COVID-19 RRT Responder Availability

During the COVID-19 response, a major RRT operational challenge has been an insufficient number of RRT responders available for deployments. This insufficiency was relative to the countries’ specific situation and response context, including the COVID-19 transmission scenario and human capacity availability. Factors underlying this challenge include: (1) the exclusion of individuals with a higher risk for severe COVID-19 illness (eg, individuals ≥65 years of age, individuals with certain underlying health conditions) from deployment for their health and safety, and (2) RRT responder concerns regarding the elevated risk of contracting the virus and/or being carriers when returning home to their households. ^{31-Reference Ramaci, Barattucci and Ledda33}

To overcome a limited COVID-19 responder pool, recruitment of new responders along with the use of a COVID-19 just-in-time (JIT) training, in lieu of a standard RRT orientation training, may be considered. ⁶ JIT trainings are shorter, subject-matter focused, and response specific, allowing for quicker onboarding of RRT responders. ^3,6 Identifying and onboarding new responders during an active response can be time and resource intensive; using existing RRT responders who can take on multiple COVID-19 RRT roles in the field provides an alternative option to address RRT workforce constraints. Roles that have substantial cross-over with other RRT responder roles due to inherently similar skillsets (eg, risk communication and social mobilization roles; case management and infection prevention and control roles) can provide greater deployment coverage in the field with fewer personnel. ⁶ Deploying individuals in dual roles can be facilitated by means of pre-deployment, role-specific JIT trainings focused on their translatable expertise.

RRT responders considered to be at higher risk for severe illness can still be used in the response by assigning those individuals to the country’s emergency response coordination unit instead of the field. ^{Reference Chen26,31} As a trained response workforce, they can take on response coordination roles and/or provide remote technical assistance to their RRT counterparts in the field. ³ If a country has the IT infrastructure for teleworking, another option may be to have the RRT responder at higher risk for severe illness support the emergency coordination unit remotely.

RRT SOPs addressing health, medical evacuation, and insurance can be strengthened to address RRT responder concerns regarding COVID-19 infection. ³ COVID-19 RRT safety measures (described in the next section) should be promoted and explained during RRT recruitment. Extension of these resources to RRT responders’ families in the event they become infected can be considered to address concerns about ongoing COVID-19 transmission. ^3,6 If financially and logistically feasible, temporary post-deployment lodging for RRT responders can be provided to protect household members who may be at higher risk for severe illness.

COVID-19 RRT Responder Health, Safety, and Resiliency

The second major RRT operational challenge during the COVID-19 response is the limited capacity to monitor RRT responders’ health, safety, and resiliency. Underlying this challenge has been: (1) deficient or nonexistent RRT safety monitoring protocols meeting the rigorous safety measures requisite when deploying for COVID-19, and (2) the disruption of responder stress management due to intense COVID-19 safety measures limiting social interaction and physical support, which underlie typical coping mechanisms. ^{Reference Raven, Wurie and Witter13,Reference Benedek, Fullerton and Ursano34,35}

To address this challenge, pre-deployment processes can be expanded to include COVID-19-specific safety considerations. An example might be instituting and/or expanding pre-deployment medical examinations to include screening for severe COVID-19 illness risk factors, ensuring those at higher risk are not deployed. ^3,6,31 Additionally, assessments should be implemented for proper donning and doffing of personal protective equipment (PPE) and ensuring the proper fit and use of respirators, if required. ^23,24 While assessments can be done remotely using videos and/or interactive sessions, PPE donning and doffing and respirator use can be intricate processes; practice and confirmation of proper use should occur before deploying and monitored during deployment, if feasible.

To ensure RRT responder safety during deployment and post-deployment, COVID-19–specific health monitoring processes can be implemented to immediately identify when an RRT responder feels ill, reduce delays in medical care, and limit onward transmission. Ideally, the SOP for this monitoring process would delineate the personnel responsible for monitoring, required IT systems, reporting frequency, RRT equipment (eg, thermometers) provision, and the downstream processes that occur when COVID-19 signs or symptoms develop (eg, isolation, testing, evacuation, and treatment procedures). Deployment of field safety experts trained in safety, security, resilience, and/or health monitoring can also be considered, if such experts are available. In addition to safety risk assessments, these deployed field safety experts can provide crucial monitoring and directly address issues of distress, burnout, stigma, and fatigue that may affect an RRT responder’s health while in the field. ^{Reference Benedek, Fullerton and Ursano34}

To promote and support RRT responders’ coping mechanisms during COVID-19, resources may be allocated to institute a resiliency program that provides emotional support, facilitates connectedness, and encourages recognition of resiliency issues. Particularly with COVID-19 social distancing measures instituted, facilitating the communication and connection of recently returned responders (eg, by means of a “buddy” system) can be considered. Regardless of the RRT responder support provided, mental health professionals can also participate in post-deployment debriefs to identify any potential stressors, provide proactive emotional support, and share behavioral health resources. ^{Reference Burnett and Wahl36}

COVID-19 Remote RRT Operations

The third major challenge identified is the difficulty converting critical in-person RRT operational processes to remote IT platforms during the COVID-19 response. Underlying this challenge is the unprecedented reliance on IT infrastructure and remote processes as a result of the rigorous COVID-19 social distancing requirements. ^{Reference Ting, Carin and Dzau37-Reference Kwon, Zhang and VandenBussche39} RRT pre-deployment briefings, JIT trainings, and post-deployment debriefs—essential processes to ensure a prepared, effective, and supported workforce—are traditionally conducted in-person and, thus, have been specifically impacted by this challenge.

In addition to procuring the necessary IT infrastructure to remedy this issue, the SOPs for these critical RRT operations should be adapted to the remote COVID-19 environment. SOPs must identify who will facilitate these operations, what modality will be used (eg, group teleconference vs individual phone calls), how resources/files will be shared, and what COVID-19 information is pertinent to include. For alternative training modalities, keys to success weigh heavily on their integration with traditional education and existing training programs. ^{Reference Lateef40} Many RRT management programs already use technology platforms to communicate with and train RRT responders. If adequate IT infrastructure cannot be instituted, shifting from remote group interaction to individual phone calls may be an option; however, plans should account for this method being more time and resource intensive.

Acknowledging the rapidly evolving COVID-19 guidance, processes to regularly update the pre-deployment briefing and JIT training content should be considered. ⁶ For example, an electronic resource library can be a tool to compile and provide updated resources for RRT responders. Standard materials should be used to ensure RRT responders receive uniform and applicable information with the potential for downstream implications for RRT readiness and impact. ^3,6

For the post-deployment period, debrief SOPs will need to consider a remote platform to ensure there is no delay in collecting responder feedback due to any instituted post-deployment self-isolation periods. Responder feedback should be elicited immediately upon return from the field, as this critical information is used to inform ongoing response efforts.

COVID-19 RRT Stigma

Stigma targeting COVID-19 RRTs is the final RRT operational challenge, hampering the implementation of COVID-19 response activities. Although prevalent in other outbreaks, the novelty of the virus and rapidly changing information during the COVID-19 response has made stigma a pervasive issue notably in the community and within RRT responder households. ^{Reference Raven, Wurie and Witter13,Reference Logie and Turan41,Reference Nuriddin, Jalloh and Meyer42} Factors contributing to this stigma include fear, lack of knowledge, and the perception of RRT responders as COVID-19 carriers. ^{Reference Ramaci, Barattucci and Ledda33,43-46} Stigma can affect acceptance of COVID-19 interventions, and may contribute to RRT responder stress, fatigue, and burnout. ^{Reference Ramaci, Barattucci and Ledda33,Reference Benedek, Fullerton and Ursano34} Additionally, responders may experience avoidance, a form of stigma, within their own household and community. ^{Reference Ho, Chee and Ho32,35}

To address community stigma, the pre-deployment briefing should include information about COVID-19 stigma as well as tools and/or JIT training to better equip responders in addressing it. This can include the provision of communication materials for responders to distribute, guidance on how to engage with the community, answers to commonly asked COVID-19 questions, and talking points to communicate the RRT’s mission. ^21,22 If possible, responders can engage with locally trusted community leaders, health-care workers, and/or local organizations who can publicly support the RRT responders and liaise with the community. ^47,48 Due to the unprecedented nature of the COVID-19 pandemic, there has been an influx of information in many communities where RRTs deploy. ⁴⁹ Hence, there is a need for RRT members to engage with partners and “ground truth” to discover potential reasons behind the stigma of RRTs. This also underscores the critical need for RRT responders to receive JIT training on COVID-19–specific risk communication and community engagement. ⁶ Social mobilization efforts should be tailored to the COVID-19 transmission scenario, the specific location, and needs of the community being supported.

Overcoming stigma in responder households is critical in transitioning a responder back to their normal routine and to their personal resiliency. Sensitization campaigns and the provision of communication materials to household members concerned about an RRT responder returning home can be considered. ^21,22 Such measures can be implemented in the pre-deployment, deployment, and post-deployment phases to ensure ongoing communication and support is provided to the RRT responder household.