Remote training – tips and tricks

Background

I am often contracted to run training or strategic planning sessions in my area of work: in fact this is what I was doing early this year about the same time many countries were starting to understand the threat of COVID-19. The format is usually to bring around 15-30 people together, in a residential setting, outside of a capital city (to avoid distractions) for something like 3-5 days.  Since the pandemic hit, of course, this approach has not been possible and we’ve all had to learn new ways of working.  As part of the project I was working on when the pandemic hit I was committed to running a further training of trainers on health financing advocacy for participants from 10 francophone African countries.  This training took place virtually, after long delays, at the end of 2020.  I emphasise the term “virtually” rather than “online” as this was a scheduled, “live” training course rather than an online-based learning format.

Working in this way has been a big learning experience so I thought I would share some tips and tricks.

What you can’t do in a “virtual” setting

As a trainer I take a participatory approach: I want participants to engage and speak as much as possible, and I want them to discover for themselves the insights that they need to obtain from the training, and to share their experience and knowledge with others.  I believe this approach allows for much more ownership by participants and therefore more effective learning.  If the conclusions or key messages of a given session reflect things that you or other participants have said or thought, it makes the content more illuminating and memorable.  While, as a trainer, I generally have something to add to what participants come up with, participants always come up with ideas and insights that I had not heard before.

The tried and tested methods to training in this way involve deep interaction between participants: buzz groups, physical movement (without going into detail this can be very useful for exploring issues like power inequalities), visual and drawing techniques.  I realised that a lot of this would not be as easy to do on a virtual platform. On the other hand I did not want to simply revert to “teacher-led” approaches where the leader does a presentation and then fields questions.

Depending on your perspective, some of the things that aren’t so possible in an online setting might be a blessing.  For instance, I’ve never been much of a fan of warm up or energiser activities.  Having said that, I acknowledge that many trainers are and participants are often fond of them. Which is why I normally let them take care of this type of activity.

Another big difference is that when I run training in the usual way, conversations often roll on during breaks and also evenings if the setting is residential.  The opportunity for interaction even outside of the meeting room isn’t there in a virtual environment.

A final concern I had when planning online was how to maintain the momentum and peoples’ interest because again, I knew I would not have a “captive” audience, free from distractions.  As we all know it is hard to resist the temptation to multitask while sitting on a conference call…  then again, people are very often multi-tasking even during in-person training.

What you can do in a virtual setting

Despite having to forego a lot of the usual ways of doing things I’ve learned that there are actually lots of things you can do in a virtual setting that you can’t do easily in-person, and also that there are quite a few features of the virtual approach that can make training more effective.

Firstly, because people haven’t travelled from far and wide to be in one place, there is no need to try to cram everything into an intensive few days.  I’ve found that this increases the energy levels and can increase the quality of participation.  And increased energy levels means that the lack of energiser activities is not a big problem!

Spacing sessions out also allows for far more adaptation and tailoring. It is possible to adapt content based on feedback and impressions of each session and tailor the course on the fly.  While I always chop and change a bit I realised I could rewrite and strengthen the course to a much greater extent.  (It’s worth saying that this is a lot more work and takes up a lot more time, but I think the results make it worthwhile).

Another significant advantage in my view is that it is possible to run small group sessions sequentially rather than simultaneously.  Most video conference platforms have breakout group options, but my experience as a participant has tended to be that they produce fairly superficial results and rarely get substantively discussed back in the plenary.  However, small group work is really useful.  Even with 20 participants, it can be hard to make sure everyone gets a say. But when groups are restricted to 5 or 6 it is possible and even acceptable to make sure everyone speaks.  I suspect it also helps to make sure everyone is paying attention since there is nowhere to hide. 

Because nobody is in the same place you can involve anyone from anywhere – so it is an opportunity to bring in subject experts to support or provide additional input.

And finally, just think of how much this saves in terms of travel costs, and carbon footprint.  I really hope that when the pandemic is over we don’t just revert to the old ways

Some top tips

With these main pros and cons in mind here are a few ideas on how to go about running an effective virtual training course.

1. Participant intro slides

People on conference calls don’t always share video permanently, either because they prefer not to or, as is the case in many of the countries I work with, because it uses up slow and expensive bandwidth.  But it is quite nice for participants to get to know each other.  One fairly easy way to do this is to ask participants in advance to complete a template with which to introduce themselves: who they are, what they do, where they work, what motivates them. A photo… I would provide a fairly loose template and encourage participants to tailor their intro.  Compile the slides before the start, and call on participants to introduce themselves when they see their slide come up (this also resolves the challenge of people talking over each other).  Once you are sure all participants have consented to have their information shared, save the slides in the…

2. Shared drive

This is fairly obvious but I thought it would be weird not to mention it.  In the context of the work I have just done there were quite a lot of backup files since it was a training of trainers, and participants were being relied on to read resources before and after. So for instance session files included detailed notes for facilitating training exercises which I referred to during the session but did not actually use.  I include everything, even my personal facilitation notes.  The key thing for a course that is running over several days or weeks is that it is useful to have a folder for each session, so that participants can quickly reference what they need.  You can subsequently compile final documents into one mega-file (if you use Word you do this by creating a Master document).  Speaking of running over several weeks or days…

3. Space it out and keep it short

You don’t need to cram it all into one week!  In fact it is much better not to. because it can be hard to concentrate and absorb technical content when it is crammed.  I ran 2 “main” sessions a week, on the same days and at the same times.  (When it came to the small group sessions I did them sequentially, also over the space of a week – so more facilitation time needed but still not imposing too much on the participants since they were not involved in every session).  And keep it short – have you ever been able to focus on an online call for 3 hours?  I kept my sessions to 90 or 120 minutes.  I’d be prepared to try a slightly longer session, with a break, but only if it was really necessary.  I suspect 3 hours is the absolute limit.  Spacing it out also allows for better:

4. Prep work

Of course, you can ask participants in any setting to do prep work but with a spaced out, gentler schedule it becomes possible to do this for every topic.  I set pre-reading, and sometimes some tasks asking participants to share experiences or knowledge.  I also combined prep work with…

5. Evaluations

Pre course assessments can be done whatever the training format, but a broken-down, spaced out approach makes it possible to take a pulse of what is happening at much more regular junctures.  Three or four questions on an online questionnaire can be completed rapidly and can help provide insights for improving / changing content for subsequent sessions.  They also feed into your final evaluation.  As well as these participant evaluations it is useful to do…

6. “Live” reports.
Live or close to live.  Often the preferred format in a workshop is to write up participants comments on a whiteboard or flipchart; and at the end of the day you are left with 20 pages of flipchart where each eloquent participant intervention is summarised into about 5 words, and it is very hard to remember the substance.  If like me you can type quicker than you can write on a flipchart, documenting participant comments on-screen is a winner.  Most platforms have a “whiteboard” function but my preference is to use the slide deck by enabling a type-in text box to show in slideshow mode. (You need to enable macros but it is very easy – look it up!).  The advantage of this is that at the end of the session, when you close up, you can save these inputs right into the slide deck which is of course in the shared drive (see 2.).  Other live report ideas: have a participant do a summary of each session at the start of the next (provide a simple one slide template such as: “what we covered, what I learned, what I want to know more about”); and secondly if like me you were lucky enough to have a ninja supporting the work, have them write up a brief report after every session.  There are other ways to use the technology to your advantage:

7. Use the tech.
There are always shy participants, and there are always dominant ones. One thing that becomes very clear is that people who don’t like to talk in a big group may be comfortable writing in the chat box.  So keep an eye on this and validate those comments, acknowledging who made them and making sure they appear in reports.  Also, as long as everyone consents to this, record the sessions and make the recordings available to participants later. This is also helpful for those who are dealing with bad connections or who miss sessions; a good editor could also compile them for future training although always make sure participants are happy with how recordings will be disseminated or published.  I’ve also noticed that even when using a platform with a chat function some participants continue to interact on other messaging platforms.  We had a group chat set up on a messaging app which also became a forum for exchange.  Quieter participants may also find it easier to engage in…

8. Small groups.
Breakout groups are a staple of any workshop or training format.  They help broaden participant, deepen conversations, and introduce participants to people and perspectives they don’t know as well.  As mentioned above when you have no more than five people and establish from the outset that people will take turn to comment, it nudges participants to join in; albeit in a safer and less intimidating way.  One of the prep tasks I set for small groups is to come up with key questions that were presented in the main group but that they want to clarify – a sort of “ask me anything” format.  You can have these questions sent in confidence so that it is not obvious who asked.  As always, give the opportunity to everyone to answer them before providing your own views.  One challenge I came across was that participants who were not in a given group had a bit of a fear of missing out.  They were reassured by the fact that the groups were live-reported and also that recordings would be made available.  However one participant suggested that it should be acceptable for “non group members” to observe sessions without commenting so as not to interfere with the members’ participation.  As noted above I ran these groups sequentially which meant I could lead every single one, ensuring focus on the objectives of the session – something that is not possible when running them simultaneously.  I checked that everyone was OK with this and they were, and it worked well. 

9. Bring in experts.
Use the opportunity of the virtual setting to bring in input from different voices. Participants will be thankful not to hear you the whole time, and it can also be a way to ensure diversity of perspectives.  You may even be able to ask one or two participants to provide expert input on a given topic: and because your course is “spaced out” you can give them plenty of time to think about it and prepare. Much better than tapping them on the shoulder during a break to tell them you need them to speak during the tough post-lunch session later the same day…  Whoever you bring in, brief them well, provide templates for any presentations, and view their content beforehand if possible.

10. Keep it relaxed and focused on people.
If you have a well-spaced format it also means you can drop or add sessions fairly easily, providing everyone agrees.  I kicked off my course with a shorter “curtain-raiser” session where we dealt with objectives, expectations, schedules, and an activity aimed at identifying some of the key issues we would be dealing with, not in a deep technical way but in a human, person-centred way (important if you are dealing with a topic as dry as health financing).  I also decided soon after starting to add a final “closing” session as I realised the content in my last session would take up all the allotted time. The closing session was aimed at giving out “virtual” participation certificates and giving every participant a chance to talk about what they learned and next steps.

Absent COVID-19 strategies in the UK

Earlier in the summer the UK government unveiled an “alert system” for COVID-19. I was struck at the time that the alert levels assumed only one direction of travel: from higher to lower alert. The small arrow on the number 4 (which was the alert level at the time of publicaton) pointed downwards; and the wording of the actions implied that movement was always going to be from higher to lower. If the system is read from bottom up (i.e. moving from 1 towards 5), the actions don’t make sense – for instance, level 3 refers to relaxing of restrictions, which is not what would be required if the movement was from 2 to 3 (instead of from 4 to 3). Downing St was risking being a hostage to fortune and sadly we are now in a situation where alert levels are increasing. This did not seem to be envisaged by the strategy at all.

Shortly after the UK moved back up from level 3 to 4 on September 21st, the five-level alert system seems to have been quietly dropped, as a new three-tier alert level was introduced on October 12th. However it seems that the same error has been made, this time in reverse. The implication of the new system is that inexorably, locales in the UK will move from “medium” (level 1), to high (level 2) and then very high (3). It gives little reassurance that any location can move down the levels, and this is once again built in to the framing of the tool. There is no way out, and it provides no information on how locations at different levels will be supported to cope with the situation. No wonder local leaders don’t want to know.

Careless Walk Costs Lives

Viral blame games

Running risks

“Selfish asshole”; “inconsiderate”; “spreader”; “poluter”. “Do a runner: Horrific video shows coronavirus particles from runners can infect you even if you’re 2m away”.  I’ll be getting my baseball bat when I next see a runner; when I’m in my car I run them off the roads…

Source: The Sun Online, 9 April 2020

 

I wonder if the authors behind a simulation study (and a well circulated blog post) on release of saliva particles and potential Covid-19 risk considered the potential impact of their work on attitudes towards runners? And yet, above are the sorts of words I’ve seen in discussions about the piece.  

As it happens, despite the apparently very technical imaging in the published “white paper”, there is unfortunately no information that can enable an informed judgement about the findings.  Methods are not described and no review has been done of the work, ostensibly because it is too important to go through the normal channels : “we decided it would be unethical to keep the results confidential and keep the public waiting months for the peer review process to be completed”.  The researchers may or may not have done an excellent job of their simulation.  Most of us don’t have the expertise to judge this.  But they haven’t yet provided any information that would allow even an expert to assess this.

Appealing as their argument for publishing their headlines is, unfortunately this puts the work in similar territory to Donald Trump’s promotion of hydroxychloroquine treatment: based on partial, unvalidated data.  Not a suitable basis for public policy.

There is limited evidence that the team (not public health researchers) correctly understand the modes of transmission of the Covid-19 virus; their footnote citing “intensive debates” on this topic is somewhat at odds with the WHO’s findings on transmission mechanisms – namely that airborne transmission is very limited.  One of the WHO’s sources of evidence for this is a study of 75,465 COVID-19 cases in China, with no reports of airborne transmission.

It can’t hurt.

“It can’t hurt”, said Trump when talking about experimenting with untested treatments.  Unfortunately it can hurt and has already hurt, with reports of fatal overdoses by people self-medicating with chloroquine, as well as hoarding drugs that patients with other diseases need.

But: the recommendation that runners keep 5m rather than 1.5 or 2m away from others, can that hurt?  Very doubtful.  And yet, there are still potential harms to this sort of headline.  Firstly, the risk of normalising the use of sub-standard information when dealing with very serious problems.  It’s not more OK to accept the simulation paper just because the immediate impacts are unlikely to be harmful or just because the authors seem to be scientists (the authors of the hydroxychloroquine papers were scientists too…).  This is not to say that informal research in the form of using emerging “real time” data, and learning directly from practice in the field can’t be incredibly useful in developing new hypotheses and responding to emergencies. Along with some colleagues we found excellent examples of exactly this, which we wrote about in a recent article.  Research doesn’t have to be published in a journal to be good or useful.  But it does have to be published and explained in a clear, transparent way so it can be assessed alongside other evidence.

Are there any other ways it can hurt?  A number of runners I know have had insults hurled at them in the past few weeks when out and about. This started long before the paper described above was published.  But misguided publications risk compounding existing prejudices.  Consider the change in tone between the blog post linked above (“I’m a runner so I’m going to keep a bit further away from people” – fine) to the screaming use of the word Horrific in the Sun newspaper – which has a somewhat higher readership than the Medium blog.  Suddenly, runners are the enemy.

As it happens, runners tend to be a pretty robust bunch. Not only that but by and large they are pretty considerate.  Though as in any walk of life there are probably a fair few who aren’t. I would say this of course – I am a runner.  I want to be able to keep on running (considerately). 

But the point isn’t really about runners: it is more about blame. Having worked in HIV responses for over 20 years I’ve heard many times over how specific sub-groups have been blamed for HIV and targeted, stigmatised and excluded as a result.  We know that in the era of Covid-19, Asians have been on the receiving end of severe prejudice and hate crime attacks in Europe and the USA.  Pandemics have been blamed on “others” – almost always excluded, marginalised others – since time immemorial. While nobody really knows what the next steps in the response to Covid-19 are going to look like it seems likely that the same pattern will emerge.  And not only is that tragic for those on the receiving end but will also make it very hard to win against the virus.  So this is not about not being mean to runners. It is about looking out for that prejudice and challenging it wherever it emerges, in a positive way and with correct information.

UK Covid-19 testing – # tests and yield

Update 31 March 2020.  I’m going to leave the post below up, as well as the previous one. They still tell a bit of a story about who is being tested. However I’m not that happy with the interpretation. There is some confusion between the number of tests carried out and the number of individuals tested (since some may be tested more than once).

 

Update from this post which explains the importance of yield.

Earlier in the week the UK reported results of over 8,000 tests in a day but this number has fallen. It is hard to say if the number exactly represents the number of tests in a day since the processing time for Covid-19 tests varies.  Testing levels are still well short of where they need to be.

I have updated the yield chart to include a second measure of “cumulative yield”, i.e. the average yield of all tests done, on each day.  It again indicates that more and more of those being tested are symptomatic.  It may also suggest that an increasing proportion of those with those symptoms are Covid-19 patients, with a rapidly increasing burden on the health system.

As ever, the new numbers of positive cases don’t represent all cases – they just represent the cases identified through testing, which as I understand it still primarily takes place in hospital settings.

Covid-19 testing data.

Testing times

Questions continue to be asked about the UK’s Covid-19 testing strategy.  Are we test, test, testing as the World Health Organisation Director General recommended?  Why are health care workers not able to access tests for themselves? Why isn’t everyone with symptoms being tested, or all contacts of known cases?

The government has explained that there has been a transition of the strategy from community testing to testing of suspected cases in hospitals.  While this has been perceived as a scale back in testing, it actually comes alongside a significant scale up in the number of tests being done every day.  When PHE publishes its daily report on testing it reports the number of tests and the number of negative and positive cases as cumulative figures.  I plotted the values for testing on a graph. Data is missing for some days, so in those cases I have input zero – although because the data is cumulative it is smoothed out by the values on the next day that data is available.  Here is how the number of tests each day has progressed:

And here is a chart of the number of daily tests:

The good news is that testing is ramping up. We’re currently running at over 8000 tests a day.  Two weeks ago we were at 2000 and a month ago we were in the 100s.

It really matters who you test.

What difference has the change of strategy made? For this we have to look at the “yield” – the proportion of tests coming back positive.  Good testing programmes have a higher yield since they are targeting those most likely to be infected.  The table below shows the yield of testing over the same period:

 

An important caveat is that the because of the timelag between testing and getting results the two numbers (tests done / positives) do not correspond exactly.  It should be assumed that we’re looking at positive results from tests conducted a day or two earlier.  But we can still see a broad pattern.

It is worth looking at the left hand side first.  The highest yield on any day was very early on. This was when very little testing was happening – fewer than 200 a day. This was likely some form of sentinel surveillance testing but at a very low level.  It would be interesting to know where these tests took place but the data is not available.

Then on 31 January a number of cases were detected.  Although this was high “yield”, it was also very early in the “contain” phase, so there were still only a handful of cases.  Rigorous contact tracing and testing very early on meant a high likelihood of finding and containing additional cases.  However, as time went on over the next week or so, new community contact testing yielded few if any new cases.  This is because while those who had tested positive had interacted with dozens of people who were tested as contacts, the infection was not passed on to the majority of those contacts.  Community testing was effective in terms of containment of the early outbreak (in Brighton and Hove).

The strategy moved to hospitals when it became clear that there was already quite a lot of Covid-19 infection circulating in the community, and too little testing capacity to rigorously trace contacts of each new case. Remember – this can mean testing dozens of contacts for each new case. That is feasible when there are a few cases but not when there are hundreds, and when testing capacity is limited.

As this happened, around the second week of March, it also led to big increases in testing yield. More and more of the “right” people were being tested.  As of 19 March the yield was just under 12% of close to 6000 tests, which explains the very high number of new reported cases (in fact the yield may be even higher if the new positives relate to samples taken a day or two earlier).  Assuming that those being tested are hospitalised with respiratory complaints it also suggests that for now at least the majority of those cases are still not Covid-19 related. But unfortunately this is changing rapidly.  It also means the figures for new cases probably primarily represent people who are ill enough to be in hospital; and we know that most people with Covid-19 don’t fall into this category.  However they can still pass on the infection.

As the government scientists have said, testing still needs to be scaled up further, and the Prime Minister has promised to do this.  But even better would be the roll out of rapid testing and of an antibody test that would detect whether someone had previously been infected and recovered.  The ability to test quickly at home or in communities is going to be vital in future stages of the pandemic, so that it becomes easier to quickly identify and contain any resurgent cases, as happened at the beginning in the UK. This was shown to work in the Italian town of Vo. But given current testing technology and capacity it isn’t possible yet.

I’ve put the numbers in a spreadsheet here: Covid testing.

Update on the new Covid-19 measures

Since writing yesterday’s post I have started to feel less optimistic.  Shortly after the post went up I saw the BBC Newsnight interview with Health Minister Helen Whately in what was, in my view, an incompetent, unclear and ill-informed appearance.  I have also read the detailed guidance on self-isolation and shielding vulnerable people.  Many people don’t understand how the advice applies to them.

A few days ago I was suggesting that one way to distinguish fake information on Covid-19 from accurate information was that good public health information is generally concise and easy to follow.  And yet the guidance above is long, rambling and vague.  While I still think it is correct to allow a measure of flexibility, I feel like many people will need an interpreter to get their heads round this advice.  We urgently need to translate it into clear, easy to use actions.  If the government can’t do this then community groups, local support groups and so on are going to have to do it themselves.

It is also clear that the lack of compulsion under the new measures have left many people worried about their future, in particular small businesses which have not been told to close but who will effectively have no clientele for the foreseeable future.

Take Back Control – Covid-19 edition

The latest UK advice on reducing social contacts, household self-isolation, and measures to shield old and vulnerable people represents a significant shift in the effort to combat the virus.  But while many countries introduce stringent “lockdowns” and just next door in France President Macron raised the prospect of punishment for anyone not complying, the UK government was keen to portray this as a voluntary or advisory effort.

Asked if laws to force compliance would be introduced, Boris Johnson said that the government already had powers but prefered to rely on peoples’ common sense and good will.  People self-isolating in the UK will be able to exercise outdoors – alone – while over in Albania, walks in the park are out of the question.  “Hiking is not vital at this time of war“, said the Prime Minister.   We heard phrases like “if at all possible” and “largely” – that stopped short of absolute injunctions, recognising that there may be exceptions, but that they really should be exceptional.

Meanwhile the Chief Medical Officer Chris Whitty emphasised more than once the importance of UK citizens understanding how tough these measures were and how long they might last.  He also explained that the risk presented by Covid-19 is not just Covid-19 related illness and death, but also the significant indirect impacts such as the inability of an overstretched NHS to treat other health problems, as well as the negative health impact of measures that will isolate and restrict people.  The response is not a war against Covid-19 so much as a national effort to protect the ability of the NHS to look after our health.

I believe this approach is based on two related, sensible, insights.  Firstly that in public health, even when you know exactly what people should do, it is very hard – perhaps impossible – to force everyone to do it.  Especially if you need them to do it for a long period of time.  Secondly, people are more likely to stick to something that they have some ownership over – where they have understood the issues and figured out how to adapt their lives.  These are not just new-fangled “nudge” theories – they are lessons learned from decades and even centuries of public health.

It’s a big relief to me that the government has stepped back – for now – from the temptation to take a more authoritarian approach.  I would not have been at all surprised if this new government had leapt at the chance given the tendencies it has shown in the short time it has been in power.  The fact that it hasn’t suggests to me that it is in fact listening to the people who know how to fight epidemics.  On the other hand questions are being asked about whether this approach means small businesses – which have not been ordered to close – will be protected, since they will not be in a position to claim on their insurance.  We are yet to hear concretely how the government will achieve protection of the thousands of small businesses and “gig economy” workers.

Strangely, after years of Brexit messaging based on the disingenuous catchphrase “take back control” it feels like with Covid-19 we have a chance to do just that.  As I said in my first post on this subject, I think local groups, neighbourhoods, and communities have it in their power to act, and support each other, and to react as the situation changes.  I hope we all find ways to use this power.  But government reassurance and support for those suffering hardship will be vital to this working.

~~~Update 17 March 2020~~~ Since the above post went up I’ve recognised a number of huge failings in the government’s approach. More here.

Covid-19 misinformation

You have probably seen a lot of information and advice circulating about Covid-19.  It is tempting to circulate this, especially if it provides hope in the form of previously unheard advice.

It is important to be careful about scrutinising any new information that appears.  I worked through an example with one of my kids earlier. She said it looked legit because it said it “came from a hospital board member”. But: had she heard of that hospital? Was the individual named? Had the hospital actually issued that advice? The answer was no in all of these cases!

So firstly, it is always important to be clear what the source of information is.

Secondly, does it say things that you’ve not heard before?  Probably, because this is what makes these bits of information so attractive.  However, it also makes it more likely that they are not correct. The WHO and NHS advice is as accurate as it can be based on current knowledge. There are no secret self-tests or solutions that some doctor in Wuhan came up with that somehow escaped everyone else’s attention.

Other warning signs are that misinformative pieces are often poorly written, and often long and rambling, sometimes with a touch of hyperbole or capital letters or exclamation marks. Good health communications are generally brief, precise, and designed to be easy to act on and remember.  If in doubt, check where information came from and compare it with official sources.

The BBC has an article about some of the most common fake advice stories.

Mental Health and Covid-19

The World Health Organisation published guidance on Covid-19 and mental health. The link to the full document is here but I thought it would be useful to provide a simpler summary which I have copied below and which is attached as a PDF.  In my summary I have not included the elements specifically related to health care workers.

Covid Mental Health WHO

Covid-19: how to look after your mental health

The World Health Organisation (WHO) has recognised that the spread of Covid-19, and the response measures being put in place, are creating a lot of stress among people, and has come up with some advice on how to manage this for both you and those close to you.  Exactly how you act on these will depend on your circumstances and your communities, but they should provide a starting point for thinking about what you can do.

The full guide (https://www.who.int/docs/default-source/coronaviruse/mental-health-considerations.pdf) is quite long and includes advice for health care workers, so I have summarised some of the main points here.

In general

• The virus is affecting people from many countries – it is not attached to any one ethnicity or nationality. We know that the onset of the virus has led to some people being attacked and insulted because of where they come from. It is important to be empathetic to anyone affected, in and from any country. Nobody affected has done anything wrong.
• Remember that the vast majority of people who are affected go on to make a full recovery, and their life will go on with their jobs, families and loved ones. Once they are recovered they cannot transmit the virus.
• News reports can be very worrying, as can ill-informed information sources. Avoid watching, reading or listening to news that cause you to feel anxious or distressed; focus on getting information that will allow you to take practical steps to prepare your plans and protect yourself – for instance from the WHO (https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public) or NHS (https://www.nhs.uk/conditions/coronavirus-covid-19/?fbclid=IwAR20eLC0Y3pGeiYSAXCfGlEpvDS5UgdNsTcPLEHlw-r942_bYzFCeOwHixw) websites. These can help you tell facts from rumours.
• As well as protecting yourself be supportive to others when they need it, either because they are affected by the virus itself or by the control measures that may be introduced.
• Listen to the experiences of those who have been affected or who have supported those affected and who are willing to share their experience.

Supporting children

• Children may be especially anxious. Help them find positive ways to express fear and sadness. Children feel relieved if they can express and communicate their disturbing feelings in a safe and supportive environment.
• Avoid separating children and their caregivers as much as possible. If a child needs to be separated from his/her primary caregiver, make sure they receive appropriate care and that regular contact with parents and caregivers is maintained (e.g., by phone, social media depending on the age of the child).
• Try to keep familiar routines in daily life as much as possible, especially if children are confined to home.
• In times of stress, it is common for children to seek more attachment and be more demanding on parents so discuss this with them. If your children have concerns, addressing those together may ease their anxiety. Children will observe adults’ behaviors and emotions for cues on how to manage their own emotions during difficult times.

Supporting older adults

• Older adults, especially in isolation and those with cognitive decline/dementia, may become more anxious, angry, stressed, agitated, and withdrawn. Provide practical and emotional support through informal networks (families) and health professionals.
• Share simple facts about what is going on and give clear information about how to reduce risk of infection in words older people with/without cognitive impairment can understand. Repeat the information whenever necessary. It may also be helpful for information to be displayed in writing or pictures.
• Encourage older adults with expertise, experiences and strengths to volunteer in community efforts to respond to the COVID-19 outbreak (for example the well/healthy retired older population can provide peer support, neighbour checking, and childcare for medical personnel that are still working).

Supporting people in isolation

• Stay connected and maintain your social networks. Try as much as possible to keep your personal daily routines. If health authorities have recommended limiting your physical social contact to contain the outbreak, you can stay connected via e-mail, social media, video conference and telephone.
• Pay attention to your own needs and feelings. Engage in healthy activities that you enjoy and find relaxing. Exercise regularly, keep regular sleep routines and eat healthy food. Keep things in perspective.