CBRNeWORLD Professor Lucy Easthope, Co-Founder of the ‘After Disaster Network’, talks to Zoe Rutherford about understanding the afterwards W e’ve covered coronavirus in various ways since the pandemic began, and mostly it’s been about the here and now, what we are doing to mitigate the virus, innovations, treatments and processes we’ve created, and the people behind this work. One area that doesn’t get much thought in the midst of a major incident or disaster though, is what happens once it’s over, two or three years down the line. Disaster response and recovery planning is not a specialty you may think of when dealing with a pandemic. More likely you’ll link this work to floods, earthquakes, and large scale industrial incidents, and think it mostly involves rehoming displaced people and returning infrastructure to pre-disaster norms. But disaster recovery is a lot more than that. It has plenty to teach us about what to expect in our post pandemic future, and what we need to be doing now so that potentially the outlook is less bleak. One person who knows more than most about all this is Professor Lucy Easthope, the UK’s leading authority on disaster recovery. Lucy has been involved with disaster response and recovery in all its forms throughout her career. Originally inspired to get involved in the field by very early activists fighting for the families affected by the Hillsborough disaster, she hasn’t looked back. Her portfolio is vast, including mass fatality planning, legal aspects of emergencies, identifying lessons post incident, and community resilience in practice. She has also responded to major disasters around the world. Lucy has many feathers in her cap and runs a consultancy supporting organisations when disaster hits. Most recently, during Covid, she has played a vital role, advising the Prime Minister’s Office. She is also co- founder of the After Disaster Network, University of Durham and a Research Fellow at the Centre for Death and Society, University of Bath. Ultimately, Lucy is a practical person and understands, as she put it: “That we An honest death August 2021 CBRNe WORLD www.cbrneworld.com CBRNe Convergence, Orlando, USA, 2-4 November 2021 www.cbrneworld.com/events/cbrne-convergence-orlando 29 The CBRN community is uniquely placed to understand areas of pandemic response. Walter Reed hospital during a 1910 flu epidemic ©DoD “While natural disasters capture headlines and national attention short-term, the work of recovery and rebuilding is long-term” Sylvia Mathews Burwell live in what's called a high-reliability, high-risk world. If we want nuclear power, we get nuclear accidents. If we want to fly, we get plane crashes. If we want to have international relations, we get terrorism.” All of this is of great interest to her, and knowing there’s no such thing as a risk-free world has allowed her a particular niche in understanding the afterwards and aftermath. Whether we can do things that make it better for communities affected by disaster. Like many in mass fatality planning, Lucy has always felt that a global pandemic was inevitable in her lifetime. That may sound fatalistic, but in the CBRN world not so much. We tend to the view that if you don’t prepare for the worst, how will you be ready for it. And Lucy gives credit to the CBRN milieu, and her work within it, for teaching her about biological risks. “The CBRN world helps you to have a sense of spectrum, and those things that you're really, really frightened of at the end of the spectrum. This didn't feel like that.” When it comes to the pandemic, the CBRN community is uniquely placed to understand areas of the response that many others will not, and no one better appreciates the importance of PPE. The UK essentially lost its PPE stockpile due to budget savings presented to parliament in 2017 and 2018. This is an area that Lucy feels has been woefully unexplored. She says: “We lost that and therefore all our plans became unworkable. We were a car without wheels.” This was why we couldn't facilitate goodbyes for families in hospitals, or run mortuaries properly, or allow care home visiting, all the human factors that Lucy has spent over 20 years planning for. “I couldn't protect without PPE, and I don't think the public understand what we've lost, and what I lost.” When it comes to training and exercising it is always done to a very good standard, and one of the things about CBRN is that we show off the kit. Then suddenly, “it was now do it without the kit. That’s where the UK was last spring, with a less severe threat, but a comparable disability,” Lucy says. In terms of recovery, the loss of PPE that removed the ability to say goodbye to loved ones is no small issue. Lucy maintains: “This pandemic has inflicted a state of ambiguous loss, particularly around the lack of goodbyes.” Preventing this particular sense of loss has been something the death industry has been working towards for decades. “We’ve come a long way from sealing the dead in CBRNe Convergence, Orlando, USA, 2-4 November 2021 www.cbrneworld.com/events/cbrne-convergence-orlando "Behold Harry, entrance 9 3/4s, simply smash your gurney into the wall to be transported to another realm..." Guy's Mortuary in London has dealt with a number of chemical suicides ©Z Rutherford 30 www.cbrneworld.com CBRNe WORLD August 2021 An honest death CBRNeWORLD Saving one protecting everyone www.epiguard.com coffins then notifying next of kin that someone has died. Everything we've done, even in the most horrific forensic and disaster cases, has been about facilitating a less ambiguous loss,” says Lucy. Issues around unknown or misunderstood infectivity of the deceased, lack of PPE, and simply trying to cope with the care and disposal of a huge number of bodies, has had a massive impact. Something that may not occur to everyone is the effect that the loss of rites and rituals can have on a society and its ability to recover after a major incident. “It’s exactly what I was worried about with a CBRN attack, where the plans we have to deal with are very similar to pandemic ones, they require a society to either truncate or possibly lose altogether key rites and rituals around death. That leads to a long term psychological harm of ambiguous loss,” said Lucy. We have learned from previous incidents when it comes to families, compounding loss, and inhibiting recovery. In days past it could take months for families to receive their loved one’s personal effects. This wasn’t a priority for those with the power to return them, as they were focused on ensuring an efficient and successful incident investigation. Things have changed in recent years, however. “I think you'll recognise that I don't necessarily have to fight as much as I did about the personal effects,” Lucy says. “With Grenfell it was one of the first things we secured, with a personal effects contract.” As for future impact, Lucy feels that at present we are storing up so much anger and pain, and that distress will come out in the second year. It’s what is shown on the recovery graph she uses frequently. She maintains that a lot of countries need to build this into their CBRN plans, and currently aren’t doing so. Taking the example of the use of portable cremators for CBRN incidents, and cremating bodies at the incident scene, Lucy can see both the underlying thinking and how this might store up future harms. “You don’t recover a society that has suffered ambiguous loss. It’s a very long and difficult process,” she states. We need to look at, and learn, from the public's reaction to the pandemic, even with the worst threats people will still ask a lot of questions about cases of ambiguous loss. Another big issue in the UK was the implication from some in power that there wasn't a plan. “Of course there were plans,” says Lucy, “but they relied on a whole load of equipment we didn't have anymore.” Despite this Lucy saw that pretty early on, “the death professionals rallied, and we didn't have quite as much panic as I thought we might.” PPE, personnel and plans are all important parts of the response to major incidents, but there are different facets to recovery. This starts during the incident, with how it is handled and the communications, well before it’s over. As Lucy puts it: “Decisions made in response will often be right for that moment, but have huge consequences for recovery, and this needs to be factored into our response plans.” One of the main lessons we need to learn from this pandemic is how to be truthful. When it comes to mass fatalities it is important to be honest with the public about the deaths we may be facing, as an unprepared public is a harmed public. “This was a big thing for me,” says Lucy, “very early on the Prime Minister's Office were like, this could kill lots of people. We don't know how to tell the public that.” Now we know what we're dealing with, but those in and around the death industry always thought we were going to have a problem with the optics of the dead and death. “We've lost honesty,” says Lucy, “we've lost lack of political interference. It's been very difficult to be honest during this disaster, and that's what we're missing.” It hasn’t always been that way. In 2006 there seemed to be open dialogue about the situation surrounding the assassination of Alexander Litvinenko. There was open discussion about a dangerous trail of polonium around London, and the way it was being managed. Westminster council was even allowed to publish its decontamination framework. This was, perhaps, due to the fact that although other people could have been affected only one ‘foreign’ man was dying, which is much easier to manage and talk about than the possibility of thousands of deaths. Ultimately change is needed, with greater openness about death. Telling people what should happen to a loved one, is paramount to making a situation less detrimental. One thing Lucy has seen that is very draining for NHS staff in particular is the moral injury and compassion fatigue. “You could do anything as long as you're given the resources to do it.” This includes the moral empowerment to do things right. In the case of a chemical death for instance, saying, ‘I don't care what’s in the newspapers, we‘re going to leave these bodies in situ to off-gas safely so the wives and husbands can view them tomorrow.’ “That takes balls,” says Lucy. The optics of how we handled the dead right through this pandemic has been very much, nobody must see piles of deceased in the corridors. “We didn't want that,” Lucy adds, “but there have been scenarios where sometimes scientific decisions have to be made about, say the deceased, and I don't know how you would make them now.” Recovering our honesty is something she is very passionate about. “I'm not looking for a new era, just rediscovering how we used to do this well. We're international case studies for other countries on what we call citizen science, trusted risk communication, taking the communities with you, we need to return to this”. What’s key for Lucy is being really honest about situations and our capabilities. She writes in her book, The Recovery Myth , that we would be safer as a society if we were much more honest and upfront about our limitations. That takes huge amounts of political courage and Lucy just doesn’t see the spirit of inquiry we’ll need to get to that point. She is also concerned that this thinking, “forces things like the CBRN threats you and I wrestle with further and further into shadowy corners, because they're not supposed to not happen or to have a death toll. I 32 www.cbrneworld.com CBRNe WORLD August 2021 CBRNe Convergence, Orlando, USA, 2-4 November 2021 www.cbrneworld.com/events/cbrne-convergence-orlando An honest death CBRNeWORLD CBRNeWORLD realise we've lost a lot of our ability to be honest.” Honesty crops up when talking to Lucy, not just in terms of being honest about death tolls, and practices, but as regards earning trust, which would ultimately have an impact on the long- term recovery of society. She answers: “In relation to something like contaminated dead, the public has every right to ask questions and I've been really heartened that with the pandemic our cycle of questions has come quite quickly. There's a difference for me, I don't want to make people trust, I want to be trustworthy.” One thing that she hopes to see in her lifetime is the separation of health and risk science from political response. One thing that we’ve never really managed to iron out is, if it's CBRN then it's a bad guy, and if it's hazardous response it’s an accident, convoluting the type of response mechanisms we put in place. “But if you're in my world,” says Lucy, “they can be very similar.” She also feels terrified, whilst we are in our current position of convoluted response, unclear messaging, and distrust of government, about the sources of information on something like a nuclear accident. Imagine going on Twitter for confirmation of an emergency and instead seeing a tweet from Cumbria claiming: “I don't believe it. I've just driven past and it looks fine to me. #coverup #bildenburg” Focus is an issue that Lucy feels we need to keep an eye on right now. Yes, we are still in the midst of a pandemic, but it can’t be ‘all pandemic, all the time’. “Particularly in the American and African response worlds, some agencies must be thinking, ‘You've got to allow us to keep an eye on the other threats that are going on.’" She suggests that if we are coronavirus-focused all the time, we've taken our sights off the likes of anthrax, Ebola, and Marburg. “My issue here,” she says, “is there’s worse out there than this. I think we should be careful to get this right, because obviously we don't want look like we're playing it down, but using all our A game on coronavirus puts us at risk.” We have been somewhat lucky. The blunt answer to why we handled, at least one part of the pandemic well, is that we have not seen the deaths we planned for. We have had to go to extreme measures in some instances, but essentially this is a manageable pandemic, without influxes of tens of thousands of dead in one day. Our top end projections were for 800,000 extra deaths in the UK. “There was something there about the difference between how excess deaths have been calculated and what actual excess deaths might've looked like,” says Lucy. “Excess deaths on top of all normal arrangements being exceeded, a further 800,000 would have been horrific. We certainly have had a number of deaths that have required mortuary staff to innovate and be very agile and flexible, but we’ve not seen what I planned for.” Currently there’s a long way to go on the road to recovery. We may have missed the honesty boat this time, but hopefully we can learn for the next one and not repeat the same mistakes. “Some people say we are in a state of readiness now, but I think it’s the opposite; people will want to forget,” Lucy maintains. “ On the bright side though, there could be interesting things to come from the pandemic in terms of future mass fatality management, to make the next one easier in terms of loss and recovery. We have proved that we can make the process from death to burial or cremation easier and faster for loved ones. Innovations like digital death registration, and failings in previous plans that the Coronavirus Act fixed, have enabled us to avoid some of the backlogs at registration and coronial stages. These may seem like simple steps, but being able to hold a funeral reasonably quickly and without complications, can have a huge impact on relatives’ long-term welfare and how society adjusts to, and recovers from disasters. It's not a popular message, but Lucy says: “Britain has managed the pandemic incredibly well, and one of the reasons we haven't had to go to those higher level scarier stages in the death plan is because our hospital mortuaries, funeral directors, and deceased management advisory group, absolutely rallied, and our local planners have been incredible. I think for someone coming into emergency management now it’s going to be quite exciting.” Only time will tell how well we recover from this pandemic, and there are certain to be bumps along the way. The one thing we must continue to focus on is the fact that people can handle the truth. If we’re going to have any meaningful recovery, from this disaster or the next, we need to work on how we communicate our plans, and the reasoning behind them, with honesty and transparency. Recovery doesn’t begin when the response ends, they go hand in hand. Lucy’s new book ‘When the Dust Settles’ published by Hodder will be out in March and able to pre-order from September, you can follow Lucy on Twitter @lucygobag 34 www.cbrneworld.com CBRNe WORLD August 2021 CBRNe Convergence, Orlando, USA, 2-4 November 2021 www.cbrneworld.com/events/cbrne-convergence-orlando An honest death CBRNeWORLD The UK has been a leader in DVI for a number of years, and this investment has paid dividends for Covid ©Z Rutherford