https://odysee.com/@notanotherbrick:f/DR-SEAN-BROOKS-PHD-%E2%80%93-THEY-WILL-FALL-ILL-AND-THEY-WILL-DIE-Da:5?r=DyM2sxMQFj2iEYXKp3oMy
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Thursday, August 26, 2021
Friday, August 20, 2021
A Brief History of the Apocalypse.
A Brief History of the Apocalypse.
Daniel and Enoch both prophesized regarding weeks of years. Enoch provides us with descriptions of 10 of them, which Daniel touches on the last eight, primarily. I refer to them primarily because they numbered stuff in a simple way :)
The weeks are weeks of prophetic years, also known as times. A time is 360 literal years. Seven sets of 360 literal years is a week. 360 because lunar calendar, and Babylonian astrology. Much prophecy is based on the fact that every 72 years we go through 1 degree in the precession of the equinoxes. So enoch describes 25200 literal years which is most of a Solar Cycle (it is two prophetic years short, more or less) and this is fitting because his name means cycle of the sun. The Hindus also prophetically describe this cycle but they include the missing 10 degrees. 25960 years is their count.
In a nutshell he tells us that righteousness was the rule in the first week (62nd of daniel) in his time which was the time of Adam around 20670bc. As this week ended a people emerged worshipping "the prince who will come".. they destroyed a prehistoric city and temple in the second / 63rd week and as a consequence a flood was decreed. This coincides with the end of the Satya yuga of Hinduism, which was the golden age.
Weeks compared to ancient sea levels
A few were chosen to survive and carry on the seed of righteous civilization, presumably holding the knowledge of the previous world and its sciences.
From the 64th week through to the 67th week the basics of civilization were re established such as agriculture and pottery and metallurgy. However Enoch tells us that as technology emerged ALL THE LIVING WERE CURSED WITH BLINDNESS AND MADE TO FORSAKE WISDOM. In the 68th/ 7th week beginning in 5550 bc (when sea levels stabilized according to science) the apostate generation rose, while the righteous were taught the nature of the sevenfold path. Writing and the priesthood became a foundation for civilized existence.
In the 69th/8th week which began in 3030bc (72 years or one solar degree after the hindu kali yuga began) the conquering angels had the tools necessary to escalate the campaign to purge the Earth. Or as enoch says a sword was given to them to enslave sinners. Most of recorded history begins here... the rulers of the hierarchy had now domesticated humans on a large scale through the knowledge of their priesthoods. Human sacrifice and various occult forms of population management were developed and empires exploded in size and power... writing and math grew in sophistication.. hammurabis code and the law of moses were put forth halfway through the week... and the kings prospered.
The 9th // 70th week summarized was the tale of the Roman Republic, the 4th beast symbolized by a 3 headed eagle which was ruled by no king but simply men - and how they conquered the world. Enoch says that in this week the godless works are judged and vanquished, and the world is written down for destruction.
This week began in 509 bc with the foundation of the roman republic by treachery. Rome and the catholic church are the antichrist. a number of events confirm this prophecy. Notably the sacrifices, by which the old world religions honoured their gods, were ended by imperial decree.under theodosius in 392 AD. This was 2 and a half prophetic years into the 70th seven.
And as it was written 360 years after the sacrifices were ended by force the abomination which desolates arose. This was the year 752 AD when the Catholic Church became a Kingdom, through a forged document known as the Donation of Constantine... which claimed for the church 3 kingdoms as their rightful territory. The document also declares the pope VICARIVS FILII DEI or vicar of christ.... Now if we analyze the Roman numerals of this title: 5+1+100+1+5+1+50+1+1+500+1 = 666. Food for thought. The word Vatican means prophesizing serpent... aka false prophet. And the room from which the pope addresses audiences is literally a snakes head.
https://images.app.goo.gl/8Pg4TuPVNpnDY7tW9
Anyways Through the conquest of the king of the Francs this forged document was made reality, and thus the little horn of the church uprooted and conquered 3 major horns through deceit. This was 3 and a half years into the 70th week. 42 prophetic months remained yet.
The trumpets initiated 210 yrs or 7 prophetic months following this event, in the year 962 AD. Now here's a secret : each trumpet lasts 150 years, and it resonates strongest 75 years after it is blown. The trumpets are phases of a great war against the human populations of earth by archons angels and the forces of heaven. This war is waged as men are inclined to disobey gods will due to their own corrupted nature. 962 AD is properly the 0th trumpet. I will describe their course.
Trumpet 1: 1112 /1187 AD this is the prophetic resurrection of body of christ, the Morning Star, 3 prophetic years after his death, And as he spoke he came as a conqueror As the Knights Hospitallers.. who would come to conquer Jerusalem (the base of the evening star), and become a banking/military juggernaut for centuries. Not to mention their legendary status in freemasonry. As an example of their power; after they were betrayed by france and the pope... the king of france and the pope were killed. And the kings sons all died in short order, as well. This trumpet also is the beginnings of the great plagues in the form of leprosy https://blog.nationalarchives.gov.uk/templars-curse-king-france/
Trumpet 2 : 1267 / 1337 AD A great angelic government arises burning with fire and a third of the creatures in the sea perish, as the waters became blood. FYI blood is meant to indicate corruption or poisoning - as it is unholy to consume blood.. the sea represents the masses of people, the lower class. This government was the golden hordes of the mongols... A comet preceded their incursions into the west. Through them the black death which killed a third of Europe was manifested. Dark sciences were used to bring it upon the people.. as is the case in all plagues.
T3. 1412/1487 Wormwood. Waters made bitter and poisonous. A third of the LIVING creatures in the sea die.. Living creatures refers to those who are spiritually awake. Higher status, higher spiritual intelligence. The Jews were expelled from the Spanish Church, and the inquisition sought them out. In fact all who were openly aware of the antichrist tended to be killed through one device or another. The Jesuit order was founded during this trumpet- an order which used poison to strike down heretics. Overseas the remnant of an ancient religion were annihilated quite brutally. Plague of great pox aka syphillis
Trumpet. 4 1567 1642 1/3 [The stars and moon are darkened] the reformation/enlightenment.Plague = Smallpox. Note : the 6th seal is in 1652, and also speaks of a darkened sun and blood moon. Suns represent kings, and during the 70th seven all kings of the earth were conquered. The moon turning to blood signifies the rise of a corrupted and poisonous religion dominating this period.. during the latter portion of this prophetic year the pope himself became utterly enslaved to the power networks of his church.
Also note that this is the 49th prophetic year since the week of the flood. Read the laws regarding Jubilee in the Bible.... yes this law applies on the prophetic level. So the final prophetic year from 1652 to 2012 ad was characterized by "liberty" and the freeing of slaves. Fun facts right? In fact on the liberty bell the bible verse regarding this is inscribed. And what was the motto of the french revolution?
T5. First woe 1712//1787. 1717 Grand lodge of freemasonry founded. Inoculation and vaccination are invented. Abbadon/apollo the god of plagues and death is incarnated on earth. Napolean ( whose name means the true apollo) conquers Europe and supports the first mandatory vaccination campaigns.
"And they had tails like unto scorpions, and there were stings in their tails: and their power was to hurt men five months.
And they had a king over them, which is the angel of the bottomless pit, whose name in the Hebrew tongue is Abaddon, but in the Greek tongue hath his name Apollo."
T6. 1867//1937. Ww1 and ww2. More scorpions.
THE 71ST SEVEN THE 10TH WEEK OF YEARS T7 December 25th 2012//2087. Initiation of VIALS.
As enoch writes: in the 7th year of the 10th week the great eternal judgement of mankind will begin.
As you can tell the judgement initiated in 2020 right on que. We are in the first vial and you can guess what the mark is.
In 2013 the black pope of the Jesuits became the true pope. There is a 1000 year old prophecy foretelling 112 Pope's. Yep Francis is 112.. as prophesized he is the final pope and the antichrist reigns over the earth. "who will lead his flock through many tribulations into perdition and the destruction of the city."
https://en.m.wikipedia.org/wiki/Prophecy_of_the_Popes
Bill Gates, Fauci, and Joe Biden are three notable figures who are devout Catholics. Meaning they owe their allegiance solely to the black pope, as he is vicar of christ on earth. So in fulfillment of prophesy they will continue pouring the vials of gods wrath. The first vial states that the plague we now face will generate very severe skin eruptions on a large scale very soon. There are of course scientific reasons for this. Anyhoo...
2nd vial begins in 2024. ALL CREATURES IN THE SEA DIE. This will be around 2/3 of humanity killed before 2030...
Blessed are they who live to see 1135 days, or 2087... this is 72 years, or one solar degree, into the next cycle of the sun, and the "fulfillment point" of the 7th trumpet - an eternal kingdom is founded.
Time is short y'all remember god even under the reign of satan.
BOOK OF ENOCH, PROPHECY OF WEEKS: https://www.sacred-texts.com/bib/boe/boe096.htm
Wednesday, August 18, 2021
Employers and Covid Vaccines – What’s Legal and What’s Not?
MARCH 3, 2021
Employers and Covid Vaccines – What’s Legal and What’s Not?
Professor of Law Emerita and Program Chair for Paralegal Studies at the School of Professional and Continuing Studies, University of Richmond
As the vaccines roll out and hopes rise about a return to pre-pandemic life, the reluctance of some to get the vaccine has led to questions about what employers can do to either mandate or encourage vaccination. While it is far too early for any judicial decisions on the issue, Guidance from the Equal Employment Opportunity Commission (“EEOC”) provides some assistance in making the determination. The EEOC’s Guidance is not binding on courts, but may be considered by the courts because of the EEOC’s role in enforcing the relevant laws. There is some case law regarding mandatory flu vaccines as well, which is largely consistent with the EEOC Guidance.
In general, the guidance indicates that mandating vaccines is lawful, but requires accommodation of individuals whose disabilities or religious beliefs would prevent vaccination. In addition, depending on the vaccine provider, the questions that are asked before vaccination may constitute a medical exam, which the employer would have to justify under the Americans with Disabilities Act (“ADA”) if covered by the statute. Providing incentives for vaccination instead of a mandate might also implicate the ADA. Employers implementing vaccine programs must carefully consider their approach to avoid running afoul of legal protections for employees.
Employers that require vaccination must reasonably accommodate employees who have disabilities that prevent vaccination, unless the employer can establish that accommodation would cause undue hardship. Undue hardship under the ADA is defined as “significant difficulty or expense.” Under the ADA, the determination of the reasonableness of any accommodation and of whether undue hardship exists is always case specific. Nevertheless, one can imagine accommodations that might be reasonable such as telecommuting, wearing personal protective equipment, or changing the structure of the workplace or job to minimize contact with other people. Some employers may be able to establish that having an unvaccinated employee in a job that requires close contact with other people poses a significant risk of viral transmission that cannot be ameliorated by other means, i.e., that the employee poses a direct threat to health and safety. For other employers, the accommodations will be sufficient to reduce or eliminate that risk. The availability of accommodations should always be discussed with the requesting employee, as the law requires the parties to engage in an interactive process to ascertain the possibility of accommodation. Further, the employer is permitted to request medical documentation of the need for an alternative to vaccination as an accommodation.
Like employees with disabilities, employees with sincere religious beliefs that preclude vaccinations must be accommodated, unless the employer can show that there is no accommodation that does not cause undue hardship. Undue hardship for religious accommodations is easier for an employer to demonstrate, as it is anything more than de minimis cost or burden. If personal protective equipment and social distancing would reduce or eliminate the risk and is consistent with job responsibilities, an employee who brought and wore his or her own mask could probably be accommodated without undue hardship.
These determinations regarding accommodation will almost certainly be influenced by evolving medical knowledge about the pandemic. At present, it is not clear that vaccination eliminates the risk of transmission so if that is the concern, personal protective equipment may well be deemed equally protective. If scientific knowledge were to change, however, the accommodation requirement will change with it.
If no reasonable accommodation is possible and the unvaccinated employee poses a direct threat to self or others in the workplace, the employee may be barred from the workplace. The determination of direct threat is guided by the statute and regulations. A direct threat is defined as a “significant risk of substantial harm to the health or safety of the individual or others that cannot be eliminated or reduced by reasonable accommodation.” Like reasonable accommodation, the determination of whether someone poses a threat must be individualized to the person and the workplace, and must be based on current medical knowledge. The regulations also contain factors that guide the determination, including the duration of the risk and the nature, severity, likelihood and imminence of the potential harm. Finally, while the individual posing the threat may be prohibited from coming to the workplace, before any discharge, the employer should be careful to insure that the termination does not violate any existing laws, including those that may be enacted as part of the next Covid relief bill. For example, while the specialized leave provisions for Covid enacted in 2020 have expired, leave requirements may be reenacted. In addition, in light of the understandable suspicion that some people of color have of the medical community, terminations may fall more heavily on certain racial or ethnic groups, raising questions about discrimination.
According to the EEOC, employers who mandate the vaccine and provide the vaccine to their employees or employ a contractor to do so will be conducting a medical exam or inquiry under the ADA when they ask the pre-vaccination questions designed to ensure that the vaccine is safe for that individual. Such inquiries of employees must be justified as “job-related and consistent with business necessity.” The guidance points out that to satisfy this test, the employer must show that an unvaccinated employee would pose a direct threat to self or others. Voluntary vaccines provided by the employer do not implicate this statutory provision nor does a requirement that the employee obtain the vaccine from any available source. The difficulty with the latter is that in many places, obtaining a vaccine remains challenging without, and maybe even with, employer assistance.
Given the legal uncertainties surrounding mandatory vaccines, it is appealing to employers to offer incentives for the vaccine without requiring it, and some employers are choosing that route. Vaccine incentives come with their own legal uncertainties, however. If the incentive is substantial, it may raise the question of whether the vaccine is truly voluntary or effectively mandatory. The EEOC has addressed employer wellness programs in the context of the ADA and there is a possibility that a vaccine incentive program might be deemed a wellness program. ADA regulations require that wellness programs be voluntary if they require disclosure of any disability-related information, and as discussed above, the administration of the vaccine does.
In 2016, the EEOC promulgated regulations on wellness programs which limited the size of any incentive to 30% of the cost of self-only coverage for the employer’s lowest cost major medical plan. These regulations were legally challenged, however, and did not ultimately become effective. In January 2021, the EEOC issued a new proposed rule on wellness programs but its publication has been delayed by the Biden administration. It is unclear whether the proposed rule will be published in the Federal Register for comment as is, revised, or simply withdrawn. The as-yet-unpublished rule indicated that only small incentives were allowed in wellness programs that required response to disability-related inquiries. But as indicated, there is no certainty that a vaccine program will be considered a wellness program. Regardless, the law relating to wellness programs certainly suggests that any incentive to vaccinate should not be too generous.
Finally, any incentive program, like a mandatory vaccine, may require reasonable accommodation for employees who cannot receive the vaccine because of a disability. Employers should be prepared with alternative ways for such employees to earn the incentive. A Kroger program, for example, allows employees to earn the $100 vaccine bonus by taking an educational class. Education about vaccine safety or paid time off to obtain the vaccine may be other ways to encourage employees to get vaccinated.
The Covid-19 pandemic has raised a host of new legal issues and caused us to rethink accepted ways of doing and being. While we all long for a return of the days when we can go to shops, restaurants and gyms without fear, employers should carefully consider what approach to take to the vaccines, in light of the ongoing legal uncertainty.
OSHA backtracks on liability regarding vaccines
Charlotte, NC — The Occupational Safety and Health Administration (OSHA) has done an about-face regarding an employer’s liability if it mandates the experimental COVID-19 vaccine and an employee suffers an adverse reaction.
As recently reported, OSHA stated it would follow current legal standards under 29 CFR 1904.7 making a business liable for any injuries an employee has to a vaccine if the shot is required by the employer.
However, OSHA states it, along with the Department of Labor (DOL), wants every American to submit to the government’s medical experiment and it will no longer follow the legal standards.
“DOL and OSHA, as well as other federal agencies, are working diligently to encourage COVID-19 vaccinations,” an update to OSHA’s frequently asked questions (FAQ) page states.“OSHA does not wish to have any appearance of discouraging workers from receiving COVID-19 vaccination, and also does not wish to disincentivize employers’ vaccination efforts. As a result, OSHA will not enforce 29 CFR 1904’s recording requirements to require any employers to record worker side effects from COVID-19 vaccination through May 2022. We will reevaluate the agency’s position at that time to determine the best course of action moving forward.”
Prior to this 180-degree turn, the FAQ page stated: “If you require your employees to be vaccinated as a condition of employment (i.e., for work-related reasons), then any adverse reaction to the COVID-19 vaccine is work-related.”
Businesses were allowed to encourage the shots and even help arrange for shots to be given without facing liability.
“Note that for this discretion to apply, the vaccine must be truly voluntary,” OSHA stated. “For example, an employee’s choice to accept or reject the vaccine cannot affect their performance rating or professional advancement. An employee who chooses not to receive the vaccine cannot suffer any repercussions from this choice. If employees are not free to choose whether or not to receive the vaccine without fearing adverse action, then the vaccine is not merely ‘recommended’ and employers should consult the above FAQ regarding COVID-19 vaccines that are a condition of employment.”
The COVID-19 jabs remain experimental with only emergency authorization use from the Food and Drug Administration (FDA). It has led to the largest number of vaccine-related deaths ever recorded by the Centers for Disease Control (CDC) in its Vaccine Adverse Event Reporting System (VAERS).
More deaths have been recorded in the latest VAERS report, 4,647 through May 17, following the COVID-19 shots than all vaccine-recorded deaths over the last 22 years combined. VAERS, historically, only records 1 to 10 percent of vaccine deaths according to a Harvard University study.
CDC GREEN ZONES equal Segregation?
Interim Operational Considerations for Implementing the Shielding Approach to Prevent COVID-19 Infections in Humanitarian Settings
This document presents considerations from the perspective of the U.S. Centers for Disease Control & Prevention (CDC) for implementing the shielding approach in humanitarian settings as outlined in guidance documents focused on camps, displaced populations and low-resource settings.1,2 This approach has never been documented and has raised questions and concerns among humanitarian partners who support response activities in these settings. The purpose of this document is to highlight potential implementation challenges of the shielding approach from CDC’s perspective and guide thinking around implementation in the absence of empirical data. Considerations are based on current evidence known about the transmission and severity of coronavirus disease 2019 (COVID-19) and may need to be revised as more information becomes available. Please check the CDC website periodically for updates.
What is the Shielding Approach1?
The shielding approach aims to reduce the number of severe COVID-19 cases by limiting contact between individuals at higher risk of developing severe disease (“high-risk”) and the general population (“low-risk”). High-risk individuals would be temporarily relocated to safe or “green zones” established at the household, neighborhood, camp/sector or community level depending on the context and setting.1,2 They would have minimal contact with family members and other low-risk residents.
Current evidence indicates that older adults and people of any age who have serious underlying medical conditions are at higher risk for severe illness from COVID-19.3 In most humanitarian settings, older population groups make up a small percentage of the total population.4,5 For this reason, the shielding approach suggests physically separating high-risk individuals from the general population to prioritize the use of the limited available resources and avoid implementing long-term containment measures among the general population.
In theory, shielding may serve its objective to protect high-risk populations from disease and death. However, implementation of the approach necessitates strict adherence1,6,7, to protocol. Inadvertent introduction of the virus into a green zone may result in rapid transmission among the most vulnerable populations the approach is trying to protect.
A summary of the shielding approach described by Favas is shown in Table 1. See Guidance for the prevention of COVID-19 infections among high-risk individuals in low-resource, displaced and camp and camp-like settings 1,2 for full details.
Table 1: Summary of the Shielding Approach1
Level
Movement/ Interactions
Household (HH) Level:
A specific room/area designated for high-risk individuals who are physically isolated from other HH members.
Low-risk HH members should not enter the green zone. If entry is necessary, it should be done only by healthy individuals after washing hands and using face coverings. Interactions should be at a safe distance (approx. 2 meters). Minimum movement of high-risk individuals outside the green zone. Low-risk HH members continue to follow social distancing and hygiene practices outside the house.
Neighborhood Level:
A designated shelter/group of shelters (max 5-10 households), within a small camp or area where high-risk members are grouped together. Neighbors “swap” households to accommodate high-risk individuals.
Same as above
Camp/Sector Level:
A group of shelters such as schools, community buildings within a camp/sector (max 50 high-risk individuals per single green zone) where high-risk individuals are physically isolated together.
One entry point is used for exchange of food, supplies, etc. A meeting area is used for residents and visitors to interact while practicing physical distancing (2 meters). No movement into or outside the green zone.
Operational Considerations
The shielding approach requires several prerequisites for effective implementation. Several are addressed, including access to healthcare and provision of food. However, there are several prerequisites which require additional considerations. Table 2 presents the prerequisites or suggestions as stated in the shielding guidance document (column 1) and CDC presents additional questions and considerations alongside these prerequisites (column 2).
Table 2: Suggested Prerequisites per the shielding documents and CDC’s Operational Considerations for Implementation
Suggested Prerequisites
*As stated in the shielding document*
Considerations as suggested by CDC
- Each green zone has a dedicated latrine/bathing facility for high-risk individuals
- The shielding approach advises against any new facility construction to establish green zones; however, few settings will have existing shelters or communal facilities with designated latrines/bathing facilities to accommodate high-risk individuals. In these settings, most latrines used by HHs are located outside the home and often shared by multiple HHs.
- If dedicated facilities are available, ensure safety measures such as proper lighting, handwashing/hygiene infrastructure, maintenance and disinfection of latrines.
- Ensure facilities can accommodate high-risk individuals with disabilities, children and separate genders at the neighborhood/camp-level.
- To minimize external contact, each green zone should include able-bodied high-risk individuals capable of caring for residents who have disabilities or are less mobile. Otherwise, designate low-risk individuals for these tasks, preferably who have recovered from confirmed COVID-19 and are assumed to be immune.
- This may be difficult to sustain, especially if the caregivers are also high risk. As caregivers may often will be family members, ensure that this strategy is socially or culturally acceptable.
- Currently, we do not know if prior infection confers immunity.
- The green zone and living areas for high-risk residents should be aligned with minimum humanitarian (SPHERE) standards.6
- The shielding approach requires strict adherence to infection, prevention and control (IPC) measures. They require, uninterrupted availability of soap, water, hygiene/cleaning supplies, masks or cloth face coverings, etc. for all individuals in green zones. Thus, it is necessary to ensure minimum public health standards6 are maintained and possibly supplemented to decrease the risk of other outbreaks outside of COVID-19. Attaining and maintaining minimum SPHERE6 standards is difficult in these settings for the general population.8,9,10 Users should consider that provision of services and supplies to high risk individuals could be at the expense of low-risk residents, putting them at increased risk for other outbreaks.
- Monitor and evaluate the implementation of the shielding approach.
- Monitoring protocols will need to be developed for each type of green zone.
- Dedicated staff need to be identified to monitor each green zone. Monitoring includes both adherence to protocols and potential adverse effects or outcomes due to isolation and stigma. It may be necessary to assign someone within the green zone, if feasible, to minimize movement in/out of green zones.
- Men and women, and individuals with tuberculosis (TB), severe immunodeficiencies, or dementia should be isolated separately
- Multiple green zones would be needed to achieve this level of separation, each requiring additional inputs/resources. Further considerations include challenges of accommodating different ethnicities, socio-cultural groups, or religions within one setting.
- Community acceptance and involvement in the design and implementation
- Even with community involvement, there may be a risk of stigmatization.11,12 Isolation/separation from family members, loss of freedom and personal interactions may require additional psychosocial support structures/systems. See section on additional considerations below.
- High-risk minors should be accompanied into isolation by a single caregiver who will also be considered a green zone resident in terms of movements and contacts with those outside the green zone.
- Protection measures are critical to implementation. Ensure there is appropriate, adequate, and acceptable care of other minors or individuals with disabilities or mental health conditions who remain in the HH if separated from their primary caregiver.
- Green zone shelters should always be kept clean. Residents should be provided with the necessary cleaning products and materials to clean their living spaces.
- High-risk individuals will be responsible for cleaning and maintaining their own living space and facilities. This may not be feasible for persons with disabilities or decreased mobility.11 Maintaining hygiene conditions in communal facilities is difficult during non-outbreak settings.7,8,9 consequently it may be necessary to provide additional human resource support.
- Green zones should be more spacious in terms of shelter area per capita than the surrounding camp/sector, even at the cost of greater crowding of low-risk people.
- Ensure that targeting high-risk individuals does not negate mitigation measures among low-risk individuals (physical distancing in markets or water points, where feasible, etc.). Differences in space based on risk status may increase the potential risk of exposure among the rest of the low-risk residents and may be unacceptable or impracticable, considering space limitations and overcrowding in many settings.
Additional Considerations
The shielding approach outlines the general “logistics” of implementation –who, what, where, how. However, there may be additional logistical challenges to implementing these strategies as a result of unavailable commodities, transport restrictions, limited staff capacity and availability to meet the increased needs. The approach does not address the potential emotional, social/cultural, psychological impact for separated individuals nor for the households with separated members. Additional considerations to address these challenges are presented below.
Population characteristics and demographics
Consideration: The number of green zones required may be greater than anticipated, as they are based on the total number of high-risk individuals, disease categories, and the socio-demographics of the area and not just the proportion of elderly population.
Explanation: Older adults represent a small percentage of the population in many camps in humanitarian settings (approximately 3-5%4,5), however in some humanitarian settings more than one quarter of the population may fall under high risk categories13,14,15 based on underlying medical conditions which may increase a person’s risk for severe COVID-19 illness which include chronic kidney disease, obesity, serious heart conditions, sickle cell disease, and type 2 diabetes. Additionally, many camps and settlements host multiple nationalities which may require additional separation, for example, Kakuma Refugee Camp in Kenya accommodates refugees from 19 countries.16
Timeline considerations
Consideration: Plan for an extended duration of implementation time, at least 6 months.
Explanation: The shielding approach proposes that green zones be maintained until one of the following circumstances arises: (i) sufficient hospitalization capacity is established; (ii) effective vaccine or therapeutic options become widely available; or (iii) the COVID-19 epidemic affecting the population subsides.
Given the limited resources and healthcare available to populations in humanitarian settings prior to the pandemic, it is unlikely sufficient hospitalization capacity (beds, personal protective equipment, ventilators, and staff) will be achievable during widespread transmission. The national capacity in many of the countries where these settings are located (e.g., Chad, Myanmar, and Syria) is limited. Resources may become quickly overwhelmed during the peak of transmission and may not be accessible to the emergency affected populations.
Vaccine trials are underway, but with no definite timeline. Reaching the suppression phase where the epidemic subsides can take several months and cases may resurge in a second or even third wave. Herd immunity (the depletion of susceptible people) for COVID-19 has not been demonstrated to date. It is also unclear if an infected person develops immunity and the duration of potential immunity is unknown. Thus, contingency plans to account for a possibly extended operational timeline are critical.
Other logistical considerations
Consideration: Plan to identify additional resources and outline supply chain mechanisms to support green zones.
Explanation: The implementation and operation of green zones requires strong coordination among several sectors which may require substantial additional resources: supplies and staff to maintain these spaces – shelters, IPC, water, sanitation, and hygiene (WASH), non-food items (NFIs) (beds, linens, dishes/utensils, water containers), psychosocial support, monitors/supervisors, caretakers/attendants, risk communication and community engagement, security, etc. Considering global reductions in commodity shortages,17 movement restrictions, border closures, and decreased trucking and flights, it is important to outline what additional resources will be needed and how they will be procured.
Protection
Consideration: Ensure safe and protective environments for all individuals, including minors and individuals who require additional care whether they are in the green zone or remain in a household after the primary caregiver or income provider has moved to the green zone.
Explanation: Separating families and disrupting and deconstructing multigenerational households may have long-term negative consequences. Shielding strategies need to consider sociocultural gender norms in order to adequately assess and address risks to individuals, particularly women and girls. 18,19,20 Restrictive gender norms may be exacerbated by isolation strategies such as shielding. At the household level, isolating individuals and limiting their interaction, compounded with social and economic disruption has raised concerns of potential increased risk of partner violence. Households participating in house swaps or sector-wide cohorting are at particular risk for gender-based violence, harassment, abuse, and exploitation as remaining household members may not be decision-makers or responsible for households needs.18,19,20
Social/Cultural/Religious Practices
Consideration: Plan for potential disruption of social networks.
Explanation: Community celebrations (religious holidays), bereavement (funerals) and other rites of passage are cornerstones of many societies. Proactive planning ahead of time, including strong community engagement and risk communication is needed to better understand the issues and concerns of restricting individuals from participating in communal practices because they are being shielded. Failure to do so could lead to both interpersonal and communal violence.21,22
Mental Health
Consideration: Ensure mental health and psychosocial support*,23 structures are in place to address increased stress and anxiety.
Explanation: Additional stress and worry are common during any epidemic and may be more pronounced with COVID-19 due to the novelty of the disease and increased fear of infection, increased childcare responsibilities due to school closures, and loss of livelihoods. Thus, in addition to the risk of stigmatization and feeling of isolation, this shielding approach may have an important psychological impact and may lead to significant emotional distress, exacerbate existing mental illness or contribute to anxiety, depression, helplessness, grief, substance abuse, or thoughts of suicide among those who are separated or have been left behind. Shielded individuals with concurrent severe mental health conditions should not be left alone. There must be a caregiver allocated to them to prevent further protection risks such as neglect and abuse.
Summary
The shielding approach is an ambitious undertaking, which may prove effective in preventing COVID-19 infection among high-risk populations if well managed. While the premise is based on mitigation strategies used in the United Kingdom,24,25 there is no empirical evidence whether this approach will increase, decrease or have no effect on morbidity and mortality during the COVID-19 epidemic in various humanitarian settings. This document highlights a) risks and challenges of implementing this approach, b) need for additional resources in areas with limited or reduced capacity, c) indefinite timeline, and d) possible short-term and long-term adverse consequences.
Public health not only focuses on the eradication of disease but addresses the entire spectrum of health and wellbeing. Populations displaced, due to natural disasters or war and, conflict are already fragile and have experienced increased mental, physical and/or emotional trauma. While the shielding approach is not meant to be coercive, it may appear forced or be misunderstood in humanitarian settings. As with many community interventions meant to decrease COVID-19 morbidity and mortality, compliance and behavior change are the primary rate-limiting steps and may be driven by social and emotional factors. These changes are difficult in developed, stable settings; thus, they may be particularly challenging in humanitarian settings which bring their own set of multi-faceted challenges that need to be taken into account.
Household-level shielding seems to be the most feasible and dignified as it allows for the least disruption to family structure and lifestyle, critical components to maintaining compliance. However, it is most susceptible to the introduction of a virus due to necessary movement or interaction outside the green zone, less oversight, and often large household sizes. It may be less feasible in settings where family shelters are small and do not have multiple compartments. In humanitarian settings, small village, sector/block, or camp-level shielding may allow for greater adherence to proposed protocol, but at the expense of longer-term social impacts triggered by separation from friends and family, feelings of isolation, and stigmatization. Most importantly, accidental introduction of the virus into a green zone may result in rapid transmission and increased morbidity and mortality as observed in assisted care facilities in the US.26
The shielding approach is intended to alleviate stress on the healthcare system and circumvent the negative economic consequences of long-term containment measures and lockdowns by protecting the most vulnerable.1,24,25 Implementation of this approach will involve careful planning, additional resources, strict adherence and strong multi-sector coordination, requiring agencies to consider the potential repercussion among populations that have collectively experienced physical and psychological trauma which makes them more vulnerable to adverse psychosocial consequences. In addition, thoughtful consideration of the potential benefit versus the social and financial cost of implementation will be needed in humanitarian settings.
References
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- Rashad, M, Farrell, S. April 24, 2020. Reuters, Islam’s holiest sites emptied by coronavirus crisis as Ramadhan begins.
- ABP News Bureau, April 24, 2020. Pakistani Imams Overrule Lockdown for Ramadan, 253 Healthcare Workers get Infected with COVID-19.
- Operational considerations for multisectoral mental health and psychosocial support programmes during the COVID-19 pandemic, Version 1.1.
- Public Health England: Guidance on Shielding and Protecting People Who are Clinically Extremely Vulnerable from COVID-19.
- Van Bunnik, Bram A.D., Morgan, L.K., et a. Segmentation and shielding of the most vulnerable members elements of an exit strategy from COVID-19. University of Edinburg.
- Michael TM, Clark S, Pogosjans S, et al. COVID-19 in a Long-Term Care Facility — King County, Washington, February 27–March 9, 2020. MMWR Morb Mortal Wkly Rep 2020; 69:339-342. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e1
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