“THE SHIELDING APPROACH”: FEMA CAMPS INFORMATION, OUR SAVING GRACE Part 2 of 3, from Vaccines and Related Biological Products Advisory Committee October 22, 2020 Meeting Presentation https://www.fda.gov/media/143557/download
“Fiction is the lie through which we tell the truth.” – Albert Camus
I say, “Just tell the truth.”
FOLLOW THE YELLOW BRICK ROAD! (Have you read my article about the Wizard of Oz?)
Last October 22, 2020 a group of fifteen entities (I do not refer to them as people or human, they are various levels of demons) met to hammer out details for FEMA camps under martial law to murder everyone who refuses the mark of the beast, or is displaced by the catastrophes caused by the Wormwood System, in advance of the final end of the planet. This is far, far worse than the Japanese internment camps of World War II. And this is more than ‘just’ (as if!) Covid: this is all overarchingly a part of the Holy War and their refusal to bow down to God coming as Jesus Christ in the Singularity Event coming, which if anyone at all acknowledges usually refers to as “cataclysms” the way Velikovsky did. A deeper awareness and acknowledgement – the profoundest of acceptances – must take place on the individual level.
Satan is the consummate deciever, and they have done their homework for ages. The pseudosciences of psychology, psychiatry and social engineering, the work of Cark Gustaf Jung, Sigmund Freud, B.F. Skinner and John B. Calhoun’s MOUSE UTOPIA studies enabled them to utilize eugenics, economics, and social programs in a trajectory that must be seen for what it is, Satan’s long-term plan achieved by implementation of a welfare state. Just as Derek Prince explained so thoroughly and clearly in these talks on THE ENEMY WE FACE, all of this world and the heavens below the firmament (they call that the Van Allen Belts) is Satan’s kingdom of power. Worldly freedom has been a delusion, matter is a cymatically-controlled construct, and that cymatics is controlled with PHARMAKEIA AND PROGRAMMING AND THAT IS ALCHEMICAL MAGIC: SORCERY.
Metals are the underpinning, and key in the manifested material body, which is the container for the soul in the meat suit and why we detox of them. In the apocryphal texts we are told that metal, jewelry and coins were incepted to enslave us. Remember that the Most High would allow no iron at all on His altars: this is why. The aliens – the fallen angels – are archons and demons and they depend on metal. Light bodies – we human beings, Children of the Light – are incarcerated into these bodies with free will to pick a side! Our weapons are spiritual. Oh my goodness, I could go on! So as you read this second part of this three-part series, understand that this Trojan Horse plandemic has been “rolling out” since time immemorial in the Holy War coming to its finale soon, the final countdown, as so prophetically sung about by that heavy metal – how obvious does this charade have to get! – band from the 80’s, which we are in.
We are the hunted, the herded: their target, set up by being made toxic from within with heavy metals, chemicals, gender-reversing pesticides and plastics, nanotechnology and parasites. The MK Ultra umbrella of Elon Musk’s satellites and the 5G towers, all operated by quantum computers, is just a refinement of their long-term plan. When those still becoming aware of all facets acknowledge that all of this is to entrap souls (consciousness) because Jesus Christ is coming as the LIGHT OF THE SINGULARITY, they will SEE. The only benefit this infernal smart technology spread all over the earth has is paradoxical, in that it is destructive but is spreading the message to all humans, even in the most remote places on earth, and that is a requisite.
THEY CALL IT THE SHIELDING APPROACH
FEMA CAMPS ARE COMING, IT IS NOT A CONSPIRACY THEORY. The C.D.C has published their outline for their implementation and I share it here. This is the biggest pharmakeia sorcery in the history of the world. Last night I revisited The Epic of Gilgamesh as well as The Emerald Tablets of Thoth, and then the alchemical research of Isaac Newton, whose words were twisted by the catholic church to craft the narrative for the globe lie: unless there are texts older than these that I am not privy to, this strong delusion is unparalled.
Under the name “Shielding Approach” their internment camps are to shield humans from communicating, and control thinking in the absence of empirical data. They come right out and say it. They know that we are made in the image of the Most High and, as it is written in the apocryphal texts again and again, are smarter than them and will figure everything out.
In the PDF Vaccines and Related Biological Products Advisory Committee October 22, 2020 Meeting Presentation (the same title of this article), the C.D.C., who I personally testify is a group of murderers. Every government regulatory agency is. Why? BECAUSE THEY EXIST TO CRAFT AND ENFORCE SATAN’S LIES, THEFT AND MURDER. PERIOD. In my life it was destroying my family and they are still trying to snuff me. Their refusal to diagnose and treat me for Lyme disease was the last straw on my camel’s back, stealing my family from me with their lies, and using my malignantly evil Washington D.C. newsman ex-husband (of two years only! a stranger!) as a major narcissistic sabotaging player to boot.
The vision that I had at age nineteen while pregnant with my daughter Emily is the reality we live in now. In my lifetime it is prophecy fulfilled: NOT FOR A CONSTANT MOMENT BUT THE WORLD WILL BE OBLITERATED. Some of us humans have known for years that there would be an end times with FEMA camps. My childhood nightmares revolved around this PERILOUS TIMES HAVE COME: MY CHILDHOOD PRECOGNITIVE NIGHTMARES is that article. At age eighteen I watched the movie THE DAY AFTER and began prepping, but it was off/on as because since I had rejected the C.I.A.’s multiple recruiting attempts in my last year of high school, they made my life hell and I have been MK Ultra’d since birth (before, really) – read DO YOU KNOW THIS FACE, HOW IT BEGAN, IMAGINATION LIMITS OUR FUTURE, DMT AND ALL: (Re-post, note date), THE PHYSICS OF THE SOUL, PSALMS 91, LYME TRUE HISTORY OF PARASITES, THE KALI YUGA POST: Conciousness, Addiction and HOME and KEY POINT HEALTH, THE DOTS JUST KEEP ON CONNECTING, in which I expose the federal mental health system and how it is used to destroy families.
We are both blessed if you are able to read ANYTHING I publish here because I am so censored. Why am I so heavily censored?
BECAUSE I AM APPARENTLY – AS FAR AS I HAVE BEEN MADE AWARE – THE ONLY HUMAN BEING CONNECTING ALL OF THESE DOTS AND BRINGING ALL OF THE WORLD THEATER, EVERY SINGLE THING HAPPENING, EVERY “RABBIT HOLE” AND DISCLOSURE, EVERYTHING THERE IS THAT IS BECOMING “A THING” IN THE MINDS OF MEN, AND TYING IT TO DETOXING THE PARASITES FROM THE BODY, THE GOSPEL JESUS CHRIST PREACHED, FOR WHICH HE WAS CRUCIFIED.
In the post on December 7, 2020 called Our Saving Grace, Part 1 of 3, I showed you the progess a client was making and it should be absolutely clear to my readers that the devils Jesus told us to cast out are the parasites, which are archons.
In 2018 I was divinely inspired to write about how archons – TICKS, parasites – GROW IN A VACUUM in an article called THE EXTRATERRESTRIAL PARASITES AND THE FRAUD OF DISEASE… READ THAT AND UNDERSTAND THAT THIS IS WHY THE SINGULARITY MUST COME. THIS IS THE DNA RESCUE MISSION OF THE CREATOR OF LIGHT AND OF SOUND AND OF ALL THAT IS.
A note on DNA: below are three images of DNA being “beamed” to earth from YAHWEH. The first is from a WSO video, the second is from one of the photographs I took looking outside my window on December 19, 2018 the day before my daughter-in-law Nichole was murdered by the elite with Fentanyl, and the third was just two weeks ago here in Virginia. This DNA is from The Purifier, a part of the Wormwood System investigated so well by Hush Puppy and his team, Deborah Tavares, and many others I have named here within the last three years on this website. We are being PURIFIED BACK TO OUR LIGHTBODIES, but one MUST acknowledge Christ. The fact that people dismiss this necessity is proof of the millenia of mind control against this. Some of us can HEAR THE DNA PURIFICATION PROCESS, and this is why we were tested for our high-frequency hearing abilities as children, when every few years a select few of us would get called into the side room of the school principal’s office and were tested and tabulated. No explanation ever given, no papers to take home: no permission. I write about this and more in my book.
DEFINITION OF MESSIAH: LIBERATOR
The National Institute of Mental Health in Washington, D.C. had an employee named John B. Calhoun, M.D., who was tasked to craft a study – which then ran for over a decade – on how to disintegrate human society. The division that Dr. Calhoun worked in at the N.I.M.H. has the lengthy title of SECTION ON BEHAVIORAL SYSTEMS, LABORATORY OF BRAIN EVOLUTION AND BEHAVIOR. That sounds quite Frankenstein-ish, doesn’t it? So the study was begun in the early Sixties in the same time period that the C.I.A. was expending great efforts to establish the Hippie Movement, destroy the family structure and church-going, and create a drug-addicted culture sickened by sugar, wheat and pesticides, chemicals and everything else heretofore mentioned. A LONG RANGE PLAN. Not JUST satanic: SATAN’S PLAN. NAME HIM, BECAUSE SATAN IS REAL. You MUST IDENTIFY THE ENEMY.
IT IS IMPORTANT THAT YOU UNDERSTAND THE SITUATION IN WHICH THE APOSTLE JOHN TRANSCRIBED THE THE BOOK CALLED REVELATION IMPRISONED IN A CELL ON THE ISLE OF PATMOS. Why is this important? The designer of the study elaborates below.
In his summary of the MOUSE UTOPIA ten-year human population, published
in the Royal society of Medicine, Volume 66 (interesting number, eh? Coincidence? There are none!) in January 1973, John B. Calhoun, M.D., in true sorcerer’s magic spell requirements, attributed the true meaning of the decade-long study, and its spiritual place in the Holy War of Satan against the Most High. He referred to what Jesus told the disciple John, who was ankle-shackled in the towering fortress prison on the Isle of Patmos where he was given the prophetic vision which he recorded in the book of Revelation:
“I shall largely speak of mice, but my thoughts are on man, on healing, on life and its *evolution. Threatening life and evolution are the two deaths, death of the spirit and death of the body. Evolution, in terms of ancient wisdom, is the access to the tree of life. This takes us back to the white first horse of the Apocalypse which with its rider set out to conquer the forces that threaten the spirit with death. Further in Revelation (ii.7) we note: ‘To him who conquers I will grant to eat the tree of life, which is in the midst of the paradise of God.'”
This is the sorcery of Satan’s minion, a demon in the flesh named John B. Calhoun, with a degree called medical doctor which is symbolized by the cadeuceus, doing exactly what Hollywood does with its holly wood sorcerer’s wand casting film spells of what they wish to alchemically come to pass upon humanity and the earth.
Why? THIS HAS ALWAYS BEEN SATAN’S PURPOSE EVER SINCE HE FELL. THIS IS A WAR AGAINST LIGHT ITSELF. The material body is a materialized PUNISHMENT they hold in cymatic prison with metals and programming to enslave us because we are their power resource – THEY HAVE NO POWER.
This is why they use trauma. Remember my posts FEAR TO LOVE and THE BODY KILLS THE SOUL? Connect the dots please, in your own lives. Wake everyone you love up even if they shun you for speaking the truth. As Derek Prince so eloquently said, our victory will look to the world like a defeat. We must not cling to the structures amassed here as any reflection of safety or validity! We must NOT love our lives in exchange for the death of our souls.
The demon employee Dr. Calhoun continued – mind you, this was 1973, and they were working HARD to create the welfare state and establish racial tensions and make abortion acceptable, and Gloria Steinem who spearheaded (another telling euphemism) their women’s liberation movement was a C.I.A. operative in this timeframe, and the L.S.D. experiments .. which I witnessed growing up next to Spring Grove State Hospital in Catonsville, Maryland, home to the Catonsville Nine who burned the draft records in 1968 and helped end the Vietnam War by that life-saving act of love – read this article!) and the new age movement, rock and roll, 440Hertz…
The proof that every system in the world exists to kill us, and that the fallen angels, working under Satan, poisoning us to affect our right use of the free will the Most High gave us using alchemical magic to prevent us from escaping the frequency prison and entrap our souls in the hell they will suffer eternally (the cloud cube of trans/posthumanism, THEY THINK, LOL! What hubris Satan has still! He is death and he will end!) when the FINAL SINGULARITY EVENT WHICH IS PLANETARY EXTINCTION LEVEL COMES.
Human beings were instructed by the Most High GOD not to eat from the tree of life. Here’s why:
As the chapter of my upcoming book on this is called: ALL ROADS LEAD TO COVID. Please take serious consideration of the admission in his titling of the study report to the world rulers: IT IS CALLED DEATH SQUARED BECAUSE THE BODY KILLS THE SOUL. TWO DEATHS. There is a first death and a second death: the body, then the soul. Satan rebels to the very end in his futile attempts to miscegenate and destroy the Children of the Light. He sure was jealous when the Most High created Light, who we call Jesus. And in Revelation 22:2 we read that the LEAVES of the tree are made available to those who overcome the deceits of the devil, the threats in this world – especially in these last days. NOT the fruit: the LEAVES. But only for those who don’t take the mark of the beast and who confess in their heart to The Light of the Singularity, who is Jesus Christ, Yehoshua, Yeshua Ha’ Mashiach: the MESSIAH.
Therefore naming government’s Mouse Utopia Study report “DEATH SQUARED” is part of the requirements of casting their magic spell. Just like the Harry Potter series, and Magnolia, and Peggy Sue Got Married, Total Recall, all Harry Chaplin’s work, Winter’s Tale – ALL THE FILMS. And if you haven’t read or watched Winter’s Tale, please do! Here is my decoding of it I did for my son Max THE MOVIE WINTER’S TALE DECODED.
JESUS IS THE DNA RESCUE MISSION.
DNA RESCUE MISSION!
DNA RESCUE MISSION!
DNA RESCUE MISSION!
Back to the MOUSE UTOPIA United States government researcher John B. Calhoun M.D., who goes on to proclaim:
“This takes us to the fourth horse of the Apocalypse (Rev. vi.8): ‘I saw a pale horse, and it’s rider’s name was Death, and Hades followed him; and they were given power was given power over a fourth of the earth, to kill with the sword and with famine and with pestilence and by wild beasts of the earth’ (italics mine – JBC). This second death has gradually become the predominant concern of modern medicine, or, in the precepts embodied in the Hippocratic Oath, that precludes medicine from being equally concerned with healing the spirit, and healing nations, as with healing the body. Perhaps we might do well to reflect upon another of John’s transcriptions (Rev. ii.1): ‘He who conquers shall not be hurt by the second death.'” – Source: Death Squared: The Explosive Growth and Demise of a Mouse Population, Proceedings of the Royal Society of Medicine, Volume 66, January 1973
*Evolution is Satan’s genetic manipulation of biological life created by the Most High GOD.
I BELIEVE TICKS AND MOSQUITOES AND PARASITES ARE THE WILD BEASTS.
Everything I have been writing here since 2018, and before that, in my now-defunct Facebook group which was called Morgellons Focus: Alkaline Diet and Optimal Health in a Nano EMF Toxic World culminates in this black magic wizard’s study recap presented to Satan’s Kingdom in their medical journal. The demon Calhoun accurately states Revelation as Jesus Christ’s disciple John’s writing down verbatim what he saw and heard: that is transciption, and this is a scientist who crafted the Mouse Utopia study to the end we are a part of now in Tribulation with the world under the Strong Delusion of pharmakeia and programming (mind control). The only way to survive is to die without taking the mark of the beast, and we will address how to do that in Part 3, which I will post within the next 48 hours, God willing. – @EatingToAscend (Laura Rohrer Little Brooks)
Below is the content from https://www.cdc.gov/coronavirus/2019-ncov/global-covid-19/shielding-approach-humanitarian.html which I place here for all of us human beings to be aware of and preserve our souls from these fallen angels and Satan himself. Remember Ephesians 6: 10-19 at all times. Know that your testimony is what is required and that the battle is already won. Death is nothing: the body is a husk, a meat suit of imprisonment. My goodness! I live amongst total zombies, most of you do, I am sure. We are the elect, and we are the Body of Christ, LIGHT INCARNATE.
(For individuals using assistive technology needing help accessing the information send email firstname.lastname@example.org include 508 Accommodation and title of document in subject line of email)
PDF 3 (as in rat fink) COVID-Fink
FEMA Shielding meeting video on YT (official) https://www.youtube.com/watch?v=1XTiL9rUpkg
The online web conference meeting will be available at the following link: http://fda.yorkcast.com/?webcast/?Play/?c26e83a0f77a412296949f4f43af4c981d
Interim Operational Considerations for Implementing the Shielding Approach to Prevent COVID-19 Infections in Humanitarian Settings
Updated July 26, 2020
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 Approach?
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.
[Below is the table (summary) and here –> https://www.cdc.gov/coronavirus/2019-ncov/downloads/global-covid-19/Interim-Operational-Considerations-Implementing-Shielding-in-Humanitarian-Settings.pdf <– is the link to 26 resources used to create these FEMA camps]
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.
(Copied text of Summary of the Shielding Approach Table 1
Table 1: Summary of the Shielding Approach1
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.
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
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.
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
(Text copied from the Operational Considerations table 2 below
Table 2: Suggested Prerequisites per the shielding documents and CDC’s Operational Considerations for Implementation
*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.
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
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.
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
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
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.
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.
*Specific psychosocial support guidance during COVID-19 as specific subject areas are beyond the scope of this document.
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