Health care and societal resilience during COVID-19

by Luca Galbusera and Gianluca Pescaroli

After one and a half years, COVID-19 is still challenging risk and disaster management worldwide, calling for systemic approaches to mitigate its effects (Hynes, Linkov, and Trump, 2020). Research and practice related to the pandemic has often focused on the direct impacts to the health care sector. Yet, the pandemic has highlighted that an effective response requires multidisciplinary thinking and awareness of societal interdependencies.

Our research groups at University College London and European Commi09ssion’s Joint Research Centre (JRC) cooperated on a pan-European survey study titled “Covid-19: Emergency, Recovery and Improvement”. This explored risk perceptions, emergency communication and management, future developments of the pandemic and lessons learned. The study took place between May and July 2020, a phase following the first epidemic wave peak in most regions of interest. Based on public and voluntary participation, we collected over 3000 responses. Most of them came from Italy, Romania, Spain, and the United Kingdom. The survey results were later elaborated and discussed in a scientific publication (Pescaroli et al., 2021).

Perceptions of the emergency

Our analysis suggests how the contagion outbreaks in Italy “represented a critical ‘tipping point’ which changed the perception of COVID-19 from being a faraway event, to a collective and European ‘emergency’”. Participants identified several reasons for the spread of the virus, most prominently lockdown measures being implemented too late or not restrictive enough, jointly with the indifference, carelessness, or lack of caution among the population. Before the outbreak, respondents considered an epidemic in Europe to be rather unlikely. Moreover, national civil protection services were felt as somehow inadequately prepared, albeit with country differences.

We investigated preparedness measures adopted at the individual/household level, such as keeping medicine and food supplies, reading official information on what to do in a pandemic or other events, and organizing for working or studying remotely. The largest proportion of respondents did not take any such measure. Nevertheless, some differences emerge in the minority that did, which was highest for reading official information about the pandemic and organising for working/studying remotely.

Psychological well-being was affected more than workplace, family, and economic well-being. Key concerns included the impacts of the event on the health of participants and their families, the consequences on economy, work and study, and the saturation of hospital and emergency facilities.

As expected, patterns of consumption and access to services displayed significant changes compared to before lockdown. In particular, the daily consumption of food, water, electricity and heating appears to have increased, jointly with the use of telephone and internet services. At the same time, we registered a drop in the use of transport, health services, hospitals, banking and financial services.

The respondents worried mainly about the direct consequences of the primary crisis. Generally, there was less apprehension about other possible contingencies such as disruptions of essential services, the concurrence of events such as flooding, or risks of intentional damage actions such as terrorist acts or riots.

Emergency communication and management

During the emergency, the main information sources were the Internet and television. Some news (real or fake) were considered particularly worrying, including the blockage of imports of protective equipment such as gloves and masks, conspiracy theories, prioritization of younger patients, and the total closure of supermarkets and pharmaceutical services.

Quality of emergency communication was perceived as comparatively better when addressing restrictions of free movement and measures to prevent the infection, and worse for recommendations about physical and psychological well-being. In terms of emergency support tools, top scores were attributed to symptom-tracking apps and the free distribution of videos that teach good practice.

Future developments

Nearly half of the respondents thought that they could sustain restrictive measures for a few months and a further third for a few weeks. In this case, country differences were noticeable, also depending on the specific epidemic trends at the time of the survey. On the other side, a strong agreement was found on the idea that activities could be revived through a combination of measures to promote a progressive restart, rather than no measures or total lockdown strategies.

In terms of personal priorities after the lockdown, participants stressed a return to regular study or work conditions, getting back together with one’s family, mobility without geographical restrictions, and full access to health services. We also assessed awareness of national social and economic measures, participation in forms of volunteering, and socioeconomic priorities deemed to be the most important. The latter, in particular, were topped by investment in health and research and financial support for families and vulnerable categories (see Figure 1 for further details).

Figure 1. Results for question “On a personal level, what will be your priorities during the recovery?”.
Abbreviations: ALL (all countries), ES (Spain), IT (Italy), RO (Romania), UK (United Kingdom).

Finally, we investigated if and how the experience gained during the COVID-19 emergency can help to improve disaster management and societal resilience. In this sense, we registered a tendency towards optimism, especially as far as emergency support logistics and technologies are concerned.

Discussion and conclusions

Our study has to be considered indicative rather than representative of general populations in Europe. Nevertheless, it allowed us to gain some new insights into this crisis. In particular, we understand that “the root causes for the spread of the disease were attributed to factors that reflected global interdependencies or general mismanagement, rather than to the magnitude of the hazard itself”. This needs to be taken into account in future emergency preparedness and response strategies for pandemics and systemic crises in general. Aspects to be addressed include the strengthening of supranational governance, as well as the integration and coordination of regional response systems.

Our study reflected a shift in the use of essential services, potentially able to induce long-term changes such as higher penetration of internet-based solutions. Moreover, our data suggest the need of understanding better how pandemics could interact with climate change scenarios and technological dependencies. Further actions should promote better use of the information available for prioritising targeted resilience measures, raising public awareness of concurrent events, and enhancing communication in times of crisis.

Finally, we mention that a cognate study on public perceptions of COVID-19 has been performed in Japan (Suppasri et al., 2021) and that the JRC conducted a study on emergency and business continuity in critical infrastructures during COVID-19 (Galbusera, Cardarilli, and Giannopoulos, 2021).



Galbusera, L., Cardarilli, M. and Giannopoulos, G. (2021) ‘The ERNCIP survey on COVID-19: Emergency & Business Continuity for fostering resilience in critical infrastructures’, Safety Science, 139, p. 105161. doi: 10.1016/j.ssci.2021.105161.

Hynes, W., Linkov, I. and Trump, B. (2020) ‘A systemic approach to dealing with Covid-19 and future shocks. New Approaches to Economic Challenges (NAEC)’, Paris: OECD, 18(08), p. 2020. Available at:

Pescaroli, G. et al. (2021) ‘Linking healthcare and societal resilience during the Covid-19 pandemic’, Safety Science. Elsevier, 140, p. 105291. doi: 10.1016/j.ssci.2021.105291.

Suppasri, A. et al. (2021) ‘Perceptions of the COVID-19 pandemic in Japan with respect to cultural, information, disaster and social issues’, Progress in Disaster Science. Elsevier, 10, p. 100158. doi: 10.1016/J.PDISAS.2021.100158.


Luca Galbusera

Dr Luca Galbusera received his M.Sc. in Systems and Control Engineering (2006) and Ph.D. in Information Engineering (2010) from Politecnico di Milano, Milan, Italy. In 2013, he joined European Commission’s Joint Research Centre, Ispra, Italy. There, he currently works as a project officer at Directorate E – Space, Security and Migration. His research activities include the development of mathematical modeling, control and optimization methods for complex and networked systems; critical infrastructure protection and resilience; disaster risk reduction and emerging threats (including cyber and hybrid threats); supply chains, business continuity and economic impact assessment.


Gianluca Pescaroli

Dr Gianluca Pescaroli is Assistant Professor in Business Continuity and Organisational Resilience at University College London (UCL). His research investigates how to build and improve the continuity of operations during disruptive events, how to minimise their impacts, and how to increase the resilience of the public and private sectors. This includes managing complex challenges such as cascading risks, critical infrastructure failures, systemic and compound dynamics. In 2016, he co-founded the Research Group on Cascading Disasters at UCL. He is active in consultancies for local authorities and international organisations on topics such as resilience to cascading scenarios and stress testing. In 2020, he became the director of University College London’s multi-disciplinary Master programme in Risk, Disaster and Resilience.