H., & Kitchen, T. (2004). Planning for crime prevention: A transatlantic perspective. London: Routledge. Securiscape. (2020). Security with style thanks to Securiscape’s PAS68 street planters. Retrieved from https://www.securiscape.co.uk/products/planter Sipes, J. L. (2002). A new kind of scrutiny: Security control in landscape architecture means much more than barriers and bollards. Landscape Architecture, 92(9), 58. Speckhardt, L., & Dowdell, J. (2002). Creating safety: As the US government places a priority on protecting public spaces from terrorist attacks, landscape architects find a role. Landscape Architecture, 92(9), 64. Szantner, R. (2002). Form, function & fortification. Facilities Design and Management, 21(8), 32–35. Thackrah, J. R. (2013). Dictionary of terrorism. London: Routledge. Turgut, N. (1999). Meydanlarda çevresel zenginlik ve g¨orsel uyum analizi: Sultanahmet Meydanı u¨ zerine bir inceleme (Doctoral dissertation, Fen Bilimleri Enstit¨us¨u). Van Oss, A. (January 26, 2002). The architecture of security in the nation’s capital, finding a balance between beauty and safety. National public radio’s weekend all things considered. Aired. Retrieved from http://www.npr.org/programs/watc/features/2002/jan/security/020126.security.html WSB. (2020). Designing for safety, security and resilience. Retrieved from https:// www.wsp.com/en-GL/insights/designing-for-safety-security-and-resilience-in-oururban-environments Zilbershtein, G. (2005). Architecture in the era of terror: The security dilemma. WIT Transactions on The Built Environment, 82.

Chapter 2

Local Knowledge in Russian Flood-prone Communities: A Case Study on Living with the Treacherous Waters Kseniia Puzyreva and Nikita Basov

Abstract Owing to the climate change, the number of flood hazards and communities at risk is expected to rise. The increasing flood risk exposure is paralleled with an understanding that hard flood defense measures should be complemented with soft sociotechnical approaches to flood management. Among other things, this involves development of a dialogue between professionals and flood-prone communities to ensure that the decisions made correspond to the peculiarities of local socioenvironmental contexts. However, in practice, establishment of such a dialogue proves to be challenging. Flood-prone communities are often treated as mere recipients of professional knowledge and their local knowledge remains underrated. Building on an illustrative case study of one rural settlement in North-West Russia, we examine how at-risk communities develop their local knowledge and put it to use as they struggle with adverse impacts of flooding, when the existing flood protection means are insufficient. Our findings showcase that local knowledge of Russian flood-prone communities is axiomatic and tacit, acquired performatively through daily interaction of local residents with their natural and sociotechnical environments. Even if unacknowledged by both the local residents and flood management professionals as a valuable asset for long-term flood management, it is local knowledge that informs local communities’ practices and enables their coexistence with the treacherous waters.

International Case Studies in the Management of Disasters, 47–60 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201004

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Kseniia Puzyreva and Nikita Basov Keywords: Flood management; local knowledge; professional knowledge; community; adaptation; flood risk

Introduction Owing to climate change and associated unstable weather patterns, the risk of flooding and the number of flood-prone communities are expected to increase (Nye, Tapsell, & Twigger-Ross, 2011). In Russia, the annual number of floods has risen in the first decade of the twenty-first century, and further growth in numbers and frequencies is expected (Ministry of Natural Resources and Environment of the Russian Federation, 2010). Hundreds of settlements in the immediate vicinity of major rivers, their tributaries, and smaller water bodies experience seasonal floods affecting their livelihoods and well-being by disrupting infrastructure and economic activities and damaging properties (Government of Russian Federation, 2012). The adverse effects of annual freshets and floods are particularly evident for rural areas, where flood defenses are either absent or insufficient and critical infrastructure gets disrupted, limiting people’s access to necessary resources. Where hard engineering solutions of flood prevention, such as dams, dykes, and water storage reservoirs, are deficient, nonstructural measures of flood management that do not involve physical constructions but draw on knowledge development, dissemination of best practices, and local community engagement to reduce risks (Dawson et al., 2011) are essential for resilience to adversities. Following the recent tendency to depart from flood defense toward flood risk management (Nye et al., 2011), Russian water management regulations acknowledge the necessity for nonstructural measures, including the need to engage local communities in flood risk management (Nikitina, Ostrovskaya, & Fomenko, 2010). Nevertheless, although advances have been made in some parts of the country (Nikitina et al., 2010), implementation of such measures proves difficult in most of the flood-prone regions. Gradually adjusting to the new trends, Russia is now facing an institutional void, when the old system is being dismantled while the new policies are not yet at work (Lebel, Nikitina, Kotov, Manuta, & Birkmann, 2006). The Russian approach remains overfocused on the structural measures of flood management (Shalikovskiy & Kurganovich, 2017) that are often financially and technically nonviable in rural areas, leaving local communities vulnerable and dependent on the state to come and rescue them. With either limited or lacking means of flood prevention and preparedness, rural communities have to cope by themselves and develop their own local knowledge to respond and adapt to the risk of flooding. Simultaneously, current research on flood management in Russia focuses on assessment of flood management policy and practice at the institutional level (Lebel, Sinh, & Nikitina, 2010; Nikitina, Kotov, Lebel, & Sinh, 2011), underrepresenting local knowledge and adaptation techniques of the communities at risk. Russia is, therefore, a case both in need and of interest to investigate how

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rural communities develop and use flood protection and preparedness knowledge of their own, when flood defense infrastructure is deficient and nonstructural measures are still scarce. This study contributes to flood management research by revealing how rural flood-prone communities produce local knowledge and put it to work in order to minimize the adverse impacts of floods. Drawing on a case study of one rural settlement in Russia, this chapter illustrates how local residents acquire, share, and utilize flood-related knowledge throughout community adaptation to flood risk, and outlines the relationships between local knowledge and professional flood management knowledge that guide flood management policy and practice of the authorities.

Conceptual Framework Local Flood Management Knowledge Local knowledge is receiving increased attention from policy makers and academic researchers in various areas of environmental management, ranging from ecosystems assessment to biodiversity conservation (Fabricius, Scholes, & Cundill, 2006; Gadgil, Olsson, Berkes, & Folke, 2003; Huntington, 2000). According to the environmental management literature, local knowledge is held by groups of people with regard to their local ecosystems (Olsson & Folke, 2001) and is developed in their direct practical encounters with the ecological environment (Bruckmeier & Tovey, 2008; Lidskog, 1996; Morris-Oswald & Sinclair, 2005; Nygren, 1999; Pierotti & Wildcat, 2000). As a result, this knowledge reflects a relatively bounded domain of an ecosystem in detail, while having a weaker coverage of the processes taking place at broader spatial and temporal scales (Chalmers & Fabricius, 2007). Local knowledge develops in interaction within a local community and in its relationships with other stakeholders involved in environmental management (Olsson & Folke, 2001; Olsson, Folke, & Berkes, 2004). Specific patterns of interand intragroup interactions result in the emergence of community-specific systems of social understandings (Olsson & Folke, 2001) and meanings (Basov, De Nooy, & Nenko, 2019), reflecting the particular domain of a local environment (Fischer, 2000). Local knowledge, therefore, is not universal and what is considered environmentally hazardous in one local community may be not considered the same in another (Kronik, Verner, Mearns, & Norton, 2010; Puzyreva & de Vries, 2020). Once these systems of meanings become recognized by a local community as a relevant description of a particular aspect of the natural environment, emergent knowledge develops into a basis for action. It guides local environmental narratives and practices handling the physical world (Olsson et al., 2004). It also guides the way the local community further elaborates its understanding of the environment, focusing it on the problems that affect the community’s habitat most. Communities located in flood-prone areas produce, accumulate, and share local flood-related knowledge in order to cope with floods and protect their well-being. We define local flood management knowledge as a system of meanings a local

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community holds to describing flood management in its local environment. It is developed in interpersonal relationships within the community and its local natural environment and guides flood management activities of those who hold to it.

Engagement of Local Knowledge into Professional Flood Management Flood management is a complex endeavor no local community can handle on its own. Traditionally, flood management has been considered by the governments as a remit of professional technical knowledge and expertise. Professional knowledge is acquired through deliberate practice, training, and experience with environmental management (Ericsson, Hoffman, Kozbelt, & Williams, 2018), and developed in interaction with various professionals as well as in consultation with local communities (Fischer, 2000; Kronik et al., 2010; Olsson et al., 2004). The central agencies responsible for environmental planning and management are granted authority to aggregate local knowledge of diverse professional and nonprofessional groups (Drescher et al., 2013; Nowotny, 2003) in order to assess, define, and tackle environmental issues at the supralocal level (Agrawal, 1995; Fothergill, 2000). However, aggregated from and forwarded to different locales, professional knowledge is often limited in addressing flood risks specific to particular regions. Therefore, recent theory and practice suggest that flood management can benefit from encompassing knowledge of different stakeholders relevant to water-related insecurities (Lebel et al., 2010), including local knowledge of flood-prone communities. Three broad categories of reasons to account for local knowledge in the management of socioecological issues, such as floods, are articulated: ontological, axiological, and instrumental. The first group of reasons is associated with the ontological complexity of socioecological problems – their vast uncertainty, high stakes, and risks, as well as a variety of opinions about the problem and its possible solutions. Owing to this complexity, a mechanistic technocratic approach informed solely by scientific professional knowledge is considered insufficient for managing socioecological problems (Maxim & van der Sluijs, 2011). The society’s resilience and sustainability in front of the complex environmental issues is supposed to increase if the decision-making is informed by multiple knowledge systems (Cash et al., 2003; Fabricius et al., 2006; Raymond et al., 2010; Reid, Berkes, Wilbanks, & Capistrano, 2006). Local communities may have access to the information unavailable to central agencies (e.g., peculiarities of the socioecological context) (Bohensky & Maru, 2011), which can be used to bridge gaps in professional knowledge (Baker, 1992) if there are mechanisms allowing for incorporation of nonprofessional knowledge into the institutionalized system of expert decision-making (Nowotny, 2003). The necessity to employ local knowledge along with professional knowledge in flood management also has axiological grounding. Environmental management literature gives considerable attention to power imbalances between the two types of knowledge. Despite wide agreement on the necessity to engage different

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stakeholders and “knowledges” in the process of environmental decision-making, the authority of science and expertise, that inform professional knowledge, still holds relevant. Scientific knowledge is regarded as a benchmark to assess other types of knowledge. Considered objective and value-neutral, it guarantees political safety of decisions informed by scientific expertise (Douglas, 2013; Wisner, Blaikie, Blaikie, Cannon, & Davis, 2004). The lack of scientific expertise of local communities, however, should not ban their involvement in environmental decision-making. In democratic countries public involvement is considered a guarantor of social justice as it ensures the expression of interests and concerns of those groups that are supposed to adapt the decisions made by the professionals (Agrawal, 1995; Meinke et al., 2006). The engagement of local knowledge into flood management also has instrumental relevance, as it is seen to optimize the process of decision-making (Funtowicz & Ravetz, 1992). Participating in consultations, individuals and local community groups acquire greater awareness of current problems and policies in environmental management; opinions about policies become more consolidated and the level of objection to the proposed measures and costs of their realization decreases (Haque, Kolba, Morton, & Quinn, 2002; Morris-Oswald & Sinclair, 2005; Pearce & Warford, 1993). By holding public hearings and allowing public input, modifications can be made in the early stages of decision-making, leading to a compromise and ultimate acceptance of the redistribution of risks (Haque et al., 2002). Public consultations also allow decision-makers to check if the strategies and instruments used have reached their objectives in the social context they targeted (Kronik et al., 2010). Despite its importance, it is not easy to arrange the dialogue between local knowledge and professional knowledge. It involves new strategies, procedures, and requirements at each stage of the decision-making cycle. Where such strategies and procedures are absent, local knowledge becomes an essential, if not an ultimate, local community resource to prepare and protect itself from flood hazards.

Method To examine the ways flood-prone communities produce and utilize local knowledge to cope with adverse impacts of floods and counteract flood-related insecurities, the first author of this chapter conducted a two-month ethnographic case study of one rural settlement, located in the Volkhovsky District of Leningrad Oblast,1 Russia. Recurrent flood risk was the main criterion that informed the choice of this research site. The risk of flooding for the settlement was identified using reports by the Ministry of Civil Defence, Emergencies and Elimination of Consequences of Natural Disasters of Russian Federation, issued for Volkhovsky District of Leningrad Oblast. 1

The federal subject surrounding St Petersburg and named after the Soviet name of St Petersburg – “Leningrad.”

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Qualitative research design of the study relied on semi-structured interviews and observations. In-depth interviews lasting from one to two and a half hours were undertaken with 13 local residents. The interview questions were formulated as neutral as possible to not push informants’ narrative into researchers’ preconceived categories. The interviews were organized around three topics: flood risk in the area, actions taken before, during, and after the floods, interaction with local lead flood authorities and flood managers. Interviewees were recruited through snow-balling techniques accompanied with purposive sampling, based on permanence of prospective informants’ residence in the area. The observations registered how flood risk was reflected in the local landscape and material practices of the local residents. Data collection resulted in a corpus of textual and visual materials. Textual data were analyzed using ATLAS.ti software, supplemented with analysis of observation protocols. The constructivist strain of grounded theory was used to approach data analysis (Charmaz, 2006). This involved two phases of coding. In the first phase, interview transcripts were coded paragraph by paragraph, following the open coding technique (Saldaña, 2015). Analytical levels ranged from descriptive codes to potential analytical categories. After the initial cycle of coding, focused coding was conducted, which involved constant comparison of codes to codes, of codes to categories, and of categories to categories. As a result of categorization and reorganization, certain codes were merged, and higher-order analytical categories were created for further qualitative analysis.

Findings The Interactive Origin of Local Flood Management Knowledge The area under study is located on several islands formed by the mainstems and tributaries of the rivers Svir and Pasha, exposing local community to annual freshets. Freshets occur during springtime, when ice and snow start melting on the rivers. Freshets are an integral part of the local hydrologic regime. Their high frequency and repeatability leave an imprint on local residents’ attitudes to high water: Spring will come, and there will be water again. You see, every year we have problems getting into the house. You would need to use a boat to reach the porch, and you can only walk in rubber boots. (Local resident, male, 61 years, August 2015) Freshets vary in their intensity and velocity from year to year. During the ice drift, ice chunks often get clumped together, creating jams, increasing water levels and causing floods. Floods accompanied with ice jams can cause fast and severe damage to valuable possessions close to the riverbanks, such as boats, rafts, moorings, fences, and apiaries. Hence, while freshets are considered by the locals as somewhat of a cultural normalcy, flood – “the water in a wrong place” – is

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perceived as a force of nature, an inevitable element of living in the area, which, nevertheless, has to be dealt with to minimize its negative social and financial impacts on the local community. Through their daily interaction with the natural environment, local residents develop knowledge necessary to predict and assess flood risks. Spatially specific practices acquired and tested throughout life allow local residents to notice environmental clues, often unremarkable for people new to the local context. A local beekeeper recalls: Climate becomes milder. This year, I have noticed, the bees made their first round before the 8th of March. It is too early; it has never happened before. There is no ice on the river, no snow, it is changing. (Local resident, male, 70 years, August 2015) These subtle environmental clues related to each other within local meaning systems create the basis on which people make sense of their environments and help reduce flood-associated uncertainties. Local residents’ purposeful and unintentional observations of the natural and sociotechnical environment contribute to local knowledge encompassing detailed information about normal and excessive water levels, spatial distribution of flood risks in the area, as well as locally induced changes to the environment, prompted by transformations of social and economic activities that may serve as antecedent conditions for flooding. For example, the locals report that log driving and shipping that were once the backbone of economic activity in the settlement had been contributing to the riverbed dredging. Ceased river traffic decreased river dredging and resulted in the accumulation of sediments and debris, making riverbeds shallower hence, increasing water levels. Local knowledge emerges in local residents’ interaction with the local environment as well as in the interpersonal interactions. The local practices of “living with the water” are often grounded in historical experience and appropriated from previous generations. Examples include: I remember my father making decking. He would throw the logs and then add planks on the top. Then again, when water rises, he would add more logs and lift up the decking, and when the water is gone, he would dismantle it. We have always had decking and gangplanks and still do. Here you just cannot do without them. (Local resident, male, 66 years, September 2015) Specific ways of accommodating water and flood risk in daily life are also transmitted through oral storytelling and reproduction of practices among the local residents. One informant recalls: I was digging up the whole plot last autumn and then, the next year the flood came, and it was all devastated. I put so much effort, I did it all myself and it was all flooded at once. And then I learned

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Kseniia Puzyreva and Nikita Basov that locals, because they live here for a long time, adapted to the water with their crazy ditches. There is something, some sense in these ditches … And when I started recovering the garden, I dug these ditches, like they do. And it all worked well. (Summer resident, female, 71 years, August 2015)

Through interaction, local residents verbally and nonverbally share their expertise and insights, deepen their knowledge of the problem, and improve coping strategies.

Local Knowledge and Community Adaptation to Flood Risk Local knowledge is both defined and defines people’s daily practices and ways of living. The knowledge of frequencies, causes, and relative velocity of annual freshets, excessive water levels, and their spatial coverage guide local farming and house construction practices. Old houses that still contain watermarks of previous floods serve the baselines for construction of new buildings. In the settlement, new houses are most often built on piles, lifting the ground floor almost to the level of the first floor (Observation, September 2015) to protect furniture and valuables from potential inundation. The adjustments to the water behavior are also evident in the organization of allotments in low-lying parts of the village. Old houses adjoining the riverbanks are surrounded by deep drainage ditches used to stop water coming to the properties. The access to the properties is provided through gangplanks – bridgelike structures over the ditches. Here is the beyshlot … When you buy the land here, you are told to not to do anything with the beyshlot. We have gangplanks here to cross it over, because you are not allowed to fill it up, that’s why. (Local resident, female, 71 years, August 2015) The potential of local knowledge to inform adaptation practices becomes particularly revealing when such knowledge is either absent or neglected. The failure to account for contextual specificities and local water geography of the settlement in people’s mundane activities reflects social heterogeneity – a symbolically loaded distinction between those who have local knowledge and those who have not. The investigated rural settlement demonstrates a strict division of residents into two groups: local residents – those who live in the village permanently – and cottagers – people who come to the village in summertime to spend vacations. Owing to a limited contact with local residents and the material setting, cottagers lack corresponding knowledge and often find themselves in disadvantage when it comes to flood protection and preparedness. One of the interviewees points out: Locals, they have their own land cultivation techniques. Each year they dig up the whole plot and make a surrounding ditch to regulate water levels. They do this specifically in case of high

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water. Cottagers know nothing about this. We knew nothing. We bought a house, an old one, and decided to reconstruct the porch […] it was ok, but then it all started to sag and collapse. I mean, nothing should be cemented here, also because of the groundwater levels. You either build on piles or on the wooden floater, like locals do. (Summer resident, female, 71 years, August 2015) Local knowledge finds its implementation both in preparedness measures and community response to flooding. Knowledge of places, properties, and people at greater risk results in local residents self-organizing for rapid resolution of applied tasks during and after the flood. The tasks range from attempts to save possessions, e.g., pulling the boats ashore, to evacuation of disabled and elderly from flood-prone areas: “Why would one not help an elderly person? My neighbour helped me get my wife and mother-in-law out of here by car” (Local resident, male, 63 years, August 2015). In emergency situations, such as flooding, local knowledge guides local practices of handling the physical world and influences the way the local community responds to and prepares for future threats.

Disregard of Local Flood Management Knowledge Local communities can build detailed knowledge of the problems that affect their habitat most. Through day-to-day interaction with their local environments and each other, Russian flood-prone community develops local knowledge of water courses, antecedent conditions for floods, and geographical distribution of flood risks at the level and scale necessary for them to prepare for and cope with future calamities. Qualitative knowledge of hydrological properties of flooding and their interaction with other socioenvironmental factors acquired through repeating observation and supported by historical evidence represent a useful resource for potentially bridging the gaps in professional flood management knowledge. Literature and practice suggest that acknowledgment and accommodation of local knowledge in flood management practice may enhance professional flood assessment, mapping, and modeling – and hence result in more accurate and context-sensitive flood management solutions (McEwen & Jones, 2012). Present research, however, reveals limited engagement of local knowledge in professional flood management in the settlement. One of the factors that largely contributes to the lack of a dialogue between the locals and professionals is the local residents’ mistrust in the authorities and agencies responsible for flood management in the area. Local authorities’ inability to support local residents’ recovery from previous floods and inattentiveness to the local concerns triggers aggravation and conflict. One informant recalls: There was a meeting after the flood, I went there, and I don’t even want to mention it. They won’t listen to what they are told. It was in the community center, and they do not hear a thing. You ask a

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Kseniia Puzyreva and Nikita Basov question and they keep telling you about their reports and records, what they have done and what has been achieved. (Local resident, female, 57 years, August 2015)

The local residents’ dissatisfaction with local authorities is not limited to the official response to flooding but is related to other issues of communal well-being. Based on the earlier unsuccessful experience of collaboration with the authorities, e.g., on the maintenance of roads and other infrastructure, residents develop attitudes of disbelief and apathy toward working in a partnership with a local authority: Nobody cares. We had a lamp post where the lamp went off. We bought a lamp, came to the local administration and asked to call for an electrician. They told us we distract them from important matters, the bridge and the roads. Have you seen the bridge? It is nonsense. There were several projects of the bridge, I have seen them. There was a very good one, but they opted for the cheapest and we got this. They are not interested; they just don’t care. (Local resident, female, 71, August 2015) The lack of a dialogue between the professionals and the locals results in local knowledge remaining tacit and unacknowledged. This leaves the creation and accumulation of local knowledge reliant on residents’ performative practices and daily interpersonal interactions. Meanwhile, the changes in economic activities of the settlement influence its sociodemographic outline: the lack of jobs and resources forces local residents to move to urban areas. As the number of residents in the settlement drops, the continuity of local adaptation practices becomes disrupted and local knowledge gets subject to loss.

Conclusion This chapter examined how in the situation of an institutional void, Russian communities accumulate local knowledge to prepare and protect themselves from adverse impacts of flood hazards. The data were collected during a two-month ethnographic study of a rural settlement in the Volkhov District of Leningrad Oblast, using semi-structured interviews and observations converted into textual data for qualitative analysis. The findings suggest that flood-related knowledge of Russian rural settlements is an axiomatic tacit knowledge acquired performatively, rather than deliberately. It is developed in close and continuous interaction between people and their local environments, enhanced through local practices and rooted in historical evidence. Developed into a stable system of meanings, local knowledge molds local practices of living with water-related uncertainties. Albeit local residents may not necessarily recognize their knowledge as an asset, it allows individual households and communities to withstand floods and return to “normal” pre-event functioning relatively quickly, thus

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making them more resilient to adversities (Whittle et al., 2010). We also found that despite the recent shifts toward recognizing the value of local flood management knowledge both in the literature and in the Russian water management program documents, establishment of a dialogue between local communities and flood professionals has proven difficult. Meanwhile, knowledge of water flows, antecedent factors of flooding, its spatial coverage, the most vulnerable households and social activities that contribute to flood risks can improve local applicability of professional knowledge. On the contrary, disregard of local knowledge in flood management may have a twofold effect. First, the information that could potentially enhance professional knowledge is likely to be missed. The resultant one-fits-all solutions, often inattentive to the peculiarities of the local environments, are likely to be less efficient and effective in protecting local communities from floods than decisions tailored for the specifics of the local socioecological contexts. Second, left unrecognized and neglected, local flood-related knowledge may be lost. Unrecorded local knowledge acquired performatively is likely to dissipate where local residents and their recurrent practices of engaging with the local environments get replaced by intermittent summer visits as knowledge networks get disrupted. While the relationship between local and professional knowledge is complicated and effective dialogue requires deep restructuring of the governance system, the engagement of local knowledge in flood management is likely to give flood authorities and practitioners a chance to manage flood risks more effectively. It would also contribute to empowerment of the local communities, making them more resilient toward the increasing flood risk.

Acknowledgments This research was supported by the Russian Science Foundation (project No. 19-1800394, “Creation of knowledge on ecological hazards in Russian and European local communities”). The authors express their gratitude to Anisya Khokhlova and Daniil Voloshin for their help in data collection and analysis, and Alexander Pivovarov for conceptual discussions on the notions of local and professional knowledge.

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Chapter 3

Financial Implications of Natural Disasters: A Case Study of Floods in Pakistan Vivake Anand, Kinza Yousfani and Jianhua Zhang

Abstract Natural disasters occur all around the world, in the last two decades these natural disasters have brought sever damages to the world economy. Mostly developing countries bear severe consequences due to these natural disasters. In July 2010, Pakistan faced a massive flood, which affected almost all the countries. The disaster affected all sectors like daily life, transportation, infrastructure, etc., of the country. GOP did not have enough resources to cope with this giant disaster and called for international help. Local and international NGOs participated with GOP in the early phases of recovery. Millions of dollars were given away as the initial impact of this disaster, and GOP and other relief agents have spent other million to provide initial recovery and relief. GOP will need billions of dollars further to continue recovery from the disaster of 2010. Keywords: Natural disaster; management techniques; social safety; GOP; Financial implication; economic impact

Introduction Natural disasters are a divine phenomenon, and no human or technology can prevent the occurrence of these natural disasters. Though the effects and impacts of natural disasters can be minimized through proper disaster management techniques (O’Brien, O’Keefe, Rose, & Wisner, 2006). In the last two decades, the frequency of natural disasters has increased. And, this increased frequency of natural disasters has urged the nations to inject millions of dollars in disaster management techniques (EM-DAT, 2011). Despite the continuous improvement in disaster management techniques, financial losses and economic impacts of these natural disasters are very gigantic. When a natural disaster strikes a nation/region, it brings huge initial financial losses, affecting daily life. If the disaster is not International Case Studies in the Management of Disasters, 61–97 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201005

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managed properly, it can leave an ongoing impact on the economic development of the region (O’Brien et al., 2006). Impacts of natural disasters vary from country to country and type of disaster, depending upon the country’s ability to recover from that disaster. In more developed countries (MDCs), natural disasters cause heavy initial financial losses, but routine life and economic development are less affected, while similar disasters in less developed countries (LDCs) can affect both the financial stability of the country and economic performance (Noy, 2009; Otero & Marti, 1995). In July 2010, Pakistan faced a huge natural disaster in the history of the country. It was flooding, which started in the upper areas of Khyber Pakhtoon Khuwa (KPK) as a result of heavy monsoon rain and flowed to lower areas of Sindh where excess water met into the Arabian Sea. This natural disaster affected the almost whole country. The floodwater flew in almost all four provinces of Pakistan, and 78 out of 143 districts were severely affected. About 20.8 million people faced difficulty in conducting their daily life activities (Table 3.1). Pakistan is a developing country, that lacks proper resources, and the political situation of Pakistan has been very unstable since its independence in 1947 (Quarantelli, 1988; Mufto, 2010). Pakistan has always lacked a responsible institute, responsible for dealing with disasters. After the earthquake of 2005, the government of Pakistan (GOP) thought to build such an institute. By 2007, an institute named National Disaster Management Authority (NDMA) was developed. And, now this institute is responsible for handling all kinds of disasters. Non-governmental organizations (NGOs) and other humanitarians nowadays are very active especially in developing countries to provide support to locals. And these institutions play an important role while a country or nation is facing difficulties like natural disasters According to O’Brien et al. (2006), natural disasters incur more losses in developing countries. This chapter is carried out to find out the initial financial and economic losses due to the natural disaster of 2010 in Pakistan, and to understand the disaster management policies adopted by the GOP and other humanitarians (i.e., local and international NGOs). This chapter emphasis much on financial and economic costs associated with the flood, 2010 in Pakistan.

Table 3.1. Summary of Natural Disasters Faced by Pakistan from 1947 to 2009. Disaster

Storm Earthquake Flood Droughts Others Total

Frequency

Numbers of People Killed

Total Loss (US$, 000)

23 24 71 01 33 152

11,896 78,978 12,753 223 2,316 106,086

1,635,036 5,229,755 2,968,178 247,000 – 10,079,969

Source: EM-DAT, Emergency Events Database (2011).

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To develop a better understanding of overall financial losses, this chapter emphasizes calculating the financial worth of the commodities destroyed and commodities provided by the GOP and other relief agents to the victims of the disaster in Pakistan. The overall aim and objectives of this chapter are given below. To achieve this aim, this chapter is divided into three objectives.

The Objective of the Study To understand the financial and economic impacts of a natural disaster of 2010 in Pakistan, and disaster management techniques obtained in Pakistan; by both GOP and other humanitarians, to recover from the disaster. Based on this broad aim, this chapter is divided into three parts, and three different objectives are developed to achieve this aim. The first objective is about initial financial and economic losses caused by the disaster of 2010 in Pakistan. To achieve this objective, financial value of the destroyed assets will be calculated and to see the short-term economic impacts data from the local market will be assessed. The other two objectives of this chapter are about the disaster management policies adopted by the GOP and local and international NGOs. Three objectives of this chapter are given below: (1) To analyze the financial losses and economic impacts of the disaster of 2010 in Pakistan (2) To understand the disaster management policies adopted by the GOP to recover from this disaster (3) To understand the role played by the NGOs (local and international) during the disaster 2010 in Pakistan.

Literature Review Introduction Natural disasters occur all over the world, and it is impossible to prevent natural disasters (Fomby, Ikeda, & Loayza, 2009). These disasters come along with huge financial and economic losses. Natural disasters mostly cause damages to human lives, basic infrastructures, and affect the economic development of the country (Loayza, Olaberria, Rigolini, & Christiaensen, 2009). No country can prevent itself from the initial impacts of natural disasters, but the long-run impacts of natural disasters can be minimized through proper disaster management techniques (O’Brien et al., 2006). Long-term economic impacts of disaster vary from country to country and disaster to disasters. In MDCs, disasters cause more initial financial losses, while LDCs suffer from both initial financial losses and loss of human lives. LDCs also face difficulties in carrying economic policies after the disasters, because they lack resources and disaster management activities. NGOs and other international humanitarians play a key role in providing initial relief after the disasters in LDCs.

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Financial Implication of Disasters (Around the World) Centre of Research on the Epidemiology of Disaster (CRED) has reported an increase in frequency and severity of disaster in the last decade, and disasters cause physical and economic damages, which may jeopardize the economic growth of a country (Loayza et al., 2009). Also, in recent years, financial costs associated with natural disasters have increased substantially (EM-DAT, 2011). The Table 3.2 suggests that in the 1960s, when technology was not in the boom, and less consideration was given to natural disaster management, average financial losses due to the disasters were US$ 4.9 billion. As more awareness about natural disasters increased and governments started to inject money in disaster management, these countries became more financially and economically vulnerable to a natural disaster (Rao, 2007). As from Table 3.2, it can be seen that in the 1970s the total amount raised to US$ 9.5 billion, in the 1980s, it was further higher; average economic loss in this decade was up to US$ 15.5 billion. 1995, the year of Kobe earth quack, caused a loss of US$ 191 billion in one year, it was the highest financial loss recorded due to disasters. The second economic highest loss was recorded in 1998 when most parts of the world (Russia, United States, Netherlands, China, etc.) were facing a series of disasters; estimated financial losses this year were about US$ 105 billion (EM-DAT, 2011). In the last decade, the world has suffered a financial loss of approximately US$ 986 billion due to disasters. In the same period, only Pakistan has given up the productive capital worth of US$ 77.8 billion due to natural disasters (IFRC, 2010). According to CRED, disasters cause more deaths and less financial losses in LDCs, while developed countries are more financially affected and suffer fewer human losses (EM-DAT, 2011). With the adaption of new advanced technologies and putting more efforts into human security, advanced countries (like the United States, United Kingdom, etc.) somehow have managed to reduce human loss due to natural disasters, but initial financial losses in these are much higher (O’Brien et al., 2006). Benson and Clay (2000) in their studies found that, as the countries are being more developed, they are being more vulnerable to the financial costs of

Table 3.2. Financial Losses due to Natural Disasters Around the World. Year

Average Financial Losses Across the World (US $ Billions)

1960–1969 1970–1979 1980–1989 1990–1999 2000–2009 2010–2011 Source: Benson and Clay (2004) and EM-DAT (2011).

4.9 9.5 15.5 699 986 378

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disasters, while LDCs (like Pakistan) suffer huge costs, both in terms of human lives and financial and economic losses (Table 3.3). From 2000 to 2010, estimated financial loss due to disasters in LDCs was about US$ 97.6 billion, while developed countries accounted for a financial loss of $ 564.8 billion in the same decade. The total number of people killed in LCDs is about 10 times higher than in MDCs. These losses are very huge and can cause considerable damage to the world economy. The figures mentioned above are not total costs suffered by the world due to disasters. These amounts just indicate initial and direct material capital (buildings, machinery, livestocks, etc.) losses. The actual costs associated with natural disasters go beyond these initial costs and include indirect and secondary costs like loss of businesses, costs associated with recovery, and rise in commodity prices due to shortage of production and supply (Chhibber & Laajaj, 2007).

Financial Implications of Disasters (Pakistan) Geographically Pakistan is very prone to natural disasters (Ahmed, Malik, Ramay, Munawwar, & Pervaiz, 2011). Since its independence in 1947, until 2009, Pakistan has faced 152 different disasters and lost approximately US$10.76 billion as initial financial losses. These disasters have caused 106,286 human deaths. Table 3.4 contains a summary of natural disasters in Pakistan. In 2005, Pakistan suffered from one of the biggest natural disasters in the history of the country. Almost all areas of the country were severely affected by the earthquake in 2005. Approximately US$ 2.2 billion were recorded as initial direct financial losses and about US$ 0.5 billion were recorded as indirect losses. 73,338 people lost their lives and about 42,658 were injured due to this disaster (Phister Jr et al., 2009). The housing sector was severely hit by this disaster, approximately 203,579 houses were destroyed and 196,574 were damaged, leaving behind 2.8 billion people homeless. Damages to the house accounted for US$ 1.03 billion. Education, transportation, and livestock and agricultural sectors were also hard hit. Approximate losses to these sectors are US$ 355 million, US$ 340 million, and US$ 218 million, respectively (ADB and WB, 2005). These are not the total financial losses caused by the earthquake of 2005 in Pakistan. Financial

Table 3.3. Financial and Human Losses (2000–2010).

More developed countries Less developed/developing countries Total Source: IFRC (2010) and EM-DAT (2011).

Financial Losses (US $ Billions)

Human Died

564.8 97.6

106,759 1,067,586

662.4

1,174,345

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Table 3.4. Natural Disasters in Pakistan (1947–2009). Disaster

Storm Earthquake Flood Droughts Others Total

Frequency

Numbers of People Killed

Total Loss (US$, 000)

23 24 71 01 33 152

11,896 78,978 12,753 223 2,316 106,086

1,635,036 5,229,755 2,968,178 247,000 – 10,079,969

Source: EM-DAT (2011).

impacts exceeded much more than these initial losses. After the disaster, the GOP spent about US$ 3.5 billion to provide relief and early recovery. Table 3.5 contains a summary of direct and indirect financial losses in different sectors and relief/compensation provided by the GOP and other humanitarians. All these direct and indirect costs, if not managed properly, can leave a negative impact on the economic growth of a country (Cavallo & Noy, 2009). One major economic impact of disasters is that the conduct of economic policies is affected from short to long run depending upon the country’s ability to recover and disaster type. Like in Pakistan after the disaster of 2005, all development works were left in the

Table 3.5. Total Losses and Relief Costs (Pakistan Earthquake 2005). Sector

Housing Health Education Environment Public administration Transportation Water and sanitation Irrigation Energy power and fuel Agriculture and livestock Industry and services Total Source: ADB and WB (2005).

Direct Damages

Indirect Damages

Cost of Relief Provided

1,030.6 119.76 335.35 0.202 50.01 339.47 19.61 5.45 12.52 217.72

121.51 23.1 69.57 – 11.56 68.36 – – 26.27 113.97

1,552 303 472 151 72 416 32 10 40 300

144.41 2,275.18

141.06 575.4

155 3,503

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middle and most of the country’s resources were diverted to disaster-affected areas, and the rehabilitation process continued for three years (Humanity., 2008). When a developing country like Pakistan faces a disaster, emergency actions taken by the country disturb the current economic policies and long-term growth. LDCs mostly have fewer resources, low gross domestic product (GDP), and low per capita income, in times of emergency it utilizes most of its resources in dealing with those disaster and productive actions and financial policies are affected in the medium term. In some cases, country’s national priorities suffer and development policies are altered that leave an adverse effect on the country’s long-term economic growth. Depending on the economic position of the country before the disaster, it may require help from neighboring countries and may lend some money. Loss of productive capital due to disasters and the burden of extra loans to recover from a disaster can cause inflation and devaluation in the currency of the victim country (Otero & Marti, 1995).

Economic Implications of Disasters Full economic impacts of the disaster are much higher than just direct financial costs of disasters; these impacts can be measured after a few years of disaster occurrence (Benson & Clay, 2000). To minimize the economic impact of natural disasters in a country, policymakers need to understand the economic costs related to natural disasters. With the increasing frequency of natural disasters and huge financial costs associated with them, the relationship of disasters to the economic growth of the country has been a topic of concern for policymakers within the country (Kousky & Bank, 2009). So, various studies have been conducted to understand the economic impacts of natural disasters on the countries around the world. As expected, most of the studies have concluded negative impacts of disasters on economic growth, For instance, Auffert (2003) studied the impacts of natural disasters on microeconomic variables (production, public and private consumption, investment, and external balance) of 16 countries (6 from Caribbean and 10 from Latin America). In his paper, he mentioned that natural disaster causes a disturbance in the conduct of regular operations of the country and leave an adverse effect on microeconomic variables. His paper suggests that there is an inverse relationship between natural disasters and the performance of microeconomic variables. The more the economy is prone to natural disasters, the more difficult it will face in development due to the regular occurrence of disasters. On the other hand, Rasmussen (2004) used a cross-country sample on the Eastern Caribbean Currency Union (ECCU) from 1970 to 2002 to understand the economic impact of natural disasters. He found that natural disasters cause a reduction in the median by 2.2% of same year GDP growth, and an increase in public debt and current account deficit. In ECCU, when a natural disaster strikes a country, the government of that country mostly borrow funds from other countries to carry rescue and relief operations. These additional borrowed loans create an extra burden on the country, to be paid in shape if interest for many years and the current account of the country shows a negative flow of funds for

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many years after the disaster. In 2007, Raddatz studied the impact of disasters on low-income countries, he chose a sample of 40 countries from the period of 1956–1997. To get a better insight on the economic impact of disasters, he divided natural disasters into two groups; climate disasters (floods, droughts, global warming, etc.) and geological disasters (earthquakes, volcanoes, asteroids, etc.) and found that climate disasters only cause 2 percent decrease in real per capita GDP in the year following the disaster, while geological disasters had an insignificant effect on real GDP per capita. According to his findings, though the disaster causes the initial losses, long-term economic impacts depend upon the strength of government and its response to disasters. In his paper, he mentioned that the growth and output level of a country is much affected by the internal causes (recovery and disaster management), after the disaster, rather than the disaster itself. To understand the long-term economic impacts of natural disasters, Toya and Skidmore (2007) used a database of natural disasters from 151 countries over the period of 1960–2003. They divided the data into two parts; human life loss and economic damages, caused by the disasters. They found that deaths and damaged were much higher in countries with less educational attainment, less developed financial sector, and less open economy. They argued that developing countries do not carry disaster management tasks properly. This results in a loss of an adequate amount of money and also loss of human lives. Noy (2009) also found negative impacts of natural disasters on economic growth. He found that countries with low per capita income and less GDP are more affected in terms of output, and their growth and financial strength are weakened due to disasters. While countries with the better institution, higher level of government spending, and more foreign exchange reserves are better able to bear the initial impacts as well as secondary impacts of disasters, they have enough resources to cope with disasters and face the recovery phase in short run. But their conduct of economic and financial policies is disturbed for a time being, and by the mid-term range (usually from three to five years) they stabilize themselves (Noy, 2009; O’Brien et al., 2006). However, other studies found no or positive indirect impacts of natural disasters on economic development. Similarly, Caselli and Malhotra (2004) examined the short-run impacts of natural disasters on 172 countries from 1975 to 1996 using the Solow growth theory. They found that the sudden loss of laborers and capital due to natural disasters does not bring any change in the economic growth of a country. They argue that disasters do decrease the output, but on the same hand, human capital is lost. Thus, the ratio of productive capital to the labor force is unchanged or there are very minor changes. Thus, the loss of human capital and GDP balances each other and GDP per capita remains almost the same. In 2007, Jaramillo presented a broad modal of the relationship between natural disasters and economic growth, both in the short and long run. He studied disaster data from 113 countries from 1960 to 1996. He found that results vary from a 0.6% increase to a 0.9% decrease in economic growth depending upon disaster type. His categorization of the disaster was also based on climate and geological disasters. His results resembled the results found by Raddatz (2007). His paper suggests that short- and long-term effects of disasters depend upon the country’s ability to

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respond and type of disaster. According to him, climate disaster can cause an economy to boost if managed properly. They said that climate disasters like a flood can cause better productivity from land and can increase GDP for agricultural countries like Pakistan. To study the long-run impacts of natural disasters on economic growth, Skidmore and Toya (2002) also categorized natural disasters in two different groups, climate disasters and geologic disasters. They also found that climate disasters have a positive relationship with economic growth. They argued that climate disasters are easier to predict due to their regular pattern of occurrence. Therefore, there is less threat and human lives can be saved by predisaster programs. Mostly, property and physical capital are damaged by climate disasters. Replacing that with new and improved technology can bring improvement in total productivity. While geologic disasters are hard to predict and require more effort to recover, due to their unpredictive nature human lives and physical property are badly affected, and this type of disaster decreases economic growth in the long run. It is possible that in the short run GDP of a country increases immediately after a disaster strikes, the fact behind this is, durable goods and capital stocks are mostly affected by the disasters, and these are not measured in GDP. Hence, this results in higher GDP immediately after a disaster (Otero & Marti, 1995; Skidmore & Toya, 2002). It is generally believed that disasters harm the long-run growth of the economy. Disasters destroy natural resources, farming, fishing, agriculture, and other resources of the country. Rebuilding these resources needs a lot of capital investment and may cause inflation or financial crises. Inflation and financial crises lead to a decrease in growth in the long run (Benson & Clay, 2004). Long-run effects of disasters are difficult to predict because the growth of a country depends on how it recovers from disasters, depending upon available resources and use of these resources. A disaster in some small areas of a big economy has very little impact on its growth. But, the same disaster in a small country can have adverse effects on its growth (Auffret, 2003; Popp, 2006). From the above discussion, it can be concluded that natural disasters bring with them huge initial losses. The extent of these losses depends upon the countries policies and preplanned strategies to deal with disasters. The long-run economic impacts of natural disasters also depend upon the strength of countries’ resources and disaster management policies adopted by them (Kellenberg & Mobarak, 2008).

Disaster Management Techniques With the increase in the frequency of natural disasters, almost all the countries of the world are implementing disaster management practices in their social and economic development goals (Garatwa & Bollin, 2002; Underwood, 2010). The basic idea behind investing in disaster management techniques is that these investments will, at least, save human lives and mitigate long-term economic impacts of natural disasters. With the improvement in technology, disaster management techniques have also been changed from old postdisaster activities to more efficient predisaster planning and strategies (Paton & Jackson, 2002).

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The disaster management techniques vary from country to country, depending upon wealth and resources available to the country. For example, United States and Japan use more advanced technological tools to predict and re-act to disasters, while countries like Pakistan depend upon the help and support from others to carry postdisaster strategies (Rao, 2007; Simon & Teperman, 2001). No matter how countries plan to manage disaster, all these techniques revolve around four main phases of disaster management (Table 3.6). Despite the creation of FFC and spending millions of dollars, GOP always lacked in providing full relief to victims in case of emergencies. The reason behind this failure is, GOP always used to have two prolonged strategies for flood management. These strategies were structural and nonstructural and lacked a national policy framework. When FFC was established, it was considered to be national, but when provincial governments took the charge, polices of FFC varied from province to province (NDMA, 2011). Also, FFC considered disaster management and risk reduction isolated from national development and poverty alleviation programs (Ahmed et al., 2011). FFC seemed to carry only postdisaster activities and Pakistan again lacked an institutional framework for disaster management that could visualize the long-term picture of natural disasters.

Table 3.6. Summary of Federal Investments in Flood Protection Projects (1979–2010). Flood Plan/Program

NFPP-I (1978–1988) NFPP-II 1988 – Flood Damage Restoration Project 1992 – Flood Damage Restoration Project 1994–1996 Prime Minister’s River Management Program NFPP-III (1998–2008) Flood Protection Sector Project Japanese Grant 2008–2010 Emergent Flood Works Total Source: FFC (2010).

Location

Amount Spent (US $ Millions)

Throughout the country Throughout the country Sindh, Punjab, Baluchistan, and KPK Throughout the country

21.08 69.08 22.85

Sindh and Punjab

7.47

Throughout the country Sindh, Punjab, Baluchistan, and KPK Punjab (district Rawalpindi) Throughout the country

51.12 50.79

–

81.21

4.25 10.89 318.74

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Since 1955–2003, GOP has prepared different development plans. These plans were issued every five years. However, these plans were not specially about disaster management, but they did help in understanding the importance of proper disaster management. These plans identified that the country is lacking in water resources and operating with poor infrastructure, power, and health management, and some there are threats of floods in some parts of the country. These plans also help in identifying that governments’ approach to natural disaster is either event-based or relief drove (Khan & Khan, 2008; NDMA, 2011). Table 3.7 contains a summary of these plans.

Table 3.7. Summary of Five-year Development Plans (1955–2003). Plan

Time

Area/Sector of Focus

First Five-year Plan

1955–1960

Second Five-year Plan

1960–1965

Third Five-year Plan

1965–1970

Fourth Five-year Plan

1970–1975

Fifth Five-year Plan Sixth Five-year Plan

1979–1983 1983–1988

Seventh Five-year Plan

1988–1993

Eighth Five-year Plan

1993–1998

Ninth Five-year Plan

1998–2003

No disaster management program focus on the strengthening of the agricultural sector development of water resources, transportation No issues regarding disaster management development of hydro electro power Continued the activities from first- and second-year plans Flood control program (special focus on east Pakistan) Protection from malaria, development of the health sector No significant long-term projects The emphasis in agricultural development. No disaster management issues Protection of 5.3 million acres of land, including disaster area of 2.8 million acres Initiating environmental impact assessment (EIA) Water resource development. No issue regarding disaster management Again neglected disaster management, although the country had suffered huge losses in 2001 from floods and landslides

Source: Khan & Khan (2008).

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In late 2003, the GOP decided to assign task forces to carry out the emergency task and respond to disasters. However, this action of the GOP was not well appreciated by the federal government, and only 122 emergency rescue service teams were created in Punjab. These forces were also prepared to carry only postdisaster activities (Madiwale, Holdsworth, & Virk, 2011). After the launch of the United Nation’s international strategy for disaster reduction in 2000, GOP realized that being prepared for postdisaster activities is important but is not enough to carry on development tasks. To continue and boost economic development, it is essential that proactive measures to natural disasters should be taken, which can help in reducing the risk associated with disasters and can identify basic causes of disasters and address their vulnerability (Careem, De Silva, De Silva, Raschid, & Weerawarana, 2006). In 2005, the World Conference on Disaster Management was held in Japan. The conference aimed to urge all the nations to take initiative to establish a suitable, legal framework that must be capable of reducing disaster risk in a hostile and scientific manner. Pakistan also attended the conference and planned to develop an institution by 2009. In 2005, Pakistan faced an earthquake, which exposed the inefficiencies of existing institutions working on disaster management. This catastrophe worked as a wakeup call for GOP. After the earthquake, GOP immediately developed a federal relief commission (FRC) and earthquake reconstruction and rehabilitation authority (ERRA), to carry immediate rescue operations and ensure renovation in affected areas. These institutes were established only to work for the earthquake in affected areas. The federal government then realized the need for an institute that can carry a wide range of disaster risk reduction activities at the national level. Based on these needs, on February 1, 2006, the federal government sent a proposal to the prime minister of Pakistan to establish a national institute for disaster management. After the approval from the prime minister, the federal government promulgated the establishment of the national disaster management commission and NDMA in February 2007. These institutes are now responsible for dealing with all kinds of disasters within Pakistan. Following the federal government, provincial and district governments also announced the establishment of provincial disaster management authority and district disaster management authority, respectively (Khan & Khan, 2008; NDMA, 2011). NDMA and all preceding authorities were developed under the national disaster management ordinance 2006, now known as the national disaster management act (NDM act 2010). The act provides a detailed institutional framework to carry predisaster, during, and postdisaster activities. This act suggests that NDMA is leading the agency to implement and monitor disaster management activities performed at the province and district level.

The Response of the Pakistan Government to the Earthquake of 2005 In 2003, GOP had set task forces to help the government to conduct postdisaster activities. After the earthquake of 2005, communication transmission was destroyed and affected areas were far difficult to reach. GOP called the help of the

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military and assigned task forces to reach and evacuate the victims. Approximately 125 national and international helicopters were brought in by the military to conduct rescue and relief operations. President and prime ministers visited the affected areas right after the occurrence of the disaster (ADB and WB, 2005). GOP established a fund (named President Fund) to collect financial support from other parts of countries. The amount being collecting through this fund was fully allocated to mobilize relief efforts. The Prime minister was very concerned about the relief phase of this disaster and he appointed a relief coordinator with FRC, to relieve activities that are performed properly. The relief coordinator was also made responsible to make sure that every victim has access to shelter, clean drinking water, food, and medication. ERRA was also set up, to repair and reconstruct basic infrastructure including roads, schools, hospitals, bridges, etc. GOP established a tent village for the victims. This village was given all the facilities for daily life. GOP also announced a compensation scheme. According to this scheme, PKR 100,000 (US$ 1,220) was given to those families who have lost their member and PKR 50,000 (US$ 610) were to be given to those individuals who have caught major physical injury or lost any body part due to earthquake and PKR 25,000 (US$ 305) for those who have suffered from a minor injury. According to this scheme maximum amount to be allocated to a single family was PKR 500,000 (US$ 6,100).

Research Methodology and Design This section starts with justifying carrying this research and developing research questions to achieve the research objective.

Research Justification CRED has reported an increase in the frequency of natural disasters in the last two decades (EM-DAT, 2011). These natural disasters incur huge financial losses and leave ongoing economic impacts. Study about the consequences of natural disasters is of much interest nowadays, because countries all around the world are putting more efforts and investing millions of dollars in disaster management techniques. Although natural disasters occur all over the world, the reason Pakistan was chosen is that Pakistan is an agricultural country and climate disasters (like a flood) can put direct economic impacts (both negative and positive) on the development of the country depending upon disaster management policies used (Toya & Skidmore, 2007). Furthermore, the political conditions of Pakistan have been very unstable so disaster management has always been neglected by the GOP (Makamaka, 2010; Shamsie, 2010). Through this study, the researcher wanted to analyze that despite unstable political conditions, how GOP managed this disaster. The researcher was also one of the victims of this disaster, so to analyze the overall impact on the country was one of the personal interests of the researcher.

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Research Questions Based on the literature review and keeping research objectives in mind following research questions were developed. (1) What were the financial and economic impacts of the natural disaster of 2010, in Pakistan? (2) To what extent did NGOs (both local and international) participate in the recovery from the disaster of 2010? (3) What were the disaster management techniques adopted by the Pakistan government to recover from the disaster?

Research Design Research design explains the type of study and priorities of the researcher. Bryman and Bell (2011) have identified five different research designs. Table 3.8 lists these five research designs and provides a brief introduction to these designs.

Case Study Design This research is based on the case study design; through this study, the researcher is willing to access the impacts of a natural disaster of 2010, in Pakistan, and highlight the response of government and other institutes to that disaster. Case study design fits best with the requirement of the researcher. As, the case study design is about the careful study of a particular event (flood, 2010 in this research) regarding a specific object (Pakistan). According to Bryman and Bell (2011), a case can be anything, for example, a particular location, specific organization, individual, or an event, and the researcher is interested in elucidating the unique feature(s) of the case or explaining the events related to the case in a specific period. In this research, the case of Pakistan is highlighted and the phenomenon that is studied through this research is the natural disaster that occurred in Pakistan from July 2010 to September 2010. A case study requires data to be gathered by a wide range of sources because most of the analysis depends upon the researcher personal observation (Gummesson, 2000). Swanborn (2010) suggested that it is difficult to define case study design, and it will be better to elaborate on the characteristics of this broad research design than just giving it a simplified definition. Based on the characteristics of the case study design, this design was chosen for conducting the research. Table 3.9 displays the characteristics of the case study design and explains how these fit in this study. The case study is different from other research design because it focuses on the bounded situation. This characteristic of the design allows the researcher to study the case more deeply to confirm the validity of findings. The emphases of the design tend to be upon serious analysis of setting, changes, and the collected data. It has been often observed that this particular design favors the qualitative methods to research. It has been found that qualitative methods are very helpful in examining a case in more detail in an intensive way (Bryman & Bell, 2011).

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Table 3.8. Research Designs. Research Design

Experimental design

Cross-sectional or Social survey design

Longitudinal design

Case study design

Explanation

Implemented in this Research

In management science, experimental designs are very rarely used. This design is often used as a yardstick against other nonexperimental designs to conform to the validity of findings. This research design tends No to collect data on two or more than two objects/ variables; usually from a wide range of sources, then the data are analyzed to identify the pattern of association. Longitudinal designs are used to highlight changes in an ongoing pattern. These designs incur huge costs and consume lots of time, and very rarely used in business. Mostly these designs are used as an extension to social survey designs. This research design involves a comprehensive and detailed study of a single object. The case study design entails analyzing an event/object; mostly after the occurrence of some unusual pattern, which might have brought some changes to the normal performance of the object

No

No

Yes

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Table 3.8. (Continued) Research Design

Comparative design

Explanation

(Ghauri & Grn Haug, 2010). Case studies are proved very helpful in understanding certain phenomena and developing theories regarding the changes due to that phenomenon. The case study design is widely used in management sciences. This study design compares the data from two or more similar cases. This design suggests that comparing data from similar cases will help the researcher to understand the phenomenon in a better way.

Implemented in this Research

No

Source: Bryman & Bell (2011).

The use of data type and data collection in the case study design depends upon the research questions. In general, when the qualitative data are used in a case study design, the study tends to follow an inductive approach and when the quantitative data are utilized, the case study tends to take a deductive approach to highlight the relationship between theory and research (Bryman & Bell, 2011; Swanborn, 2010).

Data Collection The selection of a particular type of data depends upon the nature of research question(s), depending upon the research question(s) the researcher can use either of two types or both the types together (Neil, 2007). This research will need both data types to conclude the answers. To find out the answer to the first question (i.e., about financial and economic implications), quantitative data will be looked at. These data will include the financial worth of commodities like houses, roads, the value of crops destroyed, financial losses to the market sector, etc. To look at economic impacts also quantitative data will be used. These data will include

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Table 3.9. Characteristics of Case Study Design. Characteristics of Case Study Design

The Resemblance with this Research

Case studies are carried out within the boundaries of one event/object/social system (i.e., case studies are limited to specific object). This design emphasizes on the study of the phenomenon that enrolls in the case’s context. The case study focuses on the phenomenon during a certain period and tends to collect the information, before and after the phenomenon to develop a better understanding of the phenomenon or its impact. In a case study researcher has a concept in his mind and develops research questions after the study of the case and availability of data. The case study uses a wide range of data sources; mostly secondary being more prominent, relating to the case and the phenomenon under study.

This research is limited to Pakistan.

The study revolves around the flood of 2010, which Pakistan (the case) experienced. As mentioned above, the focus of the study is on the natural disaster from July 2010 to September 2010. And, the data are collected based on a pre–post disaster basis to highlight the impacts on Pakistan.

The data are selected from various sources (to be discussed in “Data Collection” section below), highlighting the impacts of floods in Pakistan.

Source: Swanborn (2010).

several people died, percentage changes in the lively hood, increase in the price level (short-term inflation), etc. To find the impact on short-term price level four basic commodities are chosen. These commodities are rice, wheat, chicken, and sugar. These four commodities were chosen because these are the most commonly used by the peoples in affected areas. To find the answer to the second and third questions (i.e., related to management techniques), both qualitative and quantitative data will be used. The aim of the research focuses on the financial losses; in the second and third question, financial worth of relief provided by both GOP and local and international NGOs will be analyzed (use of quantitative data), and also disaster management techniques used to provide this relief will be analyzed (use of qualitative data).

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Secondary Data To conduct this study, different sources of data are used. Table 3.10 provides a summary of the secondary data resources used in this research to collect the data. These sources consist of annual reports, special flood reports published by GOP, and other working agencies. Of these sources, EM-DAT was most commonly used. EM-DAT is an online database for disaster around the world; it is managed by the CRED. This website is highly trusted in terms of information on disasters. Most of the authors (e.g., Jaramillo, 2007; Rasmussen, 2004; Toya & Skidmore, 2007) have collected data of disasters from this database. Besides the GOP, five major NGOs were selected to collect the data. However, initially it was thought that research will analyze the work of local and international NGOs individually, but during the research, it was found that these five NGOs were key players in relief programs and all other local NGOs were working under these tycoons. Data from these sources were collected by content analysis. Besides these five NGOs, work performed by other NGOs was also considered; these NGOs include WWF, Handicap, etc. Data from these sources were collected by content analysis.

Data Analysis and Findings Introduction In July 2010, Pakistan experienced the worst flood in the history of the country. The flood started as a result of heavy monsoon rains in Khyber Pakhtoon Khwa (KPK) and flowed in all the provinces of the country, affecting almost one-fifth of the total country’s land area. 78 districts out of 143 districts in Pakistan were severely affected. Fig. 3.1 provides an overview of flood-affected areas in Pakistan. Impacts of this flood varied from top northern mountainous areas to lower Sindh, where river Indus meets the Arabian Sea. Flash flood in KPK and Baluchistan was very destructive causing deaths and destroying infrastructure. Mian Iftikhar Hussain, the provincial minister of information of KPK, mentioned “the infrastructure of this province was already destroyed by terrorism. Whatever was left was the left was finished off by these flood” (NDMA, 2011). While the riverine flood in Punjab and northern Sindh affected cultivated highly populated areas, in lower Sindh the ongoing riverine delta flooding has left long-lasting effects, due to soil saturation of these underlying areas. Impacts of this natural catastrophe were precarious, infrastructure was destroyed, thousands of families lost their homes, and millions were affected. Table 3.11 provides a summary of the direct impacts of floods in 2010.

Financial Impacts on Infrastructure Depending upon geography, structure, use of land, and population, the initial impacts of flood and its implication in terms of severity and expected duration of damage have varied around the country. For instance, in mountainous areas, the phenomenon of flood has been extreme and very destructive. In KPK, flood

Table 3.10. Summary of Secondary Data Sources. Document

Source

Brief Introduction

2011

Online database on disaster around the world These reports contained the financial and economic information about Pakistan, before and after the flood 2010 These reports contained information about the relief techniques applied in Pakistan during the flood 2010

Website

EM-DAT

Annual reports

2010–2011

Special flood reports

State Bank of Pakistan World Bank Asian Development Bank International Monitory Fund (IMF) Oxfam World Health Organization (WHO) World Food Program (WFP) US-AID NRSP Oxfam NDMA FFC

Annual report website

NADRA

2010–2011

Newspapers online publications

The Dawn, The News, The Guardian, BBC.com

Annual reports from NGOs

2010

July 2010–November 2010

Special reports in flood were published; these reports contained information about the progress of relief activities This source was accessed to collect information about the distribution of Watan Cards These online sources were used to get up-to-date information and to confirm the validity of the information provided in the reports

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Source: Authors.

2010–2011

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Period

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Fig. 3.1.

Affected Districts due to Flood 2010 in Pakistan. Source: World Food Program.

affected the areas where the proportion of cultivated land was relatively low, but the death rate in this province was very high. Affected areas in Baluchistan are far from the Indus river basin and the population density of this province is also low; most of the crops are rain-fed and rangeland is up to 8.6 million hectares (i.e., 80% of total area). The effect of riverine flood in Punjab and northern Sindh has been a slower onset but damaged economic stability and affected tightly populated and cultivated areas. As the flood started from KPK, it took some time to reach Punjab and Sindh and water gradually covered most of the living areas in Punjab and Sindh. By contrast, in Lower Sindh, the effect of the flood will continue to a long period, because the geographical structure and flat land will cause the soil to be saturated and will make land unusable for agriculture for a longer period than Punjab. Basic public services (transportation, health centers, food, security, etc.) and basic infrastructure (buildings, roads, marketplaces, etc.) were seriously affected due to this disaster. Throughout the country, 392,786 houses were damaged and 728,192 were destroyed in the flood. However, most of the houses destroyed were in rural areas and were single-room Kacha apartments (Kacha houses are mostly made of mud and few bricks only). Most of the places in rural areas were affected because politicians and GOP turned the water to little villages to save large cities (Guerin, 2010; Mufto, 2010; Shah, 2010). According to

Table 3.11. Countrywide Losses/Damages due to Flood 2010. Total Affected Districts

Population Affected (Million)

Human Died

Human Injured

Villages Affected

Cropped Area Affected (MHA)

Damage Cost (US$ Million)

Sindh Punjab Baluchistan KPK Other (FATA, Gigit, etc.) Total

17 11 12 24 14

7.18 8.2 0.7 3.8 0.3

411 110 54 1,156 254

1,235 262 104 1,198 147

11,988 1,778 2,896 544 347

2.48 1.76 1.3 0.67 0.048

4,380 2,580 620 1,172 1,304

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20.18

1,985

2,946

17,553

6.258

10,056

Source: FFC (2010), EM-DAT (2011), and NDMA (2011).

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Province/State

81

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Table 3.12. Summary of Damages to Road. Province/State

Punjab Sindh KPK Baluchistan Others (FATA, AJK GB) Total

Road Damaged (in km)

Financial Loss (the US $ 1,200/km)

The Amount Required for the Reconstruction of Roads (US $ 1,550/ km)

2,819 8,467 6,511 2,077 5,214

3,382,800 10,160,400 7,813,200 2,492,400 6,256,800

4,369,450 13,123,850 10,092,050 3,219,350 8,081,700

25,088

30,105,600

38,886,400

Source: World-Bank (2011), SBP (2011), NDMA (2011), and Authors.

Pakistan statistical department, the current monetary worth of such a single house is approximately US$ 1,200 per house. Considering all houses destroyed fall in this category, the total financial loss only from destroyed houses is US $873 million. Approximately 436 health centers were ruined, which limited the provision of health services to the victims. Most of the roads in flood-affected areas were destroyed which caused problems in reaching affected areas and provide relief. For example, roads to the district Thatta were completely underwater that cut off many communities from necessary supplies. In mountainous areas of KPK, damages to road infrastructure were very high, where many bridges, including bridges over the river of Swat, collapsed rendering some areas completely unreachable through normal road transport. To reach these areas, military helicopters were utilized. Table 3.12 provides a summary of the damages to the road. The researcher has worked out the financial losses from damages to roads is approximately US$ 30 million. This amount is based on the survey conducted by World Bank in 1997. From this survey, average construction cost of each kilometer (Km) of the road around Pakistan is calculated to be US$ 1,200. And, to reconstruct these roads again, GOP will need approximately US$ 38 million. This amount is calculated on the bases of most recent contracts issued by the State Bank of Pakistan. Table 3.12 suggests that damages to roads were higher in Sindh followed by KPK. The telephone line and electricity supply were also badly affected by the flood. In many towns of Sindh (including Sujawal, Hyderabad, and Thatta) and KPK (Swat, lower and upper Dir), power supply was interrupted for one to two weeks. The majority of groundwater wells were covered up with mud and silt and are still unusable. Total losses to physical infrastructure are shown in Table 3.13. These infrastructure losses include losses to all physical assets. It includes the financial worth of damaged houses, roads, damages to the telephone, and other sectors. Total losses to infrastructure are approximately US$ 1,027 million, out of

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Table 3.13. Total Infrastructure Damages. Province

Sindh Punjab Baluchistan KPK Other (FATA, AJK, and GB) Total

Losses US $ (millions)

643.1 189 45.7 140.2 9.43 1,027.3

Source: Authors.

which only Sindh has suffered the loss on US$ 643.1. From three tables (i.e., Tables 4.1, 4.2, and 4.3), it can be seen that the province of Sindh was severely affected by the flood, followed by KPK. KPK was severely affected because the flood started from here and GOP and other rescue teams could not provide instant support to the victim (to be discussed in later sections). Sindh was brutally affected because of the geographic position of the country. From Fig. 3.1, it can be seen that throughout the country, there is no exit to floodwater in all three provinces except Sindh. If there is any kind of flood in any part of the country, excess water has to flow through the Indus River and meet the Arabian Sea from Sindh. And, this flood was of such a large scale, so that river Indus could not handle the pressure and caused a severe flash flood in Sindh. One other reason behind huge losses in Sindh is that from the last 15 years, Sindh has been facing a shortage of water and the river Indus used to flow much lesser than its full capacity. So, the dry portions of the river were occupied by the people and used for agriculture and living purpose. When this huge flow of water was turned to river Indus, it destroyed all the houses, roads, and cultivated lands in the areas of river Indus.

Financial Impacts on Agriculture, Crop, and Livestock The flood just struck before the harvesting of key crops (cotton, rice, sugarcane, and vegetables). The entire crop was ready to be harvested but in the last weeks of July, the flood washed away the cultivated lands of the Indus river basin, and most of the crops were destroyed. After two months of flood, water was not receded from the fields in lower Sindh, that prohibited farmers to plant for the new wheat seed to be harvested in Rabi (winter). About 6.25 million hectares (MHA) of standing crops were washed away by the flood in Pakistan (Table 3.11). Since the past few years, cultivations of cotton are increased in Sindh, and approximately 56% of cultivated land in Punjab and Sindh was growing cotton. Crops of cotton, rice, and sugarcane were badly affected by this flood. Overall production loss of sugarcane and cotton is approximately 13.5 million metric tons. The flood also caused substantial loss to forestry, fisheries, and primary infrastructures like tube

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Table 3.14. Cultivated Land in Pakistan Before and After the Flood, 2010. Province

Total Land

Punjab Sindh Baluchistan KPK Total

20.6 14.1 34.7 10.2 79.2

(A) (B) Cultivated Cultivated Land Before Land (Soon Disaster After (2007–June Disaster, i.e., November 2010) 2010)

13.8 7.2 3.1 1.7 25.8

12.04 4.72 1.8 1.03 19.59

The Financial (C) Productivity Loss of US$ per Hectare Millions (US $) (A 2 B) * C

135 140 131 168

237.6 347.2 170.3 112.56 867.66

Source: OCHA (2011), GoP (2011), and Authors.

wells, fertilizers, animal sheds, personal seed stocks, and agricultural machinery. About 1.2 million livestock died in flood and about 14 million are in jeopardy due to the sensitive risk of disease. Table 3.14 contains the data for cultivated land before and after the flood and the average price of output from each hectare in four provinces. Looking at these data, it comes clear that approximately 6.24 million hectares of cultivated land were destroyed (Table 3.11). The total financial loss due to the loss of crops, across Pakistan is US$ 867.66 million. This financial loss is based on the data provided in Table 3.14, although data for FATA, AJK, and GB could not be found, so it can be said that actual financial loss in the agricultural sector in Pakistan will exceed from these findings. From Table 3.14, it can be seen that the province of Sindh was severely affected in the agricultural sector followed by Punjab. Sindh suffered a total loss of US$ 347.2 million, while the agricultural loss in Punjab was US$ 237.6 million.

Market Situation (Economic Impacts) The local consumer markets were severely affected by the flood. After the flood, it was difficult for the people to access and purchase commodities of daily use. Destruction of the agricultural sector and basic transportation caused the disturbance in the supply of daily usage things and pushed the prices very high. The disaster not only destroyed the market and transport infrastructure but also damaged stored food and warehousing and input for future agricultural growth. Millions of tons of wheat kept in warehouses were washed away with floodwater in Sindh and Punjab; the approximate worth of lost wheat is about US$ 522 million. This decreased the capability of businesses, increased transportation costs, and lowered the functioning of the market and availability of food commodities. These all together contributed to the higher prices of commodities

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Table 3.15. Change in the Price Level of Common Commodities. Province

Sindh

Commodity Price Before Flood Price After Flood US $/kg US $/kg

Rice Wheat Sugar Poultry (Chicken) Punjab Rice Wheat Sugar Poultry (Chicken) Baluchistan Rice Wheat Sugar Poultry (Chicken) KPK Rice Wheat Sugar Poultry (Chicken)

Percentage Changes

0.79 0.27 0.55 2.07

0.87 0.34 0.67 3.41

10.1% 25.9% 22.0% 65.0%

0.83 0.25 0.52 2.13

0.91 0.28 0.61 3.04

10.2% 12.0% 17.3% 42.7%

0.78 0.30 0.56 1.95

1.21 0.48 0.73 2.56

55.1% 60.0% 30.3% 31.2%

0.84 0.34 0.50 1.95

1.51 0.65 0.63 2.56

79.7% 91.1% 26.0% 31.2%

Source: SBP (2011), Trading-Economics (2011), Index-Mundi (2011), and Authors.

especially the food products. This follows the law of supply and demand that suggests when the supply of commodities is decreased, and on the same hand demand for commodities increased, these both together push the price very high (O’Connor, 2000). This is the same that happened to the price level of general commodities of daily use. After the flood, approximately 24% of agricultural land (calculated from Table 3.14) of Pakistan was washed away leaving behind the scarcity of crops. Reduction in supply and increased demand for products pushed the price level high for a temporary basis. Table 3.15 exhibits the data for changes in price levels for common commodities. Right after the one month of a flood, the prices of wheat and rice increased sharply from 10% to 80% in Sindh and KPK. The price of sugar increased by 24% on average and the price of poultry items increased by about 65% in Sindh, while prices of other items vary from 15% to 25%. This rapid increase in price made the disaster situation much harder, GOP has to support the flow of money and provide relief, but this short-term inflation

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decreased the purchasing power of the Pakistani Rupee (PKR). In contrast to nonperishable food products, there was a significant decrease in the prices of perishable food items like fruits and vegetables (not included in the list) in remote hill areas. This decrease in the price level was due to the incapability of traders to transport the products to other areas. In addition to these losses by the flood, there were some incidences of theft from government warehouses. In Pakistan usually the official procurement for wheat starts by 1st September; therefore, some traders and households had a sufficient part of the marketable surplus for wheat that they sold at higher prices and earned more money. This may be one of the reasons for the increase in export in the flood year.

Impacts on Livelihood (Economic) Before the flood, almost half of the population in flood-affected areas were dependent on agriculture crop farming. Livestock rearing is the second common mean of livelihood, about 15% of the affected population depended on casual wages, 9% were skilled labor, 7% were in services, and a very small proportion of households receives remittances as a means of their livelihood. The living pattern is almost the same in all the four provinces; expect KPK where the unskilled labor force is higher. After the flood struck, the principle livelihood was adversely affected and the income derived from it fell by more than 50%. The flood brought major changes in the household’s incomes. Fig. 3.2 compares the main sources of income before and after the flood. As mentioned in “Financial Impacts on Agriculture, Crop, and Livestock” section, the agriculture in affected areas has been destroyed, resulting in a sharp decline in farming as a source of income in affected areas. The figure above suggests that after the flood only 12% of farmers were able to work in fields and earn some money for their daily life, the remaining 38% farmer lost their source of income and were dependent on the

60% 50%

50%

40% 30% 20% 12% 10%

15% 10%

9.50% 5%

7%

8% 4% 3%

3% 5%

5%

Shopkeepers

Livestock

Income Support

0% Farming

unskilled Wage labor

Skilled wage labor

Services before

Fig. 3.2.

6% 1% Remittances

After

Changes in Livelihood of Households Before and After the Flood. Source: Authors.

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87

government and other aids. As it can be seen from Fig. 3.2 that after the flood, dependency on remittances and income supports has increased. After the flood, there was a huge inflow of aids and funds from other nations, that distribution of money among the victim increased the share of income support and remittances as a source of livelihood after the flood. However, these changes are for time being, it is expected that in coming years, when water will recede, agriculture will grow again and most of the people will gain access to their respective source of income. Even the disturbance of local consumer markets caused the loss of jobs of unskilled and skilled labor forces. On the other hand, NGOs needed people to work with them in proving relief to the victims, so they opened a few new jobs. The impact of these new jobs is highlighted in Fig. 3.2, under the service section. It suggests that only a small portion of peoples were given new jobs.

Overall Financial and Economic Impacts The impacts of natural disasters go beyond the initial direct impacts. Initial financial losses due to disasters in Pakistan in 2010 are highlighted in the above sections. However, these are not the only financial losses that occurred. With these direct financial losses, there was also a loss of projected incomes, savings, and other future incomes to be retrieved. And, these indirect losses also accumulate a huge amount of money. A sector-wise summary of direct and indirect losses is provided in Table 3.16. Looking at the table, it can be said that the agricultural sector was severely hit followed by housing and transportation. However, most of the sectors mentioned in Table 3.16 are recoverable, and these losses are not continued losses. After the flood is over, in some period, these losses can be recovered. For example, agricultural losses are just for a short period, and the land can be recultivated next year and farmers and the government can slowly recover their losses. As was found in the literature review, those geological disasters (like a flood) do not leave long-term economic impacts. Although the loss of human lives is not recoverable, these financial losses can be covered soon after the disaster is over. From Table 3.16, it is found that Pakistan lost almost US $ 10.4 billion is one year due to this disaster. Pakistan is a developing country, and the extent of the financial losses is very huge. This will have and had really worst economic consequence on the development of the country. After the flood, prices of daily usage commodities raised sharply, and the consumer price index (CPI) increased by 15.7% in September 2010. Pakistan is an agricultural country and the loss of key crops will cause GDP to fall in the year, real GDP growth of Pakistan in year 2010/2011 was just 1.7% as compared to 4.1% in the last year. But, also this flood caused water to reach in some areas of interior Sindh, where there was no means of water to reach for irrigation. In the coming years, it is expected that those lands will now be irrigated and extra production from that portion of land will help in recovering the financial loss suffered due to this flood. After the flood, emergency services were required around the country, and the GOP spent

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Table 3.16. Summary of Total Financial Losses due to Flood 2010, in Pakistan. Direct Losses Indirect Losses (US $ (US $ Millions) Millions)

Housing Health and education Energy and water supply Transport and communication Irrigation and food management Agriculture and livestock Private sector and industries Financial sector Governance Environment Total

Total Losses (US $ Millions)

1,120 287.91 199.73 762.08 287.80

526.47 86.32 234.48 614.87 –

1,646.47 374.23 434.21 1,376.95 287.80

3,843.13 176.37 1.34 38.30 12.09 6,733.75

1,381 115.44 696.84 34.57 – 3,690.17

5,229.31 391.83 698.18 72.87 12.09 10,423.92

Source: NDMA (2011), World-Bank (2011), and SBP (2011).

millions of dollars in providing emergency relief to victims. This heavy cash outflow caused the country to face again a budget deficit this year. Not only GDP but also exports of Pakistan were severely affected. Compared to 2009 exports only from cotton as the cotton product (clothing, and another textile) were about 51% of total export. In 2010, Pakistan was thinking to import cotton to support the textile industry. This breakdown in total export adversely affected the balance of trade that further led to a worsening off a balance of payments (BoP). Table 3.17 compares the financial value of key exports of Pakistan in 2009 to the exports in 2010.

Table 3.17. Key Exports of Pakistan. Product

Rice Cotton and cotton yarn Clothing and other textiles Source: World-Bank (2011) and SBP (2011).

Exports in 2009 (US $ Billions)

Exports in 2010 (US $ Billions)

1.8 3.2 5.8

0.7 – 1.7

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However, the long-term economic impacts of this disaster are harder to conclude, as the economic progress of the country, after this disaster, partially depends upon the speed of recovery. To provide immediate recovery, GOP asked ADB, World Bank, and IMF for loans (to be discussed in details in next sections). GOP planned to utilize these loans to carry on recovery and rehabilitation tasks. If these loans are not managed properly, interest paid on these loans will make the economic position of Pakistan even worst.

Government Response (Disaster Management) In Pakistan, there is only one authority that is responsible to manage disasters. After the formulation of this authority in 2005–2006, this was the first such a big disaster that they had to respond to. It was expected that NDMA will be working on some predisaster management schemes, but in July 2010, the authority failed to predict this disaster. However, the authority used to conduct their regular meetings for discussing the disaster management policies adopted at provincial, federal, and district levels. Even one month before the disaster (i.e., June 2010), an official meeting was called by NDMA for review of preparatory measures taken by each province. The meteorological department of Pakistan predicted some light floods in KPK, but NDMA did not pay any attention to that and no actions were taken. The authority thought these rainfalls will be normal as usual and no disaster management techniques were applied until the disaster struck. Only a few days before the heavy rainfall, the provincial government of KPK requested people to evacuate the place, but people refused to do so, as most of them do not trust government officials and had some religious issues. Soon flood picked up momentum and it became harder for NDMA to manage this as they lacked in resources and had no plans to face such a massive disaster. GOP called the military for initial help to provide initial relief to victims. The response from the military was very kind and cooperative. Table 3.18 contains the assets used by the military to provide initial relief. Within the first 72 hours, about 100 troops of military forces were sent to affected areas. Approximately 1.4 million peoples were rescued with the help of the military. The flood washed away the majority of roads, it was almost impossible for NDMA to reach and rescue the victims. NDMA made it possible with the help of the army. The military utilized its 24 helicopters and three c-130 aircraft to rescue victims. Not only they worked with

Table 3.18. Military Assets Used. Assets

Cash Trucks Boats Helicopters and aircrafts Source: Pakistan-Defence (2011).

Quantity

The US $18 Million 19 600 27

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NDMA and GOP in the rescue phase but they also utilized their financial resources, approximately 25% of their annual budget was consumed in evacuating the victims. GOP decided to conduct relief activities on federal, provincial, and district levels. On August 19, 2010, NDMA called it shareholders for a meeting and formulated a comprehensive framework to respond to this disaster. The activities of this framework were divided into three phases. (1) Rescue and Relief Phase: This phase was already started before the meeting with the help of the military. The main objectives of this phase were to move all the victims from affected areas to safer places, and provide them with basic needs, like clean water, food, shelter, and medical assistance. However, the military and NDMA together could not provide relief to all victims due to a shortage of resources. And finally, the GOP asked the UN and other international NGOs to help them to face this catastrophe. (2) Early Recovery Phase: As aids and funds started to flow in Pakistan, GOP started with its second phase of rehabilitation. The main objectives of this phase were to take victims back to their original places and provide them with the reconstruction of their property and the provision of basic needs. This phase started in September 2010 and was expected to end in December 2011, but until objectives were not yet completely achieved, as many of the victims were not given assistance in full, and they were still living in tents and were away from their original areas. Although the GOP has asked them to move but, these people were not ready to move because their homes and businesses were destroyed. GOP has planned to move these people back, until June 2012. (3) Reconstruction and Rehabilitation Phase: This phase was supposed to start by mid of 2011, but yet no progress was been seen by GOP. This phase consists of plans for redeveloping the situation to the preflood level. This phase will continue for five to six years after its start and will require about US$ 7–10 billion more. (4) To provide an immediate response, GOP also established the National Emergency Operations Centre (NEOs). The objectives of this cell were to accumulate first-hand information about the flood situation across the country. So, that NDMA can approach the victims promptly and provide relief and basic needs. GOP seemed to work efficiently only in the rescue and relief phase. Table 3.19 contains the list of basic needs provided by the GOP. (5) GOP decided to distribute these food items by throwing bags from helicopters; this activity caused a few items to be wasted. Provincial government was responsible for distributing all these basic things. The requirement of shelter and food items was very high in Sindh, while the provincial government could only fulfill approximately 4% of all needs. Corruption was highly seen in government officials on Sindh. Throughout the recovery and relief phase, military in Pakistan played a vital role. All the agencies on provincial and district levels were working with the military to approach the affected areas. With this, NDMA requested GOP not to tax the items that

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Table 3.19. Basic Commodities Provided by the GOP. Item

Food items Ready meals Blankets Shelter Relief camps

Quantity

Price/Unit (US $)

184,035 tons 2.6 million packets 1.1 million 305,290 5,392

– 1.25 3 5 –

Source: Authors.

are being imported from other countries to support the victims. GOP granted this appeal of NDMA, and about US$ 400 million goods were imported as tax-free. Due to a lack of resources, GOP asked WB and ADB to conduct primary damage and need assessment, so that GOP can make medium–longterm postflood strategic plans. Pakistan also asked for a loan from ADB and WB and IMF, by September 2010, GOP received a loan of US$ 2 billion from ADB and US$ 01 billion from WB, but due to poor economic performance in the last few years, IMF rejected the loan at first, but they provided an emergency loan of US$ 451 million. However, these loans were not utilized properly and now GOP and all citizens have to bear the burden of extra interest. NDMA along with the help of the army and UN agencies established 09 warehouses to store and distribute items imported from other countries. Most of these warehouses were located in Punjab. Only one was in Karachi, Sindh, and one in KPK. Charge of these warehouses was given to international NGOs because there was a threat of theft by Pakistani Parties. (6) To provide financial relief to the victims, GOP started a scheme, called Watan Cards. These cards work like a debit card and are supported by the VISA network. GOP distributed these cards in coordination with the National Database and Registration Authority (NADRA). GOP decided to allocate one card to the head of each family in affected areas. The total amount that one can withdraw from this card is PKR 100,000 (US$ 1,219). This amount was supposed to be issued in three installments, first of PKR 20,000 (US$ 244) right after distribution of cards, followed by two installments of PKR 40,000 (US$ 488) each. These two installments were planned to be given to only those households who have lost their homes in the flood. So far GOP has issued 1.65 million cards, out of which 1.53 million were activated, the rest 0.12 cars could not be activated because the villagers were not aware of the process of using these cards. Table 3.20 contains a summary of the distribution of cards in each province. Looking at the above table, it can be concluded that, on average withdrawal from each card is about PKR 18,888 (the US $ 230). This is approximately equal to the first installment debited in each card. Even after 15 months of issuance of cards, there is no sign of remaining installment issued by GOP. Thus, it can be

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Table 3.20. State-wise Distribution of Watan Cards. Province

Punjab Sindh KPK Baluchistan GB, FATA Total

Cards Issued Cards Activated Amount Distributed (US $ Millions)

729,105 608,324 213,110 120,410 14,581 1,685,630

608,822 599,265 204,127 107,774 14,002 1,533,990

146 131.2 48.51 24.2 3.45 353.36

Source: NADRA (2011).

said that this scheme would have worked if all the installments were provided by the government. However, the first phase of this scheme was appreciated by the people, and they expected a remaining amount which GOP failed to provide. Along with Watan Cards, GOP also started other financial schemes like Prime Minister Funds, Shahid Banzir funds, etc. These programs were based on charities received from locals. But these programs failed because people have no trust in the government. Instead, the local and private sectors donated to local and international NGOs.

Local and International Humanitarian Response As soon as the initial impact of the disaster became evident, assistance and donations started to flow in Pakistan from all over the world. These donations were not directly given to GOP, but indeed they flowed to respective NGOs because GOP has lost their faith with the local population and international organization due to some political reasons. Compared to NDMA, work performed by local and international NGOs was much quicker and organized in a batter way. However, most of the international NGOs (especially UN agencies) asked GOP and NDMA to join and assist them in their work, as these agencies were not aware of the geographic positions of victims and had language differences. UN was very humble to Pakistan in the period of a flood. Even the UN asked all NGOs to work on the plans developed by NDMA and GOP. To support the early recovery phase of NDMA, in August 2010, the UN appealed for US$ 459.7 million. These funds were received very quickly; within the first two months of appeal, approximately US$ 468 million were received by different NGOs. By December 2010, US$ 202 million was spent on the fulfillment of the basic needs of victims. In between that period, the UN launched the second and largest ever appeal to supporting the victims of the Pakistan flood. This appeal was based on 397 recovery and rehabilitation projects lasting for one to three years. The total amount requested by this appeal was US$ 1.96 billion. Although these projects were designed by GOP and NDMA, it was decided that these projects will be carried out by the NGOs. In response to this appeal, a huge

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Table 3.21. Summary of Donations to Pakistan (Flood, 2010). Donor

Amount (US$ Millions)

USAID China European Union Japan Australia Canada India Private donations from the United States Private sector and individuals (Pakistan)

384.78 47 450.9 25.6 75 53.4 5 8.39 17

Source: WHO (2010), US-AID (2011), and SBP, WB, and ADB (2010).

amount of funds flowed in Pakistan. Table 3.21 contains the summary of financial assistance given by the different organizations to support recovery in Pakistan. All these funds were allocated to respective NGOs; these NGOs were further working with local NGOs to reach the victims. India was willing to give some more funds, but the inflow of cash from India was considered controversial, because of political indifferences. After the first 15 days of floods, all the NGOs started their work. Among these international players, USAID’s response to the disaster was quicker. Approximately 30 US military helicopters and four c-130 plans were involved in rescue operations. These NGOs together rescued almost 14 million peoples. However, disaster management techniques applied by these NGOs were in coordination with NDMA, but these NGOs were quick in response because they had resources available. These NGOs all together created more than 8,000 medical camps around the county. 40% of these camps were located in Sindh near Thatta. A brief description of the work performed by these NGOs is summarized in Table 3.22.

Table 3.22. Summary of Relief Provided by Local and International NGOs. Item

Shelter/tent Clean water Hygiene kits Medical assistance Financial grant

Quantity

70,452 About 6 million peoples 4 million Over 12 million people 425,000 people

Source: SBP et al. (2010), WHO (2010), NDMA (2011), and Oxfam (2011).

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These NGOs have actively involved the recovery phase of disaster management. Approximately US$ 100 was given as a financial grant to one individual. Eligible individuals for this grant were chosen randomly, or on the recommendation of a leading local officer. In addition to these financial grants, these NGOs also launched a scheme to provide jobs to the victims. However, these jobs were on contract bases, and the new employees were supposed to work with NGOs, to help them carry further tasks. Looking at the table it can be said that, although these NGOs were following policies designed and implemented by NDMA and GOP, their work was much faster than government authorities. One reason behind their fast response is the availability of eligible staff and the proper utilization of resources.

Conclusion During this study, it was found that the initial financial impacts of the flood 2010 in Pakistan were very severe. The country lost almost US$ 10 billion as the first impact of the disaster. Millions of people were affected and the routine life of the victim in affected areas was disturbed for months. During this year, Pakistan faced a huge loss in the agricultural sector and livestocks. Short-term CPI inflation was found all around the country due to the shortage of commodities. Basic infrastructure was damaged, which will need millions of dollars to repair and it will take years to get back to their preflood situations. To provide financial assistance to the victims, GOP started a scheme, that was very successful in its first phase, but due to shortages of funds, GOP could not continue the other two phases of the scheme as promised. GOP spent billions of dollars on the early recovery and relief phase with the help of international aid. The actual amount lost due to flood and the amount spent on the recovery and rehabilitation will leave some negative impacts on the economic growth of the country. Moreover, it was found that NDMA was very active in disaster management policies. Although it lacked in overall resources, the institute was continuously working with the Pakistan army and other international NGOs to provide early relief. In previous disasters, in Pakistan, all NGOs used to work independently and apply different disaster management techniques, but during this disaster, it was found that NDMA was the main institute that was engaged in planning and implementing strategies and all other relief agents were working with NDMA. From this chapter, it can be drawn that it was quite difficult for GOP to manage such a disaster alone; local and international NGOs played a key role in evacuating the victims and providing basic needed things.

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Chapter 4

Microcase Studies on Managing Tourism Destinations in the Aftermath of Disasters Frank Haas, Jerome Agrusa and Joseph Lema

Introduction Tourism can be regarded as one of the largest industries in many countries as a source providing income and employment. According to the World Tourism Organizations (UNWTO), there were 1,461 million international tourist arrivals in 2019, a 14 percent (154 million tourists) change over the previous year (UNWTO, 2020). In general, the average annual growth of international tourist arrivals within the past 10 years is up to 15.1 percent, signifying the steadily growing travel and tourism industry globally. Reasons for tourism growth can be attributed to many factors such as globalization, the increase of affluent travelers from “emerging” markets, more efficient and affordable air travel, the increase in disposable income in some countries, and better destination brand awareness due to technology and social media. ˆ ari and Zim´anyi (2011) set forth three major reasons of how mass tourism Kov´ started to occur. First, traveling is no longer an activity that is exclusive for the wealthy. As various societies progress, the growing middle class are participating in travel due to gaining a disposable income and leisure time. Second, tourism is continuing to spread not only to the luxurious first-world countries but also developing countries are learning to generate economy through the tourism industry and are therefore attracting arrivals. Finally, the advancement of transportation such as trains and airplanes has been a major component in ˆ ari & Zim´anyi, 2011). Ships are no longer the mobilizing the general public (Kov´ dominant means of transportation as the airline industry is flourishing from lowcost carriers, servicing the middle class, to exclusive private jets catering to the wealthy. These three factors explain the rapid growth of tourism. The World Travel & Tourism Council reported that global tourism contributed $8.8 trillion to the world economy in 2018 (Economic Impact, 2019). Tourism development at locations that have experienced a disaster whether natural or man-made demonstrates positive management for a disaster. The proliferation of tourism throughout the world has had an enormous impact on the local residents as well as the destination areas itself that International Case Studies in the Management of Disasters, 99–109 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201006

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attract the tourists (Harris, 2018). There have been many types of disasters, some man made (wars, social unrest) or natural (earthquakes, title waves, volcanos) that has affected a destination’s image or perception as a tourist destination. Disasters at destinations have been known as economic disrupters. Despite being economic disrupters, some disasters are proving to provide a tremendous opportunity for tourism destinations and how local authorities can market this new type of tourism known as “dark tourism.” This is a newer form of tourism with the incredible growth of tourism around the world. This chapter will be examining the effects of disasters on destinations and how tourism can help provide economic as well as emotional relief to tourism destinations. Recently, there has been a significant rise in tourists traveling to disaster sites associated with death such as terrorism bombing, earthquakes, battlefields, and hurricanes to name a few (Smith, 2010; Stone, 2011, 2012; Stone & Sharpley, 2008). For tourism sites in the United States, some of the most visited destinations are acts of terrorisms sites such as Pearl Harbor, the beginning of the United States into World War II, and Ground Zero the beginning of the war in the Middle East for the United States. Both destinations have become top tourist sites, while originally being areas of terrorism with massive loss of life and solace (Yan, Zhang, Zhang, Lu, & Guo, 2016). Visitors felt obliged to understand their history that caused such inhumane consequences. There has been a significant growth of tourists visiting sites related to both natural and man-made disasters, death, visiting battlefield sites as well as destinations of tragedy and mass loss of life has been titled “dark tourism” (Hartmann, 2014). Dark tourist locations include Hiroshima Memorial Park in Japan, Auschwitz a Nazi concentration camp in Poland, and the Tsunami memorial sites in Thailand often used as a secure place for preserving history and remembering the victims (Robb, 2009). Modern tourists have shown a growing interest in visiting these dark tourism sites seeking different and unusual touristic experiences. Dark tourism can be classified into two categories referred to as natural disaster and human-made disaster. Natural disaster sites are dark tourism sites that have resulted from natural catastrophes such as the Wenchuan Earthquake Memorial Museum in China and Khao Lak Tsunami Memorial in Phuket, Thailand. Human-made dark disaster tourism sites are the result of political conflict, war, chemical explosion, etc., such as Hiroshima Memorial Park in Japan and Auschwitz Nazi concentration in Poland (Stone, 2011). Visiting natural disaster sites is a special form of dark tourism in which the main driving factor for travel is to feel emotion, as well as the risk dynamics of the natural catastrophe, such as an earthquake, volcanic eruption, hurricane, and flooding. Dark tourism to natural disaster sites is often called “thana” tourism due to the historical events and cultural issues. The term is related to the brutal death of a huge number of people, such as the 2004 earthquake in Haiti, which resulted in the death of three million people. Other examples of natural disaster tourism sites known as “thana” tourism or morbid tourism are the photos and guided tours taken from the aftermath of Hurricane Katrina in New Orleans, Louisiana.

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Visiting battlefields related to war such as World War I and World War II are popular tourist destinations and have been growing in popularity due to their dark tourism attributes. Destinations such as Nazi concentration camps and the killing fields in Cambodian battlefields have attracted many tourists to these destinations and surrounding areas. Most tourists that visit dark tourism sites have visited war-affected sites, the holocaust, and sites of genocide (Biran, Poria, & Oren, 2011; Cohen, 2011). In addition, many tourists have visited battlefield sites after World War II and the Vietnam War. This chapter will demonstrate disasters that are both human-made and natural then outline how they can lead to a segment in the development of tourism known as dark tourism. Furthermore, an illustration of how two of the wars that the United States have been involved in have produced disaster tourism destinations or human-made disaster tourism destinations such as Vietnam with the Vietnam War and Pearl Harbor being the bombing that started the United States’ entry into World War II. The other section of this chapter presents the effects of natural disasters such as the 2015 Gorkha earthquake in Nepal which has resulted in a new visitor for the country, that being dark tourists.

Vietnam Located south of China, Vietnam is a tropical country in Southeast Asia perceived by many as a worn-torn location since the end of the Vietnam War over 45 years ago. Vietnam has transformed itself into a thriving tourism market built upon a rich culture of traditions, history, and hospitality. To connect the transformation of Vietnam from a war-torn area to a potential tourism destination, it is useful to trace the critical underpinnings and relationships that exist. 90% of the country’s population is Vietnamese (the other minority groups include Thai, Chinese, and Khmer) (Jacobs, 2000), who lived in northern Vietnam from roughly 100 BC to 900 AD then moved south. There was minimal political change throughout Vietnam until the French gained control in the 1800s, followed by the Japanese occupation during World War II. With the French failing to regain control in 1945 after the end of World War II, the North and South regions of Vietnam were established. Ho Chi Minh City (Saigon), the largest city, became the South region’s capital, while the North region’s capital was Hanoi. Today, the capital of the entire country of Vietnam is Hanoi. While being stationed in Ho Chi Minh City (Saigon), hundreds of thousands of United States troops became familiar with this city (Jacobs, 2000). When the Communists took over the South, what was known as Saigon changed to be named Ho Chi Minh City as a tribute to the Communist leader, General Ho Chi Minh (Jacobs, 2000). Ho Chi Minh City now leads Vietnam in industrial and commercial enterprises as a result of subsequent postwar reforms. With the support of the Chinese government, North Vietnam attempted to take over the whole country of Vietnam. By 1968, in order to prevent the North Vietnamese from taking over, the United States entered the conflict as South Vietnam’s chief ally and 500,000 American troops were stationed in Vietnam to

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aid and support the South Vietnamese government (Jacobs, 2000). The escalating war in Vietnam resulted in over 8.5 million Americans serving in the military during the years 1954–1975, a period of 21 years (Fisher, 1991). Furthermore, US troops remained as a strong influence until 1973 when the peace agreement was signed (Bone, 1995). A cease-fire was agreed upon in 1973 between North Vietnam and the United States governments. Then in 1975, the Communists of North Vietnam defeated South Vietnam after the United States had withdrawn its troops. As a result of the Communist takeover, Vietnam was closed to American Citizens as a result of the “Dealing with the Enemy Act” and trade sanctions that were established by the United States government. The members of the Association of South-East Asian Nations (ASEAN), along with Japan and Western European countries, also supported the economic embargo against Vietnam (Jacobs, 2000). In 1994, however, the Vietnamese government lifted restrictions on travel to Vietnam for US citizens and diplomatic ties between the United States and Vietnam were reestablished to provide an opportunity for commercial and cultural relations. Bilateral diplomatic relations between Vietnam and the United States were restored formally in 1995 which represented to the Vietnamese the opening of commerce and tourism (Agence France Presse, 1995). As some of the first economic reform attempts were proven to be unsuccessful, a more comprehensive plan bearing the name “doi moi” accelerated Vietnam toward a market economy (Bone, 1995). In a sudden policy reversal, the Communist Party’s Central Committee proposed doi moi as an economic blueprint with the purpose of complete reform and expansion into rapid market capitalism. Encouraging new forms of competition through private enterprise, this program accelerated growth (Jacobs, 2000). Reaching almost 500% a year growth during the first-half of the 1990s, the primary objectives of doi moi were to raise the standard of living and productivity of the Vietnamese people (Freeman, 1996). Vietnam has experienced remarkable growth in the 1990s with a more effective market-based system reflected in part by decontrolling the majority of prices. Recognizing private business, through reformed laws, private sector activity has opened with Vietnam strategically positioning itself to attract investment (Agrusa & Prideaux, 2002). Another demonstration of reform was when the Vietnamese government floated their currency (the Dong) at world market rates. Vietnam’s gross domestic product (GDP) growth rate by 2001 was 6.7% with industrial production increasing by 15.7%, and Vietnam tourism becoming an attractive industry for investment (Vietnam to Boost Economy, 2001). In 1990, over 25,000 foreign tourists visited Vietnam; in 1995, roughly 1.35 million foreign tourists were attracted to Vietnam bringing approximately US$818 million (Ihlwan, 1996). The Vietnamese government in 1996 had plans to attract US$6 billion of foreign direct investment with a budget of US$1.6 billion being allocated for tourism (Vietnam to Limit, 1996). Vietnam currently has a population of over 95.5 million people and US $261 billion in GDP (World Bank, 2019). Vietnam received over 18 million international arrivals, with 569,113 visitors from the United States in 2019

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(Vietnam National Administration of Tourism, 2020). The potential implications of the development of the American veteran market in particular to Vietnam were researched in a specific study as discussed below. With a large rural population and a diversifying urban economy, these demands are rapidly transforming social and economic relationships (Cooper & Hanson, 1998). Coupled with the opening of the economy and flow of foreign investment with an abundant supply of labor, the business climate for new tourism markets has emerged The United States and Vietnamese governments’ relationship has changed and new opportunities were created to attract first-time curiosity seekers from the United States as well as those who have a previous connection on a personal level to the area. Vietnam continues to strategically position itself as a tourist destination with the rapid expansion of tourism in Indo-China (Agrusa & Prideaux, 2002). Untouched regions of the world or rapidly changing areas have an attractive appeal that offers an exciting and new experience for visitors, while for others the appeal may exist in revisiting a personal life experience that may come with positive or negative images of the past. There are many areas of the world that include one or more war-torn countries; however, Vietnam offers multiple dimensions that go beyond the mainstay of mass tourism activities. Such forms of tourism related to interest in wars, post conflict periods, and even disasters have often attracted the ever-curious tourist who seeks an experience beyond mainstream tourism activities. Tourists have long traveled to sites of past conflicts; however, academic interest in this area of tourism has become more pronounced since the 1990s (Dann & Seaton, 2001; Sharpley, Stone, & Sharpley, 2009). With personal experience being one of the most memorable forms of learning, the power of experiential learning has been indicated in a number of studies that relate a prior level of knowledge and personal experience to those who will likely travel to that particular destination (Agrusa, 1994; Agrusa, Tanner, & Dupuis, 2006; Dann, 1977; Iso-Ahola, 1982). As many war-torn countries had minimal access to international visitors, such potential destinations often face preconceived notions based upon research and an image of past events. It is important, therefore, for a destination to provide a guest experience that connects the time and place of the area in an enriching way. It is reasonable to assume that American Vietnam veterans would be excellent candidates as potential tourists to Vietnam. Practices in this niche tourism market, for example, may include a veteran returning to visit a battlefield, as identified within the dark tourism sector, which has been reported in a wide variety of studies (Agrusa, 1994; Dann & Seaton, 2001; Foley & Lennon, 1996; Lennon & Foley, 2000; Prideaux, 2007; Seaton, Seaton, & Bennett, 1996; Stone, 2005; Weaver & Lawton, 2002; Zheng et al., 2018). By way of illustration of the size of the veteran population, in the United States, there are 22.7 million war veterans of whom approximately 7.5 million served at least one tour in Vietnam (United States Department of Veteran Affairs, 2010). There are many American Vietnam veterans who have a high degree of personal experience and familiarity with Vietnam particularly on a physical, emotional, psychological, intellectual, and social level. Marketing to American

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Vietnam veterans is an attractive potential segment of the Vietnamese tourism market. With conflict, there is an added dimension of the need for reconciliation and although the Vietnam War ended over 35 years ago, a number of American Vietnam veterans have indicated a willingness to return for consolation rather than pleasure with a high value placed on enriching learning experiences rather than the need for novelty. Agrusa et al. (2006) indicated in their study that Vietnam War veterans interested in revisiting Vietnam as tourists were also focused on experiential learning attractions including museums, cultural heritage, historical, monumental, and other cultural-enriching activities. Bone (1995) similarly reported in a Hawaii-based study that American Vietnam veterans expressed relative interest in other activities such as visiting educational, cultural, and nature-related attractions than war attractions. Considering the value that experiential learning brings to the tourism environment, unique opportunities exist for development of this niche market. With the phenomena of dark tourism having “become the subject of commercial practice” (Ryan, 2007, p. 188), package tours, for instance, may be a marketing strategy that embraces the experiential learner’s need to engage in new as well as familiar enriching learning experiences that have evolved in a dark site.

Hawaii’s Pearl Harbor Pearl Harbor memorial is one of the most visited tourist destinations in Hawaii with 1.5 million visitors per year. The surprise preemptive military strike by the Imperial Japanese Navy Air Service on December 7, 1941, upon Pearl Harbor Naval base formally entered the United States into World War II the next day. On December 7, 1941, shortly before 8 a.m. on that Sunday morning, hundreds of Japanese fighter planes descended on the base, where they managed to destroy or damage nearly 20 American naval vessels, including 8 battleships, and over 300 airplanes. More than 2,400 Americans died in the attack, including civilians, and another 1,000 people were wounded. Pearl Harbor is the main shrine in the United States to World War II history in the Pacific and is known as one of the major dark tourism sites in the world. Tourism has been the economic engine and the main source of employment for the state of Hawaii for many years and continues to this day (Agrusa, 1994; Linnes, Kowalski, Lema, Lam, & Agrusa, 2014; Mak, 2004). In 2018, tourist expenditure accounted for over $17.8 billion (22% of the state’s real GDP) generating $2.1 billion in tax revenue with tourism employment amounting to 217,000 which is an increase from 151,000 in 2009. The number of tourist arrivals has increased to almost 10 million in 2018 or 34.5% from 6.5 million in 2009 (Hawaii State Department of Business, Economic Development & Tourism, 2019; O’Conner, 2019). In 2017, the tourism industry accounted for over 150,000 employment opportunities for the state of Hawaii (Department of Business, Economic Development & Tourism, 2018). Tourists spent over $16.64 billion in 2017 alone (Hawaii Tourism Authority, 2017). According to an article in the Washington Post in 2013, tourism accounted for 21% of the entire state of Hawaii’s GDP (Wilson, 2013).

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The top visited tourist destination in Hawaii is the Pearl Harbor War Memorial. As a popular tourist destination, Hawaii receives tourists from both the US Mainland as well as international visitors, with the majority of the international visitors coming from Japan. Over the years, the Japanese visitors have dominated Hawaii tourism, but recently their numbers have declined from the record high levels of the 1990s. According to Hawaii’s Department of Business, Economic Development and Tourism, the number of Japanese tourists visiting Hawaii peaked in 1997 at 2.2 million visitors (DBEDT, 2004). In 2019, Japanese tourists were the largest and most important international segment of tourists to Hawaii. As one of the most favored destinations for Japanese tourists to Hawaii is visiting the Pearl Harbor World War II memorial. While it was the Imperial Japanese Air Force that bombed Pearl Harbor throwing the United States into World War II, Japanese tourists to Hawaii have Pearl Harbor as a most see during their Hawaii trip. Largely, Japanese visitors are group travelers rather than individual explorers and not independent but rather interdependent travelers. With high repeat visitation, over 40% of Japanese travelers to Hawaii have made multiple visits. The psychological trust that Japanese people have with other Japanese fits with the notion of dependence upon another’s benevolence that is also known as “amae” (Nakamura, 1964). Extending to people and places of where amae relationships exists provides a comfort of “Japanese-ness” that may have extended from Japanese only schools and language media broadcasts where amae frequently appears (Agrusa, 2000). Hawaii poses an environment where comfort in depending upon others for advise, help, and opinions fosters the relationship of amae for many Japanese tourists. With Japanese tourists consisting of over 20–30% of visitors or roughly 1.5–2.2 million Japanese visitors yearly, they comprise a large segment for international tourism to Hawaii. Currently, these numbers are significantly lower from the height of Japanese tourists to Hawaii in 1997 when approximately one out of every three tourists were from Japan. For 2019, the Department of Business, Economic Development and Tourism (DBEDT) stated that visitor arrivals in Hawaii to be almost 10 million with Japanese arrivals totaling 1.52 million.

Nepal Earthquake On April 25, 2015, Nepal was hit by a devastating earthquake of 7.8 magnitude with approximately 9,000 people killed and more than 22,000 people being injured (Shrestha, Bajracharya, Kargel, & Khanal, 2016). This earthquake is also known as the Gorkha Earthquake. This earthquake was the most disastrous natural disaster that has occurred in the history of Nepal (Kunwar & Chand, 2016). Referenced as the deadliest day in the history of Everest, the Gorkha earthquake caused an avalanche that killed 21 people. Furthermore, after the earthquake, a second major avalanche in Langtang valley where more than 250 people went missing (Shrestha et al., 2016). The lives of the Nepalese people were severely impacted by this natural disaster. Being located in the Himalayas, Nepal is very prone to earthquake damage due to its geology, urbanization, and architecture (Carswell, 2017).

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Tourism is a major economic driver for Nepal and one of the main sources of income in Nepal (Government of Nepal, 2015). Since the Gorkha earthquake, a new form of tourism has developed in Nepal, that being dark tourism. Visiting destinations of that once house major cultural heritage sites such as the Kathmandu Durbar Square, Patan Durbar Square, Bhaktapur Durbar Square, Changu Narayan Temple, Boudhanath Stupa, and Swayambhunath Stupa that were destroyed. With the introduction of dark tourism, there is a bright side to this devastation from the earthquake for the country of Nepal. While a number of cultural heritage sites have been destroyed and are no longer available, the number of tourists visiting where these sites were has bounced back in recent years (Kunwar & Chand, 2016). The resilience of the Nepalese people is evident by the speed of rebuilding of some of the cultural heritage sites destroyed by the Gorkha earthquake such as Basantapur Durbar Square. On the other hand, the amount of death and devastation will take decades if not longer to rebuild these tourist site. Despite not having the cultural heritages sites reconstructed, the number of tourists visiting the earthquake relic sites has rebounded and demonstrate the growth of dark tourism as a sector of the Nepal tourism industry.

Conclusion Both human-made and natural disasters can be devastating for many regions of the world that provide long memories of affliction, pain, and suffering for many as evidenced over the years. While not easy to forget these significant happenings, the paradox of fostering tourism development to preserve the important disastrous events that have taken place can provide valuable sources of benefits that extend far beyond economics alone. Memorializing these events through destination positioning may even bring some level of reconciliation in certain circumstances that allows for opportunities of peace and understanding among tourists if presented in the pursuit of authentic and articulate accounts of these historical underpinnings. A multidimensional approach to disaster tourism should consider not only the physical destruction but other aspects such as the social, political, emotional, psychological, and in many instances spiritual perspectives that not only provide a well-rounded experience for visitor but a transformational learning experience that can last a lifetime. While transformative travel has gained momentum as a strong motivation to engage in a journey, it can also create high affinity between the traveler, event, and the representative destination. With increasing levels of digital technology being integrated into destination marketing and planning, highly scalable yet customized travel journeys can be presented to tourists along with unique realtime packaging of coordinated events and tourism attractions that can be particularly appealing to the tourist seeking a unique disaster-themed experience. The potential benefits of affinity between the tourist and the destination may provide even further equity in the results of the relationship of tourism in disaster destinations.

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Chapter 5

Comparing the Experiences of African States in Managing Ebola Outbreaks from 2014 into 2020* Peter Mameli and Darryl Bobb

Abstract Eradicating Ebola from West Africa was struggled with from 2014 through 2016. While at first inefficient and ineffective, undeniable progress was made in responding to the outbreak once countries and organizations steeled themselves for the task at hand. A separate outbreak occurred concurrently in the Democratic Republic of the Congo (DRC) during this period. This episode marked the seventh time that DRC had dealt with the virus over a roughly 45-year span. In 2017, there was an eighth occurrence. Moreover, in 2018, DRC faced its ninth and tenth outbreaks. Comparing the experiences of countries in West Africa facing the disease for the first time, with a state that has a long history addressing its impact, is offered here as a means of better understanding successful disease management where public health epidemics are concerned. Results indicate that early investment in cultivating disease-specific practices, combined with establishing cooperative networks of actors across levels of political response, enables improved mitigation and response during outbreaks. Keywords: Ebola; health; Africa; governance; disease; disaster

Introduction Why have some African states experienced more success than others controlling Ebola virus disease outbreaks between 2014 and 2020? This question becomes more important to investigate with each passing month as the disease continues to *

Support for this project was provided by a PSC-CUNY Award, jointly funded by The Professional Staff Congress and The City University of New York.

International Case Studies in the Management of Disasters, 111–129 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201007

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threaten a variety of countries into the third decade of the twenty-first century. The analysis offered here will begin by examining how West African states addressed Ebola occurrence within their borders between 2014 and 2016. To provide contrast, the management of Ebola by the Central African state Democratic Republic of the Congo (DRC) will be reviewed in regard to epidemics it faced in 2014, 2017, and between May and July of 2018. The 10th historical occurrence of the disease in DRC, which began on August 1, 2018, is ongoing. Information presented in the current study is only reflective of results in early 2020. Ebola is a virus of zoonotic origin found on the African continent. The disease is spread through contaminated bodily fluids and has a history of high mortality rates among those infected. Ebola was initially identified in a Central African outbreak during 1976. Since that time, there have been intermittent eruptions in various locations, with an increase in severity and frequency after 2013. Response to the outbreaks is multifaceted, incorporating involvement of a multitude of players and techniques to achieve disease redress. The most effective and efficient means of engagement remain case sensitive, although best practices have emerged over time. Understanding which practices and influences have proven to be the most important during the period of study engaged here captures the two worst outbreaks of the disease in recorded history and requires special scrutiny as the health community continues to confront this increasing infectious disease threat.

Methodology In this chapter, government action will be considered across sets of practices that address internal and external influences on Ebola response. The practices can be understood as falling within two broad camps: those that impact New Public Management (NPM) values and those that impact New Public Governance (NPG) values. NPM values reflect improvements in the internal environments of public sector organizations, including states. NPG theorists have focused more on the external environment of government organizations (Mameli, 2016a, 2016b). It is posited that as practices representing NPM and NPG values are satisfied, a country’s ability to respond to an Ebola outbreak improves. Table 5.1, developed by Mameli (2013) as part of an unrelated study, will be used to track the overall findings of this chapter for individual countries. To enable placement in the quadrants of the matrix, a review of what Robert Behn has called “governance failure” will be carried out (Behn, 1998). Table 5.2

Table 5.1. New Public Management and New Public Governance Matrix. Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

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Table 5.2. Relationship of Governance Failure Categories to New Public Management and New Public Governance Values. Governance Failure

Organizational operations Analytical foresight Executive control Legislative planning Expanse of judicial decision Political responsibility Civic participation Bureaucratic leadership Vertical network cooperation

NPM or NPG Value

New New New New New New New New New

Public Public Public Public Public Public Public Public Public

Management Management Management Management Management Governance Governance Management Governance

identifies what types of failure categories can be mapped, and how they relate to the matrix above (see Mameli, 2016b for further discussion of the categories included here. While the first seven are those identified by Behn, the final two are provided by Mameli). It is suggested that the most capable disease management would be found in states that have fully actualized both NPM and NPG values, as evidenced by experiencing the least governance failure categories. When success is determined in most NPM or NPG categories, a state would be identified as having “High” achievement for the associated values. When a state is found wanting in governance failure areas, it will be displayed as having “Low” achievement. The specific practices that will be observed within individual country Ebola responses provide the information to determine if governance failures occurred. The practices outlined in Table 5.3are to be considered when determining whether

Table 5.3. New Public Management and New Public Governance Practices. NPM Practices

Deploying resources Ongoing surveillance and monitoring Contact tracing Safe burial practices Communicating strategies

NPG Practices

Engaging local and national partners Engaging international partners Engaging private sector partners Engaging nongovernmental partners Activating networks

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or not a particular state illustrates a particular type of governance failure (some of these approaches are highlighted in McNeil, Jr, 2019). Where the practices are mostly satisfied, a state would be identified as having succeeded in a given area. When practices have not been sufficiently addressed, the state would be seen as unsuccessful in a particular category. For the purposes of considering if NPM values are being met, a focus will be kept on the following activities: First, deploying resources to address Ebola outbreaks will be considered. This initial concern feeds into the second practice of whether or not ongoing surveillance and monitoring activities were being faithfully discharged proactively. Resource availability will also affect the vital role that contact tracing plays where this particular disease is concerned. Time is of the essence when trying to control and eliminate Ebola. Suppose surveillance is capable of determining an outbreak early. In that case, immediate follow-up with all individuals who were in contact with those infected is essential to prevent widespread disease spread in a short period. With a currently yet-to-belicensed Ebola vaccine deployed in the field during late 2018; this practice takes on even more importance as knowing who to vaccinate revolves around identifying contacts and possible disease disbursement. If the vaccine should prove effective in fighting Ebola, this step will require particular scrutiny during future studies. Conducting safe burial practices was the fourth NPM practice that has proven to be critical in controlling the virus. As Ebola is a blood-borne contaminant, handling of bodies according to strict protocols is necessary to prevent further infections (Cumming-Bruce, 2014). Finally, in order to facilitate the first four concerns, effective communication of strategies, tactics, and goals are required by the government and its leaders. If these five practices are achieved, it can be said that that country under review has not experienced significant NPM governance failures, and has a “High” NPM capability. Often, however, these practices are not achieved without also having actualized NPG values (Fink & Sengupta, 2014; McNeil, Jr, 2014a). NPG practices involve creating working relationships with actors across a range of sectors and levels of the political system to fight Ebola. As Table 5.3 highlights, states that exhibit partnerships with external and internal players create an environment that is capable of supporting enhanced actions where issues of complex interdependence are concerned (such as public health threats). Establishing support structures with International Governmental Organizations (IGOs), other states, internal governmental agencies, nongovernmental players (NGOs), and private sector institutions creates a web of entities that can be called on should crises arise. However, ensuring coordinated response involving these relationships requires activating the networks that have been cultivated. This practice is of particular importance, for if it fails to materialize help will not be provided in a useful fashion. When most of these five practices are achieved, a state cannot be said to have experienced NPG-related failures. In such a case, the state would be seen as having a “High” NPG ranking when being reviewed.

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The Ebola Outbreak in West Africa: 2014–2016 The region of West Africa had never experienced Ebola before the 2014–2016 surge of the virus. That two-year long episode primarily impacted the countries of Guinea, Liberia, and Sierra Leone. Smaller-scale outbreaks occurred in the states of Mali, Nigeria, and Senegal. Although not a part of this chapter, it is important to note that select Western European countries and the United States each saw a smattering of cases, primarily resulting from aid workers returning home from West African states battling the illness. Among the issues that stood out during the West Africa epidemic was the inability to quickly control the spread of the virus through multilevel and multiactor management techniques (Youde, 2015). In fact, the early stages of the crisis were widely criticized for slow and ineffective response across a variety of actors, sectors, and levels of the global political system. As shown in Table 5.4, Guinea, Liberia, and Sierra Leone found themselves in Quadrant 4 of the NPM/ NPG matrix prior to August 8, 2014. The date August 8, 2014, represents when World Health Organization (WHO) declared the Ebola outbreak to be a “Public Health Emergency of International Concern” (Editorial Board, 2014; Walsh & Sifferlin, 2015). It can be viewed as something of a defining point in the global fight. Reviewing response patterns across affected states before and after this bifurcation becomes an essential part of learning how to manage such situations when they develop in the future. Word of the disaster was declared to the international community by international NGOs tending to the epidemic’s ill in late March 2014. The gap between initial identification and unified international response is important to highlight in the trajectory of the outbreak, for it signifies a timeframe within which Ebola gained ground and increased its damage (Editorial/Letters, 2014). As the members of the United States Blue Ribbon Study Panel on Biodefense stated about this particular Ebola crisis: The recent Ebola outbreak happened not because any single institution or nation failed, but because they failed collectively. (The Blue-Ribbon Study Panel on Biodefense, 2015) Indeed, an examination of governance failures present across high profile actors during the early stages of the crisis supports the Panel position (Mameli, 2016a). Weaknesses in government surveillance, contact tracing, and executive

Table 5.4. New Public Management and New Public Governance Matrix for Guinea, Liberia, and Sierra Leone Prior to August 8, 2014. Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

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efforts to manage the eruption early on served to allow Ebola to race through the countryside and into the capital cities of Guinea, Liberia, and Sierra Leone. As this was the first time any of these countries had dealt with this particular disease, they were also unprepared to immediately address the need for establishing safe burial protocols in the communities affected (Sack, Fink, Belluck, & Nossiter, 2014). On March 25, 2014, Guinea identified its first wave of cases (86 cases, with 59 deaths). This was quickly followed on March 27, 2014, by outbreaks in Liberia (8 cases, with 6 deaths) and Sierra Leone (6 cases, with 5 deaths). From the earliest stages, it was reported by a variety of news sources and international NGOs that the three countries did not have adequate healthcare infrastructure to handle the severity of the occurrences (Kieny, Evans, Schmets, & Kadandale, 2014). Weakened internal health facilities and public sectors did not lend themselves to immediate response (Flynn, 2014; Grady, 2014; Nossiter, 2014). Combined with an inability to foresee this particular type of epidemic arising due to analytical failure, the initially staid response of the three Presidents deepened the overall problems surrounding mitigation. This resulting lag served to dampen engagement with the virus for a time. What many observers hoped for was a rallying of support networks to address the emergency quickly and effectively. The impacted countries did have connections with more affluent states, IGOs, INGOs, and NGOs. However, while existing, said networks proved anemic when pressed to recognize and react to warnings and cries for help early. By the time international awareness had sufficiently been piqued, and WHO moved to declare the Ebola epidemic a Public Health Emergency of International Concern, a significant amount of time had been lost. As the international community began to become more engaged behind the emerging leadership of the United Nations, WHO, and the donor countries of France, the United Kingdom, and the United States, significant positive change could be seen to develop in the management of the disease on the ground. The disease began to slow late into 2014 and early 2015. Personnel, hospitals, equipment, and funds flowed into the effected states specifically aimed at creating conditions for better management of the infection. France focused its efforts on Guinea, the United Kingdom on Sierra Leone, and the United States in Liberia. With this support and expertise available to governments, public awareness campaigns were furthered, local populations were trained, and efforts to halt the infections improved despite some problems with infighting among those involved (see Gladstone, 2014a; McNeil, Jr, 2014b, for more on the Liberian example). High profile problems involving missing, misappropriated, or pilfered donor funds in each of the three states should not be seen as indicative of overall response progress at this point in the process (British Broadcasting Corporation, 2017). Table 5.5 displays how the shift toward increasing partnership and cooperation helped tilt the balance of NPM and NPG values in favor of the affected countries. By the close of the epidemic Guinea, Liberia, and Sierra Leone saw movement from Quadrant 4 to Quadrant 2. While these three countries still struggled with a

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Table 5.5. New Public Management and New Public Governance Matrix for Guinea, Liberia, and Sierra Leone after August 8, 2014. Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

variety of NPM concerns, active networking and support structures alleviated some shortcomings sufficiently to allow for containment and resolution of the crisis. WHO announced that the Public Health Emergency of International Concern for the region was over March 29, 2016. The devastation from the outbreak is captured by the data presented in Table 5.6. These numbers reflect adjusted reporting as of 4/13/2016 (Center for Disease Control and Prevention, 2016). Overall, for the three hardest hit nations in the epidemic, there were 28,616 cases identified with 11,310 deaths – representing a 39.5% mortality rate across the block. The final tallies show just how

Table 5.6. Closing Case and Death Rates: Guinea, Liberia, and Sierra Leone. Country/Cases and Deaths

Guinea

Liberia

Sierra Leone

Cases Deaths Percentage

3,814 2,544 67%

10,678 4,810 45%

14,124 3,956 28%

difficult it can be to regain control of an epidemic of this nature once the early advantage has been lost. Table 5.7, below, displays the resulting effects of more focused action in the areas of deploying resources, contact tracing, communicating strategies, and safe burial practices.

Table 5.7. Governance Failures in Guinea, Liberia, and Sierra Leone after August 8, 2014. Government Failures/ Ebola Crisis

Organizational

Guinea

Sierra Leone

X

X

Liberia INGOs WHO

Donor Countries

X

It is suggested that countries experiencing outbreaks around or after this point in time were better positioned to avoid the missteps of the West African nations preceding them.

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Mali, Nigeria, and Senegal: Preparation and Coordination in Action Speaking to the advantages of early preparation and quick, coordinated response are counterexamples of Ebola outbreak management from July 2014 forward in the countries of Mali, Nigeria, and Senegal. Unlike Guinea, Liberia, and Sierra Leone, these actors did not need to hail attention from outside their borders, as much as take advantage of backing already present – or being offered. This can be credited to the prior awakening of the world community to the severity of the disaster that had already been taking place. Weintraub (2014) notes that efforts to detect the disease early, and then trace cases, isolate the patients, and treat the ill, were necessary steps to rapid success. Additionally, engaged leadership was required as well as involving the public in efforts to address the crisis. Similar stories were told of Mali, Nigeria, and Senegal. Although stumbling did occur, it was quickly addressed, with early and rapid identification of patients and contacts ultimately being at the core of successful control efforts (Bryant, 2015; Otu et al., 2017). Table 5.8 displays an NPM and NPG values matrix that mimics the more successful one presented for Guinea, Liberia, and Sierra Leone at the close of the epidemic. Here, we see Quadrant 2 reflected as the dominant aspect of the matrix. Quadrant 2 shows the countries of Mali, Nigeria, and Senegal struggling with some elements of actualizing NPM values due to capacity and resource availability limitations, but still being able to respond effectively with the support of outside partnerships (NPG values). Mali saw its first case, of its first Ebola eruption, on October 23, 2014. This occurred several months after international interest had been stimulated and when external coordination had begun to hit its full stride. It was also three days after the outbreak in Nigeria had ended. WHO declared the first case in Mali a Public Health Emergency of International Concern. Combined with the support of the government and international partners on the ground, early recognition was important to establishing successful response patterns. Specifically, the rapid identification of patients was noted as an essential part of this tool kit (Bryant, 2015). Repurposing treatment facilities that had been used for Lassa Fever outbreaks and using existing laboratories in Bamako also allowed for rapid management of the case. The resulting success was due to preparation, coordination, and action (WHO, 2015b). However, Mali’s Ebola experience was not free of problems. In

Table 5.8. New Public Management and New Public Governance Matrix for Mali, Nigeria, and Senegal, 2014–2015. Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

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particular, the fact that there were two bursts of Ebola in Mali indicates that successful containment on the first go-round was fleeting (McNeil, 2014c). As noted, the first wave was addressed rapidly by the use of careful contact tracing and follow-up procedures. The second eruption of the virus in November 2014, however, was misidentified by hospital staff in the capital and resulted in a loss of time that could have improved responding to its emergence (McNeil, 2014c). Despite this initial failure, in the second round, sound health management practices combined with engaging external partners, enabled analytical and organizational shortcomings to be handled more effectively. Nigeria’s first Ebola case was identified on July 20, 2014. Its occurrence was roughly three weeks prior to WHO’s declaration of Ebola as a Public Health Emergency of International Concern. Doctors treating the first Ebola case in Lagos did not take proper precautions to protect themselves, and became infected with the virus (WHO, 2014a). Some parties suggest there was confusion about what to do during the immediate identification of the initial case (Otu et al., 2017). Subsequently, however, treatment facilities were established with government and international support in Lagos and Port Harcourt, and existing laboratories were used to test for the disease. In addition, the President addressed the population, apprising them of the situation, and reassuring them that government actions were underway to contain the outbreak. The careful and quick response to the Ebola outbreak, following identification of the initial case, enabled WHO to declare it over on October 20, 2014. Senegal saw its first case on August 28, 2014, approximately three weeks after WHO had declared Ebola a Public Health Emergency of International Concern. Fortunately, Dakar had long been a center for response to African humanitarian crises. Existing contacts with international actors, both within and outside of the country, combined with preparing early for the possibility of seeing cases within their borders, allowed for steady and swift management of the disease (WHO, 2014b). Support of the President and Prime Minister, as well as WHO declaring the first case in Senegal as a Public Health Emergency, enabled focused attention to be drawn to the situation at the outset of the country’s experience – not weeks or months into it. Most impressive, perhaps, was the conversion of a textmessaging program used to raise awareness about diabetes to launch an information campaign of over 4 million Ebola warnings to citizens across the country (James, 2014). Weaknesses of the Senegalese response involved a limited ambulance fleet in numbers, and the fact that there were no treatment facilities available outside of Dakar (WHO, 2015). These conditions represent organizational and analytical failure that was struggled against by the responders involved. That these conditions did not lead to an expanded problem is testament to the general preparation, and coordination of multiple actors, that was put into addressing the earliest evidence of the disease. Table 5.9 captures the governance failures exhibited by Mali, Nigeria, and Senegal during these outbreaks. Table 5.10, reflecting adjusted reporting as of 4/13/2016, presents the results for the case and death rates in these countries (Center for Disease Control and Prevention, 2016). Overall, there were 29 cases identified with 14 deaths, representing

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Table 5.9. Governance Failures for Mali, Nigeria, and Senegal, 2014–2015. Government Failures/ Ebola Crisis

Organizational Analytical

Mali Nigeria Senegal INGOs WHO

X X

X X

Donor Countries

X X

a 48% mortality rate across Mali, Nigeria, and Senegal. These countries were often touted as international models of rapid response and containment during and after the crisis (see Bryant, 2015; Weintraub, 2014; WHO, 2015b, for three such examples).

Table 5.10. Closing Case and Death Rates: Mali, Nigeria, and Senegal. Country/Cases and Deaths

Mali

Nigeria

Senegal

Cases Deaths Percentage

8 6 75%

20 8 40%

1 0 0%

Democratic Republic of the Congo and the Ebola Outbreaks of 2014, 2017, and 2018 No country has had more experience with the Ebola virus than DRC (the former country of Zaire). The disease was first identified there, and Sudan, in 1976. Ebola has reappeared in DRC nine times since, with its 10th outbreak active at this point in time. As such, it serves as an example of lessons learned, or not, where addressing the virus is concerned. To many, DRC is a country that knows how to contain and eliminate the virus (WHO, 2014c). The seventh, eighth, and ninth DRC emergencies will be focused on here – capturing the 2014 to 2017 and 2018 outbreaks, respectively. Combined, these epidemics offer signposts to how a country more familiar with the disease has learned to deal with it as an ongoing concern. The difference between those seeing the disease for the first time in West Africa and those with a longer history of engagement can be instructive for determining best practices related to preparedness, mitigation, and response. Tables 5.11 and 5.12 offer composite sketches of how DRC has handled these most recent episodes. The 2014 outbreak was officially announced by WHO on August 24. By the time it had run its course in November, 66 cases had been identified with 49 deaths. Preparedness and partnership allowed the response to proceed rapidly once the illness had been identified.

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Table 5.11. New Public Management and New Public Governance Matrix for Democratic Republic of the Congo, 2014, 2017, and 2018 Ebola Outbreaks. Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Table 5.12. Governance Failures and the Democratic Republic of the Congo’s 2014, 2017, and 2018 Ebola Outbreaks. Government Failures/ Ebola Crisis

Organizational

DRC 2014

DRC 2017

DRC 2018

X

X

X

INGOs WHO

Donor Countries

DRC had the advantage of having dealt with the disease for approximately 40 years prior – and being aware that it could always reappear. In the DRC’s case, the effort expended building up disease-specific relationships in that time enabled control efforts to be rolled out quickly once the new cases appeared. While problems existed with shortages of medical personnel across the country and internal resourcing weaknesses, strategic response was still possible. Healthcare workers quickly collected blood samples for analysis by the national government in Kinshasa, and a range of best practices were put into place to contain disease spread. From contact tracing to engaging community leadership in response to advocating safe burial procedures, the country’s internal healthcare system moved quickly to begin managing the situation (WHO, 2014c). Support from external players was also necessary for steadying engagement. Rather than lacking or sluggish, as had been noted in the situations of Guinea, Liberia, and Sierra Leone, support from actors beyond DRC was robust. WHO, Doctor’s Without Borders, the United States Centers for Disease Control and Prevention, the Canadian National Microbiology Laboratory, and UNICEF were among those organizations offering support in one way or another during the eruption (WHO, 2014c, WHO, 2014d). The 2017 outbreak was narrower in impact than the one in 2014, and brought to an end within a remarkably rapid 42-day window after its May 11 identification by the country’s Ministry of Health (WHO, 2017). In total, eight cases were reported and four deaths attributed to the disease. WHO declared the epidemic over on July 2, 2017 (Centers for Disease Control and Prevention, 2017). Again, existing knowledge of the disease and communication with necessary partners to address it were critical elements to successful management.

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No doubt, the appearance of Ebola in a rural and remote part of the country helped to dampen its spread long enough for the government and its partners to act. But this does not diminish their resulting success. Within days of identifying a potential problem zone, blood tests were run on suspect individuals and the existence of the virus was confirmed at laboratories in Kinshasa. Follow-up contact tracing led to 583 individuals, none of which resulted in infection. Despite the remote location, mobile field testing units were deployed to the site of the outbreak, the government announced the existence of the epidemic quickly, and local authorities were brought into the process of education and awareness. Due to a special WHO contingency fund created after the 2014–2016 crisis, these special services and equipment were made in an efficient manner (Yong, 2017). A wide range of international partners from the public, nonprofit, and private sectors joined in the process as well. While participation does not necessarily speak to effective coordination, the fact that the forces were mobilized quickly for the 2017 outbreak certainly made resources available for deployment in a rapid fashion. The resulting success in eradication is no doubt partially explained by this fact (Yong, 2017). According to the WHO (WHO, 2018a), the ninth Ebola outbreak raised initial concerns that the disease could “spread to other parts of DRC, and to neighboring countries.” A public health emergency of international concern was not declared by WHO. However, within hours of the outbreak being declared on May 8th, WHO released $2 million from its Contingency Fund for Emergencies, deployed a team to augment capacity in the field, and activated an emergency incident management system. WHO would also open its own operations center, and send about 50 epidemiologists, clinicians, and experts in logistics, infection control, communications, and vaccination to the country. WHO shipped protective gowns, aprons, boots, and masks for caregivers, as well as bleach spray, body bags, and other equipment. The Wellcome Trust, Britain’s equivalent of the Bill and Melinda Gates Foundation, donated $2.7 million to the effort, and the British government’s development agency donated $1.3 million (WHO, 2018a). Two days after a laboratory confirmed that the virus had killed two people in the remote Equateur Province, teams from the country’s health department, along with doctors from the WHO and Doctors Without Borders, had reached Bikoro, a market town about 20 miles from Ikoko Ipenge, the village at the outbreak’s epicenter (McNeil, Jr, & Cumming-Bruce, 2018). The Ebola virus still spread from the rural northwest area of the Democratic Republic of Congo to Mban´ daka, a city of 1.2 million and the capital of Equateur Province. According to McNeil, Jr & Cumming-Bruce (2018), Dr. Seth F. Berkley, chief executive of Gavi, the Vaccine Alliance, stated this outbreak was the first time a new Ebola vaccine, known as rVSV-ZEBOV, was rolled out since it was found to be 100 percent effective in field tests in Guinea in 2016. Gavi agreed to pay for the creation of an emergency stockpile of 300,000 doses. The vaccine needs to be stored at minus 80 degrees by the manufacturer, Merck, Sharpe & Dohme. Because the vaccine was still unlicensed, WHO had to approve its release for

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emergency use (WHO, 2018b). The vaccine is now being dispensed in the 10th DRC outbreak. Additional data and experience with the drug will help evaluate its usefulness. The outbreak was deemed over by WHO on July 24, 2018. Table 5.13, below, provides the DRC case and death rates for the DRC 7th, 8th and 9th Ebola outbreaks.

Table 5.13. Closing Case and Death Rates: Democratic Republic of the Congo. Country/Cases and Deaths

Cases Deaths Percentage

DRC 2014

DRC 2017

DRC 2018

66 49 74%

8 4 50%

54 33 61%

Democratic Republic of the Congo and the Ongoing 10th Ebola Outbreak The most recent Ebola emergency in DRC was the second of two 2018 outbreaks. The 10th episode began on August 1, 2018, approximately seven days after the 9th eruption had concluded. A Public Health Emergency of International Concern was formally declared on July 17, 2019, after prior considerations for this status were rejected by WHO. Among the more important features of this latest outbreak has been its degree of occurrence and overall spread. Beginning in the North Kivu province, with cases also found in the Ituri province, there has been an impact on populations in both rural and urban areas. Importantly, as part of this 10th outbreak, Ebola appeared in major cities, and there are new cases still being discovered in the countryside that are not clearly linked to existing information on contacts. In fact, at this point, the August 1, 2018, emergency is recorded as the second largest Ebola epidemic ever – running second only to the 2014–2016 medical crisis that swept through West Africa. Reasons for pattern shifts in the DRC from better-managed outbreaks to this one can be found beyond the virulence of the viral strain itself, several of which are offered below for consideration. First, complicating matters during the latter half of 2018, and into 2019, was a change in leadership that took place at the national level of government. Joseph Kabila, the longtime President of the country, stepped down from his post after nearly18 years, opening the way for DRC to conduct an election. However, the election had been delayed for two-year’s time (Editorial Board, 2019), and when finally conducted in 2018, there were serious problems at the polls calling results into question. In addition, opposition groups were not allowed to demonstrate for several months prior to the election, and some potential candidates were prevented from running on contested grounds (Congo Research Group, 2019).

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As a result of these peculiarities, DRC struggled with the outcome, but by the end of January 2019, Felix Tshisekedi was declared the winner despite a call for a recount based on accusations of voter fraud that was rejected by the Constitutional Court. Criticism of the former government, and accusations of a nondemocratic process being put in place for the election, as well as the problems surrounding the possible illegitimacy of results all impacted on how thoroughly the country could focus on Ebola (de Frevtas-Tamura, 2019). Indeed, two major cities with Ebola cases (Buni and Butembo) saw their elections suspended in part due to the outbreak, and in part to rebel groups active in the region. The rebel activity brings forth another important factor to consider, the role of violence on health management when executive control of a region is in question. The current DRC crisis speaks to how physical violence can hasten disease spread when it emerges during an infectious outbreak, rather than prior to it. While DRC has been lauded by many as among the more successful African states to manage Ebola, the August 1, 2018, eruption has proven especially difficult to address because of ongoing rebel hostilities in the northeastern portion of the country where current cases are situated. Raids, clashes, and attacks on both health workers and medical encampments have forced disease containment efforts to slow or halt, allowing all areas of public health management to slip at critical points in the response process (McNeil, Jr, 2019). An inability to stabilize the region of impact has significantly hampered both NPM and NPG practices. Further still, the resulting disruption threatens to allow the disease to leap into neighboring countries. Cases have been identified, and isolated, in Uganda to date (Mameli, 2019). Key to combating this latest outbreak has been the deployment of an experimental, currently yet-to-be-licensed, vaccine developed by Merck Pharmaceutical. Over 66,000 doses have been distributed so far in the country, with another 120,000 being made available for use by Merck – but the number of doses could run out if cases continue to grow across the country. Vaccinations have been dispensed to “rings” of critical need health workers in an effort to reign in the virus. However, violence and public distrust in this environment continue to make tracing and vaccinating contacts of the infected difficult to fully carry out (McNeil, Jr, 2019). While many believe that the use of the vaccine has had a positive impact on prevention, more research is needed to be certain of this result. Still, this is a significant shift in response in the effort to slow the disease (The Conversation, 2019). So significant that neighboring South Sudan has also begun vaccinating its health professionals with the drug in an effort to prepare for the possible jump of the virus across its DRC border (Winsor, 2019). The contours of the latest Ebola outbreak in DRC offer important insight into critical causes of success and failure in the management of this infectious disease. While DRC had displayed progress in handling outbreaks up until August 2018, a break in its ability to successfully manage the latest occurrence points out that organizational planning, forecasting, and executive influence are essential elements in achieving well-functioning NPM practices within a state - as well as

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Table 5.14. New Public Management and New Public Governance Matrix for Democratic Republic of the Congo, 2018–2020 Ebola Outbreak. Quadrant 1: NPM High/NPG High Quadrant 3: NPM High/NPG Low

Quadrant 2: NPM Low/NPG High Quadrant 4: NPM Low/NPG Low

Table 5.15. Governance Failures and the Democratic Republic of the Congo, 2018–2020 Ebola Outbreak. Government Failures/Ebola Crisis

Organizational Analytical Executive

DRC 2018–20

INGOs WHO

Donor Countries

X X X

supporting NPG practices with partners beyond the affected state. As Tables 14 and 15 (above) highlight, all areas of NPM and NPG practices have become more difficult to actualize in an environment where physical violence disrupts disease management operations. Current efforts take place under duress, with reduced support from both internal and external actors. NPM actions from deploying resources to surveillance and contract tracing are compromised in such a setting. Additionally, NPG practices focused on partnerships and network activation cannot be effectively and consistently installed – despite the willingness of actors beyond the DRC to participate. Table 5.16 identifies recent WHO case and death rates for the outbreak.

Table 5.16. 1/1/20 DRC 10th Outbreak. Country/Cases and Deaths

DRC

Cases Deaths Percentage

3,382 2,232 66%

Conclusion: The Path to Successful Ebola Management Ultimately, the results of this study are multifaceted. Primarily, the findings display that states with poorly actualized NPM and NPG practices are less able to

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redress an Ebola outbreak than states with mixed abilities, or those ranked as “High” in both categories. States that struggled with achieving both NPM and NPM practices during an outbreak (Guinea, Liberia, and Sierra Leone, in the early stages) speak to the first part of this conclusion. As states exhibited improvement in NPG practices over time in the course of an outbreak (Guinea, Liberia, and Sierra Leone), or from the start of one (Mali, Nigeria, Senegal), results showed that they are likely to achieve greater success containing the virus. Even if NPM practices were yet to be in full swing, functioning NPG networks could aid in promoting disease management if state control of an affected region was in place. Logic also suggests that states with functioning NPM practices and poorly actualized NPG practices would also fare better than states weak in both categories during a crisis. Additional results relating to the DRC continue the trajectory, and deepen understanding, of the overall argument. In the case of DRC, from 2014 into mid2018, it is illustrated that a state high in both NPM and NPG practices is in better position to resist epidemic spread than those with lesser abilities. Yet, the DRC’s struggle with the latest outbreak of the disease displays that weakening NPM practices, particularly those brought on by the executive inability to exert control over all areas of a country, limit effective health responses in critical ways. Chief among these are the degrading of NPG network functions that would otherwise support state health management activities. The combined limiting of NPM and NPG engagement in the DRC has resulted in the second worst Ebola outbreak recorded. The resulting condition of low NPM and low NPG characteristics in DRC mirrors the result found for Guinea, Liberia, and Sierra Leone at the onset of their Ebola outbreaks in early 2014. Arguably, this reflects compelling evidence that weaknesses in the best practices identified here bode ill for redressing disease spread in these instances. The above outcomes provide support for the contention that weaker states need to be in contact with, and galvanize support from, networks of external actors to successfully address infectious disease health crises. However, under circumstances of severe state disruption, even active NPG networks may be unable to impact disease spread. The NPM failures that consistently impacted Ebola management during the worst moments of the 2014–2016 West African outbreak, and the 10th DRC event, reflected state-level organizational, analytical, and executive elements that compromised progression toward eliminating the virus. Without these components of internal state governance in place, actors beyond the state are in a greatly diminished position to provide expertise and support in a meaningful way, as well. Executive engagement and active focus on the problem appears to be of greatest importance among these three. Its role during the early stages of the West African outbreak, and the current DRC crisis, has shown itself to be essential. When states find themselves unable to deploy resources, monitor disease spread, trace contacts, encourage safe burial practices, and communicate strategies to their populations efforts to better manage Ebola falter. Concurrently, the benefits from partnerships can be blunted. The more states are able to achieve

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sufficiency in both NPM and NPG practices, the better prepared they will be to offset the effects of Ebola outbreaks. However, this depends on important state governance categories operating effectively and efficiently. In short, the final answer is not that some of the best practices are more important than others overall. The shape of their involvement may differ from event to event, but they are all important in the long run. When they are unavailable, or incompletely actualized due to a state struggling to engage its health management apparatus, Ebola will be in a better position to flourish.

References Behn, R. D. (1998, May/June). What right do public managers have to lead? Public Administration Review, 58(3), 209–224. British Broadcasting Corporation. (2017). Red cross apologizes for losing $5m of Ebola funds to fraud. BBC News, November 3. Retrieved from https://www.bbc.com/news/ world-africa-41861552 Bryant, A. (2015). The secret of Mali’s Ebola response success, and how it could transform child health. Huffington Post, September 28. Retrieved from https:// www.huffpost.com/entry/the-secret-of-malis-ebola_b_8208204 Center for Disease Control and Prevention. (2016). 2014 Ebola outbreak in West Africa – case counts. United States Center for Disease Control and Prevention, Atlanta, GA. Retrieved from https://www.cdc.gov/vhf/ebola/history/2014-2016-outbreak/casecounts.html Center for Disease Control and Prevention. (2017). Ebola outbreaks 2000–2017. United States Center for Disease Control and Prevention, Atlanta, GA. Retrieved from https://www.cdc.gov/vhf/ebola/history/chronology.html Congo Research Group. (2019). The Congo elections: Where things stand. Congo Research Group, January 3, 2019. Retrieved from https://cic.nyu.edu/publications/ The-Congo-Elections-Where-Things-Stand Cumming-Bruce, N. (2014). W.H.O. issues new guidelines on safely burying Ebola victims. New York Times, International Section, November 8, p. A4. Retrieved from https://www.nytimes.com/2014/11/08/world/europe/new-guidelines-for-burying-ebolavictims.html Editorial Board. (2014). Controlling the Ebola epidemic. New York Times, August 10, The Opinion Pages, p. A16. Retrieved from https://www.nytimes.com/2014/08/11/ opinion/controlling-the-ebola-epidemic.html Editorial Board. (2019) Congo’s almost free election. New York Times, January 11. Editorials/Letters. (2014). A painfully slow Ebola response. New York Times, August 16, International Section, p. A18. Fink, S., & Sengupta, S. (2014). 2014 goals for Ebola treatment may not be met, U.N. health officials say. New York Times, December 1. Retrieved from https://www. nytimes.com/2014/12/02/world/africa/goals-for-ebola-treatment-may-not-be-met-whoofficial-says.html Flynn, D. (2014). Ebola: Liberian leader sees decline, but aid too slow. Reuters, October 9. Retrieved from https://www.reuters.com/article/us-health-ebola-liberia-president/ exclusive-liberian-leader-sees-signs-ebola-in-decline-but-aid-too-slow-idUSKCN0H X1UH20141008

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de Freytas-Tamura, K. (2019). After tarnished election, opposition figure becomes Congo’s President. New York Times, January 24. Retrieved from https://www. nytimes.com/2019/01/24/world/africa/congo-president-inauguration-tshisekedikabila.html Gladstone, R. (2014a). Ebola may be slowing in Liberia, W.H.O. says. New York Times, October 29. Retrieved from https://www.nytimes.com/2014/10/30/world/ africa/ebola-liberia-who.html Grady, D. (2014, August 16). With Ebola cases still few, populous Nigeria has a chance to halt its outbreak. New York Times, August 16, p. A6. Retrieved from https://www.nytimes.com/2014/08/16/science/with-ebola-cases-still-few-populousnigeria-has-chance-to-halt-its-outbreak.html James, D. (2014). mHealth helps stop Ebola in Senegal. Pharmacy Times. Retrieved from https://www.pharmacytimes.com/news/mhealth-helps-stop-ebola-in-senegal Kieny, M., Evans, D. B., Schmets, G., & Kadandale, S. (2014). Health system resilience: Reflections on the Ebola crisis in Western Africa. Bulletin of the World Health Organization, 92, 850. Mameli, P. (2013). Under new management: What the Arab Spring tells us about leadership needs in the Middle East and North Africa. Digest of Middle East studies, 22(2, Fall), 119–142. Mameli, P. (2016a). Learning from the early stages of the 2014–2015 Ebola outbreak in West Africa. Middle East Review of Public Administration, 2(1, Spring), 1–16. Mameli, P. (2016b) Hardening analogies in order to reduce risk in foreign policy crisis management. In P. Tworek & J. Myrczek (Eds.), Public risk management. Tome I: Perspective of theory and practice (pp. 123–139). Katowice: Publishing House of the University of Economics in Katowice. Mameli, P. (2019). Collaborative public health management of Ebola in Africa. Peace Review: A Journal of Social Justice, 31(2), 199–207. McNeil, D. G., Jr (2014a). Using a tactic unseen in a century, countries cordon off Ebolaracked areas. New York Times, August 12. Retrieved from https://www.nytimes.com/ 2014/08/13/science/using-a-tactic-unseen-in-a-century-countries-cordon-off-ebolaracked-areas.html McNeil, D. G., Jr (2014b). Ebola response in Liberia is hampered by infighting. New York Times, November 19. Retrieved from https://www.nytimes.com/2014/11/20/ world/africa/ebola-response-in-liberia-is-hampered-by-infighting-html McNeil, D. G., Jr (2014c). Second Ebola outbreak in Mali eclipses early success. New York Times, November 12. Retrieved from https://www.nytimes.com/2014/11/13/ health/mali-reports-a-second-larger-ebola-outbreak.html McNeil, D. G., Jr (2019). Earlier Ebola outbreaks, and how the world overcame them. New York Times, July, 17. McNeil, D. G., Jr, & Cumming-Bruce, N. (2018). Ebola erupts again in Africa, only now there’s a vaccine. New York Times, May 11. Retrieved from https://www.nytimes.com/ 2018/05/11/health/ebola-africa-vaccine.html Nossiter, A. (2014). Ebola now preoccupies once skeptical leader in Guinea. New York Times, November 30. Retrieved from https://www.nytimes.com/2014/12/01/world/ africa/ebola-now-preoccupies-once-skeptical-leader-in-guinea.html Otu, A., Ameh, S., Osifo-Dawodu, E., Alade, E., Ekuri, S., & Idris, J. (2017). An account of the Ebola virus disease outbreak in Nigeria: Implications and lessons learnt. BMC Public Health, 18, 3, 2018.

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Sack, K., Fink, S., Bulluck, P., & Nossiter, A. (2014). Ebola’s deadly escape. New York Times, December 30, p. D1. Retrieved from http://www.nytimes.com/images/ 2014/12/30/nytfrontpage/scan.pdf The Blue Ribbon Study Panel on Biodefense. (2015). Blue ribbon study panel on biodefense report: A national blueprint for biodefense: Leadership and major reform needed to optimize efforts. Washington, DC: Potomac Institute for Policy Studies. The Conversation. (2019) Why Ebola vaccine on trial in the DRC is raising hopes. The Conversation, February 10, 2019. Retrieved from https://theconversation.com/whyebola-vaccine-on-trial-in-the-drc-is-raising-hopes-111126 Walsh, B. & Sifferlin, A. (2014). Preparing for a pandemic: Why the worst Ebola outbreak in history was a reminder of what it means to live in an age of modern epidemics – and what it takes to be ready. In S. O’Connor (Ed.), The science of epidemics: Inside the fight against deadly diseases, from Ebola to Aids (pp. 8–13). New York, NY: Time Books, Inc. Weintraub, K. (2014). From Senegal and Nigeria: 4 lessons on how to stop Ebola. National Geographic, October 25, 2014. Retrieved from https://www.nationalgeographic. com/news/2014/10/141024-ebola-nigeria-outbreak-lessons-virus-health/ WHO. (2014a). Nigeria is now free of Ebola virus transmission. World Health Organization, Geneva. WHO. (2014b). The outbreak of Ebola virus disease in Senegal is over. World Health Organization, Geneva. WHO. (2014c). Democratic Republic of the Congo: The country that knows how to beat Ebola. World Health Organization, Geneva. WHO. (2014d). Declares end of Ebola outbreak in the democratic Republic of the Congo. World Health Organization, Geneva. WHO. (2015). Senegal: Ebola preparedness strengthening team country visit – 17–21, November 2014. World Health Organization, Geneva. WHO. (2015b). Successful Ebola responses in Nigeria, Senegal and Mali. World Health Organization, Geneva. WHO. (2017). WHO declares an end to the Ebola outbreak in the Democratic Republic of the Congo. World Health Organization, Geneva. WHO. (2018a). Ebola outbreak in DRC ends: WHO calls for international efforts to stop other deadly outbreaks in the country. World Health Organization, Geneva. WHO. (2018b). Ebola virus disease: Health emergency information and risk assessment. World Health Organization, Geneva. Winsor, M. (2019) South Sudan begins vaccinating against Ebola as Congo battles outbreak. ABC News, January 29. Yong, E. (2017). How the democratic Republic of the Congo beat Ebola in 42 days. The Atlantic, July. Youde, J. (2015). The politics and policy of Ebola: The World Health Organization and responses to global health emergencies. Political science and politics, 48(1), 11–12.

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Chapter 6

Kerala Nipah Virus Outbreak 2018: The Need for Global Surveillance of Zoonotic Diseases Smarty P. Mukundan, Ananthi Rajayya and Zakkariya K. A.

Introduction In May 2018, a fatal virus called Nipah (NiV) caused widespread panic among the public in the small state of Kerala in India, bringing this emerging and reemerging infectious disease under the spotlight. The virus considered a new age plague that had made erratic appearances across the globe with no clear causal patterns is said to be a zoonotic virus, transmitted from animals to humans, or through contaminated food or from infected humans. The virus is one of eight categories of diseases that the World Health Organization has identified as epidemic threats in need of prioritization.i Over the past 20 years, the virus has continued to spread over thousands of kilometers to Bangladesh and India. Recorded mortality rates in Malaysia, Bangladesh, and India are between 40 and 90 percent and has no vaccines or effective treatments.ii In India, the Nipah virus outbreak in a small town called Perambra, from the state of Kerala, claimed lives of 17 people in 2018. Immediately after the virus outbreak, the government of Kerala took a slew of measures to control virus spread with the help of the local and state machinery and cooperation of the public. It remains to be seen how the Government of Kerala controlled the virus outbreak within a short span of time. The model followed by the state later on earned laurels across the globe for its active measures to contain the spread of the virus. Nevertheless, it also calls for the need for transforming public health surveillance and proactive measures governments must take across the globe to protect human beings and animals from outbreaks of such zoonotic diseases.

The Trail of Nipah in the World Nipah (NiV), an emerging infectious disease of public health importance globally, features in the 2018 WHO R&D blueprint list of priority disease that needs urgent and accelerated research and development work.iii It is a zoonotic virus, a virus International Case Studies in the Management of Disasters, 131–141 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201008

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that spreads from animals to humans, from contaminated food, or through direct contact. It is an enveloped ribonucleic acid virus that shows no specific initial symptoms at the time of presentation. The signs of infection initially may be fever, muscle pains (myalgia), headaches, vomiting, sore throat, etc., to dizziness, drowsiness, altered consciousness, respiratory infections (mild to severe), neurological symptoms that indicate sign of acute encephalitis in the later stages leading to death of the infected. The incubation period, i.e., the time interval from infection to the onset of symptoms, range from 4 to 14 days and in some cases up to 45 days as per reports.iv Fruit bats that belong to the family “Pteropodidae” particularly species belonging to the Pteropus genus are the natural hosts for Nipah virus. They are the carriers of the virus but do not show signs of infection within them. However, domestic animals like goats, sheep, cats, dogs, horses, etc., are likely to be infected and widely seen in pigs too. The mode of transmission is primarily through contact of bodily fluids and tissues of the infected. The Nipah (NiV) virus generally gets spread in three modes: bat to human, animal to human, and human to human. The first outbreak was detected in Malaysia–Singapore region during 1998–1999, which initially thought to be Japanese encephalitis was later identified as Nipah virus. It was detected among pig farmers in a small village called Kampung Sungai Nipah and hence the name “Nipah,” which later spread to Singapore. The probable mode of transmission was identified as unprotected exposure to secretions of infected pigs or unprotected contact to tissues of infected pigs. But further outbreaks were not reported in Malaysia since then (Ang, Lim, & Wang, 2018). The second outbreak was found in the Indo–Bangladesh regions in 2001, where the mode of transmission was significantly different from the former. It is thought to be spread through consumption of fruits or fruit juice (date palm syrup) contaminated by urine or saliva of infected bats and later on by human-to-human transmission via droplets or fomites (objects that are likely to carry infection like clothes, utensils, furniture, etc.). From 2001 to 2008, around half of reported cases in Bangladesh were due to human-to-human transmission through those who were providing care to infected patients. The attack rates for the secondary outbreak was much higher, with much severe symptoms like neurological manifestations, Acute Respiratory Distress Syndrome, and respiratory failure with Multi Organ Dysfunction Syndrome leading to a higher mortality rate. Since then, there has been outbreaks in this region every year. During 2014, Philippines reported an outbreak, again with fruit bats being the possible source where humans and horses were reported to be affected. 17 cases were reported with 53% mortality rate, where in the people infected were primarily involved in horse slaughtering or consumed undercooked horse meat.

Impact of Virus Nipah virus is one of the deadliest viruses also known as the killer virus as the mortality rates reported for the infection are said to be very high. This has been declared by the WHO as one of the viruses that is likely to cause a global

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pandemic with high fatality rate. As the infected do not show visible symptoms in the initial stages, an accurate diagnosis of the virus may not be shown at the time of presentation but can be a carrier. This can create challenges in the outbreak detection in the effective and timely control measures and outbreak response mechanisms too. The Nipah outbreak in Malaysia in 1998–1999 witnessed 265 acute encephalitis with 105 deaths giving a mortality rate of 40%. The government had to contain it by a massive culling of pigs causing a billion-dollar pig farming industry to almost a near collapse. All though the initial outbreak of Nipah was seen in Malaysia, a reoccurrence of the virus was not found in this area (Looi & Chua, 2007). But the epidemic recurs almost yearly in small cohorts in Bangladesh. The mortality rates reported in Bangladesh and India were much higher approaching almost 75% during the period 2001–2011. In 2001, when the outbreak occurred, it almost went undetected till 2003. A lack of advanced healthcare facilities and intensive care units in the region could be one of the reasons for the numbers. First identified in Malaysia in 1998, the deadly virus has killed many people across the globe. The Indian outbreak of Nipah was reported in 2001 in Siliguri in West Bengal, and later in Nadia in 2007. In Siliguri, India, transmission of the virus was reported within a healthcare setting (nosocomial), where 75% of cases occurred among hospital staff or visitors. In 2018, Nipah affected primarily the Kozhikode district and nearby district of Kerala (Thulaseedaran et al., 2018). As of 17 July 2018, a total of 19 Nipah virus (NiV) cases, including 17 deaths, were reported from Kerala state.v Since 2001, the deadly virus has claimed lives of 67 people in India (Exhibit 6.1). With no medicine for treating or antiviral being invented so far, the only option left is to ensure supportive and symptomatic treatment for the patient and by large the management of the outbreak being spread to a larger community.

Exhibit 6.1. Morbidity and Mortality Rates of Nipah in Different Regions of India. Month/Year

January–February, 2001 April, 2007 May–June, 2018 June, 2019

Affected Region/ State

Positive Cases

Mortality

Fatality %

Silguri, West Bengal Nadia/West Bengal Kozhikode/Kerala Kochi/Kerala

66

45

68

5

5

100

19 1

17 0

89 0

Source: Compiled from Ang et al. (2018). ‘Nipah Virus Infection’ and Nidheesh (2019). ‘How Kerala Stopped Nipah in its track’.

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2018 Kerala Nipah Virus Outbreak Kerala, a small coastal state popularly known as Gods Own Country, is one of the most developed and beautiful states in the south western region of India. As per 2011 census report, it has 33.1 million inhabitants, with a high density of population than the national average (362) with 860 persons/sq.km.vi Kerala is primarily an agricultural state with half of the population dependent on that income, while the economy also depends on immigrants working in foreign countries primarily in the gulf countries. The state is also honored for its world-class medical facilities, highest Human Development Index, highest literacy rate, high life expectancy rates, and lowest infant mortality in the country. A state which has four international airports to boast of is well connected by roads too to other neighboring states. In May 2018, when a twenty-two-year-old young man from a small village called Soopikada in Kozhikode district was admitted with symptoms of encephalitis little did the medical fraternity know that there is a killer deadly virus on the lurk. The unusual symptoms for an otherwise clear medical history of the patient made the medical team suspicious. They probed and found that his brother had already succumbed to a similar illness a few weeks back and three others in the family were also showing the same signs of infection which made the team alert.(Pulla, 2018) The critical care unit team of doctors led by Dr. Anoop Kumar realized that they were dealing with a new kind of viral infection. They immediately contacted Dr. Arun Kumar of Manipal Centre for Virus Research and sent the body fluids of the four people for testing and found that they were infected by the Nipah virus which was last found in West Bengal some 2000 kms away from the state. The doctors immediately shared the findings with the authorities of the Medical College Hospital and in turn to state health machinery (Bhagavatheeswaran, Personal communication). The state Health Minister, Ms. K K. Shylaja, immediately reached the city to oversee the outbreak response. The timely intervention of the three doctors helped the government to identify the virus. Though the diagnosis that the infection was due to Nipah virus was made after the death of the second patient, what was praiseworthy was that the virus could be identified from the second patient itself. The Additional Chief Secretary (Health) Mr. Rajeev Sadanandan roped in the international bodies and experts across the world to advise the state on the way forward (Abraham, 2018). But the real challenge now for the state was on how to contain this without causing panic among the public. Post such outbreak usually it unleashes a stuttering chain of transmission, from fruit bats to human and then from human to humans mostly through care givers of the patients, close relatives, health workers, and so on. Following that 18 cases including a health worker were tested positive.

Measures to Control Nipah Virus Outbreak in Kerala The early detection of the virus helped the state to initiate the containment action which was imminent. Being the third populous city in the state, this outbreak in

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one of its small towns could have taken a different magnitude, if it was not contained well. The state swung into immediate action. The outbreak was immediately reported to the center to the Integrated Disease Surveillance Program under the Ministry of Health and Family Affairs in India and through it to the WHO. A multidisciplinary central team from the National Centre for Disease Control was sent to Kerala to investigate and respond, in close coordination with state government officials. The central team provided Kerala officials with the following guidelines and reference materials for Nipah virus, which were made publicly available during the outbreak: case definitions; guidelines for hospital infection prevention and control; guidelines for sample collection and transportation; clinical management guidelines for suspected and confirmed cases; guidelines for safe disposal of dead bodies of confirmed Nipah virus cases; and information for the general public and for healthcare personnel. Risk communication messages were delivered to the community, public, partners, and other stakeholders.vii The next immediate step was the prevention and infection control measures to arrest the spread of the virus. A team of experts from the National Centre for Disease control guided and supplemented the state’s efforts in identifying the source of infection and in clearing many doubts regarding the virus infection with a parallel public communication outreach program. The team gave clear guidelines on effective clinical management protocols to be followed. It included the testing procedures, symptomatic and supportive treatment, drug therapy, and general guidelines to be followed for infection control in the premises. The Strategic Health Operations Centre at the National Centre for Disease Control was activated to monitor the outbreak. Active surveillance programs were initiated for contact tracing with the help of National Institute of Epidemiology. A team under the leadership of multiple agencies that included Director General of Health Services, Indian Council of Medical Research (ICMR)/SG District centers, and NICD/Integrated Disease Surveillance Project took up an active contact tracing and contact management actions. Actions that worked here was clinico-epidemiological case investigations, active surveillance, reporting, forecasting, targeted interventions among high-risk groups, animal surveillance and detection, medical follow-up of survivors, and monitoring recovering patients (Rahim & Chacko, 2019). Under the circumstances, the only way forward was to isolate asymptomatic cases and quarantine them. Contacts were classified into five categories depending on the type of exposure they had with patients, like the scheme of classification followed during Ebola outbreaks. The field staff for surveillance was trained to conduct the interviews in a structured manner. Further the contacts were monitored for 21 days postexposure for development of febrile illness. 2,600 contacts were made and kept under surveillance for a period of 14–21 days, all symptomatic cases were tested for the virus. The surveillance activity continued after 42 days, i.e., twice the maximum incubation period after the last case (Thomas et al., 2019). Dedicated isolation units for infected patients and suspect cases were immediately mobilized, community contacts and hospital contacts were quarantined either at home or in the hospital. Training and capacity building of healthcare

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personnel was immediately done in the essential areas such as sample collection and transportation; safe disposal of dead bodies; contact tracing; hospital waste management; hospital infection prevention and control; and the use of Personal Protective Equipment, etc. The Virus Research Diagnostic Laboratory at Manipal Hospital and the National Institute of Virology conducted laboratory testing to confirm and rule out cases. Intensive measures were initiated with the intervention of the central government health authorities like National Institute of Epidemiology, ICMR, and experts from AIIMS, New Delhi. A multidisciplinary Central team from National Centre for Disease Control, including Epidemiologist, Pulmonologist, Emergency Medicine specialist, and expert in Zoonosis and Animal Husbandry was set up for investigation (Chattu, Kumar, Kumary, Kajal, & David, 2018). ICMR confirmed the source of the outbreak as fruit bats after isolating the virus from the sample bats (Kumar & Kumar, 2018). Despite opening a 24-hour helpline and distress lines and an authentic public communique, exaggerated news from the media and unscientific news and rumors from the social media made the public panic and this posed a challenge for the state. Villages were deserted and instances of ostracizing the family members of the infected also occurred. Rumors that fruits were the source affected the entire supply chain of fruits in the local and overseas markets. The local panchayaths along with a team of doctors and health workers visited each house to allay their unnecessary fears and gave them the facts. At the state level, the minister herself addressed press meets and updated through frequent briefings along with the top administrative and political machinery of the state and urged not to get panicky and sent targeted messages (Vendoti, 2018). Relevant health education was provided through the social, printed, and visual media. Movement of the people were discouraged and as a precautionary step, schools and colleges were closed for two weeks, public gathering and functions in the two districts were asked to be limited (Kumar & Kumar, 2018). The community response to the outbreak was also commendable. Members from the religious organizations, local bodies, NGO’s like Compassionate Kozhikode, Kerala Sasthra Sahithya Parishad (KSSP), a people’s science movement based in Kerala, and other INGO’s operating in the area played a pivotal role toward spreading awareness on Nipah, allaying fears, and anxiety of general public and humanitarian relief efforts to families of Nipah victims (Rahim & Chacko, 2019). The deceased happened to be from a Muslim community and as sample was required from the infected persons, one of the greatest challenge was convincing the relatives of the deceased index patient in conducting a dissection or disruption in the body and also in the burial of the bodies as per the infection containment protocol. With the permission of relatives, a pathological autopsy was conducted at the Medical College to ascertain the exact cause of death. In the larger interest of the community welfare, the relatives of the deceased agreed to abide by the procedure foregoing the deep religious sentiments. Had it not been the swift action of the state, the virus outbreak could have turned out to be a global pandemic. The state being the twelfth largest state by population and the districts affected having one of the largest NRI population,

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the spread of the virus could have been unfathomable. In just two weeks’ time, the virus was detected and confirmed from the second patient and containment actions were begun. The causative agent was also traced, and the state declared the state Nipah free in a span of five weeks. The outbreak was localized to two districts of Kozhikode and Malappuram as declared by the WHO.

The 2019 Outbreak In 2019, when it resurfaced this time in Ernakulam District of Kerala, the state was able to stop Nipah in its tracks without a single casualty. Under the able and vigilant team of the health Minister of the State K.K. Shylaja; Rajan Khobragade, the principal secretary of the health department; Chief Medical Officer of the district; Rajeev Sadanandan, Former Chief Secretary of Health, and the doctor in charge of the public surveillance for an emergency epidemic outbreak, what followed was a testament for the efficient surveillance, preventive measures by the state machinery. The second attack, however, was foreseen by the team well before and the state was on its lookout. Mr. Rajeev Sadananadan, former secretary, had issued a circular in November 2018 and said “there is a high probability, let’s get ready” (Nidheesh, 2019). The state by then had devoted substantially in a network, whose task was to check every newly admitted encephalitis patient since the 2018 outbreak so that the first case of Nipah – what is known in as the “index case” or “patient zero” in medical parlance – could be identified as quickly as possible. This was the lesson learnt from last year as the state was unaware in catching the outbreak last year. By the time the public health response could kick in, the first patient had already transmitted the virus to many last year.(Nidheesh, 2019) Post Nipah 2018, all the public and private hospitals were put on a high alert to report any suspicious cases or cluster of cases showing initial Nipah symptoms. An expert core team was set up for this purpose and studied the cases and took decision to send the sample for further testing at the Virology Institute, Pune. This time the state was able to track the index patient and immediately swung into action with a concerted effort of the state health department, the local health department, and few young volunteers who mobilized into a 30-member team and studied the trail of the patient for the past few days and launched a massive search for the people who were likely to be in contact with the index patient. Around 300 people and three districts were put on alert and offered all support to the families for their sustenance for the next few days. The state health department set up a base camp in Ernakulam with the state minister herself monitoring the activities ensuing that no red tape is involved in getting approvals so that speedy decisions can be made. What the state was lacking in was the testing facilities, but this time a lab was set up in the base camp so that the results could be obtained 3–4 hours instead of waiting for 24–36 hours. The state continues the surveillance for detection and prevention of a potential outbreak. Simultaneously, as part of R&D for Nipah, WHO is collaborating with the ICMR, and research protocols are under development.viii

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Lessons from the Kerala Model The outbreak emphasizes the need for a global surveillance of zoonotic diseases. Nipah virus is declared by the WHO as an emerging pathogen which has the potential to become a pandemic. The basic protocol to be followed in the case of an outbreak is firstly, surveillance: a systematic close monitoring of unusual cases or a cluster of cases and testing it; secondly, immediate reporting: reporting of the initial disease outbreak immediately after verifying from credible sources and assessment of potential public health impact of it; thirdly, verification: initial investigation to verify the disease outbreak and the source; fourthly, response intervention and containment of the disease outbreak (Hitchcock, Chamberlain, Van Wagoner, Inglesby, & O’Toole, 2007). What went successful in the state was the effective surveillance and response mechanism coupled with an effective strong and connected health systems prevailing in the state. A multidisciplinary, multipronged collaboration with the animal health and wildlife sectors for a fast action and preparedness also adds on. Lessons learnt from the Kerala model in containing the outbreak can be summarized as follows:

• • • • • • • •

Early detection of the outbreak (detected from the second patient) and a responsible reporting mechanism of the state to mitigate the undesirable consequences and alerting the officials was worth mentioning. An agile and an emergency response from the state machinery. Multidisciplinary response from human health, animal health, and wildlife professionals. Encouraging and promoting a public–private partnership of medical facilities and knowledge transfer. Effective infection control measures to prevent nosocomial infections and through households. Instituting a strict isolation protocol. Active surveillance and contact tracing. Effective countering of the rumors to avoid panic.

Overall, Kerala’s collaborative work across the public and private sectors, interdisciplinary coordination among the veterinary science and human health professionals, and cooperation and agile response across all levels from the local to district to state and central has set a benchmark on how a state can fight the deadliest of the virus. The pioneering role of Kerala Veterinary and Animal Sciences University, for its advocacy of “One Health” concept, is worth emulating. This approach of addressing the zoonotic and emerging diseases through coordination among the veterinarians, human health and environment personnel, sharing of surveillance and control mechanisms, needs to be institutionalized by all States. A seamless sharing of information and resources across the state rather than hoarding information was also another key to the successful management of the outbreak.

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Later on, the International Health Agency WHO and the Institute of Virology in Baltimore appreciated the efforts made by the state and honored the Chief Minister Mr. Pinarayi Vijayan and the State Health Minister Ms. Shylaja for successfully fighting the virus bringing in laurels to this small state in the southern part of India.

The Need for a Global Surveillance With current advances in global infrastructure, viruses are only a flight away and it may take only a few days for an outbreak to be an epidemic and to a pandemic. The outbreaks of Zika virus, West Nile, SARS, or even the latest Corona virus teach an important lesson, that unless the global health systems are prepared this cannot be contained. Countries are responsible for reporting priority list diseases/unusual illness/or even cluster diseases with potential for international public health impact cases as per the guidelines of 2005 International Health Regulations of WHO. This provides a legal framework for the prevention, discovery, and containment of infection risks at source itself, before they spread across borders, through the collaborative actions of the Countries, States, and WHO. It is said that 75% of the emerging infectious disease are zoonotic and this emphasizes the importance of a one health approach, where a collaborative movement of the human health medicine, veterinary medicine, and environmental scientists is needed to improve the health of humans, animals, and the ecosystem. NiV is a typical example for such an approach for prevention and containment of the infection. Nipah is of utmost importance to the Southeast Asian countries which is a natural reservoir for fruit bats and hence poses a potential public health risk globally in future too. Such disease also needs the involvement of multiple stakeholders and therefore a global diplomacy policy to address the global health issues. Genomic studies and seroprevalence surveys need to be prioritized for effective countermeasures in future. Surveillance of these virus-bearing species of bats as well as studies on the ecological dynamics of Nipah virus and epidemiology of spill over transmission to humans need to be focused on for which an enhanced wildlife surveillance, veterinary surveillance, collaboration with animal health services, and prealert animal early warning needs to be developed. Such outbreaks underline the need for sharing information of any unusual illnesses in animals and humans, an open-minded approach, close collaboration and coordination between the human health, veterinarians, and wildlife specialists in the investigation of such illnesses, and a responsive local and state machinery along with global governance institutions like WHO. Therefore, the roadmap for such zoonotic diseases should be the development of robust medical countermeasures to detect, prevent, and control outbreaks of infection in all countries affected with the virus and that includes diagnostics, therapeutics, and vaccines (Rosa, 2018). It is also a wakeup call for the mass agricultural industrialization, environmental mismanagement like deforestation, encroachment of wildlife into human habitats leading to the introduction of zoonotic infections into domestic animals and humans.

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Perhaps the success of the state of Kerala in containing the outbreak in a record time of five weeks could be because of the immediate response measures done by all these stakeholders. What is required in such outbreaks is not reactionary measures but proactive measures. With ongoing biological outbreaks likely to come any time in future too, it is important that government at all levels, central, state, and local levels, the public, medical community outside the state machinery, and the responsible involvement of media and social media usage learn from the Kerala model and reflect upon it.

Notes i. “Singapore Conference Explored Global Threat Of Nipah Virus,” Retrieved from https://today.duke.edu/2019/12/singapore-conference-explored-global-threatnipah-virus, December 11th, 2019. ii. See note 1. iii. “Nipah virus Key facts,” Retrieved from https://www.who.int/news-room/factsheets/detail/nipah-virus, May 30th, 2018. iv. See note 3. v. “Nipah virus – India,” Retrieved from https://www.who.int/csr/don/07-august2018-nipah-virus-india/en/, August 7th, 2018. vi. “Population 2011,” Retrieved from https://kerala.gov.in/web/guest/ population2011. vii. “Nipah virus – India,” Retrieved from https://www.who.int/csr/don/07-august2018-nipah-virus-india/en/, August 7th, 2018. viii. “Emergencies preparedness, response,” Retrieved from https://www.who.int/csr/ disease/nipah/effective-containment-in-india/en/.

References Abraham, J. (2018). Silently, additional chief secretary Rajeev Sadanandan gained the ammo to take on Nipah. The New Indian Express, June, 10. Retrieved from https:// www.newindianexpress.com/states/kerala/2018/jun/10/silently-additional-chiefsecretary-rajeev-sadanandan-gained-the-ammo-to-take-on-nipah-1826033.html Ang, B.S. P., Lim, T. C.C., & Wang, L. (2018). Nipah virus infection. Journal of Clinical Microbiology, 56(6), 6. Bhagavatheeswaran, L. Nipah in Kerala- an interview with Dr Anoopkumar. Retrieved from https://www.bmj.com/company/nipah-in-kerala-interview/. Accessed on February 28, 2020. Chattu, V. K., Kumar, R., Kumary, S., Kajal, F., & David, J. K. (2018). Nipah virus epidemic in Southern India and emphasizing “one health” approach to ensure global health security. Journal of Family Medicine and Primary Care, 7(2), 275. Hitchcock, P., Chamberlain, A., Van Wagoner, M., Inglesby, T. V., & O’Toole, T. (2007). Challenges to global surveillance and response to infectious disease outbreaks of international importance. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science, 5(3), 206–227.

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Kumar, A. A., & Kumar, A. A. (2018). Deadly Nipah outbreak in Kerala: Lessons learned for the future. Indian Journal of Critical Care Medicine, Official publication of Indian Society of Critical Care Medicine, 22(7), 475. Looi, L. M., & Chua, K. B. (2007). Lessons from the Nipah virus outbreak in Malaysia. Malaysian Journal of Pathology, 29(2), 63–67. Nidheesh, M. K. (2019, June 25). How Kerala stopped Nipah in its tracks. Retrieved from https://www.livemint.com/science/health/how-kerala-stopped-nipah-in-itstracks-1561483503936.html Pulla, P. (2018, June 2). Nipah virus: Anatomy of an outbreak. Retrieved from https:// www.thehindu.com/news/national/kerala/anatomy-of-an-outbreak-how-keralahandled-the-nipah-virus-outbreak/article24060538.ece Rahim, A. A., & Chacko, T. V. (2019). Nipah outbreak in North Kerala–what worked? Insights for future response and recovery based on examination of various existing frameworks. Indian Journal of Public Health, 63(3), 261. Rosa, K. (2018, May 30). NCDC team diligently working to control Nipah virus situation in India. Retrieved from https://www.contagionlive.com/news/nipahvirus-situation-in-india-appears-under-control Thomas, B., Chandran, P., Lilabi, M. P., George, B., Sivakumar, C. P., Jayadev, V. K., … Hafeez, N. (2019). Nipah virus infection in Kozhikode, Kerala, South India, in 2018: Epidemiology of an outbreak of an emerging disease. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 44(4), 383. Thulaseedaran, N. K., Kumar, K. S., Kumar, J., Geetha, P., Jayachandran, N. V., Kamalasanan, C. G., & Shiji, P. V. (2018). A case series on the recent Nipah epidemic in Kerala. Journal of the Association of Physicians of India, 66, 63–67. Vendoti, D. (2018). Lessons from Kerala’s bold fight with Nipah. Retrieved from https://www.orfonline.org/expert-speak/42270-lessons-from-keralas-bold-fightwith-nipah/. Accessed on March 5, 2020.

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Chapter 7

Managing Visiting Scholars’ Program during the COVID-19 Pandemic Miguel Cordova, Karla Maria Nava-Aguirre and Maria Alejandra Gonzalez-Perez

Abstract International mobility outgoing and incoming from almost every university around the world is not just oriented to highly educative standards among them, but to enhance the development of international competences for students, as well as for academics. While students’ mobility are mostly an individual effort that implies individual consequences, academics’ mobility involve several resources from universities and trigger collective processes such as research collaboration, visiting lecturers, exchange experiences and best practices meetings, plenary sessions, classes, among others. This case study aims to provide insights about how planned activities related for/with visiting international scholars suffer major disruption and collateral damages when an unplanned and unexpected global crisis occurs, which forces them to react immediately under different real-time decisions and nonexistent protocols. The chapter focuses on Latin America, using the case of the Global Business Week organized by Universidad de Monterrey (UDEM) in Mexico, and involving visiting scholars from Peru and Colombia. Keywords: Internationalization of higher education; COVID-19; pandemic; academic mobility; international mobility; health crisis; visiting scholars

Introduction It’s moving fast, against the wind. (Boromir in The Lord of the Rings: The Fellowship of the Ring)

International Case Studies in the Management of Disasters, 143–153 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201009

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Previous to the COVID-19 pandemic, some academics around the world had the privilege to be like birds with huge wings that allowed them to move to different events and institutions in the planet, in relatively shorts periods, in order to do perform multiple academic roles (networking, collaborative research, invited teaching, etc.). Allocated international responsibilities when invited to a foreign institution such as plenary sessions, teaching classes, collaborative research project meetings, workshops, among others, keep together an international collaborative network of academics who move around the world, at a business as usual mode, integrating students as well as other academics as audiences of these activities. According to Hawawini (2016) the internationalization of higher education institutions consists in incorporating an international dimension into teaching and research, as well as administrative processes, connecting the institution with the world in an integral sense and enhancing its main activities. Moreover, newest trends state that internationalization strategies in higher education need to evolve from a geographically dependent approach, to a theme-based structured (EFMD, 2018) in order to work together in transversal projects, no matter which countries are involved. This perspective encourages projects with larger numbers of countries as participants, making the internationalization dimension higher. Furthermore, several international accreditations standards for business schools consider as an important milestone the internationalization degree achieved by their faculty, students, and projects (AACSB, 2018; AMBA, 2016), understanding the value of cross-cultural perspectives as well as how to work efficiently under a global scenario. Hence, adding an international dimension into higher education systems pursues the alignment to the UN Sustainable Development Goals (SDGs) (United Nations, 2015) boosting the educational quality (SDG 4) and allowing business schools to take part in international collaborative networks (SDG 17), which provide them with valuable resources. On the other hand, due to the global pandemic declared on March 11, 2020 by the World Health Organization (WHO) because of the COVID-19 virus, the exponential rate of contagion (WHO, 2020a) would drive faculty mobility activities into difficult dilemmas and force visiting scholars, host institutions and home universities to make immediate decisions without unprecedented protocol, due to the uncertainty regarding the new virus, government decisions and travel restrictions, and unreliable information. Academics around the world were forced to cancel or postpone their visits to foreign universities; professional conference and international team research gatherings were cancelled too, but many other faculty visiting were in the middle of the ongoing COVID-19 spread. The latter faces questions such as, how faculty and higher education managerial decisions were made toward internationalization activities facing the threat of another important goal, such as good health and well-being (SDG 3), during the COVID19 global spread? The present case study aims to describe how the situation was of two management visiting academics from Peru and Colombia within an ongoing visit to Universidad de Monterrey in Mexico (UDEM), for the Global Business Week program which was held between March 9 and March 13, and how

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UDEM’s faculty reacted facing a day-by-day rapidly changing scenario, according to COVID-19’s aggressive and exponential global spread. Therefore, this work is based on a qualitative case study based on both primary (ethnographic account) and secondary data (institutional communications, government announcements, and public media). According to Yin (2014), a case study delves into the behavior of people and events since the case has a purpose to explain why and how events happen. Conducting a case study research implies a process of five steps that include design, prepare, collect, analyze, and share information about the phenomenon of study.

Global Business Week Program at UDEM One of the strategies to face the aggressive competition among universities in the new global market is the internationalization of higher education. Under these circumstances, an internationalization strategy is a way in which higher education institutions (HEIs) are responding to the opportunities and challenges of globalization (Altbach, Reisberg, & Rumbley, 2009; Bayramov & Abdrazakova, 2016). It is important to mention that the internationalization of education at Mexican universities has become a crucial element for the achievement of their objectives and as a strategy to cope with the challenges of globalization (NavaAguirre, Garcia-Portillo, & Lopez-Morales, 2019). According to De Wit, Hunter, Egron-Polak, and Howard (2015), internationalization is the intentional process of integrating an international, intercultural, or global dimension into the purpose, functions, and delivery of education, in order to improve the quality of education and research for all students and staff, and to make a meaningful contribution to society. In general, strategies of internationalization in higher education in Mexico are divided into three categories: international relations, partnerships, and consortiums; student and faculty mobility (in-and-out); and internationalization at home (IaH), with different modalities according to each university. Founded in 1969, Universidad de Monterrey (UDEM) is a private, Catholicinspired university located in San Pedro Garza Garcia, in the northeast of Mexico. Regarding internationalization, it is the Mexican university with the ´ de Programas highest component of student internationalization (Direccion Internacionales DIPI, 2017). Also, UDEM is one of the most recognized private schools in Mexico, accredited nationally and internationally. UDEM’s academic organizational structure consists of a Vice Presidency of Health Sciences; Vice Presidency of Architecture, Arts, and Design; School of Business; School of Education and Humanities; School of Engineering and Technologies; and School of Law and Social Sciences. At present, UDEM offers 46 undergraduate degree programs, 4 baccalaureate programs, 16 master’s degree programs, 13 graduate specialties, 37 medical specialties, and one doctorate. Since its foundation, UDEM has become a leading teaching and research university; it currently has 15,867 students and 1,163 faculty members (UDEM Business School, 2019).

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On the other hand, UDEM’s Business School is the largest school at UDEM, with 2,569 students, 151 faculty members, 10 undergraduate programs, and 5 master’s degrees. Its mission is based on four pillars: academic excellence; globalization; transformational leadership; and the generation, diffusion, and application of knowledge (UDEM Business School, 2019). This school has the most participation in student mobility abroad and at home in UDEM. This is important to mention that the Global Business Program is the only undergraduate degree program accredited by AACSB in all Mexico. One of UDEM initiatives of internationalization at home (IatH) is the concept of international campus. This initiative and others such as international curriculum, and international culture are permanently promoted in UDEM (Direccion de Programas Internacionales, 2017). For example, in the first semester of 2020, UDEM Business School invited two visiting scholars outside Mexico to support internationalization of UDEM. There were two specific actions. First, the participation of a Colombian scholar (P1) through the official UDEM’s Visiting Scholar Program and second, the invitation of a Peruvian scholar (P2) to participate in the “Global Business Week” (GBW), an international event organized by the Association of Global Business Students and the support of the Director of the Global Business Program. For this international event, students, alumni, faculty, businesspeople, practitioners, and academics from other institutions in Mexico and other countries are invited to participate annually. For the first semester of 2020, nominated international scholars were selected according to their credentials, experience, and availability. By an official invitation letter by UDEM, chosen scholars were asked to participate and they agreed. Even though international scholars were invited for different purposes, the physical presence of both international scholars meant to contribute to UDEM internationalization aims. After scholars’ acceptance, different on-site activities and agendas were planned for visiting UDEM Business School in Monterrey city (see Tables 7.1 and 7.2). These planned agendas were confirmed by both scholars one week prior to their arrival. However, as is noted in the next sections, the recently discovered virus in China, which rapidly and exponentially expanded to Europe, North America, and the rest of the world, reasons why the agenda needed to be immediately intervened.

The Global Pandemic: COVID-19 According to Nunes-Vaz, Arbon, and Steenkamp (2019), once a sudden and sustained event occurred, such as an epidemic, healthcare systems are stressed to the point of overwhelming their functionality, and demand for real-time decisions, considering the interconnectedness between all parallel systems in the countries’ economy. Even after the disaster, healthcare systems’ performance could be challenged by the number of cases not directly related with the disaster, but as a secondary effect of it in the population (Wong & Li, 2016). Moreover, availability of reliable information is crucial in countries that are more likely to suffer from

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Table 7.1. Visiting Scholar Program Activities (Colombian Visiting Scholar). Event

Type of Activity

“Doing Research and Conference Publishing on Latin America” Meeting Planning future projects with researchers “Yellow Research Conference Lunch” (Research exchange seminar) Radio Show Interview Global Business week Class Global Business week Class Global Business week Class “From NAFTA to Special guest TMEC” Global Business Key note Week Global Business Class Week

Hours

1.5

1.5

Audience

Faculty: Teaching and research academics Researchers

1.5

Teaching and research academics

1.5 1.5 1.5 1.5 1.5

Broad community Students Students Students Academics, students, and faculty Alumni, academics, and faculty Students

3.0 1.5

Source: Authors.

Table 7.2. Global Business Week Event (Peruvian Visiting Scholar). Event

MBA Class Meeting

Type of Activity

Hours

Class Planning future projects with researchers Class

3.0 1.5

MBA Students Researchers

1.5

Students

1.5

Students

1.5

Students

1.5

Professors, students, and faculty All community

Global Business week Global Business Class week Global Business Class Week “From NAFTA to Special guest TMEC” Radio Show Interview Source: Authors.

1.5

Audience

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natural disasters because it would lead to better decisions during the event (Goldblatt, Jones, & Mannix, 2020). According to Eyre (1999), governments and organizations need to be aware of relevant information during a disaster to facilitate the coordination of actions and decisions. Hence, disaster management has effects during the crisis as well as after it, that requires taking real-time decisions under unusual stress amounts and limited information. The COVID-19 virus has exponentially grown and by 28 March 2020 (time when this case study was finished), there were more than 623,000 cases around the world, with more than 137,000 of them having recovered and unfortunately an approximate of 29,000 dead (Worldometer, 2020). Who could think that in less than three months, since four cases of pneumonia were found in a small market in China by December 26, COVID-19 would put under a serious health threat big Eastern countries such as China, Italy, Iran, Spain, South Korea, among others? The WHO was forced in just about two months to pass from a “public health emergency of international concern” status on January 30 (WHO, 2020b) to a “pandemic” status on March 11 (WHO, 2020a). As a highly contagious disease, the WHO stated six strategic goals on its March 16 report of COVID-19: (1) interrupt human-to-human transmission, (2) faster identify, isolate, and care of patients, (3) reduce the transmission from animals, (4) address clinical issues and accelerate the development for a cure, (5) communicate and counter misinformation, and (6) minimize social and economic impacts (WHO, 2020c). On the other hand, by the time of the Global Business Week compared with European or Asian countries, Latin American and African presented a lower number of contagion cases, but with an exponential growth rate. Fig. 7.1 shows the number of cases in Mexico, Colombia, and Peru from March 9 to March 16, 2020, the week the global pandemic was announced, evidencing that even when Colombia had fewer cases than its counterparts, growing rates among these three countries are quite similar. According to Glasser (2016), escalating disasters affect more low and middleincome economies, due to limited resources that have to be oriented to disaster management, rather than focusing their investment in poverty reduction or education enhancement. Hence, Latin American countries conducted several different mandates in order to stop COVID-19’s fast spread, such as social isolation, borders lockdown, emergency status, deployment of military forces, among others. Thereafter, the Inter-American Development Bank (IDB) provided evidence that people in Latin America, since March 14, 2020 and ahead, exhibited major changes on their online preferences, by preferring in-house entertainment rather than outside ones, demonstrating that social distance initiatives could be working well in these countries (IDB, 2020). Organizations, as well as countries, have to focus on their surrounding community that allow their operational continuity, establishing predisaster management plans in order to remain responsible to them and keep them safe (Miyaguchi & Shaw, 2007). Universities depend to some extent on their local community of workers, teachers, and students, and they have to ensure their safety is within their social responsibility commitment. These contingency plans could permit

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100 90 80 70 60 50 40 30 20 10 0

Colombia

Mexico

Peru

Fig. 7.1. COVID-19 Confirmed Cases in Mexico, Colombia, and Peru from March 9 to March 16, 2020. Source: Data compiled from Official Website of Health Ministry of Peru (https://www.gob.pe/institucion/minsa/), Official Website of Health Secretariat of Mexico (https://www.gob.mx/ salud), and Official Website of Health National Institute of Colombia (http:// www.ins.gov.co/). organizations to step forward into institutionalized disaster mitigation policies (Grove, 2013). Complementary to this, Dr. Gonzalez-Perez argued that an important dimension of the same social responsibility appears when organizations need to stop their operations and daily activities in order to ensure the safety of their community within a postdisaster scenario (Forbes, 2020).

COVID-19 Has Moderated International Mobility of Academics The spread of the coronavirus, named as COVID-19, caused different reactions in countries and universities around the world. For example, the first official announcement from private universities to stop international trips in and out of Mexico, Colombia, and Peru was Mexico. This official announcement from UDEM informed visiting scholars about the situation in UDEM and suggested to verify any decision or restriction from Colombian and Peruvian universities and immigration authorities. The same day of the UDEM announcement, and two days before traveling from Colombia to Mexico, P1 based on institutional and national government guidelines decided to cancel the academic mission to Mexico. Under these circumstances, P1 offered to participate virtually in all planned activities and face this global pandemic in the best possible way. After discussions between directors and faculty of the host institution, finally UDEM decided to postpone the participation of P1 for the next semester for two reasons. First, the benefits from on-site activities and face-to-face interaction as the main aim of the institutional Visiting Scholar Program and second, there was no guarantee for technological and virtual infrastructure for the closing conference in UDEM. The option to move on-site to main virtual activities was very risky for the event.

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On the other hand, the reaction from the scholar from the Peruvian private university was quite different. At that moment the scholar received a UDEM notification (one day before travel) regarding (outgoing) travel restrictions imposed by the Mexican university, and high likelihood of quarantine when arriving home. UDEM asked the academic to verify any instructions from the Peruvian government or the home university travel to Mexico. After the confirmation of the scholar, P2 travelled to Monterrey, Mexico, as the original planned schedule, and finally arrived in Peru (returning home) one day before the Peruvian government closed its borders. After recommendations from universities and several governments, and in order to continue with the Global Business Week, UDEM modified the original agenda. It demanded additional administrative efforts, mainly the work from the Director of the Economics Department; the Director of the Global Business Program; the President of the Association of Global Business students, and one full-time faculty responsible for planning the original agenda. From the beginning, all these collaborators were involved in the agenda of the visiting scholars. Meetings or classes changed its topics; some meetings were virtual, and the final day of activities (the last day of the GBW) was eliminated from the agenda since UDEM announced to cancel all classes on Friday to start a general sanitization for all UDEM buildings on the weekend as a measure for prevention. Day by day, uncertainty was growing, and a week that started with a strong handshake, ended with a shy and distanced salutation. As a summary, the main modifications were as follows: (1) Visiting Scholar Program for the first semester of 2020 was cancelled. The P1 visit was originally postponed to the UDEM Business School during the School Business Fellowship 2020 in October (same year). The agenda would include on-site activities such as: classes, conferences, workshops, radio shows, and networking. (2) Additional activities were requested to P2 in order to accomplish the agenda. P2 accepted to participate in extra activities modifying some topics and roles. (3) No virtual activities were included in the Global Business Week since on-site and face-to-face interactions were the attractiveness of the agenda. (4) Activities with students were maintained, but activities with teaching academics and researchers were cancelled. In sum, the event offered 8 conferences, 6 of them international with a total participation of 550 students and 60 alumni. At the end, the Global Business Week in UDEM was successfully developed in spite of implications from COVID-19 and many changes.

Discussion and Lessons for the Future Unexpected global disasters, like the COVID-19 pandemic, drive organizations to real-time decisions (Nunes-Vaz et al., 2019) following nonexistent protocols. Nevertheless, lessons may be learned from several cases that occurred before,

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after, as well as during the crisis. The present case study is focused on the latter, describing how organizations and scholars have to handle a visiting scholar activity with real-time decisions toward an ongoing global health emergency. During the crisis, a well-performed level of awareness was needed in order to obtain valuable information, which is important to be available and consulted frequently through the unexpected event period. Hence, it has to be available from the institutional sources, and faculty need to be aware of it as many times as possible, allowing them to make informed decisions through reliable gathered information (Eyre, 1999; Goldblatt et al., 2020). In addition to this, communication has to be fast, even at the risk of being informal. Making it faster could prevent health risks, and fulfill expectations of professors and audiences. It would be recommended that only one person be in charge of communicating to academics the information they may need and of sudden changes. Moreover, acting under ethics statements for every part involved in the activities exhibited a proper commitment. In the case of the host university, committed with its principles of integrity, having an institutional release first than universities of Peru and Colombia, UDEM warned visiting professors at least two days before travelling. HEIs have to stick to core values, adding an ethical component to their decisions. In other words, academic integrity is a core element while taking important decisions at institutions. Stopping organizations’ operations after the disaster could be an important decision of social responsibility toward the academic community (Forbes, 2020). Furthermore, having additional Plans B, C, D, E, and F could be a good idea. Alternative plans for virtual meetings need to be supported by proper technological infrastructure, which need to be included even in the design phase of buildings. Even on-site activities should consider alternative options in case of extraordinary situations. Having alternatives or contingency plans tends not only to reinforce business continuity through institutionalized disaster mitigation policies (Grove, 2013), but social responsibility of the community jobs too (Miyaguchi & Shaw, 2007). Finally, collaboration and flexibility among parties involved could make changes easy for everyone in the process. Trust and close relationships between visiting professors and UDEM were very useful at the time while making unexpected changes in the original schedule. Visiting professors exhibited a good disposition and a collaborative behavior that facilitated ongoing changes.

Final Remarks All lessons captured and highlighted in this case study are focused on finding a balance between health, human lives, national government measures, international coordination, economic impacts, and internationalization of higher education, or in other words, between SDGs 3, 4, 8, 16, and 17 considering that academic and administrative faculty involved in the situation need to make immediate decisions based on limited information, and act fast.

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Organizations have to prompt a constructive sense of disaster risk management into their direct community, as well as of the potential effects that these unexpected events may cause across the multiple interdependencies in the society’s processes. A community’s broader sight of disasters would reinforce its commitment to follow and support contingency plans. Moreover, organizations have to take responsibility of proper information diffusion and its timing, in order to provide their communities with adequate mechanisms to decide under stressful situations. In addition to this, organizations would need to turn those contingency plans into disaster mitigation policies, providing them structure and continuity over time. Universities could incorporate lessons highlighted in this case study to establish contingency plans for their predisaster and postdisaster operations, and/or reinforce their current disaster mitigation policies. Furthermore, academic mobility has to be taken as a trigger for collective initiatives that involve other academics and large groups of students, putting them at risk under a potential disaster situation. Therefore, academic mobility, as an intensive multiple-task and travel initiative, needs to be specifically included in universities’ disaster management procedures.

References AACSB. (2018). 2013 eligibility procedures and accreditation standards for business accreditation. Retrieved from https://www.aacsb.edu/-/media/aacsb/docs/accredita tion/business/standards-and-tables/2018-business-standards.ashx?la5en&hash5 B9AF18F3FA0DF19B352B605CBCE17959E32445D9 Altbach, P., Reisberg, L., & Rumbley, L. (2009). Globalization and the university: Realities in an unequal world. In J. Forest & P. Altbach (Eds.), International handbook of higher education. Dordrecht: Springer. AMBA. (2016). MBA accreditation criteria. Retrieved from https://associationofm bas.com/wp-content/uploads/2019/09/MBA-criteria-for-accreditation.pdf Bayramov, S. V., & Abdrazakova, A. (2016). Internationalisation of higher education: Challenges, strategies and policies. KazEU Khabarshysy/Vestnik KazEU, 109(2), 190–198. De Wit, H., Hunter, F., Egron-Polak, E., & Howard, L. (2015). Internationalisation of higher education. A study for the European Parliament. Brussels: European Parliament. ´ de Programas Internacionales DIPI. (2017). A customized educational Direccion ´ de Programas model. Un modelo educativo personalizado. UDEM, Direccion Internacionales, Monterrey. EFMD. (2018). New silk roads and higher-education: Towards new models of internationalization? Retrieved from https://blog.efmdglobal.org/2018/09/24/newsilk-roads-and-higher-education-towards-new-models-of-internationalization/ Eyre, A. (1999). Disaster management in South-East Asia: Emergency response and planning in the coming millennium. Risk Management, 1(2), 67–70. doi:10.1057/ palgrave.rm.8240024 Forbes. (2020). Cuando la continuidad de negocio pudiera ser irresponsabilidad social. Retrieved from https://forbes.co/2020/03/29/red-forbes/cuando-la-continuidad-denegocio-pudiera-ser-irresponsabilidad-social/

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Glasser, R. (2016). Forefront for AD-minister – special issue on: Disaster risk management and business education: Sustainable and resilient business, July 15, 2016. AD-Minister, 28, 5. Goldblatt, R., Jones, N., & Mannix, J. (2020). Assessing OpenStreetMap completeness for management of natural disaster by means of remote sensing: A case study of three small Island states (Haiti, Dominica and st. Lucia). Remote Sens, 12(1), 118. doi:10.3390/rs12010118 Grove, K. J. (2013). From emergency management to managing emergence: A genealogy of disaster management in Jamaica. Annals of the Association of American Geographers, 103(3), 570–588. doi:10.1080/00045608.2012.740357 Hawawini, G. (2016). The internationalization of higher education and business schools: A critical review. (1st ed.). Berlin: Springer. doi:10.1007/978-981-10-1757-5 ´ datos IDB. (2020). De golpe crece el distanciamiento social en Am´erica Latina, segun de Google. Retrieved from https://blogs.iadb.org/ideas-que-cuentan/es/de-golpecrece-el-distanciamiento-social-en-america-latina-segun-datos-de-google/ Miyaguchi, T., & Shaw, R. (2007). Corporate community interface in disaster management: A preliminary study of Mumbai, India. Risk Management, 9(4), 209–222. doi:10.1057/palgrave.rm.8250036 Nava-Aguirre, K., Garcia-Portillo, B., & Lopez-Morales, J. (2019). Collaborative online international learning (COIL): An innovative strategy for experiential learning and internationalization at home. In M. Gonzalez-Perez, K. Lynden, & V. Taras (Eds.), The Palgrave handbook of learning and teaching international business and management. Cham: Palgrave Macmillan. doi:10.1007/978-3-030-20415-0_34 Nunes-Vaz, R., Arbon, P., & Steenkamp, M. (2019). Imperatives for health sector decision-support modelling. International Journal of Disaster Risk Reduction, 38, 101234. doi:10.1016/j.ijdrr.2019.101234 United Nations ONU. (2015). The sustainable development agenda. Retrieved from https://www.un.org/sustainabledevelopment/development-agenda/ Universidad de Monterrey UDEM Business School. (2019). AMBA self audit report. UDEM, Monterrey. WHO. (2020a). Coronavirus disease 2019 (COVID-19). Situation Report – 51. Retrieved from https://www.who.int/docs/default-source/coronaviruse/situationreports/20200311-sitrep-51-covid-19.pdf?sfvrsn51ba62e57_10 WHO. (2020b). Novel coronavirus (2019-nCOV). Situation Report – 11. Retrieved from https://www.who.int/docs/default-source/coronaviruse/situation-reports/20 200131-sitrep-11-ncov.pdf?sfvrsn5de7c0f7_4 WHO. (2020c). Coronavirus disease 2019 (COVID-19). Situation Report – 56. Retrieved from https://www.who.int/docs/default-source/coronaviruse/situationreports/20200316-sitrep-56-covid-19.pdf?sfvrsn59fda7db2_2 Wong, H. T., & Li, S. (2016). Healthcare services demand in post-disaster settings: The 2014 earthquake in Ludian county, Yunnan province, China. International Journal of Disaster Risk Science, 7(4), 445–449. doi:10.1007/s13753-016-0107-4. Worldometer. (2020). COVID-19 coronavirus outbreak. Retrieved from https:// www.worldometers.info/coronavirus/ Yin, R. (2014). Case study research design and methods (4th ed.). Thousand Oaks, CA: SAGE Publications.

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Chapter 8

Managing E-commerce During a Pandemic: Lessons from GrubHub During COVID-19 Anil Yasin Ar

Abstract The GrubHub Inc, started as a small food ordering service in Chicago in 2004, and has developed into an e-commerce food delivery giant worth over $3 billion. Since its merger with Seamless in 2013, GrubHub has experienced 53% year-over-year growth in revenue. While online food ordering commerce has been expanding over the years, due to the COVID-19, the industry is experiencing an economic shock. Consumers have begun to isolate themselves from outside as much as possible and local shops have been started to close one by one. As a result, demand has been shrinking to services such as GrubHub, even though otherwise would be expected. In order to survive, the company has to employ new measures and devise new ways of conducting business to protect its competitiveness through catering recently changed needs of community due to the pandemic. This case study explains and demonstrates the set of steps that are taken by GrubHub and their effects on its customers, key business partners, shareholder, and stakeholders. Keywords: GrubHub; Food delivery; Business model; Crisis management; Services; Hospitality

Problem Statement COVID-19 adversely affected all key elements of GrubHub’s business model. It hits restaurants, consumers, and the delivery personnel. The corporation has already been in a rough position due to combination of falling stockshares and negative publications on the press. With the sudden occurrence of the pandemic with quickly rising number of cases all around the globe, GrubHub co-founders, Mr. Maloney and Evans, found themselves even in a harder position. Due to International Case Studies in the Management of Disasters, 155–167 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201010

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lower_demand conditions and restaurant closings, the corporation starts to feel a greater pressure. Now, the corporation has to navigate its daily business dealings during the one of the biggest health emergencies in twenty-first century, which forces people to stay at their homes and isolate themselves from outworld. Is it possible for the corporation to reverse or at least slow down the downwardspiraling stock values under these circumstances? Can GrubHub stay in business during the pandemic and be able to meet expectations of not only its shareholders but also stakeholders?

Learning Outcomes This study aims to deliver a case to demonstrate how GrubHub, an online food delivery service provider, strategize and launch campaigns to not only carry out its daily business dealings during the COVID-19 crisis but also launch corporate social responsibility programs to support communities across where it conducts businesses. More broadly, this case provide insight about GrubHub’s strategy in terms of the company’s competitive positioning during the amid COVID-19 crisis and how it manages to reverse some of the negativities that it was suffering before the COVID-19. It highlights the importance of recognizing challenges that are introduced by the pandemic and how to accommodate consumers’ changing needs while supporting and serving multitude of share and stakeholders.

Case December 31, 2019 was not a normal day for People’s Republic of China. The republic reported a collection of cases of pneumonia that was observed in Wuhan, Hubei Province (Holshue et al., 2020). Even though it raised some concerns due to the previous experiences with SARS and similar viruses, other countries did not pay much attention (Giugliano, 2020; UN News, 2020). Yet, a week later, Chinese authorities expressed that they are facing a new kind of virus, what is known as COVID-19 or coronavirus. In a very short period of time, on January 30, 2020, total observed cases reached at souring number of 9976 in 21 countries. In the meantime, the United States of America had its first case on January 20, 2020; while Europe was experiencing even a grimmer situation (Holshue et al., 2020). On March 11, 2020, when more than 118,000 cases in 114 countries have been observed, the World Health Organization (WHO) declared COVID-19 as a pandemic crisis. Dr. Adhanom, WHO Director General, highlighted the following statement: This is not just a public health crisis; it is a crisis that will touch every sector—so every sector and every individual must be involved in the fights. (World Economic Forum, 2020) In the commencement of the pandemic, multinational enterprises as well as consumers all around the world got alarmed. S&P earnings plummeted; and, in less than a month period, industrial average hit a nearly 20% loss after eleven

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months of bull market (Casselman, 2020). The economic outlook got more worrisome after nations all around the world started imposing travel bans as well as stay-at-home orders (Chart 8.1).

S&P 500 4000

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3500 3000 2500 2000 1500 1000 500

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0

Chart 8.1. S&P Earnings are Plummeted. Source: Author’s own elaboration based on S&P Global Market Intelligence data. As the pandemic progressed and more restrictions started to take place, companies have to take precautions to sustain their businesses and compete in the new environment. One of them that needed to urgently take action is GrubHub. Despite the growing food delivery industry, company has been experiencing financial problems in the last quarter of 2019. The Chicago-based company’s value plummeted as high as 28% after projecting fourth-quarter revenue of $315–$335 million and failed to meet expectations of shareholders (Wittenstein, 2019). On top of it, COVID-19 introduced a new set of challenges. Yet, like many challenges and crisis, new opportunities present themselves for the firms, for the ones that can strategize and adapt fast. Henceforward, GrubHub has to act quick and introduce action plans to prevent further economic loss that it has been experiencing.

The Online Delivery Industry Up until recent years, the food industry has been relying on the same selling and delivery systems. A customer or a patron could call a restaurant and ask for what is available. If they are lucky, they may have a flyer or a printed menu in front of them. After they decide what to order, they have to decide either to ask for a delivery or request a pick up. Depending on the restaurant size and means, either one of the consumer’s request would be fulfilled. If it is delivery, the restaurant

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would charge a small fee for delivery and customers were expected to tip the delivery personnel. Otherwise, restaurant would provide a guesstimate of the food preparation and customer is expected to pick the order at the appointed time. With the technological advancements, food industry went under a major disruption. In the earlier years of the transformation, programmers were only capable of offering the restaurants’ information to users and enabling them to communicate with respective restaurants through a designated website. Depending on the country, a user could provide credit card information via app, ask for mobile credit card terminal, or prefer to pay in cash upon delivery. This suddenly cut the time that is needed to place order as well as increased the efficiency of ordering food. After many major brands and local consumers see the opportunity that the third-party food delivery mobile applications provided, they invest heavily into either being part of online and mobile platforms or crafting their own websites that make their products attractive and desirable to consumers. As a result, the consumption has gone up. Yet, the biggest boom in the industry was when virtual credit cards became more widespread and encryption of the information got better over time. Food delivery industry reached a new peak after the once distrust of technology evolved into a pleasant buying experience, which previously only involved a phone call and sharing credit card information with a stranger. In other words, strong resonance of “privacy” and “security” give a backwind to industry. Despite all innovations, industry growth rate has been slowing down last couple of years. In the last quarter of the 2019, the industry was seen as “dead end.” A Bloomberg article title read as “Food Delivery Looks Like Another Gig-Economy Dead End” (see the article Sen, 2019). The saturated market with many players as well as the high upcharges for restaurants to become members of the delivery networks shrunk the profitability for the industry. GrubHub, in a recent communication to its shareholders, stated that they “didn’t then and still don’t believe now that a company can generate significant profits on just the logistics component of the business. It is a commodity and there are significant variable costs that are hard to leverage even with technology and scale” (GrubHub, 2019, p. 4).

GrubHub Started as a solution for Mr. Maloney and Evans’ frustration “by the lack of dinner options as well as the pain in the [neck] of calling restaurants and reading credit cards,” in 2004 at Chicago, GrubHub was founded. The business model that foresee was simple, connecting consumers with restaurants through online platform and providing them up-to-date menu options. As a result, they managed to create a platform, which features 300,000 restaurants to customers in the United States, as well as London (GrubHub, 2020a, 2020b). Achieving to become one of the leading online and application base digital food delivery marketplaces in the United States and London, it is succeeded to generate $1.3 billion in revenue at 2019 (PR Newswire, 2020a, 2020b). This success is attributed to GrubHub’s unique business model that is relatively hard to replicate. Centering the GrubHub’s IT know-how and online presence, the model foresees GrubHub to provide digital transformation consultancy for its member restaurants. These services ensure the transfer of menus,

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updating the prices, and integrating restaurants to GrubHub’s online delivery and digital ordering platforms. Once the transformation completed, GrubHub acts like a broker. It provides prices and market knowledge on available food to the consumers and gets an amount of commission between 5% and 15% from each order placed. If a restaurant uses GrubHub’s delivery services instead of having its own delivery network, even though customers pay extra while they are checking out, the corporation charges restaurants a predetermined extra fee. Besides serving as an online food delivery system, the business model also encapsulates using GrubHub’s online presence as a digital advertisement platform. It generates revenue through commercials that are placed by restaurants on its website as well as the app. This business model is the key to GrubHub’s success from its inception to up until October 2018 (See the Table 8.1. GrubHub Business Model on the page 160). On October 2018, GrubHub declared that the last expected earnings of 2018 will be around in the range of $40–$50 million, whereas the market expectation was $72.6 million (Reuters, 2018). This caused a big disappointment among its shareholders. This translated to beginning stock value lost. Since shareholders started to distance themselves with corporation, new investors also shied away from GrubHub. To prevent further value meltdown, GrubHub’s Chief Financial Officer Adam DeWitt highlighted that the company will spend an extra $20–$30 million dollars for delivery expansion. GrubHub signed agreements with big corporations such as KFC, Taco Bell, and Shake Shack (Wall Street Journal, 2020). Despite the attempt to reverse the downward spiral, the corporation reported net income loss as $277 million for 2019 fiscal year. This translated to nearly $0.30 loss per share (GrubHub, 2020a, 2020b). The trend begun in September 2018 and continued during 2019. During this time period, the stock value of the corporation tumbled 60% down. Into the first quarter of the 2020, stock prices have been still going down (Chart 8.2). 160

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Chart 8.2. GrubHub NYSE Share Prices Based on FTSE Data. Source: Author’s own elaboration based on FTSE Russel data.

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Table 8.1. GrubHub Business Model. GrubHub Business Model and Value Creation Key Partners

• • •

Restaurants Delivery personnel Shareholders

Key Activities

• • • •

Processing online orders Sourcing and maintaining delivery operation and personnel Creating and managing technological infrastructure Processing transactions in a safe and efficient manner

Source: Author’s own elaboration.

Key Resources

• • •

Technology platform Restaurant partnerships Delivery personnel

Key Channels

• • •

Websites Mobile app for Android Mobile app for IOS

Revenue Stream

• •

Commision out of each order Marketing programs

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GrubHub top managers have reasoned the downward movement with two main motives: first, a new competitor threat in the industry, UberEats. GrubHub cited this threat as “scaled third-party transportation network brought delivery capabilities to tens of thousands of independently owned and enterprise restaurants that couldn’t or didn’t choose to provide their own delivery services” (GrubHub, 2019, p. 3). The second was put forward by the Chief Executive Officer Matt Maloney and Chief Financial Officer Adam DeWitt as “easy wins in the market are disappearing a little more quickly than we thought,” and they tied it to slowing online ordering trend among current and newly acquired users (Nasdaq, 2019). On top of this, GrubHub has been experiencing negative publications. Some of the publications are due to high commissions and how the current delivery system fails to compare to its competitors. This puts GrubHub in even harder position. One of the best examples of this is the Shake Shack. Shake Shack highlighted the reason why its financial earnings were lower than what it is expected is the GrubHub’s ineffective delivery system (Fickenscher, 2019). Therefore, corporation advocates that their loss is due to the GrubHub’s mishandling their recent partnership and delivery structure. While company has been struggling all of the aforementioned problems, COVID-19 created a new set of difficulties. The two key components of the GrubHub’s business model got dramatically affected: (1) restaurants and (2) consumers.

COVID-19 Threats to Restaurants in Target Economies Even during previous recessions no one’s been told you can’t go outside, or you can’t gather. Ellen Zentner, chief US economist at Morgan Stanley (Shwartz, 2020) Small bars and restaurants are struggling to stay open due to COVID-19. Some businesses shut their shops earlier than their normal business hours, move to take-out only, or due to reduced demand decide to not open their businesses. Some others decide to not even open doors as their fixed cost could push them out of the business. In the meantime, there are businesses that have already closed their shops indefinitely as the virus becomes more widespread. In an effort to prevent the increasing number of COVID-19 cases, state officials and prominent politicians all over the world either ask all restaurants and bars to close their businesses to dine-in customers or limit their services to only a certain amount of people. These efforts are especially more pronounced in the two main targets of the GrubHub, London and United States. For instance, in a recent statement, New Hampshire (NH) Governor Chris Sununu announced that NH Restaurants can cater customers only through either drive-through or takeout and banned to host dine-in consumers up until April 7, 2020 (New Hampshire Public Radio, 2020). In a similar fashion, but with a different tone, Boris Johnson, the British Prime Minister, urged public to stay in the home and told the restaurant, caf´e, and pub owners to “close tonight as reasonably as you can and not to open tomorrow… other than for take-out” (BBC News, 2020). These government sanctions further introduce a grim outlook for restaurants that have already struggling with relatively low customer inflow.

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In some other parts of the United States, even though there is no law placed to forbid dine-in, business owners start to take their own precautions. While Tennessee Governor Bill Lee has not given a statement concerning the shutting down of restaurants, several establishments in the region have been making changes and taking precautions of their own. For instance, Firehouse Restaurant CEO Tom Seaton states that Firehouse restaurants are still answering calls and catering pick-up orders, but the regular dining area is closed. Yet, a week later, the restaurant chain issued a statement highlighting that “As the ongoing situation with COVID-19 grows more uncertain and difficult each day, we have increasingly grown doubtful that staying open, even in this limited capacity, is the best way to keep everyone safe” (News Channel 11, 2020). The volunteer closings of restaurants are not limited by the small or medium business owners. Starbucks, one of the biggest coffee shop chains, broadcasted that it is going to close its doors in London in order to maintain safe social distance, four days prior to P.M. Boris Johnson press released about restaurant, caf´e, and bar closure (The Sun, 2020). Another big-name restaurant, which followed the similar strategy to cope with the pandemic, is McDonald’s. Paul Pomroy, McDonald’s Chief Executive Officer for the United Kingdom and Ireland, states in the company’s website that “maintaining safe social distancing whilst operating busy takeaway and Drive Thru restaurants is increasingly difficult and therefore we have taken the decision to close every restaurant in the UK and Ireland by 7 p.m. on Monday 23rd March” (McDonald’s UK & Ireland, 2020).

COVID-19 Threats to Consumers in Target Economies The pandemic affects all walks of the life in one way or the other. People who are over 50 have been anxious to leave their homes and continue their daily routine due to the experts warning on how deadly the virus can be if they are exposed. Similarly, even though there are exceptions to this, young people are observing self-isolation as well as social distancing in growing numbers. In addition, governments are issuing “lockdown” guidance all around the globe and implementing strict rules about when people can leave their home and under what circumstances. For instance, on March 23, 2020, Boris Johnson declared a countrywide lockdown with the following statement: From tonight, only supermarkets, convenience stores and pharmacies can be open, and people will only be able to leave the house once a day to exercise and once to go to the shop… We will stop all gatherings of more than two people in public excluding people you live with. P.M. Boris Johnson (Reuters, 2020) Similar precautions also have been observed in many counties and states in the United States of America. In the United States, Illinois, following after New York and California, order its citizens to stay at their home except in emergencies cases or grocery shopping trips. Even though it means that three biggest cities and economic hubs, Los Angeles, New York, and Chicago, are to be

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completely locked down, governors emphasize the importance of social distancing, reduction of gatherings, and practicing self-isolation in prevention to spread of the COVID-19. After death toll reached at one of the peaks on March 2020, New York Governor states that “No, this is not life as usual. Accept it, and realize it, and deal with it” (The New York Times, 2020). Joining New York Governor, Illinois Governor J.B. Pritzker issued a statement stating that “we must enact an immediate stay-at-home order for the state of Illinois” (New York Post, 2020). Additional states and cities that issue stay-at-home order following New York, California, and Chicago are Connecticut, Delaware, Hawaii, Indiana, Kentucky, Louisiana, Massachusetts, Michigan, New Mexico, Oregon, Washington, West Virginia, and Wisconsin, Philadelphia, Pennsylvania; St. Louis, Missouri; and Denver, Colorado, are also under stay-at-home orders. These sanctions meant to job loss for people as it pushed small and medium enterprises out of business. By the time on March 26, a staggering number of 3.28 million people filled unemployment claims during the United States imposing strict measures to stop the coronavirus spread (Bloomberg, 2020). In return, people’s disposable income floored, and they reduce their spending to minimum. They prefer to save money for unforeseeable health expenses and basic needs.

Crisis Management I wanted to personally connect with you about the actions we’re taking to help you, our restaurant partners, and our drivers, to ensure the health and safety of everyone while supporting our entire community. Matt Maloney (CEO and Co-founder, GrubHub) With the complete lockdown in states and government orders, restaurants have been struggling. GrubHub, which identifies restaurants and delivery personnel as their key corporate partners, needs to take a step to support them in the time of major crisis like COVID-19. In addition, the corporation needs to keep serving customers while accommodating their new demands. For instance, due to social distancing rules and recommendations, many people in GrubHub’s target market and key partners do not wish to contact with people during delivery. It requires the corporation to find and devise new ways of delivering food and protect its stakeholders, while competing with others and meeting shareholders interest.

Customer Care After lockdowns have been placed where GrubHub operates and perceives as the biggest market, such as Chicago and New York, the corporation sees the need of changing its delivery strategy. Listening to its consumers’ concern on whether or not the COVID-19 could be spread through take-out or delivery, GrubHub shifts its delivery system from in-person to contactless delivery to offer extra precaution and provide a piece of mind to its consumers and delivery personnel.

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Contactless delivery stands for delivery without having a direct or face-to-face interaction with the deliverer. Food and orders can get consumers delivered through leaving the delivery in front of a door, a designated place by the customer, or at a designated part of the kerb. To accommodate this change, GrubHub updated its website as well as app. If a consumer prefers to have a contactless delivery, he or she can choose through navigating delivery options and designate a specific place to arrange a safe drop-off sight. In addition, after Centers for Disease Control and Prevention publishes that urges people to “consider options such as ‘grab-and-go’ bags or delivery” and states the importance of keeping “distance as much as possible when picking up food”, this proactive approach led to a major success. Julian Rai, GrubHub delivery personnel from Colorado, states in his interview with a local newspaper reporter Mr. Kevin J. Beaty/Denverite that “food delivery requests are as much as double the normal volume” (Beaty, 2020).

Restaurant Support On March 15, 2020, GrubHub announced that the firm is going to takes steps to help their key business partners, restaurants. Mr. Maloney, co-founder and CEO of the GrubHub, stated in his e-mail to consumers that the firm is going to cut commission fees that restaurants pay. He stated that this would help restaurants with their cash flows in the time of crisis and help them to pay their employees rather than letting them go in the time of hardship. These actions receive wide array of positive feedback. As a response, New York and Chicago mayors thank GrubHub for their support to local businesses and cutting the commission fees at their press conferences at the following manner: The City of Chicago is deeply concerned about the risk COVID-19 is placing on the health of our residents and communities, as well as the impact it’s having on our working families and neighborhood economies and restaurants… That is why we applaud corporate leaders like Grubhub who are stepping up with practical measures to support small businesses and their employees. Lori E. Lightfoot (Chicago Mayor) (PR Newswire, 2020a, 2020b) Banding together during hard times, putting people over profit, and supporting our local businesses is a model we should all follow, and I thank Grubhub for leading the way. Bill de Blasio (New York City) (NY Daily News, 2020) This demonstrates that the firms stay side-by-side with local shops and restaurants to support society and businesses. Furthermore, GrubHub implemented additional set of actions to broaden its support to restaurants. It is stated in the latest communication of the firm that GrubHub will match all promotions offered by independent restaurants with their “Smart Promotions” feature to help businesses grow. Also, the corporation announced that all donations collected under the roof of “Donate the Change” will be donated to restaurants that are impacted by the pandemic.

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Delivery Personnel To provide additional financial relief to its drivers and personnel, GrubHub established “Community Relief Fund.” This fund aims to contribute and support charitable organizations that support drivers adversely affected by the coronavirus outbreak. Also, the corporation launched a policy on March 3, 2020, stating that GrubHub will match the donations from its customers. If a GrubHub delivery driver gets exposed to the COVID-19, the corporation will issue a statement emphasizing that it will pay one-time payment of two weeks’ worth of earnings, which is calculated as an average of the last three weeks of earnings and no less than $100 for any individual. Other precautions mentioned in the previous sections also contribute to the protection of the drivers and their well-beings. Contactless delivery strategy not only enables drivers to deliver food with a mitigated health hazard but also keeps them receiving orders in a very rough economy. Also, it gives an economic as well as mental safety to delivery personnel.

Conclusion COVID-19 adversely affects all key elements of GrubHub’s business model. It hits restaurants, consumers, and the delivery personnel. The corporation has been in a rough position due to falling stockshares as well as negative publications on the press even before the breakout became pandemic. Hence, it needed to act fast and strategize its business dealings. In a very short time, it managed not only to achieve meeting the needs of its customers and shifting its operation procedures but also to create better relationship with its stakeholders through corporate social responsibility projects. These actions help the corporation to reverse negative image and publications among public and help rebounding its stockshares as well (Chart 8.3).

NYSE:GRUB - Share Pricing 55 50 45 40 35 30 25

NYSE:GRUB - Share Pricing

Chart 8.3.

GrubHub Share Prices are Recovering. Source: Author’s own elaboration based on FTSE Russell data.

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This case illustrates that managing a business during pandemic depends on three key factors: (1) timely innovative solutions to meet the needs of society during crisis, (2) addressing stakeholders concerns through implementing various policies, and (3) supporting the employees. In addition, GrubHub efforts demonstrate that it is not only about surviving through time of a disaster but also about creating a win-win situation and helping society while implementing new strategies to support its business dealings in the time of catastrophe.

References BBC News. (2020, March 20). UK pubs and restaurants told to shut in virus fight. Retrieved from https://www.bbc.com/news/uk-51981653 Beaty, K. (2020, March 15). Food delivery gigs abound in COVID-era Denver. Denverite. Retrieved from https://denverite.com/2020/03/15/food-delivery-gigsabound-in-covid-era-denver-for-now/ Bloomberg. (2020, March 26). Mass job cuts across U.S. threaten to leave millions without health insurance. Bloomberg. Retrieved from https://www.bloomberg.com/ news/articles/2020-03-26/mass-job-losses-threaten-to-leave-millions-in-u-s-uninsured Casselman, B. (2020, March 11). Dow ends 11-year bull market as coronavirus defies economic remedies. The Coronavirus Outbreak: New York Times. Retrieved from https://www.nytimes.com/2020/03/11/business/economy/marketsplunge-coronavirus.html?action5click&module5Spotlight&pgtype5Homepage Fickenscher, L. (2019, November 5). Shake shack shares drop 20% on botched Grubhub partnership. New York Post. Retrieved 2020, from https://nypost.com/ 2019/11/05/shake-shack-shares-drop-20-on-botched-grubhub-partnership/ Giugliano, F. (2020, March 23). The lessons from Italy’s Covid-19 mistakes. Bloomberg. Retrieved from https://www.bloomberg.com/opinion/articles/2020-0323/italy-s-covid-19-trial-and-error-and-lessons-for-france-and-u-k?srnd5premium GrubHub. (2019, October 28). GrubHub. GrubHub. Retrieved March 19, 2020, from https://s2.q4cdn.com/772508021/files/doc_financials/2019/q3/October-2019-Shareholder-Letter.pdf GrubHub. (2020a). About us. Retrieved from https://about.grubhub.com/about-us/ what-is-grubhub/default.aspx GrubHub. (2020b, February 2). GrubHub investor. Retrieved from https://investors.grubhub.com/investors/press-releases/press-release-details/2020/Grubhub-Repo rts-Fourth-Quarter-And-Full-Year-2019-Results/default.aspx Holshue, L. M., DeBolt, C., Lindquist, S., Lofy, H. K., Wiesman, J., Bruce, H., … Gerber, S. (2020). First case of 2019 Novel coronavirus in the United States. New England Journal of Medicine, 382, 929–936. McDonald’s UK & Ireland. (2020, March 22). An update from McDonald’s UK and Ireland - see you soon. Newsroom. Retrieved from https://www.mcdonalds.com/gb/ en-gb/newsroom/article/News.see_you_soon.html Nasdaq. (2019, November 3). Customer "promiscuity" drives Grubhub’s earnings into the ditch. Retrieved from https://www.nasdaq.com/articles/customer-promiscuitydrives-grubhubs-earnings-into-the-ditch-2019-11-03 New Hampshire Public Radio. (2020, March 16). N.H. restaurants ordered to serve customers through takeout or delivery only. NHPR. Retrieved from https:// www.nhpr.org/post/nh-restaurants-ordered-serve-customers-through-takeout-ordelivery-only#stream/0

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New York Post. (2020, March 20). Illinois joins New York, California in issuing ‘stayat-home’ order over coronavirus. Retrieved from https://nypost.com/2020/03/20/ illinois-joins-new-york-california-in-issuing-stay-at-home-order-over-coronavirus/ News Channel 11. (2020, March 22). Firehouse restaurant halting all services due to coronavirus pandemic. Retrieved from https://www.wjhl.com NY Daily News. (2020, March 13). Coronavirus concerns prompt GrubHub to suspend $100M in payments. Retrieved from https://www.nydailynews.com/ coronavirus/ny-coronavirus-grubhub-100-million-commission-20200313m5scbjadhbfb3fblx5bzeybr44-story.html PR Newswire. (2020a, March 13). Economic relief effort up to $100 million for independent restuarants and delivery partners impacted by Covid-19. Retrieved from https://www.prnewswire.com/news-releases/grubhub-and-major-cities-acrossthe-us-launch-economic-relief-effort-up-to-100-million-for-independent-restaurantsand-delivery-partners-impacted-by-covid-19-301022993.html PR Newswire. (2020b, February 05). Grubhub reports fourth quarter and full year 2019 results. Retrieved from https://www.prnewswire.com/news-releases/grubhubreports-fourth-quarter-and-full-year-2019-results-300999712.html Reuters. (2018, October 25). GrubHub shares tank on disappointing fourth-quarter profit forecast. Reuters Technology News. Retrieved from https://www.reuters.com/ article/us-grubhub-results/grubhub-shares-tank-on-disappointing-fourth-quarterprofit-forecast-idUSKCN1MZ1YH Reuters. (2020, March 23). Britain’s Johnson says will stop large gatherings and weddings. World News. Retrieved from https://www.reuters.com/article/us-healthcoronavirus-britain-johnson-en/britains-johnson-says-will-stop-large-gatheringsand-weddings-idUSKBN21A3K8 Sen, C. (2019, October 31). Food delivery looks like another gig-economy dead end, New York City, New York, United States of America. Shwartz, D. N. (2020, March 21). Coronavirus recession looms, its course ‘unrecognizable’. New York Times. Retrieved from https://www.nytimes.com/2020/03/21/ business/economy/coronavirus-recession.html The New York Times. (2020, March 20). New York bans gatherings, nonessential workers to stay home. New York Times. Retrieved from https://www.nytimes.com/ aponline/2020/03/20/us/ap-us-virus-outbreak-new-york-2nd-ld-writethru.html The Sun. (2020, March 21). Coffee break pret a manger and Starbucks temporarily closing all UK stores due to coronavirus. Retrieved from https://www.visualcapitalist. com/infection-trajectory-flattening-the-covid19-curve/ UN News. (2020, March 11). Coronavirus: Pandemic alert should be trigger for countries to do more against COVID-19, Geneva, Switzerland. Wall Street Journal. (2020, February 5). Grubhub spends to draw in more diners; tight competition is pushing food-delivery rivals to experiment, adapt to industry in flux. Retrieved from https://www.wsj.com/articles/promotions-eat-into-grubhubs-profit11580938842 Wittenstein, J. (2019, October 28). GrubHub tumbles as competition, ’promiscous’ diners hurt growth, New York City, New York, United States of America. World Economic Forum. (2020, March 11). Coronavirus is officially a pandemic - but we can change its course: Today’s WHO briefing, Davos, Switzerland.

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Chapter 9

The Role of Communications in Managing a Disaster: The Case of COVID-19 in Vietnam Lena Bucatariu

Abstract Despite a ravaging pandemic worldwide, Vietnam managed to contain the local outbreak, partly owing to its carefully implemented risk communications campaign. This chapter investigated the effectiveness of official Vietnam government communications, the sentiment of foreign media reporting on Vietnam, and any challenges. Content analysis was applied to samples from government communications (43 samples); international articles (46); and social media conversations (33). Official government communications were quite accurate, timely, and effective in displaying transparency, employing war symbolism, and shared responsibility, but should more clearly separate between state and expert, offer differing views, and highlight the benefits of compliance. International articles praised the government’s viral PSA TikTok video, its transparency, and the netizens’ nationalist narratives. While some evidence was found for infodemic, blaming, and heroization, the sample was too small to be conclusive. Future studies should expand the timeframe to a longer duration, quantitatively appraise a wider sampling of social media conversations, and possibly conduct primary interviews with experts, policy makers, and the public. Keywords: Crisis communication; public health; disease management; social media; Vietnam; content analysis

Introduction Declared an outbreak by WHO on 30 January 2020 (Kandel, Chungong, Omaar, & Xing, 2020) and later a pandemic, COVID-19 is an infectious disease caused by SARS-CoV-2 (Zhang & Chen, 2020), a zoonotic virus that has International Case Studies in the Management of Disasters, 169–196 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201011

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infected about 2,000,000 people in 210 countries and territories to date (Anon, 2020). A rather unique case, Vietnam shares a porous border with China where the epidemic began, has a limited budget and weak healthcare infrastructure, and yet has been maintaining a very low number of infections, high recovery rates, and no recorded zero deaths at the time of writing (Worldometer, 2020). When assessing the world’s preparedness to handle a health crisis, the WHO applies its framework of International Health Regulations (IHR) to benchmark each country’s capacity to prevent, detect, verify, assess, and respond to the crisis (Kandel et al., 2020). According to the IHR standards, not only healthcare infrastructure is important but, in fact, the nation’s capacity for emergency risk communications is key since “reaching out to communities at the local, national, and global levels are essential for prevention, detection, and control of the infection” (Kandel et al., 2020, p. 1049). Moreover, it has been stated that natural and made-made hazards are to some extent predictable, whereas public health outbreaks are characterized by “deep uncertainty” and “do not adhere to specific boundaries,” hence the need for effective strategies for health risk communications (Zhang & Chen, 2020). While studies on corporate crisis and natural hazard risk communications are abundant in the literature (Barton, 1993; Covello, 1992; Donahue, Eckel, & Wilson, 2014; Palenchar, Heath, Levenshus, & Lemon, 2017; Parker, 1992; Van Ruler, 2018), there are only a few investigations into public health emergencies, mostly dealing with past outbreaks of SARS, MERS, Ebola, and H1N1 (AtlaniDuault, Mercier, Rousseau, Guyot, & Moatti, 2015; Fung, Tse, Chan, & Fu, 2015; Kott et al., 2016; Luoma-aho et al., 2010; Tang, Bie, Park, & Zhi, 2018). Further, the literature has even fewer studies discussing the immediate threat of the COVID-19 pandemic (Guarner, 2020; Luo et al., 2020; Mehta et al., 2020; Xu et al., 2020), usually offering a medical perspective on disease pathology rather crisis communications. In order the address the gaps, this chapter brings strong theoretical underpinnings both from theories of risk communication such as framing (Kott et al., 2016), message-centered approach (Zhang & Cheng, 2020), and the art of rhetoric (Johnston, Taylor, & Ryan, 2020) and from industryrelevant, evidence-based public health frameworks such as the health belief model (HBM) (Champion & Skinner, 2008; Sheppard et al., 2020). This chapter starts with a discussion of key theoretical models of public health communications and negative aspects of risk communications, followed by the Methodology explaining how data were collected and analyzed; continues with Findings from official government communications, international news about Vietnam, and local instances of challenging communications from social media. The Discussion section compares Vietnam findings with key literature and provides some implications for policy makers, followed by a summary of the answers to the research questions and recommendations for further research.

Literature Review This section opens with operational definitions of communication, risk, crisis, disaster, and risk communications, discusses key theories underlying public health

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communications, and concludes with a review of the dark side of communications, such as blaming, sensationalism, and unconfirmed communications.

Models and Frameworks for Pandemic Communication The following section gives some important definitions pertaining to communications in the context of emergency, crisis, disaster, and public health risk, followed by a discussion of key theoretical models. Operational Definitions In the broadest sense, the Latin term communicare meant “to share with,” “to share out,” or “to make generally accessible” (Glare, 1968, p. 369 cited in Leroy, 1979). As Van Ruler (2018) highlights, there are at least three directions to view communication, namely one-way, two-way, and omnidirectional diachronic. In particular, the first type of communication is defined as “a one-way process of meaning construction, in which the sender attempts to construct or reconstruct the meaning developed by the receiver” (Van Ruler, 2018, p. 368) and is used extensively in this chapter, especially in the sections dedicated to official communications by the Vietnamese government, by Vietnam’s state-owned media, and from official international news channels. The second type of communication is “a two-way process of meaning construction, in which two or more people construct new meanings together” (Van Ruler, 2018, p. 368) and applies particularly to the sections analyzing unofficial communications made in Vietnam’s public digital sphere, especially on social media. Although highly relevant to understanding the complex interactions typical of a public health crisis, the third type of communication aimed at “meaning construction” and “the continuous development of meaning itself” (Van Ruler, 2018, p. 368) is underrepresented in this chapter due to limitations of time and the rapid pace of a still ongoing pandemic development. For the purpose of this chapter, communications will be understood in the context of an emergency, such as disaster, crisis, or risk, particularly relation to public health risk, such as the COVID-19 pandemic of 2020. Risk has been defined as “the tensions between certainty and uncertainty, degrees of probability, knowable patterns, achievable rewards, and preventable harms” (Palenchar et al., 2017, p. 712). Further, as Covello (1992) highlights, risk communication is a “process of exchanging information among interested parties about the nature, magnitude, significance, or control of a risk” (p. 359). Barton (1993) defined crisis as “a major unpredictable event that has potentially negative results” (p. 2), and Fink’s addition that the crisis “increases in intensity and is given much scrutiny by the media” (quoted by Wigley & Zhang, 2011, p. 3) aptly describes the current pandemic. Another suitable characterization of the COVID-19 pandemic is as a disaster, i.e.: …an unusual natural or man-made event (..) which temporarily overwhelms the response capacity of human communities, groups of individuals or natural environments and which causes massive damage, economic loss, disruption, injury, and/or loss of life. (Parker, 1992, p. 4)

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Throughout this chapter, the terms risk, crisis, disaster, and emergency may be used interchangeably to refer to public health emergencies, i.e., the COVID-19 pandemic and other recent outbreaks such as SARS in 2003, MERS in 2015 (Fung et al., 2015), H1N1 swine flu in 2009, and Ebola outbreak in 2013–2016 (Tang et al., 2018). In the realm of risk communications, the following section reviews several key theoretical underpinnings, namely the rhetoric of argumentation for preparedness, framing and risk perception, the message-centered approach in the model of Government–Expert–Public risk communications, and the HBM which is an evidence-based public health framework.

Preparedness Communications and Risk Perception During emergencies that jeopardize people’s health, safety, and livelihood on a national scale, the authority tasked with preparedness and risk communications is a country’s government, particularly the public relations function (Seeger, Sellnow, & Ulmer, 2001, pp. 155–166). According to Paton, preparedness refers to knowledge and actions to reduce current risk to health and damage and build capacity to minimize disruptions in the future (2003). More specifically, preparedness includes governments, organizations, and individuals’ capacities “to effectively anticipate, respond to and recover from the impacts of likely, imminent or current disasters” (Paton, 2019, p. 329). To ensure the community is prepared, governments and government-affiliated entities need to strengthen the community’s capacity and resilience in the face of danger by portraying realistically the type of harms posed by the emergency and their likelihood (Johnston et al., 2020). Several message sources are involved in emergency communications, including various government departments and levels from national to regional to local, emergency services, e.g., public health services in the case of disease outbreak, nonprofit foundations, and other community entities (Johnston et al., 2020). To reach both persuasive and safety objectives, each actor communicates its legitimacy and capacities to respond to the crisis. To illustrate, government communications use argumentation rhetoric to highlight the country’s leadership and associated agencies as experts (Toulmin, 2003). In rhetoric, an argument comprises the claim, the grounds, and the warrant: the claim is what the communicator wants the audience to believe, the grounds are the proof (facts or evidence), and the warrant is the direct or indirect link that connects the grounds to the claim (Johnston et al., 2020). As Heath (1992) proposes, the accumulation of warrants provided by the speaker enables the audience “to estimate whether sufficient facts exist, in light of the warrant, to justify the conclusion” (p. 49). In this sense, government-initiated risk communications are a “warrant” that links the claim – that the government is making efforts to prepare the public for the imminent disaster – with the proof such as money or capacity-building initiatives (Johnston et al., 2020). However, preparedness is not only the government’s job, as individuals and communities themselves need to “share responsibility for their own protection, by taking protective actions and avoiding the harms that may befall them”

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(Donahue et al., 2014, p. 90). Often, preparedness communication is unidirectional from government or expert sources and meant to inform rather than persuade or engage (Johnston et al., 2020). While engagement-based communications are more commonly employed at later stages of a hazard, e.g., during response, research has shown that community-based initiatives bring positive results as early as the preparedness phase, and a mix of informational and engagement approaches should be employed throughout the crisis (Frandsen, Paton, & Sakariassen, 2011). Despite warnings, citizens do not usually prepare for an emergency until the danger is near, even in situations when the audience have high awareness of the risk and its harm potential (McLennan, Paton, & Wright, 2015). Perception of risk has been defined as “the process of collecting, selecting and interpreting signals about uncertain impacts of events, activities or technologies” (Johnston et al., 2020). In a public health emergency, risk signals can refer to chance of getting infected or the seriousness of disease progression. The public try to weigh potential consequences versus actual impact in the individual’s life, and there is a correlation between low risk perception and limited information seeking, coupled with few protective measures taken (McLennan et al., 2015). As a corollary, community engagement is paramount to ensure that individuals feel responsible to do their part in preparing and keeping safe during a public health emergency (Johnston et al., 2020). Thus, government communications need to strike a balance between defending the warrants (investment in equipment and manpower to strengthen the agencies) through official informational channels while at the same time appealing to citizen’s sense of duty to share the responsibility of taking care of themselves and each other (Johnston et al., 2020). An interesting point in disaster communications is the effect of an individual’s internal or external locus of control, i.e., the belief that their actions can or cannot influence an outcome (Mishra, Suar, & Paton, 2009). The problem is compounded if individuals display an optimism bias (i.e., “I won’t get sick, only old people catch the virus.”) as they are more likely to dismiss risk information and warnings (Johnston, Lai, Houghton, & Paton, 1999). Although official communications often emphasize the agencies’ readiness and expanded capability, such messages could be detrimental and shift the individual’s locus of control externally, to over-rely on the government intervention (Mishra et al., 2009). As a result, individuals may get a false sense of security, downplay potential threats to self, and become less receptive to messages of shared responsibility (Mishra et al., 2009). In view of the above, and the government’s capability to cope with the pandemic needs to be conveyed in a way that enhances the public’s self-efficacy, i.e., belief in their own ability to take the necessary actions (Johnston et al., 2020).

Message-centered Approach While preparedness communications are often employed to cope with natural and man-made hazards, the message-centered approach to communication has been used to analyze the reasons for the government’s initial cover-up at the beginning of the COVID-19 outbreak in Wuhan, China (Zhang & Chen, 2020). Using the message-centered approach, the authors proposed a simplified model which can be reduced to communications between the three key actors – the

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government, experts, and the public (Zhang & Cheng, 2020). In the model, the three interactions concern communications between government–public, government–expert, and expert–public. During public health outbreaks, the government is the main decision-maker in charge of the risk process as well as the originator of pandemic-related communications (Zhang & Cheng, 2020). Firstly, in the government–public communication, the government has the responsibility to deliver information about the public health crisis that is correct, adequate, and made available openly (Zhang & Cheng, 2020). As shown in the literature (Covello, McCallum, & Pavlova, 1987), state representatives are sometimes “frustrated by what they perceive to be inaccurate public perceptions of risk and unrealistic demands by the public for risk reduction” (Covello et al., 1987, p. 1). In a two-way communication, there is a feedback loop in which the public expresses their concerns and information needs, which shapes the government’s further messages to address those needs (Covello et al., 1987). One issue that government agencies face is how to decide the extent of disclosure to members of the public without causing exaggerated fear (Boholm, 2019). To explain the Wuhan early nondisclosure of the outbreak, the authors cite “consideration of maintaining social stability” and balancing “public risk tolerance” (Zhang & Cheng, 2020, p. 64). Second, government–expert communication is a crucial element in the risk communication network, i.e., an example of internal communication (the public is not involved) to assess risk and decide on a course of action (Zhang & Cheng, 2020). For experts, risk is understood and mitigated through the lens of professional experience, technology, and specialist judgment (Zhang & Cheng, 2020). By employing a census of public health expert opinions, the government can better assess the likelihood and impact of various scenarios and make decisions to mitigate loss (Boholm, 2019). In a transparent environment, experts’ opinions should be backed by scientific evidence and put above personal or political interests (Zhang & Cheng, 2020). Additionally, any disagreements between experts due to the interdisciplinary nature of public health risk management should be discussed and disclosed so that the public are not exposed to fringe opinions or downright misinformation (Boholm, 2019). Thirdly, expert–public communication is another example of external communication which aims to “bridge the gap between expert and public views on public health issues through strategic communication” (Zhang & Cheng, 2020, p. 65). Unlike other informational types of communication where the focus is on transferring existing knowledge and making sure that the receiver can decode it as intended, risk communication in a public health crisis has the additional hurdle of transferring uncertain or incomplete knowledge (as the pandemic is ongoing) in a way that encourages the public to make their own informed decisions (Gesser-Edelsburg, Shir-Raz, Hayek, & Sassoni-Bar Lev, 2015). However, to make this exchange effective, the public need to voice their requests for clarification to experts instead of seeking information from alternative sources or rumors (Zhang & Cheng, 2020). As seen above, the three actors need to demonstrate partnership within the risk communication network, and as evidenced in the Wuhan outbreak, the government needs to disclose accurate information on time and effectively (Zhang & Cheng, 2020). By applying the message-centered framework to the initial phases of the COVID-19 outbreak in Wuhan, China, the authors concluded that the

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Chinese government lacked “scientific risk communication into policy decision,” the local authorities delayed reporting key facts and communicated externally “in an ambiguous way,” which affected the public’s understanding of and perceptions toward COVID-19 (Zhang & Cheng, 2020, p. 64). Further, officials discounted the “inherent uncertainty and different levels of risk perception” of an ongoing crisis, which exacerbated rumors and fuel some panic (Zhang & Cheng, 2020, p. 64). In light of their analysis, the authors recommend increased accessibility and openness from the government, allowing for multiple and evolving points of view from experts and the public in a collaborative network (Zhang & Cheng, 2020).

Health Belief Model The idea of the public as a partner is also found in the HBM, which was developed to address the need for a risk communications tool kit to aid Health Care professionals (HCPs) such as doctors, clinicians, and pharmacists (Sheppard et al., 2020). Developed for potential tuberculosis patients who do not seek screening (Champion & Skinner, 2008), the HBM is a useful public health model to understand why community members do or do not take action when facing a health risk to themselves or the community (Champion & Skinner, 2008). As a public health behavior framework, the HBM proposes that individuals rely on personal beliefs and direct cues to guide their actions (Champion & Skinner, 2008). One step back, beliefs are shaped by the person’s perception of threat, the benefits of taking action, obstacles to the new behavior and self-efficacy, or confidence in their ability to act (Sheppard et al., 2020). As the authors suggest, HCPs applying the HBM model when communicating during the US COVID-19 epidemic have to take into account socioeconomic factors such as limited access to information among lower-income individuals, and cultural norms, e.g., how do Asian or Hispanic communities react to “social distancing” rules (Sheppard et al., 2020). In times of health crises, individuals process information differently, and behavior will be affected by three key factors: (1) perceived threat – “How dangerous is the COVID-19 outbreak overall?’; (2) perceived susceptibility – “How vulnerable am I to be affected?”; – and (3) perceived severity – “If I do get sick, how likely am I to become critical or die?” (Sheppard et al., 2020). As a corollary, individuals are more likely to modify their behavior if the perceived threat is higher, and especially if they perceive themselves to be more susceptible, i.e., vulnerable to infection and complications (Sheppard et al., 2020). Particularly for COVID-19, the authors recommend HCPs to rely on case data about risk factors (obesity, age, etc.) when explaining the danger to potential patients, while at the same time “be careful to avoid implying that there is no health to younger, healthier individuals” (Sheppard et al., 2020). While echoing the “shared responsibility” message recommended by Johnston et al. (2020), Sheppard et al., 2020 suggest tailoring conversations to have cultural relevance, e.g., mention the threat of infecting family members to an individual whose subculture values family or the elderly (Sheppard et al., 2020). When dealing with individuals who have mental health concerns (e.g., anxiety, OCD), HCPs are advised to leverage the positive aspects, i.e., benefits of safe behaviors, benefits of more free time for family or hobbies when working from

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home. Building the person’s self-efficacy or confidence in their ability to act responsibly can also help shape behavior and reduce perceived barriers to change when possible, e.g., by suggesting financial aid and other services to mitigate financial distress for manual labor who depend on out-of-home work (Sheppard et al., 2020).

Unconfirmed Communications While official sources make efforts to deliver evidence-based, scientific messages through official news channels, there are often parallel lines of unconfirmed, misconstrued, and sometimes downright incorrect communications circulating through blogs and social media, a phenomenon usually referred to as “infodemic” (Cinelli et al., 2020). The following section provides an overview of sensationalism, framing and blaming, and how they may affect communication during a public health emergency. Sensationalism and Framing in Health Communications While the previous section dealt with personal factors (e.g., perceptions of threat), external influences such as the media also play an important role in framing risk and shaping behavior during an outbreak (Kott et al., 2014). For instance, the way the public perceives issues is intertwined with the way the media report and reflect on those issues (Gollust & Lantz, 2009). To illustrate, if the public do not trust media due to sensationalizing health news, then individuals are less likely to adopt the recommended health and safety measures (Gollust & Lantz, 2009). Typically, individuals make decisions based on perceived threat rather than actual risk (Rubin, Rubin, & Haridakis, 2009), which makes framing a necessary tool to highlight important information for the audience (Menashe, 1998). Originating in psychology, framing enables journalists – who are the source of communication – to influence the public’s interpretation of an issue or event, e.g., by creating emotions toward a health risk (Entman, 1993). This becomes crucial in a pandemic when individuals have limited personal experience with the issue and thus are more likely to trust media content (Jackob, 2010). For example, when a health risk is framed as serious and relevant, the audience may feel afraid, which motivates behavior that will reduce their fear, e.g., buying sanitizer or avoiding crowded places (Kott et al., 2016). On a psychological level, exaggeration or sensationalist portraying of health threats by the media can result in disproportionate fear or panic in the early stages of an outbreak, followed by mistrust and reluctance to follow safe behaviors later on if the initial fear turned out to be unfounded (Kott et al., 2016). Other dangers of sensationalism include misrepresenting scientific evidence, e.g., as in the public overestimating the chance of infection with H1N1 in 2009 or overreactions to SARS in 2003 due to frequent media coverage (Kott et al., 2016). For accurate and responsible reporting, the Center for Disease and Prevention recommends messages be simple, consistent, repeated from various sources, and offer a solution or positive action steps that individuals can take to reduce risk (Kott et al., 2016).

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Blaming and Heroes Outside of traditional sources such as government agencies and mass media, individuals are increasingly resorting to social media for information in times of uncertainty, which can have unwanted consequences of content reliability and ethics (Denecke et al., 2016). For instance, an analysis of social media discussions in France during the H1N1 outbreak found a discourse of “geography of blame” and conspiracy theories that blamed the outbreak on the government, pharmaceutical companies, or the elites (Atlani-Duault et al., 2015). Similarly, a Finnish social media study during the same period found that although official government communications were timely and evidence-based, they did not address the public’s concerns, e.g., antivaccine groups on social media and speculations from grassroots bloggers (Luoma-aho et al., 2010). As stated, looking for someone to blame is a common phenomenon while making sense of a crisis (Atlani-Duault, Ward, Roy, Morin, & Wilson, 2020) and its counterpart is heroization, i.e., “the investment of hope and trust in a context of risk and unease” (Atlani-Duault et al., 2020, p. e137). The authors identified typical “local heroes” such as ordinary individuals during the 2014–2015 Ebola outbreak, whistle blowers such as Dr. Li Wenliang in Wuhan who jeopardized his career to inform the public and ultimately lost his life to COVID-19, and exhausted health workers in Italy or France fighting the virus without sufficient protective equipment (Atlani-Duault et al., 2020). Subsequently, the authors highlighted the traction that local heroes could have among their community and encouraged governments to track social media conversations to identify and cooperate with heroes, counter misinformation and blaming, and reframe official communications to directly address the public’s most current concerns (Atlani-Duault et al., 2020). As the COVID-19 pandemic is ongoing in 210 countries and territories, Vietnam has taken some strong measures to contain the virus, with high compliance among the population, and very encouraging results despite a limited budget and weak healthcare infrastructure (Ebbighausen, 2020). To illustrate, although sharing a porous border with China where the virus originated, Vietnam has been maintaining a very low number of infections per population, single-digit daily new cases, high percentage of recoveries, and is one of only three countries currently above 250 cases that has recorded zero deaths (Worldometer, 2020). As demonstrated above, timely and consistent risk communications are crucial in handling a public health epidemic; therefore, this chapter aims to evaluate the effectiveness of COVID-19 communications taking Vietnam as a case study. Research questions: (1) How effective are the official Vietnam government communications concerning the COVID-19 outbreak? (2) How does foreign media report on Vietnam’s COVID-19 situation and communications? (3) What are some challenges of unconfirmed COVID-19 communications in Vietnam?

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Methodology This chapter employs content analysis, a research method used to group written documents into identified categories of related meanings (Moretti et al., 2011). Here, content is understood as written materials such as news articles, SMS text messages, social media posts, or blogs. Visual content was occasionally commented on, but not extensively, as it did not make the focus of this analysis. The research design had three steps: first, content analysis was performed on official media releases originated by the government, irrespective of channel or platform/medium of communication, including COVID-19 communications from public dissemination government websites, news articles from government-owned online media outlets, SMS communications from national and local government agencies, government-endorsed health tracking apps, and government’s official social media accounts on Facebook, Zalo, and TikTok. Data were captured and analyzed primarily via NVivo 12 software, with some analysis done manually especially for SMS and social media content. Vietnamese original content was translated by an independent translator with care to preserve the original tone of voice and intention. Sampling: due to the relatively short duration of the outbreak so far, all government communications were included for the duration of 3 February 2020 to 10 April 2020 (inclusive). Second, content analysis was performed on publicly available Englishlanguage news articles originated by media publishers outside of Vietnam which are independent of Vietnam’s government. This distinction is important as freedom of press is to a certain extent restricted within Vietnam (Marr, 2017), and therefore by using non-Vietnamese sources, the analysis hopes to achieve a more objective, triangulated view (Saunders, Lewis, & Thornhill, 2019) of how the international community sees Vietnam’s communications during COVID-19. News articles for this step were captured from news.google.com and yahoo.news.com and analyzed primarily via NVivo 12 software. Sampling: due to the relatively short duration of the outbreak so far, all English-language articles containing the key words “covid-19 1 Vietnam” and “coronavirus 1 Vietnam” were included for the duration of 3 February 2020 to 10 April 2020 (inclusive). Third, content analysis was performed on a limited sample of publicly available informal communications such as social media posts, editorial pieces by grassroots and celebrity bloggers, and user comments in the public sphere. Sampling: purposive sampling was performed with the specific aim of identifying instances of unofficial communications and challenging messages (if any) in the Vietnamese digital sphere such as conspiracy theories, exaggerations, blaming, and heroization. To identify these data, the Vietnamese equivalents of the following key words were used, followed by “1 Covid-19” or “1 Corona” or “1 Coˆ Vi” (The slang Vietnamese equivalent, literal translation “Miss Vi”). For example: “blame 1 Covid-19/Corona/Coˆ Vy,” “hate 1 Covid-19,” “fake news 1 Covid-19,” “charity 1 Covid-19,” “Celebrity 1 Covid-19,” etc. After visual inspection on social media platforms (Facebook, youtube.com) to establish relevance, NVivo was used to capture content directly from pages for further analysis.

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Data collection duration for all content was February–April 2020, starting from the 1st Ministry of Health communication of 3rd February 2020, until the cut-off date for last communication of 10 April 2020 (inclusive). An initial coding key was developed based on the theoretical models and frameworks identified in the literature, with subsequent iterations as coding progressed and more themes and patterns emerged from the data (Saunders et al., 2019). All coding was done by the author directly into NVivo 12 software and consulted with the local translator.

Findings This section details findings arranged by themes based on content analysis of official government communications, international media reporting on Vietnam’s situation, actions, and communications, as well as subsection dedicated to more challenging phenomena of blaming, rumors, and fake news.

Factual, Transparent, and Timely Communications in a Variety of Platforms For stage one of content analysis, 43 total samples of official communications found on public dissemination media channels were analyzed, which spanned a variety of platforms including government web portals, state media, Text messaging, outdoor propaganda, and social media. From the analysis (Table 9.1 above), it can be inferred that the government employed a variety of traditional and new media, with special mention for SMS or Text messaging, official government accounts in social media and even a Ministry of Health account set up in platforms targeted at a younger population such as TikTok. To track disease spread and enhance contact tracing, the government created their own apps for medical health declarations and locationbased tracking across the nation, named NCOVI. Overall, the tone of communication is factual, based on evidence and statistics, such as number of infections, number of recovered, disease symptoms quoted from WHO [World Health Organization], quotes from government officials, and clarifications of new rules and regulations, for example: The Ministry of Health has confirmed, social distancing does not mean prohibiting transportation, and not yet social locking down. (SMS, Ministry of Health [MOH], repeated verbatim on government Facebook page.) Fact-based content is accompanied by visuals of patient tracking and mapping, attached to official communications and reproduced at the end of news articles in state media. By their level of detail and accuracy, the visuals are effective in conveying timely information while at the same time indirectly reinforcing transparency, such as detailed cases by province, and tracking of all patients linked to Bach Mai hospital hotspot in Hanoi (Le, 2020).

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Table 9.1. Content and Tone Analysis of Communications for Public Dissemination Collected from Open Sources during February 3rd–April 10th, 2020. Official Communica ons - Various Pla orms Pla orm/channel From www.chinhphu.vn, h p://www.gov.vn/

Government Web Portal

tuoitre.vn, State-influenced thanhnien.vn, media vnexpress.vn, etc.

Sample Frequency daily

Ministry of Informa on and Communica ons

SMS / Text message

People's Commi ee of HCMC Government Informa on www.facebook.com/t hong nchinhphu Current Affairs VTV www.facebook.com/t hoisuvtv Ministry of Health's TikTok account @boytevietnam

Facebook

TikTok

Zalo (Vietnamese social media app) Government Apps Billboard & Outdoor

Official Government Account NCOVI, SUCKHOE Vietnam Outdoor, na onwide. High penetra on in rural. Total sample

3

1

Factual, reassuring, strict

text, some with links

reassuring

text, some with links

Factual, reassuring

text, some with links

warrants (supply of goods), shared responsibility

Factural, reassuring

Repeats (usually verba m) from Government Web Portal

several mes/day

Factual, reassuring

text, some with links, some visual (infographic) Short videos, text

as needed

Repeats content from VTV news (Na onal TV). Preven on, rules, FAQ, shared responsibility, war rhetoric Fun, engaging mainly videos Campaign #ONhaVanVui (#StayHomeIsFun). Users share from users and celebri es moments at home, dance challenge, etc. Winner aired on TV. KOL's song about "Why aren't you home yet?" Song about Factual, text, links, Repeats (usually verba m) from reassuring visual (photos) Government Web Portal Factual, visual, some Medical health declara on, updates on reassuring text outbreak, preven on, etc.

N/A

Engaging

visual with call Depict desired behavior, shared to ac on responsibility. Call to ac on.

3

2

several mes/day 3

several mes/day

2 2

Content/themes

every 2-3 days, mely to address developments mely to address scam, encourage dona on mely to address panic buying as needed

daily 4

14

Format text, some visual (infographic) text, some visual

Updates on outbreak, preven on, warrants, endorsement of local government Repeats news (some mes verba m) from Government Web Portal: updates on outbreak, preven on, warrants, endorsement of local government preven on, clarifying/disspell rumors, warn against fake news, threaten if noncompliance, shared responsibility, endorsement of local government shared responsibility (dona on), warn popula on against scams

4

Ministry of Health

Tone of voice/Mood Factual, reassuring, strict Factual, reassuring

5 43

Source: Developed based on primary research by the author of the current study.

Transparency is further highlighted through rhetoric warrants, including details on capacity building and testing, quarantine facilities, mobilization of the army, close monitoring of patients’ condition: Border Defence force had increased their human resources. (Government Web Portal, repeated by state media) Until now, the Ministry of Health has been testing all patients, their families, nurses, doctors who have been at Bach Mai Hospital from 10- 28.3. It is estimated that there are 40.000 people who have to be tested for Covid-19. (Government Web Portal, repeated by state media)

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Three out of 4 critical cases have stopped receiving breathing support from medical machines, 1 is about to change from ECMO to breathing machine support. (Government’s Official Facebook account) When needed, swift updates with simple and clear language are timed to respond to emerging situations, such as avoiding panic buying or protecting citizens from scams: Food, commodities and necessities are abundant, enough for the citizens’ needs. (SMS, Local government of Ho Chi Minh City) The Ministry of Information and Communications advises our people to increase awareness, do not transfer money or provide personal information to strangers via phone. In case this happens, please report to the police immediately. (SMS, MOIC)

Tone and Content Are Adapted for Some Media While all samples analyzed were supported by facts and evidence, many of the communications also have a reassuring and uplifting tone, with words and phrases that aim to calm the population, for example: Vietnam is still in control of the situation (SMS, Ministry of Health) Please keep calm, stay strong and unite to win the epidemic! (SMS, MOH) War rhetoric is often evident in language used by government officials and repeated by the state media, such as the metaphor of the virus as an “invisible enemy,” the citizen’s shared responsibility to shelter in place “any home remains in that home” to “fight,” help the “nation,” and “win the war”: After more than four months of being severely wounded by a common enemy – Covid-19, at this moment, nations are constantly researching this invisible enemy as well as finding ways to restrain it. (VTV Report) The entire nation will fight against nCoV together. (SMS, MOH) Any city remains in that city, any district remains in that district, any ward remains in that ward, any quarter remains in that quarter, any home remains in that home. (Prime Minister, quoted by state media)

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To match with the young target and informal style of TikTok, the tone is more fun and exciting, for example, the PSA announcement to wash hands is an animated video with upbeat music about a virus that is “hot” and nicknamed “Co Vy” which means Miss Vy, a pun on COVID’s pronunciation (See Ghen Co Vy, 2020, Weblink to original video https://www.youtube.com/ watch?v5BtulL3oArQw). Catchy and fun, the video went viral on TikTok, Facebook, Zalo, and other social media, was even played in supermarkets, and spun numerous responses with dance routines of netizens miming hand washing moves (see Vietnam – Coronavirus Song – Dance Challenge TikTok – Fight Against Corona, 2020, Weblink to original video https://www.youtube.com/watch?v55Xtyc34y52I). Although most content aims to inform and motivate people – sometimes in an entertaining manner – to take reasonable action, a strict or harsh tone is occasionally employed to warn against criminal activity such as spreading fake news or engaging in unethical behaviors: He [the Prime Minister] requests anyone who has the responsibility to fight this pandemic not to spread fake news and inaccurate information that leads to confusion among the citizens. (Zalo (local social media app), quoted in state media) Do not spread fake news. Do not take advantage of the epidemic. (SMS, MOH)

International Reporting of Government Communications Is Overwhelmingly Positive For this step, content analysis was performed on a total sample of 46 Englishlanguage news articles originated by media publishers based outside of Vietnam to provide a more neutral position, independent of the Vietnamese government’s influence. Among the samples inspected, 20 articles had a positive tone in reporting on Vietnam’s COVID-19 actions overall, of which seven articles specifically discussed Vietnam’s crisis communications, all with positive sentiment (see highlight in Table below). Two articles were found somewhat sensationalist in their reporting, and they are addressed in a later subsection. As seen in the Table, all seven articles reporting on Vietnam’s COVID-19 crisis communications are overwhelmingly positive. Specific praise is given for:

•

Fun, viral content especially PSA video and TikTok She explained: Ghen means jealous. Coˆ Vy seems to be a pun on COVID. Coˆ means madam. Vy is a common Vietnamese name. The video portrays the virus as someone trying to break up a couple. At the start of the video, the couple argues and in the end, they get together.

The Role of Communications in Managing a Disaster (euronews.com, quoted by others) The unlikely earworm by a usually staid communist government drew hundreds of thousands of views on YouTube, and was also featured on HBO’s comedic news show ’Last Week Tonight’, with host John Oliver calling it a “genuine club-banger”. (futurism.com)

•

Nationalistic responses from citizens There are social media posts cheering health workers and a viral poster-style meme reading: “To stay at home is to love your country! (Financial Times) It is hard to miss statements such as “So proud of Vietnam,” “I am so lucky to live in Vietnam right now,” and “Thank you my government” on social media these days. (thediplomat.com)

•

War rhetoric The premier has said: “Every business, every citizen, every residential area must be a fortress to prevent the epidemic.” This has hit a nerve with many Vietnamese, who are proud of their ability to stand together in a crisis and endure hardships. (Deutsche Welle)

•

Hero vice Premier Dam The country’s most popular coronavirus fighter, vice Premier Vu Duc Dam, has been celebrated on Facebook as a “national hero.” (Deutsche Welle)

•

Quite transparent and open to public opinion compared to China The [Vietnamese] government learned from observing the flow of information [on social media] how it could build trust and strengthen self-reliance in communities. The Vietnamese government seemed to recognize that Chinese-style information blocking only worsened the situation (…) In turn, the Vietnamese authorities remained transparent about the disease information. (thediplomat.com)

•

Accurate reporting rather than self-accolades But unlike China’s Communist Party-run tabloids, Vietnam’s state-run newspapers have focused more on accurate reporting than defensive propaganda. The Party’s propaganda speaks of “quiet determinism, not jubilant success. (thediplomat.com)

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Other positive commentary in the international press is given to Vietnam’s actions concerning COVID-19, especially swift and firm handling of border and quarantine controls, closing of schools, testing of incoming visitors, contact tracing up to three levels, and success stories of recovering patients. The overall sentiment is that the Vietnamese government is “doing the right amount” as voted by 62% of survey respondents and highest worldwide (daliaresearch.com) and aptly summarized in a headline: During the COVID-19 Pandemic, Do as the Vietnamese Do (CounterPunch.org)

Few Negative International Views for Economic Actions Not Communications Among the 46 foreign-based English-language articles inspected, 26 articles did not have a positive tone in reporting on Vietnam’s COVID-19 situation: of these, nine articles were factual or neutral, simply reporting actions without condemning Vietnam or taking a strong stance, a further nine articles balanced positive with negative sentiment, e.g., mainly positive toward COVID-19 government actions, but concerned about the economic prospects, and only three articles had a negative sentiment – see highlights in the Table below (Table 9.3). As it can be seen in the Table, a great number of media outlets both regional and global reported the situation factually (usually in short length), focusing on new developments and government actions, such as hotspots of disease outbreak, contact tracing, social distancing measures, border control, and defining nonessential businesses. More in-depth pieces (usually longer articles) are more likely to present a historical and contextual view, e.g., overall political situation of Vietnam in South East Asia, government challenges in past years, and to comment on economic implications rather than strictly medical issues, such as the value and conditions of fiscal exemptions, rescue package for firms affected by COVID-19, future imports, and revising the GPD growth estimates. Finally, the three negative articles identified emphasize the downsides of Vietnam’s actions and how it affects current and future developments. To illustrate, one article reported that closing schools for several months disrupted education for those who could not study online [after the article was published, the government has been offering catch-up lessons on National TV for grade 12 students], limiting trade was disrupting supply chains and keeping investors away, which may result in electricity shortages. Although the economic orientation of these articles is somewhat remote from the topic of COVID-19 communications, they were nevertheless presented here to balance with the overwhelmingly positive reporting of government crisis communications. To be noted, in the entire sample of 46 articles, no openly negative commentary was found to directly criticize the government’s communications about COVID-19.

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Table 9.2. Content and Tone Analysis of Positive Foreign Media Coverage about Vietnam’s COVID-19 Actions and Communications Collected from Openly Available Foreign Media during February 3rd–April 10th, 2020. International Reporting of the Covid-19 Situation in Vietnam - Positive Sentiment Media type

Name of source

Financial Time daily www.ft.com newspaper

Sample 1

Country of Sentiment origin

Format

Topic/Summary

US

Text, visual

Praises the government's social media, viral memes, MOH text messaging

Postive

regional news https://asiatimes.com/ 1

Hong Kong Positive

Praises 'war rhetoric' and 'bunker mentality' in Text, visual communications, transparency in communications, Tiktok PSA song

regional news thediplomat.com

1

US

Positive

Text

Public Radio and TV Deutsche Welle

1

Germany

Positive

Praises propaganda posters, youtube handText, visual washing song, war rhetoric, social media sentiment on Hero vice premier

regional news thediplomat.com

1

US

Positive

Praises Vietnam's transparency in Text, visual communications, allowing FB criticism, and learning from Wuhan communication mistakes

News and video portal

futurism.com

1

US

Positive

Text

various

www.euronews.com, timesofindia.com, thejakartapost.com, dailymotion.com etc

5

various

Positive

Text, visual, Praise viral video on "Miss Vy", gives explanation video of pun.

press agency

www.xinhuanet.com

1

China

Positive

Text

Mentions decree, measures taken for announcing and reporting

Industry portal www.just-style.com

1

UK

Positive

Text, visual

Vietnam developed a practical guide for industry by MOH collaboration with WHO and ILO

Twitter

@VikkiHopes

1

Canada

Positive

Text, visual Canadian family stranded in Vietnam feels safe

newspaper

mirror.co.uk

1

UK

Positive

press agency

www.xinhuanet.com

1

China

Positive

Humanitarian web portal monthly magazine opinion research firm

https://reliefweb.int/

1

US

Positive

www.counterpunch.org 1

US

Positive

daliaresearch.com

Germany

Positive

Text, visual British boy recovers in Vietnam hospital China appreciated medical aid from Vietnam in phase 1 Japan praises Vietnam's actions to contain the Text, visual virus Vietnam is taking the right measures to stop Text Covid-19 Vietnam has highest rating for government is Text, Visual "doing the right amount" to curb covid-19 FPT technology group of Vietnam donates dorm Text, visual for quarantine & medical equipment Vietnam praised for have conducted more Text testing than the US Praises government measures, citizen's Text, visual selflessness, and medical workers Praises government for in-depth contact tracing Text, visual to multiple levels

www.dw.com

1

PR Newswire

finance.yahoo.com

1

US

Positive

Public Radio

www.npr.org

1

US

Positive

News portal News portal

https://www.newsmak 1 er.news/ https://economynext.c 1 om/

TV station and www.aljazeera.com newspaper Press agency

1

prensa-latina.cu

1

Total samples

20

Singapore Positive

Summarizes overwhelmingly positive social media reactions, nationalism narratives for overseas returnees, netizens's about love of Vietnam and feeling safe, 'uncle soldier' figure

John Oliver TV host praises Vietnam PSA song about washing hands, trending on Tiktok

Text

Sri Lanka

Positive

Qatar

Positive, Text Sensationalist

Cuba

Praises government actions, sensationalizes the Positive, timeline in headline "Vietnam hopes to get rid of Text, visual Sensationalist Covid-19 disease in a month" although quoted officials do not give time

Vietnam miracle - all patients cured (1st phase)

Source: Developed based on primary research by the author of the current study.

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Table 9.3. Content and Tone Analysis of Balanced or Neutral Foreign Media Coverage about Vietnam’s COVID-19 Actions and Communications Collected from Openly Available Foreign Media during February 3rd–April 10th, 2020. International Reporting of the Covid-19 Situation in Vietnam - Balanced, Neutral, and Negative Sentiment Name of source

Media type news agency

uk.reuters.com

media organization media publishing group

forbes.com

Sample 1 1

Country of origin

Sentiment

Format

UK

Negative

Text

US

Negative

Text

Hong Kong

Negative

Text

Malaysia

Neutral

Text

Future electricity shortages due to travel ban limiting investors Government business rescue package should be larger

UK

Neutral

US

Neutral

Text, visual Text, many visuals

Travel warning for Vietnam Reports on decree for non-essential business closure Neutral summary of government actions Man fled quarantine center before being tested

1 asiatimes.com

regional news

www.thestar.com.my www.edinburghnews.s newspaper cotsman.com https://abcnews.go.co News portal m/ www.thestar.com.my, various xinhua.net, etc. https://www.khmertim regional news eskh.com/ channelnewsasia.com, various guestofaguest.com, nypost.com, etc. press agency www.xinhuanet.com press agency www.xinhuanet.com stock exchange reddit

www.nasdaq.com www.latimes.com

newspaper

www.nst.com.my

regional news

1 1 1 5 1

1 3 1

Neutral

Text, visual

Cambodia

Neutral

Text, visual

various China China

Neutral Neutral Neutral

Text, visual Text Text

US

Neutral

Text, visual

US

Balanced

Text

Malaysia

Balanced

Text, visual

US

Balanced

Text

Malaysia

Balanced

Text

US

Balanced

Text

1 thediplomat.com

regional news

1 www.thestar.com.my

regional news

Asia region

4 1 1

thediplomat.com Total sample

1

Topic/Summary Vietnam factories affected by China supply chain Vietnamese students affected by interruption in education

Vietnamese socialite attends fashion shows and has Covid-19 Update on number of infections Economic update Local Vingroup to produce ventilators for Covid-19 Actions curb spread but cannot stop imports forever Vietnam adjusted GDP growth, but business relations not affected Vietnam presenting aid to Laos & Cambodia shows Vietnam's effort but also desire to assert supremacy Government business rescue package is timely, but should be implemented and monitored carefully Praise for government actions, but concerns about the economy

26

Source: Developed based on primary research by the author of the current study.

Relatively Few Incidences of Challenging Communications A sample of 33 units were collected from various publicly available social media channels specifically searching for accounts that are not associated with official sources, see Table below. As it can be seen, most netizens have positive, uplifting communications, evidence that the government’s patriotic discourse triggers altruism and optimism among citizens: “I LOVE VIETNAM. VIETNAM IS AWESOME! Below are addresses that’s giving out free food or selling them at super cheap prices (below 5k VND/meal) from now til 15/4. If you live close to the area and happen to see people in need please direct them to the closest one available. Greatly appreciated! (Facebook, netizen)

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Smile, the sun has risen Its light is shining everywhere And all the worries will disappear into clouds and winds (Youtube.com, song by local artist) With all the national power And millions of loving hearts Fighting invader Corona Not a single complaint (Youtube.com, song by local artist) Among the sample, there were eight instances of challenging messages, namely blaming or hatred, fake news, and medical mask scams. In particular, netizens were angered by other citizen’s seemingly disobedient or selfish behavior, for example: Patient 17, a wealthy socialite who flew business class from Europe after attending fashion shows was blamed for bringing the virus back, which broke Vietnam’s infection-free record of 14 days (the previous 16 patients had already recovered). Returning overseas students who complained about quarantine conditions were scorned for not contributing to their nation and a Vietnamese from Daegu, South Korea, was condemned for bragging on social media about how she avoided quarantine. Some fake news and scandals also surfaced, such as a claim that official statistics were underreporting cases, scares that the country would be under complete lockdown (which led to some panic buying), and misinformation that the local government had ordered preparations for cremation of deceased COVID-19 patients (currently there are still no deaths in the country). In most situations, the government has taken quick action to dispel rumors via social media, official channels, and even SMS. Another noteworthy discussion concerns the shortage of medical masks. According to a government decision, medical face masks will only be available for medical workers at medical facilities, which prompted wholesale buying and hoarding among some individuals who later tried to resell the masks at 500% price difference (available on Zalo, Facebook marketplaces). Some businesses also tried to take advantage of the pandemic and were fined or shut down for manufacturing faulty masks or repackaging used ones.

Discussion and Implications This section discusses the similarities and differences between the public health crisis communications according to the literature and how they compare with the findings from Vietnam. Overall, three situations emerge: (1) instances when Vietnam communications are well aligned with literature recommendations, (2) instances when Vietnamese communications are partly aligned with literature guidelines, and (3) instances when the Vietnamese local context does not allow for a comparison, i.e., the local realities are simply different from the literature.

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As illustrated in Table 9.5, the items of Vietnamese government communications reviewed in the sample appear to be well aligned with literature findings in terms of rhetoric of warrants, claims, and grounds, giving a realistic depiction of threats, having the government as the originator of communications, and having accurate, consistent, and timely communications in a variety of official channels. As summarized in Table 9.6, some items of Vietnamese government communications reviewed in the sample appear to be less aligned with best practices, which can have valuable implications for policy makers. For instance, government communications in Vietnam could benefit from using customizing content to build self-efficacy among the public and leverage more on the perceived benefits of following the rules versus the unfortunate consequences of noncompliance. To illustrate, an Italian official made a powerful emotional COVID-19 appeal to motivate those who fled northern Italy before the lockdown “You are carrying to the lungs of your brothers and sisters, grandparents, uncles, cousins, and parents, the virus that has severely strained the health system in northern Italy” (Anon, 2020) To apply to the local cultural context, the Vietnamese government can conduct primary research to capture public perceptions, attitudes, and motivators, that can later be incorporated into more customized communications. Another important issue in the literature is the triangulation of communication between the three actors: government, expert, and the public in message-centered theory (Zhang & Cheng, 2020) which echoes the definition of two-way and multiway communication (Van Ruler, 2018). From the samples reviewed, it appears that in Vietnam there is some overlap of the government as expert (Ministry of Health) which may reduce opportunities for the public to question and challenge communications (Coombes, 2005). As an implication, the government of Vietnam could open a “citizen’s voice” channel or other anonymous avenues of two-way communication that involve experts and address the latest public concerns (Buchel et al., 2015). Thirdly, the analysis revealed several instances in which the Vietnamese realities are quite different from those discussed in the literature as seen in Table 9.7 below. For instance, while commonly sensationalism in the media and its perils are a recurrent theme in the literature (Kott et al., 2016), the only two instances of sensationalism found in the sample are not from Vietnamese outlets, but rather from international media reporting on Vietnam (see Table 9.2 in Section 4.3). Both samples limit exaggeration to the article’s headline, and do not directly refer to COVID-19 communications, but rather to the outbreak situation in general, i.e., the fact that all 16 patients in phase 1 had recovered and an overly optimistic timeline to the end of the crisis (see Table 9.2 last entries for aljazeera.com and prensa-latina.cu). Another common theme in the literature is the spiraling infodemic on social media which may result in heroization and blaming (Atlani-Duault et al., 2015).

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Table 9.4. Content and Tone Analysis of Informal Social Media Communications about Vietnam’s COVID-19 Actions and Communications Collected from Openly Available Social Media during February 3rd–April 10th, 2020. Non-government and Challenging Communications Purpose Platform/channel Source Facebook, various netizens, local and Love of Vietnam social media expatriates youtube.com, Vietnamnews.vn Creative works Facebook

Facebook

various local artists student club art school individual netizens

Sample 22 4 1 1 12

Food donations

Facebook celebrities, netizens #14DayCampaign Facebook, various netizens Hero social media

Facebook, Blaming Instagram

1 6

individual netizens

Tone of Format voice/Mood Uplifting, text, many patriotic emoji, visual

individual netizens, government responds Marketplace and individual netizens, Fake/overpriced Groups on Zalo, government medical masks responds Facebook, etc. Total samples

Love for Vietnam, feeling safe, protected. Government is taking the right actions to protect citizens.

Uplifting, music video patriotic Patriotic visual Encouraging visual Uplifting, patriotic Uplifting Uplifting, patriotic Hateful

2

Fake news Facebook

Content/themes

2 Strict 4 Strict

Song lyrics about disease prevention, shared responsibility, against fake news, war rhetoric. War posters - fighting the enemy covid-19 Art school respond sto UN brief with poster on social distancing. text Netizens list free food shops and shops that offer very cheap food for those affected by Covid-19 text, visual Celebrities encourage people to donate food supplies to peddlers/hawkers text, visual Hero vice Premier Vu Duc Dam as a strong fighter against Covid-19, affectionately nicknamed "Uncle Dam". Heroization of doctors, health care workers. text, visual Hatred for Daegu returnee who flaunted escaping quarantine. Hatred for socialite patient 17. Creating fake accounts on behalf of patient 17. Unconfirmed information about local Ho Chi Minh City government directive to prepare cremation for Covid19. Official local government account addressed the fake news directly on social media. text Businesses and individuals found selling fake or Visual, some overpriced medical masks - government takes action to text with links warn, give fines and/or make arrests.

33

Source: Developed based on primary research by the author of the current study.

Table 9.5. Comparison with Literature – Theories with Extensive Evidence of Alignment. Input from literature

Extensive evidence of applying best practice from literature Current Vietnam Case Study Remarks

Risk communciations are a warrant linking the claim e.g. the government is making efforts with the grounds i.e capacity-building, money. (Johnston et al, 2020). Government communications should NOT be overly positive or the public may downplay potential threats and not share responsibility (Mishra et al, 2009). Government as decision-maker and originator of pandemic communications (Zhang & Cheng, 2020).

Vietnamese government risk communications often employ grounds (military deployed, qarantine facilities, testing, hospitals) to support the claim that the government has the situation under control. Vietnamese government risk communications are mostly factual, display a realistic level of threat and encourage citizens to continue fighting. The Government Web Portal and Ministry of Health is the first and foremost source on Covid-19 updates.

Crisis information from the government must be correct, adequate, and made available openly (Zhang & Cheng, 2020).

Vietnamese government Covid-19 news is factbased with case data for each province and Extensive evidence. nationwide. Daily updates of new cases and their tracing, new regulations, symptoms, etc.

(CDC) recommends messages be simple, consistent, repeated from various sources, and offer a solution or positive action steps that individuals can take to reduce risk (Kott et al, 2016).

Vietnamese government communications are written in concrete language, have facts and numbers, are published on multiple official channels, and offer solutions e.g. shop online, toll free number to contact if sick, etc.

Source: Developed by the author.

Extensive evidence.

Extensive evidence.

Extensive evidence.

Extensive evidence.

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Table 9.6. Comparison with Literature – Instances Where More Alignment Could Be Beneficial. Opportunities to apply more learnings from literature Current Vietnam Case Study Implications Some evidence. Consider conducting While shared responsibility Government communications should surveys and interviews with the public features prominently in balance warrants with shared to uncover perceived self-efficacy and government communications, responsibility, public's self-efficacy develop customized there is opportunity for more (Johnston et al, 2020). messages/content. emphasis on self-efficacy. Some examples of the government Some evidence. Could have more twoTwo-way communication, feedback addressing emerging situations e.g. way channels for citizens to ask loop in which the public expresses actions against fake masks, questions. As more patients are their concerns and information warnings against spreading fake recovering, can develop needs, the government responds. news, frequent press conferences communications to preempt stigma (Covello et al, 1987). with the media. against Covid-19 patients and Input from literature

Communications should leverage on the positive aspects i.e. benefits of recommended behaviors (Sheppard et al, 2020).

#StayHomeIsFun or #HappyAtHome campaign gives examples of alternative behaviors

Expert-public communication to “bridge the gap between expert and public views on public health issues” (Zhang & Cheng, 2020, p.65) Disagreements between experts should be discussed and disclosed so that the public are not exposed to fringe opinions or downright misinformation (Boholm et al, 2019).

Some overlap between government and expert = Ministry of Health, which may lead to some confusion due to power Not found in sample. Most official FAQs sampled seemed to give answer as 'unsure/unknown' rather than presenting different views.

Some evidence. Consider conducting surveys and interviews with the public to uncover more perceived benefits e.g. protecting vulnerable family members, indulging in hobbies, etc. Limited evidence. Should more clearly separate government versus expert to resolve the tension of compliance. Limited evidence. Should have more open debates between different experts and reach evidence-based conclusions with multiple points of view.

Source: Developed by the author

While both phenomena were found in the sample, it appears that the Vietnamese public takes a rather different approach to each. To clarify, no instances were found of Vietnamese netizens blaming the government, pharmaceutical companies, or research labs for the virus; instead, outrage was commonly triggered by the perceived “selfish” or “ungrateful” actions of fellow nationals who did not comply with government guidelines (see Table 9.4, Section 4.4). Additionally, heroization did not undermine the government’s efforts as was the case in Wuhan, France, and Italy (Atlani-Duault et al., 2015), but rather unexpectedly reinforced it. Based on social media samples collected, the emerging hero of the COVID-19 fight in Vietnam is in fact a government official, Deputy Prime Minister Vu Duc Dam, who is affectionately referred to as “Uncle Dam” in grassroots posters and mentions by individual netizens (see Table 9.4, Section 4.4). While the differences above may be surprising, some could be partly explained by the country’s different cultural and geopolitical circumstances (less freedom of press, communist ideology), but also due to a limited sample of communications from unofficial or unconfirmed sources.

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Table 9.7. Comparison with Literature – Local Realities and Special Circumstances. Some unique local findings Input from literature

Current Vietnam Case Study

Framing a health risk as serious motivates behavior, but sensationalism may lead to disproportionate fear or panic (Kott et al, 2016)

Remarks Some evidence of panic buying, but not sensationalism. Recommendation for further research to extend sampling to include more non-official sources, e.g. from bloggers, social media.

Few instances of media sensationalism, but possibly due to state-controlled nature of media in Vietnam.

“Geography of blame” and conspiracy theories that blamed the outbreak on the government, pharmaceutical companies, or the elites (Atlani-Duault et al, 2015).

Netizens' anger is directed at other citizens whose behavior is perceived as irresponsible or selfish, e.g. patient 17 bringing Covid-19 back, students complaining about quarantine conditions, returnee bragging about avoiding quarantine.

Evidence of blame, but in a different direction. Vietnamese do not appear to blame the government or pharmaceutical companies.

‘Local heroes’ such as ordinary individuals during Ebola outbreak, whistle blowers such as Dr. Li Wenliang in Wuhan, exhausted health workers fighting the virus without enough protective equipment (AtlaniDuault et al, 2015).

Local named hero is a member of government - 'Uncle Dam' (vice Premier). Unnamed heroes are medical staff, portrayed as wellprepared, well-equipped, and ready.

Evidence of heroization, but not subversive to the government narrative. The main hero is a member of the Government, health workers are well-equipped. (rhetoric warrant).

Source: Developed by the author.

Conclusion and Recommendations Considering the evidence above, most of the research questions have been answered partially or in full, as follows: (1) How effective are the official Vietnam government communications concerning the COVID-19 outbreak? Based on the sample, the official government communications were found to be quite effective in terms of delivering accurate information, timely to address issues, and consistent throughout a variety of traditional and new media such as SMS, TikTok, and phone apps. In terms of message type, tone, and content, most messages are factual and reassuring, with a good balance between warrants endorsing the government’s capacity building and citizen’s shared responsibility to do their part. It was found that many messages are wellconstructed to reflect war rhetoric and nationalism while still including an entertaining aspect to match new media’s mood such as TikTok. To maximize effectiveness, the policy makers should address the overlap of government as expert (Ministry of Health), invite more differing views from interdisciplinary experts, and open more direct avenues for citizen’s voice. Additionally, as the pandemic progresses, future communications may need to include customized benefits and motivators, which can be collected via primary research with members of the public.

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(2) How does foreign media report on Vietnam’s COVID-19 situation and communications? Overall, the samples reviewed showed a strongly positive sentiment when reporting specifically on the government’s COVID-19 communications, with frequent mentions of the catchy viral PSA song and TikTok dance challenge, the eye-catching propaganda posters and netizen’s nationalistic narratives, and allowing for criticism on social media. More in-depth articles juxtapose the Vietnamese government’s highly transparent COVID-19 communications positively either against past local crises or by favorable comparison with China, where Wuhan officials had been less responsive during the early days of the outbreak (see Table 9.2, Section 4.3). (3) What are some challenges of unconfirmed COVID-19 communications in Vietnam? Some evidence of unconfirmed or challenging communications was found in unofficial sources, mainly vilification of noncompliant citizens, rumors of local government ordering preparation of cremation for COVID-19 deaths (currently there are no COVID-19 deaths in the country), a scam for identity theft, some panic buying and a medical mask scandal (see Table 9.4, Section 4.4). However, considering that Vietnam has over 45 million Facebook users of which 65% use the platform actively (Doan, 2020), it is believed that the sample of 33 units is not sufficient to give a conclusive answer to this research question. This chapter is not without limitations, primarily due to the short duration of data collection from 3rd February 2020 to 10th April 2020, the small sample size which overrepresented government communications at the detriment of grassroots social media conversations, the focus on text rather than visual and multimedia content, and the uncertain nature of a still ongoing pandemic. Further research should expand the current investigation by applying more rigorous quantitative techniques to a larger body of informal communications from bloggers and social media. The timeframe of data collection should also be expanded, ideally to encompass all stages of the crisis from Wuhan outbreak to Vietnam’s patient zero, local transmission and epidemic until the end of the crisis. For more in-depth exploration, future researchers may conduct primary data collection with epidemic experts, policy makers, and members of the public affected by the outbreak.

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Chapter 10

Passage from the Tourist Gaze to the Wicked Gaze: A Case Study on COVID-19 with Special Reference to Argentina Maximiliano E. Korstanje

Abstract The Day the World Stopped is a science fiction film that narrates the days of mankind amid an alien invasion headed to avoid the climate change. We made the decision to use a similar title to narrate the facts that precede the outbreak of COVID-19 in Wuhan, China, and its immediate effects on the industry of tourism. Over years, scholars cited John Urry and his insight over the tourist gaze as well as the importance of tourism as a social institution. Of course, Urry never imagined that one day this global world would end. This chapter centers on the needs of discussing the concept of the wicked gaze, which exhibits the end of hospitality, a tendency emerged after 9/11. This chapter punctuates on the decline of hospitality—at least as it was imagined by ancient philosophers—in a way that the tourist gaze sets the pace to a wicked gaze. Whether hospitality and free transit were the foundational values of West, COVID-19, and the resulted state of emergency reveals a new unknown process of feudalization which comes to stay. The chapter is framed based on long-dormant philosophical debates, but given the complexity of this issue, the efforts deserve our attention. Keywords: Mobility; nation-state; tourism; the end of hospitality; tourist gaze; wicked gaze

Introduction On December of 2019, news about the outbreak of a virus known as COVID-19 was coming from China. This virus not only caused a severe respiratory syndrome in elderly people but also has rapidly disseminated worldwide. The outbreak may be originally traced back to Wuhan (Hubei) and officially recognized by the International Case Studies in the Management of Disasters, 197–211 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201012

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WHO (World Health Organization) as a global pandemic in March of 2020. To the moment, there is no official vaccine or medicament to deal with this virus, totalizing in the world almost 515,022 and 23,199 fatal victims. The number of victims is headed by Italy (8,215) followed by Spain (4,145), China (3,287), Iran (2,234), France (1331), the United States (1,119), the United Kingdom (434), and the Netherlands (220) (ciphers to March 26, 2020). The coronavirus disease has a rapid potential for transmission though its lethality is low (3% of total infected people). Particularly, this mortality rate increases in the case of the elderly population (reaching 14% in people older than 60 years old). People also may be infected by touching a contaminated surface or being in close contact with another infected person. Some complications include pneumonia or acute respiratory distress. Although governments have not found an antidote or vaccine for this virus, many administrations have blocked their airspace to commercial flights and closed the borders or even imposed a strict quarantine to their citizens. In consequence, experts agree that coronavirus not only implied serious economic losses for the tourism industry but also the global capitalism. Some countries like China suggest restrictive measures that prevent mobility and citizen circulation while the United States, England, and Mexico call attention to the needs of protecting the industry and consumption. Whatever the case may be, this new virus poses a serious (if not the most terrible danger) challenge for the tourism industry. All that we know regarding risk or disaster management should be revisited according to the advance of COVID-19. The tourism and hospitality industries, as well as other service sectors, were suddenly closed while the foreign tourists were suspected (feared) as potential carriers of COVID-19. This chapter reviews not only the effects of COVID-19 in the industry but also the tendency, which was born after 9/11, that we have studied as the end of hospitality seems to be reaffirmed. Hotels were refurbished to attend infected travelers subverting the commercial hospitality to unconditional hospitality. At the same time, Argentines living abroad were expatriated and placed in a compulsory quarantine. The tourist gaze which historically characterized the Global North was transformed to a wicked gaze. We coin this term to denote the exaggerate frights of locals to be in contact with foreign tourists or Argentinean tourists who have visited Europe, China, or the United States. Doubtless, COVID-19 certainly accelerated a climate of hostility against (foreigner) tourists as never before. In this context, let us explain to readers that the first section explores the contributions of Enrico Quarantelli, as an authoritative voice, to expand the current understanding of emergency states. Based on the sociology of disasters, he argued that beyond our paradigms when the disaster takes places nobody is prepared. In fact, this is the nature of emergencies. The second section complements efforts in focusing on the logic of hospitality in the Derridean texts. We are living in days where our conceptualizations on hospitality are being radically shifted. The third section deciphers the chronological events that involved Argentina in view of the advance of COVID-19 as well as the philosophical dilemmas revolving around we dubbed as the wicked gaze. Centered on Urry’s contribution, we argue that the tourist gaze which was proper of global imperialism sets the pace to a wicked gaze where the tourist is feared, suspected,

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and rejected. The old dichotomies explained earlier by Bauman where the privileged tourist was fitted against the vagabond have been now blurred. Today’s tourists carry a grave infection that should be contained. Like a terrorist who looms in clandestine darkness, lay citizens are portrayed as a weapon that kills others while touring. This moot point is hotly debated in the last section.

The State of Emergency: A Preliminary Debate One of the questions one might ask is what is a state of emergency? Enrico Quanratelli, who does not need the previous presentation, argues convincingly that postdisaster protocols often fail because it is the nature of the disaster. Experts and all pundits who are trained extensively to lead recovery campaigns may very well make the incorrect decision when the event takes hit. This happens because of two main reasons. On the one hand, our rational decisions are based on irrational sentiments which lead us to make bad decisions. On the other hand, disasters or crises are unexpected events that disrupt the possibilities of responsiveness in society (Quarantelli, 1985, 2005). As one of the fathers of disaster studies, Quarantelli brought into a reflection on the importance of the psychological perception in the fields of preparedness, a point very well developed in countless studies framing disaster management (Kellens, Terpstra, & De Maeyer, 2013; Miceli, Sotgiu, & Steffani 2008; Wachinger, Renn, Begg, & Kuhlicke, 2013). As Cass Sunstein puts it, sometimes our emotionality makes us think to exaggerate some minor risks (which are of lower probability) while other major risks which have further impacts on our daily lives are certainly minimized or simply overlooked. He interrogates further the reasons behind our psychological structuration that make us feel secure or insecure. To some extent, fear paralyzes, but what seems to be clear is that undemocratic nations exert often censorship over their citizens increasing the probabilities to experience major disasters than democratic nations. He toys with the belief that in the established democracies, the check and balance institutions play a leading role ensuring a communicational process where the debate prevails. Deliberative democracy does not resolve everything but gives that the conditions for involuntary errors (by the side of experts or politicians) can be solved. This problem beyond risk management distinguishes democracies from populism or other authoritarian forms of governments. Having said this, the state of emergency can be prevented when the involving factors that jeopardize society are publicly discussed by different stakeholders. His main thesis holds that states should avoid the populist demands—introduced by pressure groups—inviting to take part the net of experts in the decision-making process. Sometimes, pressure groups and other interests press the government to make bad decisions that affect public health. The problem lies in the fact that risk management is culturally enrooted into what experts dubbed as the precautionary doctrine, which means the use of rationality to detect and eliminate major risks. As Sunstein cautions, the precautionary doctrine, far from being useful, obscures more than it clarifies. Under some conditions, the concept ignites a panic paving the ways for the risks it was

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originally designed to contain (Sunstein, 2002, 2005). In his seminal book, Society must be defended, Michelle Foucault and Ewald (2003) call the attention on the role of discipline as the symbolic mechanism that structures a communal sentiment of reciprocity in society. Per his viewpoint, society is usually traversed by multiple relations and tensions certainly marked by the discipline, power, and the genealogy of the race (racism). To wit, far from being accumulated, the power circulates through all spheres of community. As he noted, in order for the society to be united, the notions of jurisprudence and history provide citizens with a (fabricated) dominant discourse where the truth occupies a central position. Through the articulation of an economy of truth, as Foucault adheres, society systematically recreates the conditions for the circulation of power. Foucault adds that this economy of truth is epitomized in the figure of Science, which situates as the rational Oracle to be consulted in case of emergency or chaos. In this vein, lay citizens are intellectually disciplined by the net of experts who reserve a complex jargon to describe the sensible world. This begs a more than an interesting question, what happens when an external threat, like a war, threatens society? Foucault goes on to answer that political life is not characterized by peace or the lack of warfare. Instead, society is molded by the war which never disappears but mutates to more subtle forms of government. In peace times, war is quarantined in the core of politics waiting for being liberated. For Foucault, to put the same bluntly, politics seems to be the warfare by other means. History, after all, is a discourse about who says the truth, a truth forged by war and blood. It is important not to lose the sight of the fact that the borders of state are drawn differentiating a common space, here which belongs to people who look like me, us. In contraposition, foreigners are demonized as potential intruders who put the social order in danger. Foucault is clear when he affirms the race struggle which characterized the politics of states in former centuries sets the pace to a new biopolitical mechanism of control: the discipline. In a nutshell, states have exerted a radical control over their populations exorcising war beyond their borders, but in so doing, they introduced the metaphor of risk to regulate the daily life. Like a vaccine which is an inoculated virus which may decimate an entire population, risks are originally external threats nuanced and dispossessed from its negative assets. The power of discipline corresponds with the possibilities to incorporate external dangers in the core of society while avoiding its most nefarious effects (Foucault & Ewald, 2003). Risks are hypothetical calculations which never take place in reality. This position echoes Zygmunt Bauman in his book Liquid fear. Unlike animals which feel basic fears, humans are the prey of elaborate secondary fears that are socially and culturally framed. In this way, these fears resonate in society because they are diffuse and abstract probably enrooted in a future which never takes place in real life. Bauman coins the term derivative fears to denote the existential position of the self grounded in its own conscience of its mortality. We live in a society (together) with other imagining dangers, which, in reality, do not exist. Through this imagination (fantasy), the process of solidarity is enhanced. While risks can be defined as human attempts to reduce the contingency to tolerable levels, no less true seems to be that a paradoxical situation emerges. The Hobbesian society is based on the monopoly of

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state to regulate internal violence or at least the War of all against all. This opens the doors to a philosophical paradox because the civilized life leads people to forget their own real vulnerability. Bauman uses the term Titanic syndrome to denote the myopia of the civilized order to prevent imminent disasters. In modern societies, citizens are cognitively trapped in their fears which are individually lived and internalized. As a result of this, there are little efforts to see the disaster when it takes hit. Media packages and disseminates a Spectacle around the causalities of traumatic events—like 9/11 or Katrina hurricane—which leads to misunderstanding the reasons behind the catastrophe. When this happens, the possibilities the disaster repeats turn higher. Last but not least, Jean Baudrillard cites the plot of Steven Spielberg’s film (Minority Report), where Police achieve successfully a risk-zero society where crimes are prevented earlier than occurred. The film sits in Washington in the year 2054, where Precrime—a specialized group of police—employs psychics known as precogs who, supported by high technology, see the future. As mutated humans, their capacities to forecast crimes help police to imprison criminals before the crime to be committed. Baudrillard holds the thesis that modern risks works as Precogs subordinating the present time to a previsualized future never take place in real life (Baudrillard, 2006). Baudrillard was a trailblazing voice who questioned the influence of precautionary doctrine in modern life while laying the foundations to a much deeper understanding for sociologists in what he named the Spectacle of terror (Armitage, 2010; Bishop, 2009; Campbell, 2010; Kellner, 2006, 2015). Postmodernism not only affects human solidarity but also blurs the borders between today and tomorrow through the orchestration of an administration of fear (Virilio, 2006; Virilio & Richard, 2012). As Virilio and Richard eloquently observe: Once chimeric, fear has become a foundation. All of our confidence in reason and the perfectibility of the human species has progressively given away to a principle of fear that replaces faith with fear as the cornerstone of our attitudes towards existence. The spread of fear thus appears to be the product of a nuclear era with pervasive totalitarianism where science, once the hope of Western Enlightenment, has now taken on a threatening appearance. (Virilio & Richard, 2012, p. 9) Here a question immediately arises: is the nature of human solidarity in risk by the advance of post-modernity?

The Nature Hospitality The term hospitality comes from hospitium (Lat) and was commonly practiced by ancient cultures as Romans, Greeks, Celtics, and Germans. In perspective, hospitality is understood as a tribal institution, which prompted a rapid circulation of citizens in peace times and a strategic alliance of self-protection (among cities)

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against external invasions (Nicols, 2011; Sanchez Moreno, 2001; O’Gorman, 2007). As Nicols puts it, hospitality served as a friendly guest–host relationship where members of different communities were welcomed and hosted. Hospitality is directly related to solidarity. In strong opposition to the hostility that shares the same etymological root, hospitality establishes a strong line of connection among groups or states. Quite aside from the conventional controversies in the academic circles to determine the origin of hospitality, the figure of hospitium was seen as sacred throughout the ancient world. In the cosmologies of ancient philosophers, foreign travelers should be assisted and protected during their trip in the same way humans are protected and guided by Gods in the afterlife. Ancient tribes believed that disasters such as quakes, famines, or mass death were the results of God’s rage because the sacred law of hospitality was not dully honored. Still further, it is noteworthy that Europe launched to colonize the world in the seventh and eighteenth centuries. Internally, the law of hospitality was incorporated as the mainstream cultural value of Western civilization. Anthony Pagden explains how hospitality was ideologically invoked to legitimize the Conquest of the Americas. The Treaty of Tordesillas and the papal Bulls of Alexander VI which conferred authority to the Kings of Spain and Portugal over the Americas were widely resisted by writers and philosophers in England and France. Even within the Spanish academic circles, there was a serious dispute to what extent natives in America should obey to the King and of course in what terms. The dispute was suddenly resolved when rumors and stories were heard about the impossibility of some tribal groups to honor hospitality. Spanish travelers (Hominem viatores) who needed to trespass a territory to reach other destination were attacked or locked down by some tribes. This news not only shocked Spanish philosophers but also gave the excuse to legitimate the authority of the King and the subsequent dispossession of their lands. The Salamanca School enthusiastically claimed that Indians were subhumans because they ignored the sacred law of hospitality (Pagden, 1995). To put the same in other terms, hospitality and conquest were inextricably intertwined. The doctrine of free transit and mobilities were two mainstream values of the modern nation-state. A disruption in the goods exchange or transit circulation entails a serious risk for the liberal society. To set a clear example, when strikers or some province declares its autonomy or independence, the first step consists in blocking the ways to prevent interstate mobility (Korstanje, 2018). From its inception, the modern nation-state appealed to the geography of territory to draw new borders that organize the political life. The sense of free transit occupied a central position in the ethnogenesis of nationhood. If the border marked a specific in-group belonging, everything outside the contours of the nation was frightened. The function of the wall was associated to appease potential intruders while internally an unspeakable violence indoctrinated the agency (Guidotti Hernandez, 2011). Having said this, the Otherness was a big problem for the modern capitalist ideology which may allow or deny its entrance. As the previous argument is given, hospitality regulates the relation of host– guest when they do not know the interest of each other. Guests are unfamiliar not only with the visited territory but also with the local customs. Some of them can

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be assassinated or seriously harmed unless protected. Likewise, hosts are not cognizant with the origin of guests, they can be criminals or thieves. Hence, hospitality serves as an anthropological institution originally designed to regulate the risks created by the host–guest encounter (Korstanje, 2017). In consonance with the aforementioned assertion, Jacques Derrida & Dufourmantelle (2000) give an elaborated distinction between conditional and unconditional hospitality. Undoubtedly, the question of hospitality is based on the urgency to deal with xenos (foreigners). Hospitality operates from a distinction between here-us and there-them. The border plays a leading role in the configuration of liminal space where the “Other” is scrutinized and interrogated before being welcomed or rejected. In the dialogues of Plato, as Derrida adheres, the foreigner is portrayed as an “Other” who interrogates furtherly us. The reign of dogmatism is frequently shaken by the presence of the foreigner who asks for hospitality. In perspective, Derrida strongly believes that hosts are often accompanied by a different language that confronts the dominant discourse. The political authority, as well as the paternal hegemonies, seems to be placed in jeopardy by the outsiders which act as a mirror. Hospitality may be very well offered or not, but what is more important is that only the outsider needs to answer to the dilemmas of its identity. The hosting state asks who you are and what you want. Finally, Derrida suggests that there are two types of hospitalities: conditioned and absolute. While the former signals to the gift exchange between hosts and guests where the lodge is paid, the latter is given generously without asking anything in return. He toys with the belief that foreigners have rights but they need to credit their identities or properties. Nobody assists unknown people. The absolute hospitality is a utopia, as he recognizes because nobody opens the doors of the home to the “unknown Other.” Not surprisingly, hospitality and hostility share the same etymological origin. Hostility is also invoked to regulate and expulse the undesired guest (which is considered as a parasite). Derrida’s legacy helps to understand the role of hospitality in the configuration of the modern nation-states. The term visa can be traced back to visum (lat.), which is a verb expressed in the pastime of videre (to see). As Derrida notably observed, the state needs to see and inspect furtherly on the intensions of the foreigner (Korstanje, 2015). In a previous work, which entitles Mobilities Paradox: a critical analysis, we hold the thesis that the power of Western civilization cemented on the idea of accepting mobilities as an unquestionable reality, but far from this, we live in sedentary closed (if not inhospitable) societies. The state was created to be the watchdog of liberal capitalism. In doing so, several nomad tribes were restricted to live together in the geographical limits of the nation. The mobility was internally granted as a right among equal citizens only within predesigned circuits while the border was imposed as a precondition between civility and savagery (Korstanje, 2018). Echoing Zygmunt Bauman (2017), it is vital to decipher the paradoxes and complexities of the mobility-based cultures. At a first glimpse, a privileged group is legally encouraged to travel worldwide, whereas the major part of humanity is strictly restricted to the soil. In Tourists and Vagabonds, Bauman eloquently argues that the modern political citizen feels pleasure in being there, but the vagabond has no such luck.

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Vagabonds are trapped in the immobility where there is no access to the cultural capital tourism confers. As a sign of status, by traveling, we are paradoxically denying the nature of the travels. We move from here to arrive there (to reach a destination). In touring there is no point of arrival because there is no point of departure. As he cites: In the tourist life, the length of stay in any place is hardly ever planned; neither is the next destination. The point of tourist life is to be on the move, not to arrive; unlike in the case of their predecessors, the pilgrims, the tourists’ successive stopovers are not stations on the road, since there is no goal beckoning at the end of life travels which could make them into stations. If the successive addresses add up into an itinerary, it happens only retrospectively, when logic is discovered or imputed which did not guide the wanderer at the time of his wandering. When still on the move, no image of the future state is at hand to fill the present experience with meaning; each successive present, like the works of contemporary art, must explain itself in its own terms and provide its own key to read out its sense. (Bauman, 2017, p. 13) To some extent, Bauman does not focus on the function of hospitality in his text, but he lays some foundations to understand the complex interconnection of state and mobilities. It is unfortunate that the specialized literature historically divided the fields of hospitality in commercial and noncommercial hospitality overlooking its anthropological nature (Korstanje, 2018). As Lynch et al. (2011) remarked, one of the aspects of hospitality-related studies centers on the lack of shared definitions or consensus about what hospitality means. Different disciplines, even authors, have elaborated their definition leading experts to a state of chaos and fragmentation. It is important not to lose the sight of the fact that two academic waves are today in dispute to determine its nature. While some voices bemoan that hospitality should be recognized as a mechanism to control and regulate human relationships, others refer to its liminal space where the host– guest exchange predominates. Of course, this position suggests that hospitality needs personal contact to prosper. Just after the turn of the century and the attacks to the United States in 2001, the West closed itself to the alterity tightening the border controls and check-up points, if not accepting radicalized discourses oriented to demonize the non-Western others. Terrorism is gradually mining the West from inside, destroying not only the social ties but also its foundational cultural value: the sacred law of hospitality (Korstanje, 2019). This begs the question to what extent we can hold is hospitality dying? Two authoritative voices, like Tom Selwyn (2019) and George Ritzer (2019)— in their respective works—attempt to answer the aforementioned question. They call attention to the inevitable decline of hospitality in the global ethos. A gradual collapse allows the rise of a much deeper hostility that mediates between citizens and their institutions. To a closer look, the Brexit or Windrush case proclaims not only the hostility against the Xenos (foreigners) as the foundational cultural value

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of West but also a new era where the “Other” is not desired. Global capitalism—as a major cultural and economic force—seems to be a project unilaterally based on efficiency and prediction, which in its constituencies contradicts the essence of hospitality. Ethics of hospitality is a more than an interesting book, where Daniel Innerarity (2017) alerts on the philosophical challenges posed in the case hospitality declines. The modern society, adjoined to the Science, coordinates efforts to detect and eliminate external dangers while ushering the culture to a zero-risk world. Like a guest who asks for hospitality, risks should be contemplated as a part of life. A zero-risk society not only is impossible but also eradicates the selfhood.

COVID-19 and Tourism in Buenos Aires The British sociologist, John Urry, coins the term tourist gaze to explain the oculacentrism that has monopolized the cultural world in recent decades. The term appears not to be new; it has been borrowed from Michel Foucault who was originally concerned on understanding the medical metaphor (medical gaze) and biopolitics. What Urry innovatively sets out is that the act of traveling is something else than a ritual of the escapement. While traveling to other destinations, tourists dispose the “Others” through their gazes. By gazing, the “Others” is controlled and transformed into a gazed-Other. Urry acknowledges that the tourist gaze is not chaotically organized, but it depends on a cultural matrix carefully constructed to reinforce the production–consumption circuits of modern capitalism. This cycle (ritual) of commodities exchange is certainly based on a new aestheticized reflexibility characterized by the dominance of the Spectacle. The tourist gaze, as Urry emphasizes, organizes the global geographies, persons, cultures and landscapes transforming them in commodities which are commonly exchanged through the tourism consumption. Hence, the trajectory of goods, which is stimulated by consumption, has emptied the geographical space accelerating the social decomposition and the trust decline. Tourists do not avoid risks, but indeed risks allow the tourist experience as well as the decision-making process. For Urry, the figure of risk plays a crucial role in configuring what destinations are desired or undesired, and at the same time the subject adopts the ideological narratives of the status quo. For capitalism to be expanded, a set of experts (tour operators) draw symbolically the world in two clear-cut poles, civilized and wild destinations. The former is characterized by the order of law and rationality, whereas the latter refers to chaotic spaces where the personal security remains unwarranted (Lash & Urry, 1993; Urry, 1992, 2001, 2002; Urry & Larsen, 2011). The rapid reading on Urry’s works leads us to question: Is COVID-19 inverting this tourist gaze in a wicked gaze? Since the COVID-19 outbreak in China, Argentina keeps immune to the virus—at least until March 3, 2020 when the first case was detected. On 12 April the Argentinean government openly declares a mandatory quarantine for all their citizens, prohibiting any commercial activity as well as free transit. Bus, subways, and trains have been halved. To date, the health authorities recounted 800

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infected people and 20 victims, but this amount can be notably increased through May or June. The question here is why do we focus on Argentina as a reliable study case? What is the difference with Spain or Italy? The answer seems to be simple. Methodologically speaking, Argentina—may be in the follow-up of the state of emergency in China, Spain, and Italy—sanctioned a compulsory and strict quarantine while closing the airspace, airports, and all the external borders with neighboring countries. To this extent, Argentina is the best example of how the lockdown not only stopped the commercial activity but also the industry of tourism and hospitality. The nations react differently to this pandemic, but basically, we can note two groups. Those nations which moved by the needs of protecting their industries do not adopt a strict quarantine, and those nations which implement restrictive measures to impede the domestic mobilities face serious economic harms. To mitigate the negative effects in the economy, President Alberto Fernandez disposed a set of measures and programs to support the payment of wages to workers, as well as the temporal cancellation of classes. Only basic services such as medical system, drugstores, food companies, security forces, and bus or cab drivers were allowed to work. The full suspension of activities was accompanied with the closure of the hospitality industry, which was hired to host sick patients or persons who need to keep in quarantine. Those tourists, who come from highly infected countries such as Europe, the United States, or Brazil, were forced to live two weeks in isolation. Some of them living in Buenos Aires were sent to hotels while those who lived in the metropolitan areas (Buenosairean Conurbano) were delivered to their homes. There were suspected cases where hosts escaped from the hotels placing their health in risks. In other circumstances, they lied at the borders or at airports about the quarantine addresses to violate the isolation. In consequence of this, some Argentinean citizens who respected the quarantine echoed a sentiment of hostility against tourists which accelerated the number of denounces to stop the quarantine breakers. As a result, more than 2,000 persons were detained by the security forces in recent days. Another secondary effect was the repatriation of almost 20,000 Argentinean tourists stranded abroad. The army and air forces, as well as the commercial aviation, played a leading role repatriating tourists to Buenos Aires in the first two weeks of the pandemic outbreak. To avoid a spillover effect, President Fernandez made the polemic decision to cancel the repatriations leaving almost 10,000 Argentinean citizens in the world. Under the lemma stay (at) home, journalism, and Press emphasized the importance to respect the quarantine. The gradual resolutions of the government may be very well summarized as follows: February 26, 2020: strict supervision at airports to detect potential cases of coronavirus. March 06, 2020: the suspension of truancy reports in the schools and universities. March 11, 2020: the articulation of new protocols of security for those tourists who come from highly affected areas or nations. March 12, 2020: total closure of clubs, museums, and cultural spaces of consumption as well as mega-events or sports events.

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March 13, 2020: the creation of a crisis committee applied to transport. March 15, 2020: a set of measures oriented to protect hotel staff as well as the suspension of classes until further notice. March 16, 2020: full closure of national frontiers. March 17, 2020: all tourists who came from affected areas were delivered to hotels in Buenos Aires to be in control over two weeks. March 19, 2020: the sanction of a preventive and mandatory quarantine to avoid virus propagation. As the schedule of facts shown above, one might add, needless to say, fear and suspicion in the streets of Buenos Aires prevail. Rumors about the closure of the border pressed many Argentineans to return to the country even when they were suspected to be infected. The figure of the tourist (tourist gaze) which historically was admired set the pace to a new phenomenon: the wicked gaze. How may we define this neologism in objective terms? Starting from the premise that Urry defines the tourist gaze as the interplay of expectations, narratives, and cosmologies orchestrated to maximize the selfpleasure through heritage consumption (host’s commoditization), the wicked gaze can be defined as an anti-force resulted from a process of global refeudalization where the “Other” is undesired. The tourist gaze can be explained as the urgency to be in contact with exotic cultures (to dispossess and commoditize them) and aggressively promoted by media and marketing. The tourist gaze is externally elaborated and imposed unilaterally to local cultures and peoples who are often commercialized as embellished products. Locals often negotiate and internalize the stereotypes fabricated by the Global North. The quest of authenticity rests on the needs of reconstructing the own identity internally fragmented—if not deteriorated—by capitalist exploitation. The reconstruction of heritage and ethnicity is of paramount importance as locals look to meet tourists’ expectancies through reviving local (lost or invented) traditions. As Urry eloquently reminded, the tourist gaze coexists and potentiates a wider process of high mobility based on the globalization as well as digital technologies breakthrough. Instead, the wicked gaze goes in the opposite direction. It certainly entails a feudalization of the world where an anti-tourist sentiment surfaces. Before the state of emergency, the mainstream cultural values of global society such as mobility and personal contact are temporarily suspended. The free transit which cemented the authority of nation-state is replaced by the quarantine, impeding the interpersonal fluid contact. As a result, tourists are suspected as potential enemies who silently carry the virus and may potentially infect others. Hospitality and friendship do not apply for foreign tourists any longer because they were relabeled as an undesired guest. Echoing Derrida, the undesired guest is portrayed as a parasite, an organism that predates the hosting body (society). In the same way, tourists are considered dangerous agents of infection, illness, individualism, and predation. Here much can be said, above all, when tourists break voluntarily the quarantine. In a nutshell, the wicked gaze is supported by the end of mobilities as a new issue that marked the government’s agenda just after COVID-19. This virus, which is far from being apocalyptic, endorses a

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previous tendency to closure that the West experienced just after 9/11. Here the Spectacle and the horror converge. The point is being illustrated better in the following section.

COVID-19 and the End of hospitality To discuss COVID-19 and its immediate or long-lasting effects on society is very hard in these moments because of the velocity of the mediated events. What experts know—to summarize in a few lines—is that it is little known about how this virus, which was firstly detected in Wuhan (China) in 2019, mutates. Even if the virus reproduces exponentially with easy transmissions, its mortality rate is slower than other viruses. Particularly, coronavirus disease affects seriously (almost 18% causing fatal victims) elderly groups. Experts agree that not only will a great percentage of the elderly citizens contribute to reported and diagnosed cases, but also that each diagnosed case will yield at least six other potential infected persons whose infection will remain “silent” without real symptoms. With the benefits of hindsight, COVID-19 woke up the world from its slumber accelerating the end of mobilities and hospitality, at least as we know it. The different governments adopted restrictive protocols of isolation and barriers against international commercial flights while the borders were temporarily closed. The tourism industry was cataloged as an army machine for the new times we are living. This means that not only hotels were radically recycled as hospitals to give attention to infected people but also airplanes repatriated co-nationals stranded abroad. In other terms, hospitality was refounded because of a new foundational event. The process of globalization faced its first blow on 11 September of 2001, when four commercial airplanes were weaponized against the commercial and military icons of the United States. As a foundational event, not only did 9/11 humiliate the United States, but also it showed how the pride of the West (its mobilitiesbased ideals and modern tourism) can be used as weapons against innocent civilians. From that moment onward, the West questioned its obsession for mobilities, exhibiting the risks of effacing geographical borders. The 9/11 accelerated radical transformations in Occident paving the ways for the end of hospitality. The psychological fear instilled in the United States and Europe activated more aggressive protocols of surveillance, including border closures, the emergence of supremacist discourses, Islamophobia, and tourist-phobia. Tourists as imagined non-Western others are not admired anymore; they are feared, hated, and considered as undesired guests. The second blow was the financial crisis that affected the capitalist markets in 2008—something that had a knock-on effect on the tourist industries. The crisis was employed by some reactionary circles to blame globalization and migration; it also endorses reactionary movements that led to the triumph of Donald Trump in the United States, to Jair Bolsonaro’s election in Brazil, Orban’s in Hungary, and the Brexit in the United Kingdom. What seems to be important to say is that terrorism started a new era where the enemy is not coming from outside anymore. The enemy—in a never-ending war—is living here with us and looks like us.

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This cultural metaphor produced a culture of fear that eroded common social ties. A terrorist is now a person, who looks or behaves like us; even he or she is a native of the targeted society. If during the nineteenth-century colonial rule, Westerners consume the alterity of subordinated “Others” in a post-9/11 context, they cannibalize their essence, by blurring the boundaries between risks of “being here” and “being there.” COVID-19 is a third foundational event that interrogates and affirms this trend. Like the terrorist who lives within, the virus, which circulates everywhere, is hosted by our body—for anyone can be turned on COVID-19’s behalf into a lethal weapon. Governments, now in the war, struggle against an invisible enemy. This brings us to the metaphorical extensions of the “quarantine,” as a radical rejection to the Otherness. Citizens are arbitrarily confined in some cases with no contact with their environment, living particularly in isolation. As silent carriers of the public enemy par excellence, who display no symptoms of infection by exteriority, citizens are equaled to be potential terrorists who harm the public security. Those who violate the quarantine are repressed or even jailed as an attack to the public health. Like the 1970s War on Cancer, the war against criminality in the 80s, or the war on terror in the twenty-first century, we are now caught in the tugs of war on a virus. Here there is a clear retransformation of the conditional hospitality of modern tourism into the unconditional hospitality provided by the hospital. To cut the long story short, the commercial hospitality succumbs to noncommercial hospitality.

Conclusion The historiography of nation-state and nationhood reveals that mobilities and free transit were foundational institutions in their respective consolidations. In this vein, hospitality allowed not only the entrance of the foreign citizens who were asked about their origin but also cemented the power of nation-state in a global capitalist system. Of course, the industry of tourism and hospitality accompanied a world of instant and rapid circulation. Echoing John Urry, the tourist gaze, which was finely ingrained in an economy of signs, marked the needs to consume culture as a form of entertainment. But things changed after COVID19, probably affirming a previous tendency born in the post-9/11 context. This chapter punctuates on the decline of hospitality—at least as it was imagined by ancient philosophers—in a way that the tourist gaze sets the pace to a wicked gaze. Whether hospitality and free transit were the foundational values of West, COVID-19, and the resulted state of emergency reveals a new unknown process of feudalization which comes to stay. The future of tourism in these days remains uncertain even for experts and policymakers.

References Armitage, J. (2010). Now you see it, now you don’t: A review of jean Baudrillard (2009). International Journal of Baudrillard Studies, 7(2), 1–9.

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Baudrillard, J. (2006). Virtuality and events: The hell of power. Baudrillard Studies, 3(2), 1–10. Bauman, Z. (2013). Liquid fear. New York, NY: John Wiley & Sons. Bauman, Z. (2017). Tourists and vagabonds: Or, living in postmodern times. In Identity and social change (pp. 19–32). Abingdon: Routledge. Bishop, R. (Ed.) (2009). Baudrillard now: Current perspectives in Baudrillard studies. Cambridge: Polity Press. Campbell, E. (2010). The future(s) of risk: Barthes and Baudrillard go to Hollywood. Crime, Media, Culture, 6(1), 7–26. Derrida, J., & Dufourmantelle, A. (2000). Of hospitality. Stanford: Stanford University Press. Foucault, M., & Ewald, F. (2003). "Society must be defended": Lectures at the Coll`ege de France, 1975-1976 (Vol. 1). London: Macmillan. Guidotti-Hern´andez, N. M. (2011). Unspeakable violence. Remapping us and Mexican national imaginaries. Durham: Duke University Press. Innerarity, D. (2017). Ethics of hospitality. London: Taylor & Francis. Kellens, W., Terpstra, T., & De Maeyer, P. (2013). Perception and communication of flood risks: A systematic review of empirical research. Risk Analysis: An International Journal, 33(1), 24–49. Kellner, D. (2006). Jean Baudrillard after modernity: Provocations on a provocateur and challenger. International Journal of Baudrillard Studies, 3(1), 1–32. Kellner, D. (2015). Guys and guns amok: Domestic terrorism and school shootings from the Oklahoma City bombing to the Virginia Tech massacre. Abingdon: Routledge. Korstanje, M. E. (2015). The anthropology of airports, criticism to non place theory. Advances in Hospitality and Tourism Research, 3(1), 40–58. Korstanje, M. E. (2017). Terrorism, tourism and the end of hospitality in the West. New York, NY: Springer. Korstanje, M. E. (2018). The mobilities paradox: A critical analysis. Cheltenham: Edward Elgar Publishing. Korstanje, M. E. (2019). Terrorism, technologies and apocalyptic futures. New York, NY: Springer. Lash, S. M., & Urry, J. (1993). Economies of signs and space (Vol. 26). London: Sage. Lynch, P., Molz, J. G., Mcintosh, A., Lugosi, P., & Lashley, C. (2011). Theorizing hospitality. Hospitality & Society, 1(1), 3–24. Miceli, R., Sotgiu, I., & Settanni, M. (2008). Disaster preparedness and perception of flood risk: A study in an alpine valley in Italy. Journal of Environmental Psychology, 28(2), 164–173. Nicols, J. (2011). Hospitality among the Romans. The Oxford handbook of social relations in the Roman world (pp. 422–437). Oxford: Oxford University Press. O’Gorman, K. D. (2007). Discovering commercial hospitality in ancient Rome. Hospitality Review, 9(2), 44–52. Pagden, A. (1995). Lords of all the world: Ideologies of empire in Spain, Britain and France c. 1500-c. 1800 (p. 63). New Haven, CT: Yale University Press. Quarantelli, E. L. (1985). What is disaster? The need for clarification in definition and conceptualization in research. Disasters and Mental Health: Selected, 10, 41–73. Quarantelli, E. L. (Ed.) (2005). What is a disaster?: A dozen perspectives on the question. London: Routledge.

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Ritzer, G. (2019) Inhospitable hospitality. In B. Rowson, & C. Lashley (Eds.), Experiencing hospitality (pp. 73–91). Hauppauge: Nova Science. S´anchez‐Moreno, E. (2001). Cross‐cultural links in ancient Iberia: Socio‐economic anatomy of hospitality. Oxford Journal of Archaeology, 20(4), 391–414. Selwyn, T. (2019) Hostility and hospitality: Connecting Brexit, Grenfell and Windrush. In B. Rowson, & C. Lashley (Eds.), Experiencing hospitality (pp. 51–72). Hauppauge: Nova Science. Sunstein, C. R. (2002). Risk and reason: Safety, law, and the environment. Cambridge: Cambridge University Press. Sunstein, C. R. (2005). Laws of fear: Beyond the precautionary principle (Vol. 6). Cambridge: Cambridge University Press. Urry, J. (1992). The tourist gaze “revisited”. American Behavioral Scientist, 36(2), 172–186. Urry, J. (2001). Globalising the tourist gaze. In Tourism development revisited: Concepts, issues and paradigms (pp. 150–160). Urry, J. (2002). The tourist gaze. London: Sage. Urry, J., & Larsen, J. (2011). The tourist gaze 3.0. London: Sage. Virilio, P. (2006). Art and fear. New York, NY: A&C Black. Virilio, P., & Richard, B. (2012). The administration of fear (Vol. 10). Cambridge: MIT Press. Wachinger, G., Renn, O., Begg, C., & Kuhlicke, C. (2013). The risk perception paradox—implications for governance and communication of natural hazards. Risk Analysis, 33(6), 1049–1065.

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Chapter 11

COVID-19 Outbreak in Finland: Case Study on the Management of Pandemics Sajal Kabiraj and Filip Lestan

Abstract COVID-19 has created an unprecedented situation for Finland like never before. These are desperate times for Finland. And desperate times need desperate measures. The Government of Finland is pulling out all the stops and doing everything possible in its continued fight against COVID-19 virus. The crisis primarily erupted due to the initial delay in action and lack of preparedness required to tackle this kind of crisis. Communication channels were put to best use by the Finnish Government in an effort to reach out to all the people in Finland. The people living in Finland should strictly follow the guidelines and support the measures by the Government in full tandem to ensure that the COVID-19 virus is defeated and stops further transmission by breaking the chain. This paper portrays different possible trajectories and outcomes associated with the impacts of the pandemic in Finland. Keywords: COVID-19; pandemic; Finland; emergency measures; economy; modeling

Introduction WHO describes the coronaviruses as zoonotic; it means that the virus is transmitted between humans and animals. Detailed investigations found out that SARS-CoV were transmitted from civet cats to humans and MERS-CoV from dromedary camels to humans. Several known CoV are circulating in animals that have not yet infected humans. Common signs of infection include respiratory symptoms, fever, cough, shortness of breath, and breathing difficulties. In more severe cases, infection can cause pneumonia, SARS-CoV, kidney failure, and even death. Standard recommendations to prevent infection spread include regular hand washing, covering mouth and nose when coughing and sneezing, and International Case Studies in the Management of Disasters, 213–229 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201013

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Table 11.1. Explanations of Notions Used in the Case Study. Notions

CoV

COVID-19

SARS-CoV MERS-CoV WHO

Explanation of Notion

Coronaviruses (CoV) are a large family of viruses that cause illness ranging from the common cold to more severe diseases (World Health Organization, n.d.-a) Coronavirus disease is a new strain that was discovered in 2019 and has not been previously identified in humans (World Health Organization, n.d.-a) Severe acute respiratory syndrome (World Health Organization, n.d.-a) Middle East respiratory syndrome (World Health Organization, n.d.-a) World Health Organization

Source: World Health Organization (n.d.-a).

thoroughly cooking meat and eggs. Avoid close contact with anyone showing symptoms of respiratory illness such as coughing and sneezing (World Health Organization, n.d.-a) (Table 11.1). The pandemic phases reflect the WHO’s risk assessment of the global situation regarding each CoV with pandemic potential that is infecting humans. These assessments are made initially when such viruses are identified and updated based on evolving virologic, epidemiological, and clinical data. The phases provide a high-level global view of the evolving picture. As pandemic viruses emerge, countries and regions face different risks at different times. For that reason, countries are strongly advised to develop their own national risk assessments based on local circumstances, taking into consideration the information provided by the global assessments produced by WHO. Risk management decisions by countries are therefore expected to be informed by global risk assessments, but based on local risk assessments (World Health Organization, n.d.-b). The current WHO phase of pandemic alert for COVID-19 is Pandemic phase (Fig. 11.1).

Literature Review Lessons from the Past with SARS-CoV According to (Koh & Sng, 2010), on March 12, 2003, the WHO issued a global health alert stating that a new, unrecognizable, flu-like disease may spread to healthcare workers. Back then we knew this illness as SARS-CoV. By August in 2003, there were 8422 SARS-CoV cases and 916 deaths reported from 29

COVID-19 Outbreak in Finland

Fig. 11.1.

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Phases in Distribution of COVID-19. Source: World Health Organization (n.d.-b).

countries. In that case, SARS was considered as hazardous to health among healthcare workplaces. Especially, healthcare workers contained 21% of all SARS-CoV patients. In particular, in Canada and Singapore, more than 40% of patients were healthcare workers. In healthcare establishments, first-line employees such as nurses, doctors, laboratory and paramedical staff, health attendants, and cleaners were at risk of engaging with SARS disease. The evolution of the SARS-CoV and the outbreak of SARS-CoV among healthcare workers have shown us that emerging respiratory diseases remain a concern to the whole world and that new occupational diseases can appear in the future as well. Although the SARS-CoV outbreak was successfully contained, it provided us with valuable insights, such as the occupational risks of healthcare workers, and an appreciation that the impact of infectious diseases extends beyond the illness itself (Koh & Sng, 2010).

COVID-19 Early Lessons Since the emergence of COVID-19, the epidemic has not only swept through China but also spread throughout the world. Radiology departments are crucial in the fight against the epidemic because x-ray imaging is one of the most significant methods of diagnosing COVID-19. First affiliated hospital of Shenzhen University in China (2020) protects healthcare workers at their radiology department as follows. The computed tomography (CT) examination room is divided into four levels of protective zones. There are separate CT examination rooms and special channels for suspected patients, which strictly follow the respiratory infectious disease protection guidelines of the WHO and are set as level 2 protection. Disposable medical caps, protective glasses or face masks (anti-fog type), medical protective masks (N95), clothing or gowns, disposable latex gloves (double layers), and disposable shoe covers are all required for medical staffs, and hand hygiene is strictly implemented (Lei, Zhang, Yu, & Patlas, 2020).

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Current Situation In Finland, cases of the COVID-19 have been diagnosed both among tourists infected elsewhere and those infected in Finland. So far, there are still only a few reported cases whose origin cannot be traced. Most of the COVID-19 cases diagnosed in Finland have been mild. Some of those infected have also required hospital care (Finnish Institute for Health and Wellfare, 2020). On March 16, 2020, the Finnish Government decided on additional measures to address the coronavirus outbreak in Finland. The aim of the measures is to protect the population and to safeguard the functioning of society and the economy. The measures will be in force until April 13, 2020. The Government has announced, in cooperation with the President of the Republic, that there is a state of emergency in the country as a result of the coronavirus outbreak (Finnish Government, 2020b). These measures will be implemented in accordance with the Emergency Powers Act, the Communicable Diseases Act, and other relevant legislation in Finland. The emergency measures include the closure of schools, educational institutions, universities, and universities of applied sciences. In addition to that, the restrictions regarding public meetings, events and gatherings, mobility and visits to healthcare units, and increases to social welfare and healthcare capacity are applied as well. Finland has reinstated its border checks to all its borders, and border traffic will be restricted as of March 19, 2020 (Finnish Government, 2020b).

Background Information on the Emergency Powers Act in Finland The Emergency Powers Act defines various emergency conditions, including an attack on Finland, a particularly serious major accident or a widespread infectious disease, such as the coronavirus pandemic. The purpose of the Emergency Powers Act is to secure the livelihood of the population and the national economy, to maintain legal order and fundamental and human rights, and to safeguard the territorial integrity and independence of Finland in emergency conditions. The Emergency Powers Act lays down provisions on the powers of authorities in emergency conditions. The powers defined in the Emergency Powers Act can be exercised only if authorities cannot control the situation with regular powers. Under the Emergency Powers Act, the rights and everyday lives of individuals shall be restricted only if this is necessary to protect the population. The decision to adopt the powers laid down in the Emergency Powers Act for a maximum period of six months shall be made by Government Decree (enforcement decree) when the Government, in cooperation with the President of the Republic, has declared that there is a state of emergency in the country. The final decision-making power on adopting the Act rests with Parliament. Parliament will decide whether the additional powers laid down in the Government decree will be adopted in full or in part. Parliament may also decide to repeal the Government Decree. In an urgent situation, it is possible to introduce additional powers immediately. In that case, the Decree will also be submitted to Parliament immediately. The Decree must be submitted to Parliament within a week of its issue or it will lapse (Finnish Government, 2020b).

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Impact to Date in Finland As of March 20, Finland recorded ;400 confirmed cases of COVID-19, whereas 10 patients already recovered, and there was no record of deaths (European Centre for Disease Prevention and Control, 2020; Worldometers.info, 2020) (see Appendix 1).

Impact to Date Worldwide As of March 20, COVID-19 accounted for ;250,625 cases in total around the globe. Total closed cases of COVID-19 were 99,304, whereas 89,048 infected patients recovered and 10.256 died. With this in mind, mortality rate of COVID-19 as of March 20, 2020 was 11.5%. On the other hand, still the ongoing COVID-19 disease was present in 151,321 cases, whereas mild condition and smooth recovery process was in 143,878 cases, and 7,443 patients were in critical or so serious condition (see Appendix 2). Based upon the fact of the current cases of the COVID-19, we could assume that mortality rate could be 5.2%. If we take out the average of the mortality of already closed cases and assumed mortality rate of the present cases, it would account for 8.4%. At the current impact to date of COVID-19 in Finland, we may assume that 8.4% out of the ;400 confirmed cases will account for death. This could mean that approximately 34 persons could die at the current stage of COVID-19 in Finland (European Centre for Disease Prevention and Control, 2020; Johns Hopkins University, 2020).

COVID-19 Forecast in Finland The best and worst-case scenarios for the spread of COVID-19 in Finland have been mapped out by researchers at universities in Turku and Tampere. The coronavirus outbreak in Finland could cause up to 3,200 in the worst-case scenario. That’s the conclusions in a new report commissioned by the Government from researchers at the Universities of Turku and Tampere and the Finnish Institute for Health and Welfare THL. The estimate is based on an assumption of the virus spreading widely in Finland infecting up to 60% of the population; up to 32,000 people needing hospital treatment; as many as 8,000 in intensive care; and with 0.1% of the total number of people infected ultimately dying from COVID-19. The new scenarios drawn up by researchers all paint a picture of the epidemic lasting several months and infecting a significant number of people in Finland. At the other end of the scale—the best-case scenario—20% of Finns would be infected; between 4,000 and 10,000 would need hospital treatment; and 500 to 1,000 would die, according to researchers. The spread of the virus has already put a strain on the healthcare system with a shortage of COVID-19 testing kits and thousands of calls to helplines and with the government giving local authorities permission to waive their healthcare targets during the coronavirus crisis. There’s a further strain on the system anticipated if more healthcare workers get sick or have to self-quarantine at home when family members become sick, leading to staff shortages in hospitals and local health centers (Finnish Government, 2020a).

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Emergency Measures Announced by the Government of Finland (1) Early childhood education, care units, and the preprimary education organized in connection with them will be kept in operation. This will ensure access to early childhood education and care for the children of employees in sectors critical to the functioning of society and enable parents to work. The Government advises parents and guardians who are able to arrange childcare at home to do so (Finnish Government, 2020c). (2) The premises of schools, educational institutions, universities, and universities of applied sciences as well as civic education and other liberal education institutes will be closed down, and contact teaching will be suspended. As an exception, however, preprimary education organized in schools and contact teaching for grades 1–3 will continue for the children of parents working in sectors critical to the functioning of society. A further exception is that contact teaching will continue to be arranged for pupils who require it according to a decision on special needs support; however, parents and guardians who are able to arrange childcare at home are still requested to do so. The aforementioned arrangements will enter into force on Wednesday, March 18, 2020 (Finnish Government, 2020c). (3) Instead of contact teaching, the teaching and guidance provided by all universities, universities of applied sciences and vocational education institutes, general upper secondary education, and basic education providers will be organized to the widest extent possible in alternative ways, including distance learning, various digital learning environments and solutions, and, where necessary, self-learning (Finnish Government, 2020c). (4) The matriculation examinations will be carried out by March 23, 2020 according to the condensed schedule published on March 13, 2020, taking into account the instructions issued by the health authorities (Finnish Government, 2020c). (5) Public gatherings are limited to no more than 10 persons, and it is recommend to avoid spending unnecessary time in public places (Finnish Government, 2020c). (6) All national and municipal museums, theaters, the National Opera, cultural venues, libraries, mobile libraries, services for customers and researchers at the National Archives, hobby and leisure centers, swimming pools and other sports facilities, youth centers, clubs, organizations’ meeting rooms, day care services for the elderly, rehabilitative work facilities, and workshops will be closed. Private and third-sector operators and religious communities are advised to do the same (Finnish Government, 2020c). (7) Visits to housing services for the elderly and other at-risk groups will be prohibited (Finnish Government, 2020c). (8) Visitors will be banned from care institutions, healthcare units and hospitals, with the exception of asymptomatic family members of children and

COVID-19 Outbreak in Finland

(9) (10)

(11)

(12)

(13)

(14)

(15) (16)

(17)

(18)

(19)

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critically ill individuals, family members of those in hospice care, and spouses or support persons in the maternity ward, who will be permitted to visit on a case-by-case basis (Finnish Government, 2020c). Public-sector employers will instruct public-sector employees to work from home if their duties make it possible to do so (Finnish Government, 2020c). As a general guideline, persons over 70 years of age must refrain from contact with other persons to the extent possible (quarantine-like conditions), with the exception of members of parliament, the state leadership, and elected officials in local government (Finnish Government, 2020c). The capacity of healthcare and social welfare services will be increased in the public and private sectors. At the same time, nonurgent activities will be reduced. The capacity of the private sector will be mobilized for public use as necessary. At the same time, statutory deadlines and obligations will be eased (Finnish Government, 2020c). The capacity for coronavirus testing will be increased. The National Institute for Health and Welfare will provide support in this respect (Finnish Government, 2020c). In the case of critical personnel, exceptions will be made to the provisions of the Working Hours Act and the Annual Holidays Act in both the private and public sectors (Finnish Government, 2020c). Arrangements will be made to oblige trained professionals in healthcare and social welfare and internal security, in particular, to perform work as necessary (Finnish Government, 2020c). The movement of people may be restricted in order to prevent a serious danger to life and health (Finnish Government, 2020c). For the sake of public health and health security, preparations will be launched for the closure of Finland’s borders without delay in accordance with international obligations. Passenger transport to Finland will be suspended as soon as possible, with the exception of the return of Finnish citizens and persons residing in Finland. Finnish citizens and persons residing in Finland must not travel abroad. Finnish tourists abroad are advised to return to Finland immediately. Necessary travel for work and to access other necessary services will be permitted across the northern and western borders. Freight and goods traffic will continue as usual (Finnish Government, 2020c). Finns and permanent residents in Finland returning from abroad will be placed in quarantine-like conditions for two weeks (Finnish Government, 2020c). Persons returning from abroad must agree on the date of their return to work after a two-week period of absence together with their employer (Finnish Government, 2020c). The Defense Forces will ensure the continuity of their operations and their preparedness in all circumstances. The other authorities will be prepared to provide support as necessary (Finnish Government, 2020c).

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Contain-Prevent-Protect Model Contain-Prevent-Protect (CPP) model is a holistic plan based on analytical insights and primary intelligence to address the COVID-19 landscape (Fig. 11.2; Table 11.2). Finland is currently at Stage 2 of the coronavirus pandemic that has hit over 100 countries. There is no community transmission of the virus. In Stage 2, the source of the virus is known and it is easier to trace the chain, as opposed to community transmission (Table 11.3). What does it mean? We already know that we are in Stage 2. We are not in Stage 3, clearly as of now. The third stage is community transmission, which we hope we shouldn’t have. It would depend on how strongly we close our international borders, in which the government has taken very proactive steps. But we can’t say that community transmission won’t happen.

Impact of Public Health Measures In the current absence of vaccines and effective drug treatments, there are several public health measures countries can take to help slow the spread of the COVID-19.

Fig. 11.2.

Contain-Prevent-Protect (CPP) model. Source: Authors’ own work.

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Table 11.2. Measures to be Taken for the Contain-Prevent-Protect Model. Contain

Prevent

Possible only in Stage 2 Community isolation Social distancing

Focus on hygiene and best practices introduced in the contain period

Lockdown of public institutions and places for a definite period

Partial lifting of lockdown measures on a case-by-case basis

Self-quarantine

Aim to achieve zero infected persons and all suspected cases discharge from hospitals

Counseling the affected persons and their families

Ensure no new cases being reported

Protect

Ensure measures so that relapse does not occur Maintain status quo of zero cases being reported for a definite period of time Monitoring control of institutions, organizations, and workplaces with a backup plan Accurate, time-relevant, and detailed dissemination and exchange of information based on government public private sector participation Monitoring of domestic and international borders with stricter entry barriers after opening of borders

Closing domestic and international borders Source: Authors’ own work.

The team focused on the impact of five such measures, alone and in combination:

• • • • •

Home isolation of cases—whereby those with symptoms of the disease (cough and/or fever) remain at home for 7 days following the onset of symptoms. Home quarantine—whereby all household members of those with symptoms of the disease remain at home for 14 days following the onset of symptoms. Social distancing—a broad policy that aims to reduce overall contacts that people make outside the household, school, or workplace by three-quarters. Social distancing of those over 70 years—as for social distancing but just for those over 70 years of age who are at highest risk of severe disease. Closure of schools and universities (Imperial College COVID-19 Response Team, 2020).

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Table 11.3. Explanations on the Five Stages of an Outbreak. Stage

Stage 1 Stage 2

Explanation

Outcome

This is when cases are imported from affected countries. This is when there is local transmission from infected persons.

Only those who traveled abroad test positive. For example, relatives or acquaintances of those who traveled abroad. In local transmission, less people are affected. The source of the virus is known and it is easier to trace the chain, as opposed to community transmission. Community transmission is when a patient not exposed to any infected person or one who has not traveled to any of the affected countries tests positive. At this stage, people detected positive are unable to identify where they got the virus from. For example, Italy and Spain are at Stage 3. For example, this is what happened in China.

Stage 3

This is when community transmission takes place and large areas get affected.

Stage 4

This is the worst stage, when the disease takes the shape of an epidemic with no clear end point. This is the undesirable stage, when the disease becomes a pandemic and spreads across the entire globe.

Stage 5

People across the world panic and precious human lives are lost. Nations must unite and fight together to end the pandemic.

Source: Authors’ own work (based on inputs from WHO literature, 2020).

Modeling available data, the team found that depending on the intensity of the interventions, combinations would result in one of the two scenarios. In the first scenario, they show that interventions could slow down the spread of the infection but would not completely interrupt its spread. They found this would reduce the demand on the healthcare system while protecting those most at risk of severe disease. Such epidemics are predicted to peak over a three- to four-month period during the spring/summer. In the second scenario, more intensive interventions

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could interrupt transmission and reduce case numbers to low levels. However, once these interventions are relaxed, case numbers are predicted to rise. This gives rise to lower case numbers, but the risk of a later epidemic in the winter months unless the interventions can be sustained.

Flattening the Curve The report highlights suppression strategy scenarios for the UK showing intensive care unit (ICU) bed requirements. The black line shows the unmitigated epidemic. Green shows a suppression strategy incorporating closure of schools and universities, case isolation, and population-wide social distancing beginning in late March 2020. The orange line shows a containment strategy incorporating case isolation, household quarantine, and population-wide social distancing. The red line is the estimated surge ICU bed capacity in GB. The blue shading shows the 5-month period in which these interventions are assumed to remain in place. (B) shows the same data as in panel (A) but zoomed in on the lower levels of the graph (Imperial College COVID-19 Response Team, 2020).

Slowing and Suppressing the Outbreak The report details that for the first scenario (slowing the spread), the optimal policy would combine home isolation of cases, home quarantine, and social distancing of those over 70 years. This could reduce the peak healthcare demand by two-thirds and reduce deaths by half. However, the resulting epidemic would still likely result in an estimated 250,000 deaths and therefore overwhelm the health system (most notably ICUs). The world is facing the most serious public health crisis in generations (Imperial College COVID-19 Response Team, 2020). In the second scenario (suppressing the outbreak), the researchers show this is likely to require a combination of social distancing of the entire population, home isolation of cases, and household quarantine of their family members (and possible school and university closure). The researchers explain that by closely monitoring disease trends it may be possible for these measures to be relaxed temporarily as things progress, but they will need to be rapidly reintroduced if/ when case numbers rise. They add that the situation in China and South Korea in the coming weeks will help to inform this strategy further. Professor Azra Ghani, Chair in Infectious Disease Epidemiology from the MRC Center for Global Infectious Disease Analysis, said: “The current situation with the COVID-19 pandemic is evolving rapidly; governments and societies therefore need to be flexible in responding the challenges it poses. Our results indicate that widescale social distancing measures, that are likely to have a major impact on our day-today lives, are now necessary to reduce further spread and prevent our health system being overwhelmed. Close monitoring will be required in the coming weeks and months to ensure that we minimize the health impact of this disease.” Professor Christl Donnelly, professor of Statistical Epidemiology within J-IDEA, said: “The challenges we collectively face are daunting. However, our work indicates if a combination of measures is implemented, then transmission can be

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substantially reduced. These measures will be disruptive but uncertainties will reduce over time, and while we await effective vaccines and drugs, these public health measures can reduce demands on our healthcare systems.” Professor Steven Riley, professor of Infectious Disease Dynamics within J-IDEA, said: “We have to accept that COVID-19 is a severe infection and it is currently able to spread in countries such as the US and the UK. In this report, we show that the most stringent traditional interventions are required in the short term to halt its spread. Once they are in place, it becomes a common priority for us all to find the best possible ways to improve on those interventions” (Imperial College COVID19 Response Team, 2020).

Threat of COVID-19 on the Economy in Finland In the beginning of March, authors of article called What Coronavirus Could Mean for the Global Economy clearly and without a doubt stated that the financial markets currently assign significant disruptive potential to COVID-19. These risks are more than real. Nevertheless, the modification in assets and its valuations underline the remarkable unsureness surrounding this epidemic caused by COVID-19. History cautions us against drawing a straight line between financial market sell-offs and the real economy. Though market sentiment can be misleading, recessionary risk is real. The vulnerability of major economies, including the economy of Finland, however, is threatened by the COVID-19 pandemic. In fact, an exogenous shock hitting the Finnish economy at a time of COVID-19 may cause a recessionary scenario for some time (Carlsson-Szlezak, Reeves, & Swarts, 2020). Economic recessions may be divided into one of the three categories: (1) Real recession: Most likely, this is a Capital Expenditure boom cycle that turns to bankruptcy and stops the expansion or in other words, economic growth. For instance, severe exogenous demand and supply shocks which could be caused by disasters such as wars, natural disasters, or other disruptions like in the case of the COVID-19 outbreak. This can also push the real economy into a decrease. Therefore, the COVID-19 has the greatest chance to infect its host (Carlsson-Slezak, Reeves, & Swarts, 2020). (2) Policy recession: When central banks leave policy rates too high relative to the economy’s “neutral” rate, they tighten financial conditions and credit intermediation and with a delay choke off the expansion. In the European countries, rates are already rock bottom or even negative. Outside of the monetary policy response, the G7 finance ministers have also pledged fiscal support (Carlsson-Slezak, Reeves, & Swarts, 2020). (3) Financial crisis: Financial imbalances tend to build up slowly and over long periods of time, before rapidly unwinding, disrupting financial intermediation and then the real economy. Both factors limit the systemic risk of a potential shakeout in credit, though this risk can’t be dismissed entirely. It’s difficult to see the COVID-19 contributing to financial imbalances, but stress

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could arise from cash flow strains, particularly in the micro, small, and medium enterprises (MSMEs) (Carlsson-Slezak, Reeves, & Swarts, 2020).

Possible Recovery Path Whether economies can avoid the economic recession or not, the path back into economic growth under COVID-19 will highly depend on a range of drivers, such as the degree to which demand will be delayed or foregone, whether the shock is truly a spike or lasts, or whether there is structural damage, among other factors. It’s reasonable to sketch three broad scenarios, which could be described as V-U-L (Carlsson-Slezak, Reeves, & Swarts, 2020).

•

•

•

V-shaped: This scenario describes the “classic” real economy shock, a displacement of output, but growth eventually rebounds. In this scenario, annual growth rates could fully absorb the shock. Though it may seem optimistic amid today’s gloom, we think it is plausible (Carlsson-Slezak, Reeves, & Swarts, 2020). U-shaped: This scenario is the ugly sibling of V—the shock persists, and while the initial growth path is resumed, there is some permanent loss of output. Is this plausible for COVID-19? Absolutely, but we’d want to see more evidence of the virus’ actual damage to make this the base case (Carlsson-Slezak, Reeves, & Swarts, 2020). L-shaped: This scenario is the very ugly and poor relation of V and U. For this to materialize, you’d have to believe in COVID-19’s ability to do significant structural damage, i.e., breaking something on the economy’s supply side—the labor market, capital formation, or the productivity function. This is difficult to imagine even with pessimistic assumptions. At some point we will be on the other side of this epidemic (Carlsson-Slezak, Reeves, & Swarts, 2020).

Discussion COVID-19 has created an unprecedented situation for Finland like never before. These are desperate times for Finland. And desperate times need desperate measures. The Government of Finland is pulling all stops and doing everything possible in its continued fight against COVID-19 virus. The crisis primarily erupted due to the initial delay in action and lack of preparedness required to tackle this kind of crisis. Communication channels were put to best use by the Finnish Government in an effort to reach out to all the people in Finland. The people living in Finland should strictly follow the guidelines and support the measures by the Government in full tandem to ensure that the COVID-19 virus is defeated and stops further transmission by breaking the chain. Finland has three options to choose from and exercise. The first option is to follow China’s model of mass quarantine, lockdown, and isolation. This model though very effective could perhaps be successful in an authoritarian society like

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China where people strictly observe the guidelines and instructions of the Government without any questions. It might prove difficult to implement this model in Finland where people ask questions and seek an explanation for every action and consequence. The second option is to follow South Korea’s model of trace, test, and treat of which mass testing is a major component. However, this model requires financial resources and healthcare capabilities, both which Finland possesses. There needs to be a willingness on the part of the Government. The third option could be Finland’s own strategy which it could devise on its own, which might be more suitable to the demography, topography, and conditions unique to Finland. The CPP model proposed by the authors might be a right step in this direction. However, the institutional policy makers (Governmental and healthcare professionals) are better informed as real decision makers to decide the best possible strategy to implement which would help emerge Finland as the winner from the COVID-19 crisis. It must be noted that data included within this case study were available until March 23, 2020. Consequently, the situation in real life may worsen or improve within short period of time. Finland is located more than 3,000 kilometers from the “European epicenter” of COVID-19, Italy. At the time of this case study was elaborated, Italy accounted for ;60,000 confirmed cases of COVID-19, whereas country recorded ;5,500 deaths (Worldometers.info, 2020). Therefore, the policy makers should be aware of the possible repatriation of Finns living abroad, not only within the “European epicentre.” However, the healthcare workers in collaboration with the government of Finland should ensure safety, security, and prevention with mutual operational goal, to protect the habitants and stop the spread of the COVID-19 among the cities within the country. The current situation in Finland is critical, especially in Helsinki region. Therefore, the municipal officials should take into consideration collaboration with the government of the possible lockdown of the metropolitan area of Finland. From March 22 to 23 of 2020, Finland’s confirmed cases of COVID-19 disease have raised by 105 within a single day. Even after the emergency measures which came into action on 18th of March. How can government ensure in understandable and efficient manner toward the habitants, the importance of the already undertaken emergency measures? In addition to that, how can government prepare its country with technical and informative management methods for upcoming days? It’s important to be efficient and keen in the monitoring period of the current emergency measures and forecast or predict the “possible” outcome of COVID-19 and its impact on the country.

References Carlsson-Szlezak, P., Reeves, M., & Swarts, P. (2020, March 3). What coronavirus could mean for the global economy. Harvard Business Review. Retrieved March 20, 2020, from https://hbr.org/2020/03/what-coronavirus-could-mean-for-the-globaleconomy

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European Centre for Disease Prevention and Control. (2020, March 20). Situation update worldwide, as of 20 March 2020. ECDC. Retrieved March 20, 2020, from https://www.ecdc.europa.eu/en/geographical-distribution-2019-ncov-cases ¨ VNK/2020/31. Finnish Government. (2020a, March 16). Valtioneuvoston p¨aa¨ tos Retrieved March 21, 2020, from https://valtioneuvosto.fi/paatokset/paatos? decisionId50900908f8068ec10 Finnish Government. (2020b, March 19). Government in cooperation with the President of the Republic, declares a state of emergency in Finland over coronavirus outbreak. Valtioneuvosto. Retrieved March 19, 2020, from https://valtioneuvosto.fi/ en/article/-/asset_publisher/10616/hallitus-totesi-suomen-olevan-poikkeusoloissakoronavirustilanteen-vuoksi Finnish Government. (2020c, March 19). THL. Coronavirus COVID-19 – Latest updates. Retrieved March 19, 2020, from https://valtioneuvosto.fi/documents/ 10616/21411573/Hallituksen1linjaamat1toimet11603.pdf/887504b5-4969-aa37541e-645e3390f6fc/Hallituksen1linjaamat1toim Finnish Institute for Health and Wellfare. (2020, March 19). Coronavirus COVID-19 – Latest updates. THL. Retrieved March 19, 2020, from https://thl.fi/en/web/ infectious-diseases/what-s-new/coronavirus-covid-19-latest-updates. Imperial College COVID-19 Response Team. (2020, March 16). MRC centre for global infectious disease analysis. London: Imperial College. Retrieved March 21, 2020, from https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/ gida-fellowships/Imperial-College-COVID19-NPI-modelling-16-03-2020.pdf Johns Hopkins University. (2020, March 20). Coronavirus COVID-19 global cases by the center for systems science and engineering (CSSE) at Johns Hopkins University. ARCGIS. Retrieved March 20, 2020, from https://www.arcgis.com/apps/ opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Koh, D., & Sng, J. (2010). Lessons from the past: Perspectives on severe acute respiratory syndrome. Asia-Pacific Journal of Public Health, 22(3), 132–136. Lei, Y., Zhang, H.-W., Yu, J., & Patlas, M. N. (2020). COVID-19 infection: Early lessons. Canadian Association of Radiologists Journal, 1(2). World Health Organization. (n.d.-a). Coronavirus. Retrieved March 20, 2020, from https://www.who.int/health-topics/coronavirus World Health Organization. (n.d.-b). Pandemic Influnza preparedness. Retrieved March 20, 2020, from https://www.who.int/influenza/preparedness/pandemic/ h5n1phase/en/ Worldometers.info. (2020, March 20). COVID-19 coronavirus outbreak. Retrieved March 20, 2020, from https://www.worldometers.info/coronavirus/

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APPENDICES

Appendix 1. Current Stage of COVID-19 in Finland, Last Updated: March 20, 2020. Source: Authors’ own calculation (Johns Hopkins University, 2020).

COVID-19 Outbreak in Finland

Appendix 2. Current Stage of COVID-19 World-wide, Last Updated: March 20, 2020. Source: Authors’ own calculation (Worldometers.info, 2020).

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Chapter 12

The COVID-19 Crisis Management in the Republic of Korea Sahrok Kim, K. Praveen Parboteeah and John B. Cullen

Abstract Until recently, the business environment was characterized by a world in which nations were more connected than ever before. Unfortunately, the outbreak of coronavirus disease 2019 (COVID-19) has virtually ended the borderless and globalized world we were accustomed to. The World Health Organization (WHO) officially declared COVID-19 a pandemic at a news conference in Geneva on March 11, 2020. The multifaceted nature of this invisible virus is impacting the world at many levels, and this unprecedented pandemic may best be characterized as an economic and health war against humanity. More international cooperation is crucial for effectively dealing with the present pandemic (and future pandemics) because all nations are vulnerable, and it is highly unlikely that any pandemic would affect only one country. Therefore, this case study takes a sociological approach, examining various social institutions and cultural facets (i.e., government, press freedom, information technology [IT] infrastructure, healthcare systems, and institutional collectivism) to understand how South Korea is handling the crisis while drawing important implications for other countries. All aspects of how Korea is handling COVID-19 may not be applicable to other countries, such as those with fewer IT infrastructures and less institutional collectivism. However, its methods still offer profound insights into how countries espousing democratic values rooted in openness and transparency to both domestic and worldwide communities can help overcome the current challenge. As such, the authors believe that Korea’s innovative approach and experience can inform other nations dealing with COVD-19, while also leading to greater international collaboration for better preparedness when such pandemics occur in the future. This case study also considers implications for both public policy and organization, and the authors pose critical questions and offer practical solutions for dealing with the current pandemic.

International Case Studies in the Management of Disasters, 231–249 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201014

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Keywords: Covid-19; crisis management; democracy; health care system; innovative; IT infrastructure; institutional collectivism; Korea; Korea center for disease control; pandemic; press freedom; government

Introduction According to the World Health Organization (WHO), the coronavirus disease 2019 (COVID-19) is a respiratory, infectious disease that is wreaking havoc on most societies. The virus causing COVID-19 is a novel coronavirus first confirmed in Wuhan, China, in December 2019 (Zhou et al., 2020). The virus gets its name from the crown shape on its surface, according to the National Center for Immunization and Respiratory Disease (NCIRD, 2020). The WHO declared COVID-19 a pandemic on Wednesday, March 11, 2020. The “pandemic” designation is determined based on a disease’s severity, its effects on society, and its rate of becoming geographically widespread (Brueck & Miller, 2020). The word “pandemic” comes from the Greek “pan” and “demos,” translating to “all people” (Brueck & Miller, 2020). Currently, there is no cure or vaccine for COVID-19, and the health and economic challenges the virus presents are enormous. Analysts estimate that it will cost about $7 trillion to save the world economy (Horowitz, 2020). The economic impact is also felt at many different levels and across various sectors, including, but not limited to, the negative impact on job market, the disruption of global supply chain, and the decline in consumer spending (Junankar, 2020). In terms of health, COVID-19 is causing significant loss of lives around the world. The United States’ top infectious disease specialist, Dr. Anthony Fauci, stated that “coronavirus is 10 times more lethal than the seasonal flu” (Flatley, 2020, para. 1). Consistent with this statement, the statistics show alarming and devastating global effects. According to Johns Hopkins Coronavirus Resource Center (2020), as of April 2, 2020, at 9: 27 a.m., there were 981,221 confirmed cases of COVID-19 in 180 countries, resulting in a death toll of 50,230. As shown in Fig. 12.1, this number is likely to mushroom very rapidly. Of the 981,221 confirmed cases, 82,432 are in China, where 3,199 people have died from the virus. Outside of China, COVID-19 has been confirmed in 179 countries, territories, and areas, affecting roughly 898,789 people, with nearly 47,031 deaths. The top 13 most severely affected countries

Fig. 12.1. Confirmed COVID-19 Cases Worldwide. Adapted from the Johns Hopkins University Corona Virus Resource Center (2020).

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outside of China are the United States (226,374), Italy (115,242), Spain (110,238), Germany (81,728), France (57,807), Iran (50,468), the United Kingdom (34,165), Switzerland (18,475), Turkey (15,679), Belgium (15,348), the Netherlands (14,784), Austria (11,027), and South Korea (9,976). To understand the impact of the virus on societies, most experts are looking at the mortality rate. The mortality rate is calculated by dividing the numerator (deaths from COVID-19) by the denominator (the number of reported cases). To calculate accurate mortality rates, numbers for the reported cases and the actual deaths from COVID-19 must be trustworthy. Experts have warned that the number of reported cases should be considered with caution, as cases are underreported in some countries due to shortages of tests, incomplete reporting, or different testing rules. According to WHO, the latest mortality rate among confirmed cases is 5.13% globally. The death rates for COVID-19 among the most heavily affected countries are as follows: the United States (2.4%), Italy (12.1%), Spain (9.2%), Germany (1.3%), China (4.1%), France (7.6%), Iran (6.3%), the United Kingdom (8.7%), Switzerland (2.8%), Turkey (2.0%), Belgium (6.6%), the Netherlands (9.1%), Austria (1.4%), and South Korea (1.7%). Of the many countries affected, South Korea’s mortality rate (1.7%) is low and recovery rate (58.4%) is high compared with those in other infected countries. As reported by media sources (e.g., Mcgregor, 2020), Korea stands out as the country with the most transparent and comprehensive data. In fact, the best places to obtain good data for mortality rate calculations (https://coronaboard.kr/en/) are from populations in which the reported number of cases is highly reliable—e.g., Korea. Korea’s low mortality rate and high recovery rate has been made possible through early and accurate testing followed by isolation, which reduces the risk of further transmission. Korea is known for its aggressive and innovative approach to fighting this virus, which is unlike any other nation’s approach due to Korea’s high virus diagnostic capability (Joo, 2020). In addition, data transparency, decisive leadership, innovative approaches, flexible bureaucracy, open media, a strong healthcare system, and the institutional collectivism exhibited by government officials and public citizens all are success factors for Korea’s pandemic crisis management.

Methodology This case study addresses the current state of COVID-19 worldwide and specifically examines South Korea’s handling of the crisis. The research relies on secondary, publicly available information from both the international and South Korean sources to provide an overview of the COVID-19 pandemic. A number of crossnational researchers (such as Chen, Cullen, & Parboteeah, 2015 and Cullen, Parboteeah, & Hoegl, 2004) have explained real-world phenomena considering both social institutions and national culture. Therefore, the present authors apply a similar approach to the crisis management context—specifically, examining what makes South Korea an exemplary country, considering its social institutions (e.g.,

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government, press freedom, healthcare system, and information technology [IT] infrastructure) and cultural facets (e.g., institutional collectivism). Various academic studies have also been consulted as further references. Finally, the present authors pose critical questions for the worldwide community and draw conclusions from South Korean’s handling of COVID-19 as key takeaways for the world.

COVID-19 Crisis Management The new few paragraphs detail the many success factors that have helped South Korea manage the COVID-19 crisis. As documented below, these factors range from strong institutions as well as cultural predispositions for South Koreans to accept governmental mandates.

Korea Center for Disease Control One of the most critical factors that has helped South Korea face the COVID19 challenges is a centralized authority to deal with pandemics. Specifically, the Korea Center for Disease Control (KCDC) is a government agency acting under the control of the South Korean Ministry of Health and Welfare (MOHW). The KCDC was founded in 2004 with the primary aim of maintaining safe and effective disease control. It is similar to the Centers for Disease Control and Prevention (CDC) in the United States. As shown in Table 12.1, the KCDC is keeping the public fully informed by releasing its coronavirus cases report on a daily basis. A successful fight begins with transparency. The KCDC openly provides press releases (see, as an example, the report of April 2: https://www.cdc.go.kr/board/board.es?mid5a30402000000&bid50030) showing comprehensive and sophisticated data about the regional distribution of the virus; epidemiological links of confirmed cases across 18 regions; lists of confirmed cases by region based on those isolated, discharged, and deceased (see Table 12.1); and even case distribution by gender and age group (see Graph 12.1). Alongside all other data measures, this sex disaggregated is useful for informing the public about how to more effectively respond to the crisis (i.e., who to protect and how to protect). In other countries (e.g., the United States), it is not clear whether governments are providing such data (Polglase, Mezzofiore, & Foaster, 2020). MOHW is also sharing its coronavirus data daily (http://ncov.mohw.go.kr/en/).

Government and Leadership Another critical aspect lauded as a success factor in managing the COVID-19 crisis is strong governmental leadership. In an interview with the British Broadcasting Corporation (BBC) on March 15, 2020, Korean Prime Minister Kang Kyung-Hwa succinctly summarized the government’s role in the current crisis management as “openness, transparency, and fully informing the public and thereby mitigating public fear” (BBC, 2020, 0:27–0:33). Unprecedented moments

Tested Positive Period (Since 3 January)

As of 0:00 1 April (Wednesday) As of 0:00 2 April (Thursday) Difference

Confirmed

Discharged

Isolated

Deceased

Being Tested

Tested Negative

Total

9,887 9,976 89

5,567 5,828 261

4,155 3,979 –176

165 169 4

16,585 17,885 1,300

395,075 403,882 8,807

421,547 431,743 10,196

Adapted from the Korea Center for Disease Control (2020).

The COVID-19 Crisis Management in the Republic of Korea

Table 12.1. Total Confirmed and Suspected Cases in South Korea as of April 2, 2020 at 0:00.

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80 and above

140

70-79

313 385

60-69

278

507

751

50-59

1267

40-49

409

30-39

611 927

581

462

20-29

1226

10-19

279

1478

243

0-9 67 52 0

Male

500

1000

1500

2000

2500

Female

3000

Graph 12.1. Case Distribution by Gender and Age Group, as of April 2, 2020 at 0:00. Adapted from the Korea Center for Disease Control (2020). require bold leadership. To understand the importance of government leadership and transparency, it is illuminating to consider how the South Korean government reacted to the ferry crisis (Economist, 2020). In 2014, a ferry sunk off the coast of Jeju island resort leading to the drowning of 250 school children. In this case, the government was not transparent and even tried to censor those who were complaining leading to strong disapproval from the Korean population. In contrast, the way the government has dealt with the COVID-19 crisis has been based on openness and transparency. As the Latin saying goes, “praemonitus praemunitus,” which means that advances in knowledge give tactical advantage. This is especially applicable to the COVID-19 situation, which, being a state of emergency, demands quick information, swift judgment, and immediate actions. In a media briefing on March 18, 2020, WHO advised that testing, tracing, and isolation are the indispensable pillars of handling this pandemic crisis (Lacina, 2020). As has been noted by various media sources, the Korean government has shown exceptional leadership in adhering to these WHO guidelines. The first confirmed coronavirus cases in Korea and in the United States were detected on the same day. However, in stark contrast with the United States, Korea has done well in managing the crisis by employing extensive and quick testing (Terhune, Levine, Jin, & Li, 2020). While many countries (e.g., European countries and the United States) have locked down its citizens, Korea has been able to trace and monitor people and has not even shown panic buying in masks and medications through innovative technologies and effective data use (e.g., phone apps, the coronavirus map) with minimum economically damaging lockdowns (Anajani, 2020). This is consistent with Yuval’s (2020) suggestion that government has a choice between totalitarian surveillance and citizen empowerment. This is clearly a strong example of the very value of democracy. Evidence supports that democratic government coupled with high institutional collectivism (i.e., Korea, Singapore, and Taiwan) works better than rigid institutional supremacy for handling the coronavirus crisis (Beauchamp, 2020b). Well-developed democracy

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based on trust in society is essential for overcoming COVID-19. Consistent with this, the Korean government is calling for global collaboration and solidarity by engaging in active data sharing with the global community, spearheaded by the KCDC and MOHW. By transparently sharing these data, Korea has been able to not only earn the trust of its citizens but also help minimize panic among them.

Press Freedom WHO emphasizes that timely and accurate information is key in the fight against the COVID-19 crisis. Therefore, freedom of the press is even more important at this time because free media acts as a watchdog to criticize government wrongdoings (Ilan & Shaomin, 2020). This is critical when transparent data sharing is essential to safety and health, in this case ultimately curtailing the spread of COVID-19. For example, studies indicate that democracy and press freedom can substantially impact corruption (e.g., Chowdhury, 2004; Kalenborn & Lessmann, 2013). A recent article by Wu and McGoogan (2020) suggests that free press is the best disinfectant for the coronavirus. The COVID-19 data coming from China and Russia are questionable, as there is strong government censorship over what information, and how much information, is released (e.g., by policing the internet, suppressing whistleblowers, and banning social media accounts) (Raleigh, 2020; Simon, 2020). This restriction of press freedom results in either misinformation or a lack of information, leading to misinformed publics and, consequently, hampering efforts to curtail further spread of the virus. Another example of limiting press freedom is the Iranian government imposing restrictions on coverage of western Iran—the Kurdish region—to downplay concerns about coronavirus threats (Simon, 2020). In contrast, Korea, as a democracy, has shown how transparency and press freedom (i.e., data sharing) can help protect the health and safety of citizens. Unlike other nations, Korean medical experts, spearheaded by the KCDC and the Central Disaster and Safety Countermeasures Headquarters (CDSCHQ), deliver daily briefings on the status of COVID-19.

Innovative Approaches to Testing, Tracing and Surveillance, and IT Infrastructure In addition to the above institutional arrangements that have conferred some advantages, South Korea also benefits from strong IT infrastructure. After the severe acute respiratory syndrome (SARS) outbreak, followed by the Middle East respiratory syndrome (MERS) outbreak, Korea has put pandemic plans in place. When the COVID-19 crisis began, South Korea acted quickly and developed test kits. Government authority swiftly passed through bureaucracy to have the test kits quickly approved. As Oxford Professor Colin Mayer states in his recent podcast interview, the purpose of business is “producing profitable solutions to problems of people and planet” (Soundcloud 14:02–14:07). Seegene, a Korean biotech company, prepared, in advance, to make test kits before the first COVID19 case was confirmed in China. Coupled with the government’s quick approval,

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Seegene now makes 10,000 kits per week (Watson, Jeong, & Hollingsworth, 2020). Seegene is one of five domestic Korean companies making test kits. As of March 25, 2020, a total of 47 countries have urgently requested to import Korean coronavirus test kits (Yonhap, 2020a). With a population of 51.3 million, Korea has tested approximately 327,000 people and has the highest per capita testing rate in the world (Moon, 2020). Korea’s Vice Minister of Health and Welfare, Kim Ganglip, stated in recent interview in March: “The enormous testing capability is the most important means of fending off a contagious disease outbreak” (Kim, 2020, para. 8). Consistent with this claim, in her March 15 interview with the BBC, Korean Prime Minister Kang Kyung-Hwa stated: [T]esting is central because it leads to early detection. It minimizes further spread and quickly treats those found with the virus, which is also [a] key reason behind Korea’s low fatality rates…. I think our system quickly approved the testing system after the Chinese authorities released the genetic sequence of the virus in mid-January. Our health authorities quickly conferred with the research institutions here and then shared that result with the pharmaceutical companies to then produce the reagent and the equipment for the testing. (1:27–1:45; 1:47–2:17) Korea has more than 600 coronavirus testing sites and 50 drive-through stations across the country (Fisher & Choe, 2020). These noteworthy, fast-food-style drive-through sites, inspired by McDonald’s, are the first of their kind in the world. They were first opened on February 26, 2020, and the entire testing procedure takes only 10 minutes (Kuhn, 2020). South Korea has been testing 10,000 people a day in these drive-through stations for free, since its first confirmed cases. Another innovative testing approach Korea has employed is hospital “telephone booth” coronavirus testing, which was recently invented to minimize direct contact with medical staff (AFP, 2020). In addition to its testing capability, Korea has been able to minimize further COVID-19 spread without locking down its citizen. Most notably, Korea has employed an innovative approach for dealing with the crisis by taking advantage of its strong IT infrastructure. Korea is known for being a highly wired country. According to the United Nations International Telecommunication Union’s latest report, Korea ranked #2 on the information and communication technology (ICT) Development Index (IDI), which is a measure of ICT performance (ITU, 2017, p. 31). Specifically, Korea has creatively used technology for tracing, monitoring, and surveillance. This has included monitoring by phone apps, which send alarms when infected patients are nearby; employing self-quarantine protection apps, which notify the government when infected patients are violating self-quarantine orders; and developing coronavirus maps, which provide information about available masks in stock or tracks the movement of infected patients via their credit card transactions. All these tracking measures have helped the Korean

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public avoid danger zones of infection. While some many find this tracking intrusive, it is one viable way to use open data to reduce panic. Korean citizens have shown that they are willing to cooperate for the benefit of others. Some examples of how Korea has harnessed its IT infrastructure to track COVID-19 may be seen in Figs 12.2 and 12.3. Sites like Corona Map (https:// coronamap.net/ or http://coronamap.site/) provide real-time updates on whereabouts of patients and help others avoid those areas (Fig. 12.2). In addition, sites like Mask Map (https://maskmap.site/ or http://www.coronamap.co.kr/?view5mask) give citizens real-time, color-coded updates on the availability of masks at 1,534 pharmacies across the country. Green means that a pharmacy has masks available in quantities of 1001; yellow equals 30–99 available masks; red indicates 2–29 available masks; and gray means that a pharmacy has 0–1 masks in stock (Fig. 12.3). Korea has also developed the Corona 100m mobile notification app, which collects KCDC data to show, for individual patients, the date the person was diagnosed with COVID-19, the person’s demographic information (e.g., nationality, age, gender), and a list of the places that person visited (Meisenzahl, 2020). The app also traces infected patients, and, if an app user comes within 100 m of an area visited by COVID-19-infected patients, the user receives a push notification warning (Shendruk, 2020). Such phone tracking is possible because Korea is ranked #1 in the world for smart phone ownership and has an internet usage rate of 94% (Sohn, 2018). Additionally, South Korea has also made use of its IT infrastructure to develop an automated tracing system. Rather than relying on humans to conduct tracing of infected individuals, it has developed a digital system that can quickly pull in data from mobile phone operators about movement of individuals. This

Fig. 12.2. Corona Map Traces the Locations of People Known to be Infected with Coronavirus. Reprinted from the CoronaMAP.net (2020).

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Fig. 12.3. Mask Map Showing Mask Availability in 1,543 Korean Pharmacies. Reprinted from the Coronamapwiki (2020). innovative use of data has reduced contract tracing from 24 hours to about 10 minutes. Another noteworthy tracking method Korea has employed is that of relying on credit card transactions. South Korea is, by far, cashless society in the world (Jung, 2020). Therefore, the country can track card holders’ movements by tracking their card transactions. The South Korean government has also developed an innovative “self-quarantine safety protection,” available in both Android and iPhone versions, to monitor and track infected people in self-quarantine (Beauchamp, 2020a). Government officials are notified immediately if infected patients leave designated areas during the self-quarantine period, and violators can face up to a $2,500 fine (Lowry, 2020). Finally, Korea, harnessing its IT capabilities, is using robots to fight against the coronavirus. For example, robots follow doctors’ movements and carry medical disposals or medical devices. Moreover, robots, equipped with thermographic cameras, check the temperatures of anyone entering the hospitals (Kwon, 2020).

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Healthcare It is important to note that having a strong healthcare is critical to dealing with COVID-19. Korea’s healthcare system is among the most cost-effective and efficient in the world. Based on the 2019 CEOWORLD Magazine’s Health Care Index, Korea ranks #2, only 1.02% behind Taiwan (Ireland, 2019). This measure reflects the overall quality of the healthcare system, including cost, healthcare infrastructure, healthcare professionals, government readiness, and the availability of quality medicine. South Korea’s healthcare system is run by the MOHW, which is also responsible for running the National Health Insurance Service (NHIS). Established by the government in 1989, the NHIS was created to provide affordable health coverage for all citizens. The entire population is covered by either national health insurance (97%) or the tax-based medical aid program (3%). There are private hospitals and insurance companies, but the NHIS sets the prices for most treatments, keeping treatment prices low (Kwon, Li, & Kim, 2015). Several reports credit Korea’s nationalized healthcare system as being a big factor in flattening the curve of new infections (Fisher & Choe, 2020). In addition to the early testing, tracing, and isolation noted above, another key component of Korea’s success in curtailing further outbreak is treating patients. What is remarkable about Korea’s healthcare system is the cost of coronavirus testing and treatment. Under South Korea’s single-payer, universal health insurance scheme, COVID-19 testing costs $134. However, the government is offering free testing for people falling into three categories: a doctor’s referral, or for those who have come into contact with an infected person or those who recently visited China. The government is also reimbursing medical facilities for losses incurred from imposed quarantines and is covering the costs of hospitalization and treatment if a person tests positive and is confirmed as a COVID-19 patient (Kim, 2020; Moon, 2020). Another noteworthy advantage of Korea’s healthcare system is the availability of hospital beds (Moon, 2020). According to the Organization of Economic Cooperation and Development (OECD), available hospital beds are those immediately open for inpatient use. As seen in Fig. 12.4, South Korea has 12.3 beds per 1,000 people, compared with 8.0 in Germany, 6.0 in France, 4.3 in China, 3.2 in Italy, and 2.6 in the United States (OECD, 2020). Hospital capacity is important because insufficient capacity means victims cannot be treated at the proper time as hospitals cannot absorb the increased volume of infected patients.

Institutional Collectivism—Citizens, Companies, and Government Officials In addition to social institutions, researchers agree that national culture plays an important role in explaining cross-national phenomena (Cullen, Parboteeah, & Hoegl, 2004). One of the important cultural attributes of South Korean society is their ability to put collective interests above their own individual interests. This important cultural dimension that emphasizes collective interests before personal interests is known as institutional collectivism (Gelfand, Bhawuk, Nishii, & Bechtold, 2004). The South Korean high levels of institutional collectivism have had positive impact on how South Korea has managed the pandemic.

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India Indonesia Costa Rica Mexico Colombia Chile Sweden Denmark Canada United Kingdom New Zealand United States Turkey Iceland Ireland Spain Israel Italy Finland Netherlands Portugal Norway Australia Greece China (People's Republic of) Slovenia Luxembourg Switzerland Estonia Latvia Belgium Slovak Republic France Lithuania Poland Czech Republic Hungary Austria Germany Russia Korea Japan

0.53 1.04 1.13 1.38 1.71 2.11 2.22 2.5 2.5 2.54 2.61 2.77 2.81 2.91 2.96 2.97

2.99 3.18 3.28

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Fig. 12.4. OECD Health Statistics: Hospital Beds Total, per 1,000 People. Adapted from the OECD (2020). Consider, for instance, that the public’s cooperation is essential to flattening the curve of the COVID-19 virus. It is the balance between personal privacy and how people can work for the common public good. In Korea, public health weighs heavily against individual privacy. People in Korea would give up their privacy to collectively fight against COVID-19. This is the norm of institutional collectivism exhibited by the Korean public. As the old saying goes, “if there is a will, then there is a way.” Fisher and Choe (2020) describe this as “public will”

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and note that the Korean model may not be perfectly transferable to other countries, as social trust cannot be created overnight, and other, Western democracies are facing polarization. The level of public conscience is high, and this is a trade-off most Koreans support. Ju Youngkee, professor of health and data journalism at Hallym University, has stated that “Korean people are willing to forgo privacy rights and willing to bear the digital cost of country surveillance in the name of public safety” (Moon, 2020). Additional evidence from a survey conducted in February 2020 by Seoul National University’s (SNU) School of Public Health indicates that 78.5% of respondents in Korea agreed that they would sacrifice the individual privacy for safety of the public in fighting against a pandemic (Moon, 2020). This tolerance of a certain level of surveillance for the safety of the greater good is a sign of institutional collectivism, which, as mentioned above, cannot be created overnight (Jung, 2020). Moreover, the Korean culture approves this policy, so it is moral in Korea. However, the cultural relativism view states that what is “normal” must be viewed in light of each culture. Therefore, this norm of public safety over personal privacy may not be transferable to other countries (Tilley, 2000). Having high levels of institutional collectivism has resulted in several other factors that have helped South Korea deal with the pandemic. Recent research by Chopik, O’Brien, and Konrath (2017) has found that societies with higher levels of empathy are linked with higher levels of collectivism (i.e., prioritizing group over individual interests) and prosocial behavior (i.e., sharing, donating, and volunteering). Korea ranked #6 out of 63 countries in this survey. Prosocial behavior is defined as “behavior which the actors expect will benefit the person or persons to whom it is directed” (Brief & Motowildo, 1986, p. 711). One example of prosocial behavior is the individual choice to voluntarily wear masks, which impacts other citizens because it helps prevent further COVID-19 transmission. According to the February 2020 survey by SNU, 97.6% of respondents reported that they at least sometimes wear a mask when going outside, and 63.6% of those indicated that they always wear one (Moon, 2020). Secondly, unlike people in the United States, Australia, and some European countries, the Korean public has refrained from panic buying amid the epidemic (Jung, 2020). This is one sign of the institutional collectivism or strong group cohesiveness among South Korean citizens. This has resulted from the transparency and openness of the government, which helps to mitigate public panic and fear. Other examples of prosocial behavior include the donations and volunteer efforts flooding from the public. Citizens, celebrities, and corporations are reaching out to children with disabilities and the elderly, as well as low-income families and medical staff. For example, makers of the South Korean liquor, soju, have donated 32 tons of ethanol, the main ingredient in soju, to be used as disinfectant for buildings and public places (Chung, 2020). Korean K-pop bands and other stars have donated money, hand sanitizer, and masks to various charities (Im, 2020), and the big Korean conglomerates (e.g., Samsung, Hyundai, and the SK and LG Groups) have donated medical and quarantine supplies and cash to local charity

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organizations and welfare facilities. It is also noteworthy that companies’ employees are volunteering to make blood donations (Yonhap, 2020b). In summary, the Korean public (including both citizens and companies) is exhibiting high group cohesiveness and a group conscience. Such collective efforts have been possible because there is mutual social trust between the public and the Korean government. In the end, the government’s open and transparent work to fully inform citizens has led to public trust, which, in turn, has resulted in high levels of public conscience, i.e., voluntary, and collective efforts. For instance, the South Korean government served as a role model by exhibiting institutional collectivism. About 58 senior government officials, including the president, will be returning 30% of their salaries for the next four months to share in the pain and damage Korean citizens are facing from the spread of COVID-19. The money saved from these paycheck reductions will go to help small businesses hit by the epidemic (Roh, 2020). South Korea’s welfare capitalism is another good illustration of community well-being and the security of people. Korea made significant modification to its national welfare system since the aftermath of the financial crisis (Lee, 2004). The establishment of universal health insurance scheme and Employment-Welfare Plus Center are good examples. Korea’s universal health insurance system is financially supported by government and businesses wherein a person pays a certain premium based on his or her income and assets (Jeong, 2011). In addition, Korea maintains social assistance program, such as Employment-Welfare Plus Center (http://www.workplus.go.kr/index.do). This is one stop place for employment and welfare services which provide subsidy for companies to sustaining employment during crisis, such as the COVID-19 (Meacham, Rath, Moharana, Phalp, & Park, 2019). Authors believe that this subsidy program is a win for employee, company, and the government. From company’s perspective, they can hold on to employees. It is a win for company because they do not have to rehire and retrain new employees when crisis is over. It is also a win for employees because they are not laid off. Finally, it is a win for government because subsidy helps to lower unemployment and therefore lower economic ramifications for economy of country.

Critical Questions and Conclusions From a public policy perspective, is it completely wise to shut down national borders? No country can protect itself by its own efforts as virus spreads across national borders. Korea’s response to the COVID-19 pandemic and its relative success suggests that a society that is inclined toward institutional collectivism may be inherently better adapted to fighting pandemics than societies that are more individualistically inclined. Should societies where individual rights and liberties are highly cherished adapt to better fight future pandemics? What is clear is that the world needs to work toward global unity as we are interdependent. This is advocated by prominent Israeli thinker, Yuval. He has suggested that a global agreement on traveling must be reached, meaning that

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indispensable and prescreened scientists, epidemiologists, and international public health officials must be allowed to travel across most infected regions for global collaborations (Yuval, 2020). Secondly, adverse times require bold, decisive leadership, and any action plans must consider citizens’ lives first. Lives take precedence over economics and any political priorities. Governments and the press must make their data transparent to the public to win their citizens’ support and trust. Without public support and assistance, the COVID-19 crisis will not be managed effectively. As Korea has shown, adherence to openness and transparency and fully informing citizens is key, and, more importantly, all decisions must be based on science and data. Time is critical to pandemic crisis management. Thus, research institutions, governments, and private pharmaceutical companies must maintain close communication and act quickly for testing and approval. From an organizational viewpoint, crisis management during pandemics requires new adaptive mindsets. These adaptive capabilities entail applying an open data source model to find mutually beneficial opportunities for global coordination with partners and even with competitors (Nitin, 2020). Organizations must also act on their corporate social responsibility (e.g., Samsung’s financial donation and South Korean alcohol companies’ ethanol donation). Among the public, social distancing will have the largest impact on slowing the spread of COVID-19 (Ferguson et al., 2020). In addition to travel restrictions, epidemiological models from teams of researchers in Australia (Chang, Harding, Zachreson, Cliff, & Prokopenko, 2020) and England (Ferguson et al., 2020) suggest that mushrooming of COVID-19 infections can be controlled if people follow the advice of physical distancing. Moreover, the role of academic community is important. Specifically, researchers have duty to publish their COVID-19 works openly to the global community. As history shows, pandemics occur in five- to six-year cycles—the 2003 SARS outbreak, the 2009 flu pandemics, the 2015 MERS outbreak, and now the 2019–2020 COVID-19 crisis. What will happen in 2024–2025? The future is in the world’s hands now. As influential Israeli historian, Yuval, has said, “[T]his storm will pass. But the choice we make now could change our lives for years to come” (Yuval, 2020). The answer is simple. Everyone can consider surrendering “I” and embracing “we” to create global collaborations. As Korea’s crisis management has illustrated, the key lessons are clear. Creative use of IT infrastructure, strong leadership, and institutional collectivism (i.e., collective interests) may be the strongest weapons for fighting this invisible enemy. However, it must be noted that Korea’s experience with handling COVID-19 may not be applicable to all countries. Considering cultural relativism, Korea’s practices and models must be understood in light of each country’s unique setting. Nevertheless, this case study of Korea offers profound insights into how remaining faithful to democratic values, rooted in openness and transparency to both the domestic and worldwide communities, can help prevail over the COVID-19 challenge.

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Chapter 13

Empowering Patients through Social Media and Implications for Crisis Management: The Case of the Gulf Cooperation Council Manoj Menon and Babu George

Abstract Empowered patients are allies to the healthcare system, especially in emergency situations. Social media use has emerged to be a major means by which patients interact with the healthcare system, and in times such as the current COVID-19 situation social media has to play an even greater crisis management role by empowering patients. Social media channels serve numerous beneficial purposes, despite them also being blamed for the spread of misinformation during this crisis. In this Gulf Cooperation Council (GCC) focused case study, we will discuss the increasingly greater role being played by the social media in healthcare in the region and how that empowers not just the patients but the system as a whole. In the GCC region, the healthcare sector is found to reflect a steady growth, leading to an increased drive for empowering patients by lowering the barriers to effective communication and consultation through online media. As of today, social media has become an element of the telehealth infrastructure being deployed in the region. During COVID-19, patients are seen to leverage it pointedly for online health consultations thereby lowering the stress on the healthcare system and adding to efficiencies. Keywords: E-health; telemedicine; social media; patient empowerment; crisis management; Gulf Cooperation Council

Introduction The healthcare infrastructure in the Gulf Cooperation Council (GCC) countries is under severe stress, even in normal times. The GCC is routinely hosting a huge number of foreigners in the form of pilgrims, tourists, students, laborers, and International Case Studies in the Management of Disasters, 251–269 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201015

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businessperson. GCC government provides expat medical facilities similar to those facilities which their citizens are supposed to get. Currently, the healthcare situation in GCC is satisfactory. If it is not extraordinary, then it is also not the worst. The future of health facilities in GCC depends on the decisions and policies that government will today. According to the Gulf Corporations Council Healthcare, over the course of next 20 years, these six countries will face an extreme rise in the demand for healthcare facilities. By the year 2025, the total spending will reach USD60 billion which is almost USD12 billion more than the current spending (Mourshed, Hediger, & Lambert, 2007). Due to extreme foreign inflow to patients in GCC belong to various parts of the world, so it is tough to communicate with them on more reasonable manners. Moreover, local doctors in these countries are also few. They usually import such professional from other nations but the biggest problem with this importation of skilled people that most of them cannot speak the local language fluently. This communication gap is the greatest problem of the all. To reduce this communication gap, they are applying different techniques like teaching local professional language, hiring doctors from countries with the same language, and educating locals to learn a common tongue-English. Although all these methods have potential to show results on a long-term basis, they must also find out any instant solution to these problems. To discuss the future health services in GCC, the Maarefah Management organized a congress in 2014 in which they invited local and regional experts to get their opinions. The primary objective of the conference was to bring government authorities and other stakeholders together so that they could make a long-term plan. The outlook for healthcare in GCC is inspiring in next 10 years, and the primary focus of the authorities should be on the future scenarios in which different factors like increases population and growing infrastructure will insist on more dependable heathcare provisions. Improved medical technology and advanced surgical techniques always play a vital role in healthcare facilities in any community and to fulfill this requirement more investment is required. All these factors will improve the quality of treatment and care provided to patients (Adams, 2014). Stanton (2002) claimed that healthcare professionals are present for providing health caring processes and for emphasizing individual about their healthcare needs. Where patients do not have enough information regarding their healthcare needs and they have to trust their healthcare service provider blindly. Medical facility providers help patients on the base of clinical experiments and researchers previously. Now, with the passage of time, the trend has been changing. Patient treatment model has emerged in the field of healthcare in a gradual evolution. This new and existing pattern of treatments asks the patient to engage in their treatment procedures actively. The model revolves around the patient in which he has to know all the stages of its treatment and has a choice to choose different and best treatment options. This new model indicates empowerment of the patient, and it emphasizes on patient knowledge and its perception about the disease and its treatment. The knowledge and information about the treatment make them comfortable with the

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procedures, which indeed improve the effectiveness of the treatment. Patient satisfaction is also important for the hospitals because they need to sustain their patients and patients can only be maintained if they are informed and satisfied with the hospitals (Raheem, Nawaz, Fouzia, & Imamuddin, 2014). The concept of patient empowerment helps patients to understand their healthcare requirements and fulfill it efficiently. The patient-centered model urges healthcare professional to arm their patients with the knowledge, which is copious to comprehend the current healthcare scenario and the level of effort needed for facing the diseases (Menon & George, 2018). Empowerment reduces some of the ill effects of power distance (Koc, 2013). It is observed to have significant beneficial effects in disaster risk reduction and emergency response (Dhungel & Ojha, 2012). Social media–based empowerment is self-help and self-directed behavior for victims; it is a key ally in crisis response and disaster management (Leong, Pan, Ractham, & Kaewkitipong, 2015). It also alters the roles of traditional gatekeepers of authenticity in the healthcare system (Lober & Flowers, 2011). Traditional authority figures have given way to the power of communities (Bucatariu & George, 2017). Patients empowered through social media may help practitioners reduce outlier discussions (if social media has positive influence); however, patients who are trapped in specific fake news and conspiracy echo chambers might not reconcile with the doctors easily (Fox, Ward, & O’Rourke, 2005). Given these challenges, authors like Chen, Compton, and Hsiao (2013) suggest the need for a health big data system for patient empowerment and personalized healthcare. While this may be superior to a generic social media site, patient to patient interactions particularly in the case of chronic patients are more likely to happen in the latter (Bond, Merolli, & Ahmed, 2016). In this chapter, we discuss strategies for leveraging the power of social media for seamless healthcare-related communication between different stakeholders in the system, particularly between patients and healthcare providers. We argue that this truly empowers patients. Social media is also a key lever in the crisis management strategy of any healthcare system – especially when hit by pandemics like COVID-19.

Potential of Social Media to Overcome the Healthcare Crisis in the GCC The use of Social Network Systems in any service or company can improve its efficiency by aiding in better communication. Use of this system on government level can change the outlook of whole departments, and that is why these systems have a high utilization by the governments of various countries like United Kingdom (Al-Badi, 2015). In GCC, Internet is accessible and living standard is high enough to use social media on smartphones. This media can assist them to learn about different diseases, their symptoms, and cure. Healthcare department should create online forums, pages, and groups where patients could discuss their problems and readers can get benefits from this discussion. The essential factor in the relationship between patient and doctor is trust and confidence

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(Lor & George, 2014). Provider’s reputation plays a vital role in patients’ treatment plan. Patient avoids providers with less reputation (Mekoth, George, Dalvi, Rajanala, & Nizomadinov, 2012). Social media provides an opportunity to patients to search more doctors in their area and talk to the patients of different doctors to find out the best option. While asking online questions, most people hesitate because they think their questions are silly or private. Securing the privacy of the patient identity in these online forums should allow users to ask questions anonymously (Paraskou & George, 2017). These practices will empower patients and will improve the overall healthcare situation in the region. Governments of GCC countries have employed a very high level of restrictions on the Internet to protect their citizens from its adverse effects, but they kept the web 2.0 open so that people could interact with one another in a more organized manner. Through this channel, patients can exercise their freedom comprehensively. KSA and Kuwait have the most numbers of bloggers in GCC (Alqudsi-ghabra, Al-Bannai, & Al-Bahrani, 2011). These bloggers should also take responsibility and play their part to reduce the gap between doctor and patients. If patients are provided with options for physicians to be selected, patient’s disease outcome can improve. The Internet and social media websites are the best way to spread the quick news about any viral or contagious disease so that people could take reasonable measure to protect themselves and their families (Booz Allen Hamilton, 2015). The features of social media can transform the existing liabilities of the system into revenue. Moreover, government or any other organization has to build a secure platform for doctors and physicians where they can answer the questions of patients without being judged, criticized, or harassed. So empowering patients is imperative but at the same time, people must respect doctors as they are hardworking professionals. However, empowerment of patients in any part of the world Cannot be acheived without the affirmative assistance of health professionals and proper use of technology. Modern techniques and equipment can help patients and caregivers to make difficult decisions. It can also lower down the barrier for motivated patients to redeem their selves from any illness (Wald & McCormack, 2011). To install hi-tech tools in any hospital or health center, massive investment is required, and investment is the one thing that authorities in GCC are doing pretty well. In Mohammad Bin Zayed-Hospital, UAE, is planned to be built with US$272 million, which would be the major hospital in the country. In Dubai alone, 18 private hospitals are under construction. GCC governments have tripled the healthcare investment, approaching US$100 billion, in last three years (Wright & Latif, 2015). With the cooperation of Healthcare Information & Management Systems Society, GCC countries are now moving toward mobile healthcare facilities which will strengthen the patients especially those who live in remote areas (Khaleej Times, 2013). In 2013, these countries started patient-centric care and holistic approach to empower patient. Now they are looking forward to experiencing the new process in the healthcare system. Next step is virtual hospitals with countrywide connectivity. The end of 2018 will achieve these milestones, and then

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patients in GCC would feel more empowered (Frost & Sullivan, 2009). These developments create awareness through social media which will prevent authorities from distracting from the real cause. There are still lots of challenges associated with the use of social media for the patient. The biggest of them is the privacy because some patients do not want to discuss certain diseases openly. Other difficulties for patients and doctors in using social media are a low level of security for personal information, manipulation of identity, misleading information, and the inability of lots of people to use a computer and the Internet effectively (Househ, Borycki, & Kushniruk, 2014). Social media is the largest market for different kind of products including pharmaceutical-related products. Therefore, it requires an exclusive regulatory authority. All companies should be responsible for digital content on all those online platforms that they control directly. In some countries like America, pharmaceutical companies are required to show Adverse Drug Reaction (ADR) reports even for their online products so that no one can do publicity of any drug without clearing its side effects. This rule of ADR is essential for the health safety of patients, but at the same time, it is restricting pharmaceutical companies to enter the market of social media because most of these enterprises do not have a proper marketing strategy for this medium (IMS, 2014). Another limitation of using social media for medical purposes is that anyone can access it and it is hard to handle these enormous number of people without filtering them. Doctors usually do not have much time, and there is no guarantee that patient in social media is genuine or some student preparing for his assignment. This point is making doctors reluctant to communicate openly on the social media. The bottom line is that social media has enormous potential to empower patients in GCC, and it has already empowered them to a large degree, but there are many limitations which need focus.

Technology as the Savior: Electronic Healthcare The most efficient and appreciating effort in the health sector is by ensuring that information regarding healthcare reaches up to the patients through the web. The Internet is one of the main information and communication technology to make individuals understand their healthcare requirements. Andreassen, Kjekshus, and Tjora (2015), however, claimed very steady growth in ICT progress, but it is still an effective project to keep individual understand about healthcare requirements. HISM is a health information management program, which comprises of much automating hospital workflow through enabling IT. These projects do not keep track of patients, but they are used to understand their health problem better. They try to demonstrate health concerns and details to a patient to keep them informed and make them understand toward their healthcare issues. Internetbased healthcare setups are used to track success story of each treatment, which not only helps healthcare service provider to take inspiration but also builds trust between the health professional and patient. A loyal patient is always satisfied patient, who likes to acquire the healthcare service from the same source, which

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does not only increase the confidence level of the patient but also affect the treatment outcome positively. The current crisis posed by COVID-19 in the healthcare field demands efficient health system where all the healthcare programs and patient details may be made available easily. The patient health system may classify different types of sickness, its individuals’ demand, its solution, and efficient use of resources (Aidemark, ¨ Asken¨as, M˚artensson, & Stromberg, 2013). E-health may make available details of chronic diseases, its impacts on a different patient, various remedies for a different type of patient. The information regarding patient’s health and his healthcare needs is vital. This demand and necessitation is fulfilled by a patient, which enables patient empowerment. Healthcare provider monitors and gathers facts about the sickness of the individual to provide brief information about the patient. This health record makes accessible by patient on the web or mobile which is a right direction toward patient empowerment, and in turn patients make them involve in decision-making in their healthcare process. Record keeping and evaluation of different ways of treating sickness are also essential to analyze the outcomes of different treatment and its effect on various patients (Aidemarka et al., 2013).

The Need to Build a Robust E-healthcare System Access to the Internet and the availability of a workable health information system (HIS) are key factors in our ability to deploy E-health in crisis situations. One of the most important attributes of patient understanding for its healthcare requirement is access to websites and social networks, where thousands of patients who suffer from the same disease communicate with each other, make advice, and guide them. The availability of social networks and health-related websites makes patients empower with an understanding of their conditions and enables them to manage healthcare activities (Loane & D’Alessandro, 2014). It is impossible that patients who have access to the Internet and they are unaware of management of their disease. Patients who collect information from the web are more likely to know about their disease and different ways of its treatment. Patients also get support and information online from those who are suffering from the same illness, and they share their tale about the disease and its cure. Although it helps patients a lot, on the contrary patient may get wrong information or access that information, which has low-quality content. Too much dependency on Internet information may lead patients to misconduct the disease, ignorant treatment, or depression. The most alarming side effect of Internet information is the difference between the views of patient and doctor. The patient may suspect that healthcare professional is guiding him wrongly or the patient may disagree with the healthcare service provider by specific information, which he has collected from different websites and social networks (Oliveira, 2014). In most of the countries, healthcare departments are perking up by adopting technology in their healthcare system. For instance, financial system and healthcare information system has also been introduced, which is another

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important attribute of patients’ empowerment. HIS is a database, which stores the procedures of treatment, a list of doctors, and a list of patients (Kuziemsky & Varpio, 2011). The HIS system enables the patient to better know the list of options for the treatment procedure and available doctors. The main concept of HIS is to support individual needs of healthcare rather than the team (Day, Levett-Jones, & Taylor, 2014). Computerized decision support systems (CDSSs) are IT solution that provides health professionals with actionable, patient-specific references or advice for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance clinical care of patients. CDSSs integrate with patient electronic health records and evidencebased knowledge (Moja et al., 2016). World Health Organization (2008) has set expectations from the HIS. From the individual perspective, HIS should have patient’s detail profile along its treatment details and its effect. It should also have individuals’ healthcare needs, so the patients can be empowered to deal with his healthcare needs. On the contrary, WHO (2008) also presented the side effects of too much data from each patient. According to WHO, it may overwhelm the healthcare service providers with extensive data, and there may be a problem for them to choose or extract right data. Lack of systematic knowledge of healthcare service provider may also create problems for the patient. The major advantage indicated by WHO (2008) of HIS is its effectiveness for timely action in case of emergency. HIS may help healthcare providers to treat patients in emergency after having records and treatment procedures of the same situation in the past. The biggest problem with HIS is its implementation in developing countries where data of patients are not available, and there is no worth of keeping records of patients and their histories. Without patient record makes the health awareness program in developing countries rather difficult. Having correct and complete knowledge of public health and its issues is indeed necessary for every country, but unfortunately, in developing countries, there is less or even less focus on it (Mphatswe et al., 2012). The negligence in keeping records makes patient empowerment difficult because accessing updated data is the first step to being empowered. The unavailability of updated data is faced even by the healthcare professionals themselves. Given this, it is hard to expect that patients will have the benefit of it. The absence of data is even more problematic when individuals want to know the effectiveness of their treatment, and they want to understand their healthcare needs, but health professionals do not have proof to make them satisfied with the help of success stories from the past. There is another problem that patients always feel themselves on the will of healthcare professionals; they always frustrated whether they are on the right track or not, whether treatment received fairly or not. They are always confused, which makes them depressed and ultimately affect the treatment outcomes (Mphatswe et al., 2012). As a silver lining, the concept of patient health is growing rapidly. Now, the paradigm of healthcare has changed entirely. With a focus on improved quality, efficiency, and safety, health service providers emphasize on personalized health. The services of patient health facilitated through specific environment according

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to the wish and requirements of patients. There are specific organizations, which arrange the services of P-Health. P-health framework outlines an organizationcentered approach where policies, healthcare system, and care services are delivered. One of the most prominent features of p-health is communication and information, which are used to inform and update patients for their healthcare requirements (Blobel, 2011). Personalized health is a concept, seen in organizations where organizations are obliged to provide healthcare facilities to its employees with the provision of healthcare awareness programs.

Readiness for E-healthcare in the GCC: Findings The usage of social media has been seen to have dramatically increased providing people with various opportunities to connect, share, and learn. It has transcended above the factors age, education, or ethicality and emerged as a global platform for healthcare. In the industry of healthcare, social media is used by patients to achieve various tasks: from sharing experience, giving reviews to locating healthcare institutes and engaging with professionals. Given the diversity offered by social media in healthcare, it can be noted as a bit difficult to study the effect of social media on patient empowerment and as an element in the overall E-health ecosystem. The area of online patient empowerment is an evolving area of research, with significant development since early 2000. Past researchers such as DeBar et al. (2009), Dansky, Thompson, and Sanner (2006) examined the growing importance of online healthcare, outline the benefits and weaknesses of such platforms in building patient awareness and improving healthcare consultation online. However, it was the finding of Househ et al. (2014) that led to the identification of a promising future for patient empowerment through social media, and the role of technology in achieving it. Through a detailed systematic literature review, the authors found a steady increase in social media usage to access healthcare services, information, and consultation. They also identified privacy and security being the main barriers to social media patient empowerment, thereby synchronizing with the finding of the current research. A quantitative descriptive research was utilized to study the factors influencing e-readiness of the healthcare system and also to assess the patient empowerment in using social media as a tool for e-healthcare. For the purpose of this study, respondents from all GCC countries were requested to participate at random and contribute to the study collectively. A total of 403 responses were collected and the responses were subjected to a series of statistical analyses. As seen in Table 13.1, a majority of the respondents were male (62.8%) and in the age group 25–34 years (40.4%). Regarding education level, a majority of the respondents indicated to have a graduate degree or above (50.1%), while 85.6% indicated to have full-time employment. The country of residence of a majority of the respondents is identified as UAE with 41.9% followed by Qatar with 39.7%. The household income of a majority of the interviewees was recorded as $0–$24,999 (25.1%).

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Table 13.1. Demographic Profile of the Respondents – Personal Characteristics. Variable

Age

Gender Educational level

Employment

Country of residence

Household income

Category

N(%)

18–24 25–34 35–44 45–54 .565 Female Male GED Some school but no degree Bachelor degree Graduate degree and above Full-time working Part-time working Not working looking for job Not working not looking for job Disabled Qatar UAE Saudi Arabia Bahrain Kuwait Oman $0–$24,999 $25,000–$49,999 $50,000–$74,999 $75,000–$99,999 $100,000–$124,999 $100,000–$124,999 $125,000–$149,999 $150,000–$174,999 $175,000–$199,999 $200,000 and up

18(4.5) 163(40.4) 142(35.2) 70(17.4) 10(2.5) 150(37.2) 253(62.8) 16(4) 28(6.9) 157(39.9) 202(50.1) 345(85.6) 10(2.5) 14(3.5) 32(7.9) 2(0.5) 160(39.7) 169(41.9) 16(4.0) 24(6.0) 22(5.5) 12(3.0) 101(25.1) 78(19.4) 56(13.9) 54(13.4) 18(4.5) 38(9.4) 12(3.0) 26(6.5) 6(1.5) 14(3.5)

Source: Primary data from this study.

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The demographic profile for healthcare characteristics is shared in Table 13.2. As observed, when asked to share their current health status, a majority of the respondents (54.1%) indicated to have no medical condition and being healthy, followed by 35.7% as moderately healthy. A total of 371 out of 403 (92.2%) indicated in negative to have diabetes mellitus, or obesity (371 out of 403), hypertension (377), and COPD (402 out of 403). When asked if they had any serious health condition, a total of 38 (out of 403) replied in affirmative, whereas a majority (66.7%) shared their preference to visit a private medical facility for healthcare. Similarly, when inquired about health insurance status, a majority (76.2%) indicated to hold a health insurance cover. The descriptive statistics for the key factors are shared in Table 13.3. Health Consumerism Index refers to the extent of consumerism in the attitudes of patients. The patient self-evaluation index comprised a series of questions related to identifying healthcare indicators, the pattern of tracking health indicators, updating record about health indicators, frequency of consultation with a doctor, and using a specific self-evaluation tool to monitor a health condition. The online

Table 13.2. Demographic Profile of the Respondents – Healthcare Characteristics. Variable

Quality of life

BC diabetes mellitus (DM) BC obesity BC COPD BC hypertension Major problem Do you prefer which medical facility Health insurance Source: Primary data from this study.

Category

N(%)

Healthy no medical condition Moderately healthy Minor health issues Major health issues No DM DM No obesity Obesity No Yes No Yes No Yes Government Private No Yes

218(54.1) 144(35.7) 27(6.7) 14(3.5) 371(92.2) 32(7.9) 371(92.2) 32(7.9) 402(99.8) 1(0.2) 377(93.5) 26(6.5) 365(90.6) 38(9.4) 134(33.3) 269(66.7) 96(23.8) 307(76.2)

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Table 13.3. Descriptive Statistics. Key Factors

Health consumer index Patients self-evaluation index Online health-based reading index Online interest in consultation index Consultation selection procedure index Hospital selection preference index

N

Minimum Maximum

Mean (M)

Std. Deviation (SD)

403 403

0 0

12 12

7.9777 3.8437

2.50214 3.10558

403

0

24

8.1563

6.976

403

0

19

7.2705

6.36406

403

0

20

7.0571

6.97681

403

0

10

5.0397

4.06152

Source: Primary data from this study.

health-based reading index comprises questions relevant to the online reading habits of the respondents. The online interest in consultation index refers to the desire for online consultations in the patients. The consultation selection procedure index comprises questions capturing the opinion of the respondents on a five-point scale and these items gathered information on preferred mode of consultations. Likewise, hospital selection preference index captured the preferred methods and decision criteria for hospital selection. Health consumer index reported a mean M 5 7.97 with SD 5 2.50 (indicating 66.5% favors health consumerism keeping healthcare knowledge), whereas patients self-evaluation index was reported with a mean M 5 3.8 and SD 5 3.10, i.e., only 32% subjects are interested in self-evaluation of their health. The mean and standard deviation for other components can be reviewed in Table 13.4. A Pearson correlation test was conducted between the six indices of patient empowerment through social media, with the results reflecting in Table 13.4. As seen in the table, the significant correlations are flagged with (**), indicating the relationship is accepted under the condition p , 0.05. To identify and reduce the components related to e-healthcare use, a factor analysis was conducted using 20 variables comprising of demographic variables relating to personal and healthcare characteristics. Table 13.5 presents the rotated component matrix result, outlining the raw and rescaled components and the factor loading for each element. As observed, factor loading for component 1 was found to be high for the online health-based reading index, online interest consultation index, and Consultation selection procedure index. For component 2, high loading was observed for patient self-evaluation index and health consumerism index.

Health consumerism

Pearson correlation Sig. (2-tailed) Patient selfPearson evaluation correlation Sig. (2-tailed) Online Pearson health-based correlation reading index Sig. (2-tailed) Online interest Pearson in consultation correlation index Sig. (2-tailed) Consultation Pearson selection correlation procedure index Sig. (2-tailed) Hospital Pearson selection correlation preference Sig. (2-tailed)

Source: Primary data from this study.

Patient Selfevaluation

Offline Healthbased Reading Index

Online Interest Consultation Index

Consultation Selection Procedure Index

Hospital Selection Preference

1 0.000 0.180**

1

0.000 20.036

0.538**

1

0.475 20.052

0.000 0.429**

0.775**

1

0.301 20.026

0.000 0.478**

0.000 0.820**

0.916**

1

0.596 20.033

0.000 0.479**

0.000 0.823**

0.000 0.819**

0.847**

0.505

0.000

0.000

0.000

0.000

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Health Consumerism

262

Table 13.4. Correlation Test with Significance.

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Empowering Patients through Social Media Table 13.5. Rotated Component Matrix. Rotated Component Matrix

Physical health Health condition – diabetes Health condition – obesity Health condition – COPD Health condition – hypertension Health condition – others Medical facility preference Health consumer index Patient self-evaluation index Online health-based reading index Online interest in consultation index Consultation selection procedure index Hospital selection preference index

Raw

Rescaled

Component

Component

1

2

1

2

20.044 20.002 0.021 0.001 0.044 0.026 0.066 20.161 1.452 6.49 6.182

20.018 0.015 0.002 0 0.004 20.012 0.046 0.936 2.023 1.705 0.186

20.088 20.007 0.079 0.028 0.179 0.089 0.14 20.064 0.468 0.931 0.972

20.035 0.055 0.009 20.001 0.017 20.041 0.098 0.374 0.652 0.245 0.029

6.754

21.137

0.968

20.163

3.487

1.155

0.86

0.285

Source: Primary data from this study.

Discussion In the past, various other researchers too attempted to investigate the effect of social media in the healthcare. For instance, Chou, Hunt, Beckjord, Moser, and Hesse (2009) sought to examine the sociodemographic as well as health relevant aspects and their relationship with the social media usage in the United States. The research on assessing the interest of patients in utilizing social media for healthcare is widely found (Cooper-Patrick et al., 1999; Fisher & Clayton, 2012; Korda & Itani, 2013; Thayer & Ray, 2006), but not in the GCC context. Given the limited studies of past researchers in health consumerism and patient awareness through social media, especially in the GCC region, this research study aimed to the role of social media in patient empowerment. This research study attempts to add a valuable contribution in the area of social media–based patient empowerment in the GCC as well as other countries and carry forward the research conducted by Korda and Itani (2013), Fisher and Clayton (2012), and others. For the GCC, this research study provides a significant contribution given

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the increasing percentage of social media users in the region, in contrast to other countries globally. In this chapter, the demographic characteristics and healthcare characteristics of patients in the GCC region were statistically evaluated to examine the effect of social media in patient empowerment. Results indicated that two indexes “online health-based reading and online interest for consultation” to be significant predictors of patient empowerment in the GCC region, in both male and female. A study by Eijk et al. (2013) on online health communities and the inclusion of social media in healthcare targeted patient-centric care. The authors found that online communities especially social platforms are powerful tools to deliver patient-centric care, facilitating communication between the caregivers and patients. However, they noted the challenge of building support coordination for such platforms, leading to the inability of the platforms to empower patients in self-assessment of their respective health condition. Some of the other questions that guided the researchers and the findings of this research related to these questions based on qualitative feedback are presented below. What is the current level of understanding of the patients toward e-healthcare requirements and how do they assess it? The current level of understanding of the patients toward e-healthcare requirements was found to be low, and significantly lower in males over females especially for indexes “Online Interest Consultation” and “Online Health-Based Reading.” What are the attributes that can turn patients into empowered e-patients? Patients in GCC can be converted into empowered consumers by enhancing the level of awareness in using social media to meet their healthcare prerequisite regarding consultation. This can be attained by working in collaboration with healthcare centers to encourage patients and related people to engage in online health-based reading and improve online consultation interest in patients and related individuals. This may trigger an indirect effect on improving the patient’s self-evaluation index and thereby promoting health consumerism index, consider the significant positive correlation which exists between these two indices. What are the differences in the consumers’ perception of patient empowerment and how the differences in perceptions can be managed through social media? The perception of patient empowerment in the respondents from GCC was found to be fairly lower, with the slight inclination or interest toward engaging in healthcare consultation through social media. This can be attributed primarily due to the high availability of healthcare facilities in the region, providing easy access to patients when they require. Also, with women identified to have a higher significant relationship with online healthcare consultation and interest in the online consultation, it can be said the women are the enablers of patient empowerment and should be targeted as a primary source to spread awareness on patient empowerment through social media. How can patient empowerment and patient health awareness guide them to make better choices in selecting e-healthcare services and thereby resulting in even better outcomes? The findings of health consumerism index and self-evaluation index

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indicate a slightly positive relationship of patient empowerment with social media. However, no significant relationship was found to validate this finding. As stated by Korda and Itani (2013), to transform social media platforms into a successful platform for patient development, support and empowerment require the development of tools to achieve the goals. The authors stress on various types of social media available today, highlighting the need to identify which platforms can make a significant impact on patient empowerment and how it can be combined with healthcare programs. The findings of Eijk et al. (2013) and Korda and Itani (2013) are in line with the current study that found a similar result wherein patient empowerment is found to be relying primarily on indexes: “Online Interest in Consultation” and “Online Health-Based Reading” indexes with a significant relationship (p , 0.05). However, no significance was established for indexes “self-evaluation” or “health consumerism,” irrespective of their correlation with indexes “Online Interest Consultation” and “Online HealthBased Reading.”

Conclusion The participation of the patients plays a vital role in improving the overall healthcare dynamics (George & Henthorne, 2009). It is in the best interest to increase this involvement so that the patients are more aware and certain about their well-being (George & Salgaonkar, 2006). There is an increased emphasis on the various research that goes into improving the channels that are made available to the patient, to empower them and ensure a more substantial and efficient allocation of the healthcare potential (George, Henthorne, & Williams, 2010). The type of participation has a crucial importance too as there is a need for the evidence which reinforces the information that is available on social media and the amount of trust and the conclusions drawn from it. Social media plays a significant role in opening up an outlet through which a person or a group of individuals can come together and share their experiences and information among them. This sharing of information can be among people who suffer from the same disease or facing similar circumstances. Since this information might not be backed by evidence-based research, it lacks credibility and hence might not be relevant to the patient who may or may not make use of it. Information by itself, which lacks the necessary reliability and authority, is of less use in a system like this. It is by studies in the way that patients recognize the value of information and respond to it so that its real value can be analyzed. It is only by acknowledging its usefulness that its effect and benefit to the patients can be analyzed based on its perceived accuracy and if they use it. There is the need for them to indulge in additional contextual questioning to establish the credibility, accuracy, and relevance of the information. There is the need for result and procedure-oriented research on the topic of social media and its usefulness to healthcare. All such studies need to be focused on the role that social media plays and how it has an effect on the patients’ perception; how it modulates their behavior to more healthy ones and influences their decisions about illness and

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healthcare. Additionally, it might help in raising concerns about privacy and the hazards of allowing access to medical information that is of sensitive nature. It will also play a vital part in inculcating a healthy doctor–patient relationship. The consensus from the review is that there is an overall positive perception among the patients about the use of social media for healthcare, but there needs to be an increased focus on vital issues like privacy and data security, the accuracy of information, and the overall wish for the patient to use social media in healthcare. The utilization of social media on the healthcare is substantial as it helps the patient to be empowered and have a more efficient channel of communication, especially in crisis situations such as COVID-19 (Brivio, Oliveri, & Pravettoni, 2020). There is an increased focus on the topic in literature (Smailhodzic, Hooijsma, Boonstra, & Langley, 2016); but there is still a lack of empirical literature that studies the correlation between the increasing use of social media in healthcare and the aspects of it like privacy and security. These concerns need to be addressed to ensure its effective utilization keeping in mind its advantages and disadvantages so that it has increased efficacy and shows more efficient results. In the highly interconnected world of the present, privacy is always a principle concern, more so on users of social media (George & Paul, 2020). The information regarding one’s health is considered to be of highly sensitive nature, and sharing of such information online and on social media is always a matter of concern. The need of the hour is to have more studies which correlate the increasing use of social media in healthcare and the challenges associated with it like privacy and other user concerns. It is a big step in ensuring that there is increased adoption of these methods to deliver positive healthcare results.

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Chapter 14

Technology in Medicine: COVID-19 and the “Coming of Age” of Telehealth Babu George, Lena Bucatariu and Tony L. Henthorne

Abstract Telehealth has been playing a progressively significant role in the management of the COVID-19 crisis. The enforcement of social distancing measures has had the consequence of reduced technology distance in almost every walk of life. In this chapter, based primarily on the still-unfolding experiences of deploying it during the current situation, we argue that telehealth has finally come of age and that it is time to move it from the peripheries to the center of the twenty-first-century healthcare. To provide a live context to the discussion, several instances of how telehealth strengthened our healthcare systems during the COVID-19 crisis are presented. Keywords: Telehealth; telemedicine; COVID-19; technology; management; regulations

Introduction Telehealth has been an active topic in scholarly debates and in the field of medical practice, since the 1980s or even before (Tuckson, Edmunds, & Hodgkins, 2017). Telemedicine, its subset focusing specifically on the delivery of clinical care, used to be a relatively more popular term (Ohannessian, 2015). Telehealth covers a broader range of technologies and services to the patient, in turn improving the overall healthcare delivery system (Smith et al., 2020). More recently, there have been a lot of exciting developments in technologies, medical profession, and in the State, national, and international legal frameworks guiding the adoption of telehealth (Portnoy, Waller, & Elliott, 2020). Of particular importance to notice is that telehealth has now assumed more considerable significance given the suppleness it offers in crisis situations; we see it today, as COVID-19 continues to take it tolls (Calton, Abedini, & Fratkin, 2020; Hollander & Carr, 2020; Smith et al., 2020). In fact, this current crisis may have potentially International Case Studies in the Management of Disasters, 271–280 Copyright © 2021 Emerald Publishing Limited All rights of reproduction in any form reserved doi:10.1108/978-1-83982-186-820201016

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raised telehealth to its “coming of age,” from the fringes to the mainstream. It also saw the healthcare practitioners adopting telehealth in genuinely creative and hitherto unknown ways (Deepak, Subuhi, & Ishmeet, 2020).

Background The telehealth revolution has brought into existence numerous novel kinds of businesses in the broad wellness spectrum (George & Henthorne, 2009). The general health assessments made possible by these technologies make prognosis and preventive interventions feasible for the masses. Advances in information and communication technologies have transformed almost every device used in healthcare as a part of the globally connected Internet of Things (Dinesen et al., 2016; George & Paul, 2020). The coming together of the Internet, smart devices, health insurance companies, and Accountable Care Organizations (ACOs) is fundamentally changing the way the physicians practice medicine and also the very business models of healthcare businesses. Introduction of advanced robotics into healthcare means that not only consultations but sophisticated surgical procedures could also be performed remotely (Ohannessian, 2015). In the more recent iteration, with the implementation of Electronic Intensive Care Units (eICUs), especially in acute care situations, doctors could stay at home and remotely monitor patients admitted in hospitals. The use of big data analytics in telehealth has become more common recently (Wang, Qiu, & Guo, 2017). Among other things, this helps predict problem populations and patients in advance. This way, healthcare providers could better target treatments for diseases like chronic heart diseases and diabetes. Several public health experts have stressed the need to develop an integrated and globally distributed telehealth system that would thrive on big data sourced from around the world (Mishra & Chakraborty, 2020). For healthcare facilities offering specialized and high-end services at affordable prices, say, those in India, Thailand, Costa Rica, etc., there has been a burgeoning consumer demand for telehealth from across national borders. Typically, everything but invasive procedures is done remotely and then the patients fly to these destinations for hospitalized treatments. Preventive medicine and mental health are prime candidates for telemedicine (Bucatariu & George, 2017; George, Henthorne, & Williams, 2010). In this scenario, the medical tourism profession has found a right partner in telehealth as health insurance companies are becoming increasingly open to approving such alternatives as well (Paraskou & George, 2007a, 2007b).

The COVID-19 in Context By now, it is widely agreed that COVID-19, a severe respiratory infection caused by a type of coronavirus, has its (yet unknown) origins in Wuhan, China, around December 2019 or earlier. By March 2020, it became a global pandemic; according to various estimates, the average mortality rate is close to 5%. In addition to being a

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life-threatening situation for many, the exponential proliferation of this disease created havoc in the economic and social fabrics of several countries. Social distancing measures were advocated globally; telehealth procedures, by their very nature, are a natural partner to the enforcement of these measures in the clinical settings (Ohannessian, Duong, & Odone, 2020). Countries like Israel and Japan have used telemedicine to provide care to infected passengers stranded on cruise ships for multiple weeks. Infected sailors on the US Navy ships too received extensive telemedicine support. At least ten US navy vessels reported significant outbreaks recently. In China, surprisingly, the government had invested heavily in an Emergency Telemedicine Consultation System (ETCS) and this quickly kicked in to complement the brick and mortar healthcare facilities (Zhai, et al., 2020). Available anecdotal evidence indicates that telehealth did play a surprisingly stellar job in early diagnosis and the continuous monitoring of symptoms while the patient is held in isolation or quarantine. The consumer-directed supply chain leveraged by many hospitals during the COVID-19 made it possible for patients to be prescreened remotely for symptoms and for gathering evidence such as travel history (Zhai et al., 2020). Screening algorithms powered by AI did most of these without much of direct human intervention. According to the likelihood scenarios and other constraints, the bots would then intelligently schedule patients to either hospital on-premise facilities or to a live video conference with physicians. Prevention or identifying the symptoms of the disease during early consultations is the most proper use of telehealth. It does sound like this is the main direction telehealth is currently being used amid the pandemic (Gao et al., 2020). In developing economies in Asia, telemedicine has come a long way from a store-and-forward (Brandling-Bennett et al., 2005) email-based diagnostic in remote rural areas of Cambodia (Heinzelmann, Jacques, & Kvedar, 2005) to the development of smart COVID-19 helmets with a Mounted Thermal Imaging System that measures temperature in Indonesia (Mohammed et al., 2020), NCOVI software to report symptoms in Vietnam (Nguyen, Duong Bang, & Wolff, 2020), and Afghanistan’s assessment via the Internet of Things (Azizy, Fayaz, & Agirbasli, 2020). Mobile and e-ICU systems increased the efficiency of the system multifold. A couple of physicians could monitor day and night a hundred or more patients simultaneously, thanks to the electronic distribution system made possible by interconnecting these smart units. If there is a situation involving numerous physicians being quarantined for possible infections, this could be the only workable last resort solution. Although experimentally, some of the hospital systems even used self-driving vans as mobile units. More advancement in these technologies would help lower exposure for others. Even with limited deployment, earlier indications are that telehealth has contributed significantly to preserve valuable personal protective equipment. According to popular media reports, many hospital systems that did not have these technologies and associated infrastructure collaborated with others to benefit from them. Complementary systems such as the ETHAN (Emergency Telehealth and Navigation) being used by the Houston fire department was tweaked to better serve in the current crisis. The seamless coordination of testing centers is vital in maximizing the efficiency of testing. Networking among hospital

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systems helped further this goal. Yet, true interoperability among these systems was found to be impossible, given the differences in the environments each of them developed. Aurora Health, Cleveland Clinic, Jefferson Health, Kaiser Permanente, Mount Sinai, and Providence, all have their own in-house systems and models and the current crisis points to the need of integrating these systems in a tighter manner. The good news is, although these technologies were not being heavily used in the past or not interconnected for the best efficiency, those were available still for relatively quick deployment in the crisis situation (Chauhan et al., 2020). The lack of short and easy-to-understand training programs such as videos and user guides is something that needs to be quickly addressed. Training the physicians and practice facility staff is one thing and training the patients and their family is quite a different matter. Agencies like the American Medical Association (AMA), National Consortium of Telehealth Resource Centers (TRCs), and the Centers for Medicare & Medicaid Services (CMS) have catered well to the former part. Telehealth technology developers too contributed heavily to documenting practice implementation, policy, coding, and payment methodologies. The AMA Physician Innovation Network organized several webinars on telehealth deployment for the benefit of the physicians, too. Yet, usability of telehealth is not a given thing, especially for the elderly patients (Lor & George, 2014); the slope of the learning curve needs to be reduced by means of using familiar front-end designs for client end devices and must come with step-by-step guides. Powell, Henstenburg, Cooper, Hollander, and Rising (2017) observe that the comfort and familiar home environment in which patients stay while virtually interacting with physicians should make them discuss their conditions more honestly. Obviously, the nature of the illness and any stigma attached to it would moderate this. Social media technologies could be repurposed to play a central role in the communication function (Menon & George, 2018). More importantly, in the light of the lowered thresholds of HIPAA compliance as a result of COVID-19, communication tools built around consumer-oriented platforms such as Skype, FaceTime, Google Hangouts, etc. could potentially be used for initial consultations. Deepak et al. (2020) narrate how dermatologists in India use WhatsApp for consultations these days. In mental health, the COVID-19 pandemic has spun new fields such as telepsychiatry, telepsychology, teletherapy, and teleneurology in which social media and other technologies are used to treat patients (Klein et al., 2020). To illustrate, online counseling of hidden youth (i.e., withdrawn from school and social activities) in Hongkong had better therapeutic outcomes than traditional offline methods due to anonymity, fit with lifestyle, and more power balance (Chan, 2020), although still less effective than integrated delivery. For substance-related treatment in the context of COVID-19 disruptions, doctors are no longer bound by the Drug Enforcement Administration’s requirement for faceto-face assessment and prescription, which led to growth in live interactive video communications to assess and medicate ADHD youth (Knopf, 2020). A plethora of medical specialities have capitalized on remote treatment, including reports of smartphone-based ocular imaging for eye care (Addepalli, Kalyani, Singh,

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Bandyopadhyay, & Naga Mohan, 2020), iPads for telepalliative care (Humphreys et al., 2020), virtual management with online instructions for urology infections (Grimes et al., 2020), a portal for pediatric patients (Patel et al., 2020), video telemedicine for stroke services (Markus & Brainin, 2020), and remote triage lines for cancer patients in Indonesia (Brahma, 2020). The COVID-19 crisis also brought in the widespread realization that the Internet is an essential utility. Thankfully, most government-subsidized cellular plans for the poor users in the US have recently increased free data limits. However, currently, there is no guarantee that everyone has in their possession a smartphone with the basic technical specifications needed for effective consultations with healthcare providers. Another reported challenge is language barriers for the nonnative speakers of English. Better integration of telemedicine technologies with real-time translation software could become handy in such situations. One of the doctors we talked to recommended a patient to communicate with the help of Google Translate, which did not work well. Later, a human translator needed to be found from among the hospital support staff. The US is definitely a laggard in the deployment of telecommunication technologies for supporting telehealth. To give some contrast, in China, companies like Huawei, ZTE, and China Telecom came together to interconnect the hospital-to-hospital layer of their telemedicine system with 5G technology. In mid-February, Singapore had deployed a GPS tracking system to identify and report those under quarantine. A high-tech giant, South Korea developed a comprehensive trace-test-treat system including police records, credit card data, transit pass records, CCTV footage, and a mobile phone proximity app which alerts passers-by to the presence of nearby patients (Park, Choi, & Ko, 2020). In a similar vein, Taiwan’s government made proactive use of big data to cross-reference its national health insurance database with its immigration and custom databases and trigger alerts on a patient’s travel history (Lu, Cheng, Qamar, Huang, & Johnson, 2020). In contrast, it took so much more time for Apple and Google to come up with an interoperable contact tracing app in the US, albeit with much less features. It must be noted that the deficiencies in the US system are more related to concerns about privacy and individual liberties rather than the lack of technological know-how. The panic created by an unexpected surge for resources in the US also meant patients seeking consultations with remote healthcare providers located abroad. Most patients did this with the knowledge that consultations or purchases made this way would not qualify for insurance benefits. They also seemed to embrace the risk of receiving advice from non–board-certified physicians and getting medicines shipped from unverified sources. We hope, in the post-COVID era, the regulatory system will expand its reach, not to restrain overseas consultations or treatment but to ensure that these players function within the broadly held parameters of the US healthcare system. Such agreements could help with healthcare quality assurance, secure transmission and upkeep of patient records, and bring down costs.

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Future Research Directions There are numerous questions about telehealth remaining to be fully answered and more investigations will be needed. For the benefit of future researchers, some of these pressing questions are stated below: What should be the role of technologies in telehealth (say, as enablers or disrupters of current workflows?). Which are some of the innovative technologies driving the current phase of developments in telehealth? Are technologies developed mainly exogenously and to what extent are healthcare industry experts involved in these processes? What is the role of physician support? With the increased integration of AI and telemedicine, will general practitioners become redundant in healthcare? How significant a player social media is? Will telehealth become a more prominent face of healthcare in the coming years? What are the lingering barriers (e.g., restrictions on hosting and transmitting patient records)? Are human resource management practices in the industry attuned with these developments? What could universities and industry associations do in this regard? What are the ethical implications of increased use of telehealth? Are existing regulatory frameworks conducive to promoting the beneficial aspects of telehealth while at the same time weeding out unethical practices? Where is the accountability and how is it enforced effectively? What are some of the key changes in global consumer behavior that change preferences for telehealth? How have our generally held cultural notions of doctor–patient relationship changed as a result of telehealth? Do telehealth systems give importance to cross-cultural competence? How do stakeholders in the healthcare system such as health insurance companies and pharmaceutical businesses perceive these developments? Has telehealth kept its promise of making healthcare more accessible – especially for those who live in remote areas and special populations like the elderly and the immobile ones? What is the relative place of teleeducation, teleconsulting, telemonitoring, and telesurgery in the emerging landscape of telehealth? We need to admit that most of these questions have been addressed in some manner or the other in the extant literature. However, it is equally important to realize that these questions have got dimensions that cannot be captured into any single answer. Differences in organizational and macroenvironmental factors would moderate the proposed solutions.

Conclusion The COVID-19 crisis threw telehealth into a situation akin to some parents tossing young kids into the ocean expecting them to quickly master swimming. In a typical planned deployment scenario, there would have been numerous rounds of pilot testing and simulations before using it extensively. Although not in anticipation of a pandemic, some countries did these. Norway’s “Telemedicine Agder” is one of them: this project, through simulated experiments, studied the implementation of large-scale telemedicine deployments and identified successful service models (Smaradottir, Fensli, & Moe, 2018). Many of the actual uses of

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telehealth currently are knee-jerk reactions that would probably not have passed testing phase. AlDossary, Martin-Khan, Bradford, and Smith (2017) observe that most telemedicine projects have a poor record of qualifying beyond the trials, based on clinical outcome, economics, or patient satisfaction. Although we discussed at a great length on technologies, it must be recognized that technology is not the main barrier for further long-term adoption of telehealth. Highlighting the example of the Catalonia region of Spain, Vidal-Alaball et al. (2020) observes how even an everyday old vanilla technology like telephone calling could supplement with traditional consultations and thereby ease the hospital resources for more serious cases. Bottlenecks to telehealth are more about governmental licensing regulations and the attitudes of middlemen such as health insurance companies, particularly in the US scenario. While public funded healthcare systems in certain countries do not have any motivation to innovate (George & Salgaonkar, 2006; Mekoth, George, Dalvi, Rajanala, & Nizomadinov, 2012), a silver line in the misery is that crises like COVID-19 are a great exogenous force that can shackle any resistance to change. In the US, some commercial health insurances companies had already agreed to reimburse such remote consultations. Although on a temporary basis, the CMS in the US has taken an unusually positive stance. The 1,135 Waiver issued recently as a result of COVID-19 meant hospitals could code these as regular patient visits and get insurance companies to pay for the visits from Medicare as well. However, much more things need to be achieved in this area.

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Index Absolute hospitality, 203 Academic mobility, 152 Accountable Care Organizations (ACOs), 272 Active surveillance programs, 135 Adaptation techniques, 48–49 Adverse Drug Reaction (ADR), 255 Amae relationships, 105 American Medical Association (AMA), 274 Annual Holidays Act, 219 Association of South-East Asian Nations (ASEAN), 101–102 Auschwitz Nazi concentration in Poland, 100 Avalanche, 5 Axiological floods, 50 Balance of payments (BoP), 87–88 Blaming and heroes, 177 Business model, 155–156, 158–159 Cambodian battlefields, 101 Capital Expenditure boom cycle, 224 Case study design, 74–76 characteristics, 77 Centers for Disease Control and Prevention (CDC), 234 Centers for Medicare & Medicaid Services (CMS), 274 Central Disaster and Safety Countermeasures Headquarters (CDSCHQ), 237 Centre of Research on the Epidemiology of Disaster (CRED), 64, 73, 78 Closed circuit television coverage (CCTV coverage), 14

Community, 49–50 adaptation to flood risk, 54–55 Community Relief Fund, 164–165 Comparative design, 75–76 Computed tomography examination room (CT examination room), 215 Computerized decision support systems (CDSSs), 256–257 Conditioned hospitality, 203 Consumer price index (CPI), 87–88 Contain-Prevent-Protect model (CPP model), 220–225 flattening curve, 223 impact of public health measures, 220–224 recovery path, 225 slowing and suppressing outbreak, 223–224 threat of COVID-19 on economy in Finland, 224 Content analysis, 178 Corona Map, 239 Coronavirus. See also Nipah virus (NiV), 156, 213–214 maps, 238–239 COVID-19, 1–3, 155–156, 169–170, 197–198, 232, 271–272 case studies, 7 crisis management, 4, 234–244, 275 early lessons, 215 effects, 198–199 and end of hospitality, 208–209 forecast in Finland, 217 Global Business Week Program at UDEM, 145–146 global pandemic, 146–149 international mobility of academics, 149–150

282

Index

pandemic, 144 threats to consumers in target economies, 162–163 threats to restaurants in target economies, 161–162 and tourism in Buenos Aires, 205–208 Crime Prevention Through Environmental Design (CPTED), 10, 11 Crisis, 171 communication, 171 management, 163–165, 234–244, 253 Cross-sectional design, 75–76 Customer care, 163–164 Dark tourism, 99–101, 103–104 “Dealing with the Enemy Act”, 101–102 Defense, 12 forces, 219 Delivery personnel, 164–165 Democracy, 236–237 Democratic Republic of the Congo (DRC), 111–112 and Ebola Outbreaks, 120–123, 123–125 Department of Business, Economic Development and Tourism (DBEDT), 105 Disaster(s). See also Natural disasters, 1, 99–100 management, 1 preparedness and prevention, 6–7 readiness, 2 Disease, 111–112 “Doi moi”, 102 Drought, 5 E-business, 3 E-Commerce, 3 E-health, 256 Early recovery phase, 90

Earthquake reconstruction and rehabilitation authority (ERRA), 72 Earthquakes, 5, 72 2004 Earthquake in Haiti, 100 Eastern Caribbean Currency Union (ECCU), 67–68 Ebola, 111–112 Democratic Republic of the Congo and, 120–125 Mali, Nigeria, and Senegal, 117–120 methodology, 112–114 outbreak in West Africa, 115–117 Economic/economy, 216 disrupters, 99–100 implications of natural disasters, 67–69 recessions, 224 Electronic healthcare, 255–256 Electronic Intensive Care Units (eICUs), 272 EM-DAT online database, 78 Emergency measures, 216 Emergency Powers Act, 216 Emergency Telehealth and Navigation (ETHAN), 273–274 Emergency Telemedicine Consultation System (ETCS), 273 Empowerment, 4, 253 End of hospitality, 208–209 Environmental impact assessment (EIA), 71 Ethics of hospitality, 204–205 Experimental design, 75–76 Fact-based content, 179 Federal relief commission (FRC), 72 Feudalization, 3–4 FFC, 70 Financial crisis, 224 implication of natural disasters, 64–67 system, 256–257

Index Finland COVID-19 forecast in, 217 CPP model, 220–225 current situation, 216–219 emergency measures, 218–219 Emergency Powers Act, 216 impact to date in, 217 impact to date worldwide, 217 literature review, 214–215 Five-year development plans, 71 Flood risk, 52 local knowledge and community adaptation to, 54–55 management, 48 Flood(ing), 5, 62 defenses, 48 management, 48–50 prevention, 48 Food delivery, 156–158 industry, 157–158 Framing in health communications, 176 Freshets, 52 Gaze, 3–4 Global Business Week Program (GBW Program), 146 at UDEM, 145–146 Global capitalism, 204–205 Globalization, 208 Gods Own Country, 134 GOP, 70–72, 78, 90–91 Gorkha earthquake in Nepal (2015), 101, 105–106 Governance failure, 112–113 Government, 234–237 of GCC countries, 254 Government Decree, 216 Gross domestic product (GDP), 67, 102 GrubHub, 155–156, 158–161 business model, 159 case, 156–157

283

COVID-19 threats to consumers in target economies, 162–163 COVID-19 threats to restaurants in target economies, 161–162 crisis management, 163–165 learning outcomes, 156 NYSE Share Prices, 160 online delivery industry, 157–158 Guests, 202–203 Gulf Cooperation Council (GCC), 251–252 readiness for E-healthcare in, 258–261 robust E-healthcare system, 256–258 social media potential to overcoming healthcare crisis in, 253–255 technology as savior, 255–256 Hawaii-based study, 103–104 Hawaii’s Pearl Harbor, 104–105 Health, 116 crisis, 144–145 Health belief model (HBM), 175–176 Health Care professionals (HCPs), 175 Health Consumerism Index, 260–261 Health information system (HIS), 256 Healthcare, 241 information system, 256–257 professionals, 252 Higher education institutions (HEIs), 145 Hiroshima Memorial Park in Japan, 100 HISM, 255–256 Hobbesian society, 200–201 Hospitality, 201–203 COVID-19 and end of, 208–209 Hostility, 203 Human-made disaster, 100 Hurricanes, 5

284

Index

ICT Development Index (IDI), 238 Indian Council of Medical Research (ICMR), 135 Industrial hazards, 5–6 Infodemic, 3, 176 Information and communication technology (ICT), 238 Infrared (IR), 14 Infrastructure systems, 14 Innovative approaches, 237–240 Institutional collectivism, 241–244 Instrumental floods, 50 Intensive care unit (ICU), 223 Inter-American Development Bank (IDB), 148 International Governmental Organizations (IGOs), 114 International Health Regulations (IHR), 169–170 International humanitarians, 63 International mobility of academics, 149–150 International reporting of government communications, 182–184 Internationalization at home (IaH), 145, 146 Internationalization of higher education institutions, 144 Internet, 254 Istanbul Sultanahmet Square, 15–16 case study, 15–16 control list, 21–39 literature review, 12–14 methodology, 14–16 project selection criteria, 14 research analysis, 16–20 research methodology, 16 research questions, 16 IT infrastructure, 237–238 Keep-out zone, 12–13 Kerala Nipah Virus Outbreak (2018), 134

Kerala Sasthra Sahithya Parishad (KSSP), 136 Khao Lak Tsunami Memorial in Phuket, Thailand, 100 Khyber Pakhtoon Khuwa (KPK), 62 Killer virus. See Nipah virus (NiV) Korea, 233 COVID-19 crisis management, 234–244 government and leadership, 234–237 healthcare, 241 innovative approaches, 237–240 institutional collectivism, 241–244 KCDC, 234 methodology, 233–234 press freedom, 237 Korea Center for Disease Control (KCDC), 234 Landscape elements, 12–14 Leadership, 234–237 Less developed countries (LDCs), 61–63, 67 Livestock rearing, 86 Local communities, 50 Local flood management knowledge, 49–50 disregard, 55–56 interactive origin, 52–54 Local knowledge, 48–49 and community adaptation to flood risk, 54–55 conceptual framework, 49–51 engagement into professional flood management, 50–51 findings, 52–56 method, 51–52 Local residents, 54–55 Longitudinal design, 75–76 Maarefah Management, 252 Mali, Ebola outbreak in, 117–120

Index Management techniques of natural disasters, 69–72 Mask Map, 239 Mass shootings, 6 Mass tourism, 99 Mature trees, 14 Message-centered approach, 173–175 Micro, small, and medium enterprises (MSMEs), 224 Middle East respiratory syndrome (MERS). See also Severe acute respiratory syndrome (SARS), 237–238 MERS-CoV, 213–214 Ministry of Health (MOH), 179 Ministry of Health and Welfare (MOHW), 234, 241 Mobility, 3, 197–198, 202 Modeling, 222 More developed countries (MDCs), 61–62 Mortality rate, 233 Mounted Thermal Imaging System, 273 Nation-state, 202–204 National Database and Registration Authority (NADRA), 91 National disaster management authority (NDMA), 62, 72, 89–91 National Emergency Operations Centre (NEOs), 90 National Health Insurance Service (NHIS), 241 Natural disasters, 61–62, 100 data analysis and findings, 78–94 data collection, 76–78 economic implications, 67–69 financial and economic impacts, 87–89 financial impacts on agriculture, crop, and livestock, 83–84

285

financial impacts on infrastructure, 78–83 financial implication, 64–67 financial losses, 64 government response, 89–92 impacts on livelihood, 86–87 literature review, 63–73 local and international humanitarian response, 92–94 management techniques, 69–72 market situation, 84–86 objectives, 63 Pakistan government to earthquake, 72–73 research design, 74–76 research justification, 73 research methodology and design, 73–78 research questions, 74 Nature hospitality, 201–205 Nazi concentration camps, 101 Nepal Earthquake, 105–106 New Hampshire (NH), 161 New Public Governance (NPG), 112 New Public Management (NPM), 112 Nigeria, Ebola outbreak in, 117–120 Nipah virus (NiV), 3, 131 2019 outbreak, 137 impact, 132–133 Kerala Nipah Virus Outbreak (2018), 134 lessons from Kerala model, 138–139 measures to control Nipah virus outbreak in Kerala, 134–137 morbidity and mortality rates, 133 need for global surveillance, 139–140 trail in World, 131–132 Nongovernmental organizations (NGOs), 62–63, 78, 93, 114 Oculacentrism, 205 “One Health” concept, 138 Ontological floods, 50

286

Index

Organization of Economic Cooperation and Development (OECD), 241 Pakistan government to earthquake, 72–73 Pakistani Rupee (PKR), 84–86 Pandemic(s), 6, 144–145, 214, 232–233 Patient empowerment, 252–253 Patient health (p-health), 257–258 Patient-centered model, 252–253 Pearl Harbor, 104 Pearl Harbor War Memorial, 105 Pearson correlation test, 261 Personalized health, 257–258 Phone apps, 238–239 Policy recession, 224 Precautionary doctrine, 199–200 Precogs, 201 Preparedness communications, 172–173 Press freedom, 237 Private sector in disaster management, 6 Professional knowledge, 50–51 Provider’s reputation, 253–254 Pteropodidae, 132 Pteropus genus, 132 Public health, 169–170 Public space, 10, 12 Public trust, 244 Quantitative descriptive research, 258 Real recession, 224 Reconstruction and rehabilitation phase, 90 Regulations, 277 Rescue and relief phase, 90 Restaurant support, 164 Riots, 6 Risk, 171 communication, 171 perception, 172–173

Robust E-healthcare system, 256–258 Royal Institute of British Architects (RIBA), 11 Russian approach, 48 Russian water management regulations, 48 rVSV-ZEBOV Ebola vaccine, 122–123 Scientific knowledge, 50–51 Screening algorithms, 273 Secondary data, 78 Security of urban spaces, 10 Self-quarantine protection apps, 238–239 Senegal, Ebola outbreak in, 117–120 Sensationalism in health communications, 176 Seoul National University (SNU), 243 Services, 161 Severe acute respiratory syndrome (SARS), 237–238 lessons from past with, 214–215 SARS-CoV, 213–214 SARS-CoV-2, 169–170 Site security, 13–14 Social capital, 7 Social distancing measures, 273 Social media, 170–171, 255 potential to overcoming healthcare crisis in GCC, 253–255 social media–based empowerment, 253 technologies, 4, 274–275 websites, 254 Social survey design, 75–76 Soopikada in Kozhikode district, 134 Technology, 7, 274 as savior, 255–256 Telehealth, 4, 271–272 COVID-19 in context, 272–275 future research directions, 276 Telehealth Resource Centers (TRCs), 274

Index Telemedicine, 271 Terrorism, 6 attacks, 10 “Thana” tourism, 100 Thorny plants, 14 Titanic syndrome, 200–201 Tornados, 5 Tourism, 99, 106, 197–198 Hawaii’s Pearl Harbor, 104–105 Nepal Earthquake, 105–106 Vietnam, 101–104 Tourist gaze, 198–199 COVID-19 and end of hospitality, 208–209 COVID-19 and tourism in Buenos Aires, 205–208 nature hospitality, 201–205 state of emergency, 199–201 Transparency, 180–181 Tsunami, 5 UN Sustainable Development Goals (SDGs), 144 UN World Tourism Organizations (UNWTO), 99 Uncle Dam, 188–190 Universidad de Monterrey in Mexico (UDEM), 144–145 academic organizational structure, 145 Business School, 146 Global Business Week Program at, 145–146 Urban Design and Security Plan for Washington DC, 14 Urban security planning, 11 V-shaped, U-shaped, L-shaped scenarios (V-U-L scenarios), 225 Vietnam

287

COVID-19 in, 169–170 factual, transparent, and timely communications, 179–181 few incidences of challenging communications, 186–187 findings, 179–187 international reporting of government communications, 182–184 literature review, 170–177 methodology, 178–179 models and frameworks for pandemic communication, 171–176 negative international views for economic actions, 184 operational definitions, 171–172 tone and content, 181–182 tourism market in, 101–104 unconfirmed communications, 176–177 Visa, 203–204 Visiting scholars, 144–145 Volcanic eruptions, 5 Wars, 6 Watan Cards, 91 Wenchuan Earthquake Memorial Museum in China, 100 West Africa, Ebola outbreak in, 115–117 Westminster attack, 11–12 Wicked gaze, 198–199, 205 Wildfires, 5 Working Hours Act, 219 World Health Organization (WHO), 115, 144–145, 179, 197–198, 232 World Travel & Tourism Council, 99–100

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