Pandemic Volunteers: The Imperative for Regulations and Training

Dear Editor,

Volunteer work is integral to disaster planning, preparedness, and recovery. ¹ This might explain why volunteers are often assumed to be both capable and altruistic, ² even though opposing evidence is present. ³ The coronavirus disease 2019 (COVID-19) pandemic, however, may substantially challenge these two deep-rooted assumptions about volunteers, especially in counties where large numbers of volunteers are needed to facilitate pandemic prevention measures like China. During the height of the 2022 Omicron outbreak in Xi’an, a megacity in China, for instance, a group of epidemic prevention volunteers in white hazmat suits was seen beating a man violently because the person allegedly violated the shelter-in-place rules by going outside of his apartment compound for food. ⁴ While chilling and outrageous, similar violence kept happening, ^5–7 which may change how people in China view pandemic volunteers, who were once affectionately dubbed as “Da Bai”, which literally means the “Big Whites” or the “Great Whites”. ⁸

With the public narrative of “hero to zero”, from pandemic prevention heroes to enforcers of “Zero COVID”, ^8,9 the shifting narratives around the “Big Whites” might reflect more than mere clashes of news reporting styles or political ideologies; rather, they mirror a sobering revelation of what these “Big Whites” can and are capable of doing in the name of pandemic prevention. In early November 2022, for instance, security footage revealed a shocking incident unfolding in Linxi, a city in Shandong province—seven people in hazmat suits were seen beating one civilian, while the cry for help from his wife, pregnant at the time, could even be heard from the video loud and clear, the two police officers present at the scene stood by and did almost nothing. ⁷ Although all of these seven pandemic volunteers were later arrested, ¹⁰ the presence and continued emergence of these chilling incidents raise a critical question: What can society do to prevent these incidents from happening in the future?

Laws and Regulations

One way to address the issue is by means of developing laws and regulations that specify the rights, responsibilities, and powers of volunteers. As indicated above, volunteers, regardless of how good their intentions are, are not immune to bad behaviors that could lead to severe social consequences. In the same vein, being able and willing to help does not mean volunteers are either competent or able to safely support the very people they attempt to help. While helping disinfect a neighborhood in the city of Dalian, China, a 54-year man died of a heart attack in the midst of the process—one of the many volunteer deaths that happened across the pandemic continuum. ¹¹ Reports from China, for instance, show that several COVID-19 volunteers have been killed during altercations with members of the public. ¹² These insights combined, in turn, underscore the imperative for establishing timely laws and regulations to ensure that all key stakeholders—volunteers, members of the public, and health officials—have a clear and comprehensive understanding of what should be expected from volunteers in terms of legitimate behaviors or unlawful overreach amid critical health emergencies like COVID-19.

Important Caveats

Understandably, this may not be an easy task. ¹³ While some laws are already in place that could help rectify bad behaviors—the example of volunteers beating a man is already illegal as it categorizes as an “assault and battery”—it should not matter whether they are volunteers or not, other regulations could be considerably more difficult to develop or deploy. For instance, when volunteers are resident members of the local communities they claim to be supporting, especially when without extensive training or qualifications, do they really have the authority to enforce COVID-19 rules, ranging from masking to quarantining? How strictly should volunteers be punished, if their consequential behaviors, be they unethical or illegal, were a result of misplaced good intentions and trust within the community? What happens if these volunteers are off-duty police officers, who or which departments should supervise or “police” these volunteers then? What restrictions should be in place to ensure that volunteers understand the importance of protecting people’s privacy (eg, individuals’ personal information, regardless of whether they tested positive for COVID-19) or as well as the know-how to securely protect these data? And as more attention focuses on virtual volunteering, ¹⁴ what sets of laws and regulations are needed to ensure the sustainable development of this branch of pandemic volunteering?

Who Are Pandemic Volunteers?

Volunteer management has always been an issue in disaster management, especially among spontaneous or “emergent” volunteers. ¹⁵ To establish clear and constructive guidance that could help volunteer management amid pandemics like COVID-19, one of the key steps that society needs to undertake is to define and differentiate pandemic volunteers from a legal and regulatory perspective. For instance, who should be considered pandemic volunteers? Are people who wear hazmat suits volunteers? And if not, what other mechanisms are in place to help the public identify volunteers from the rest of the population? In other words, how should people differentiate volunteers who intended to help from the “pseudo-volunteers” who might have both their intent and identity hidden under the disguise of head-to-toe hazmat suits? Different from easily identifiable volunteer vests, pandemic volunteers often wear white hazmat suits that cover them from head to toe. While the suits could help protect volunteers from COVID-19 infections, their disposable nature means that oftentimes no displays of identity are attached to these hazmat suits.

This is problematic as hazmat suits are not only used by medical professionals or pandemic volunteers; rather, they are often used by a wide range of people, ranging from civilians to law enforcement personnel. However, while already taxing, the lack of regulation on volunteers’ dress code is only one of the many problems present in post-COVID-19 volunteer management. For instance, even when the intent is clear—pandemic control and prevention, it is debatable as to whether and to what extent hazmat-suit-wearing epidemic control personnel, who could be civilians or police officers, with or without a memorable, if not shocking, criminal or disciplinary record, respectively, should be considered volunteers—people who are often perceived as altruistic, without ulterior motives, and could have access to the most vulnerable members of the society, ranging from children to the cognitively or mentally impaired. Due to the complexity of the issues, it might be difficult to develop effective policy solutions in a timely manner. However, fortunately, not all cost-effective solutions are as time-consuming as the establishment of laws and regulations. Interventions such as training programs, for instance, can oftentimes be developed and deployed swiftly and successfully. ¹⁶

Timely and Tailored Training Programs

Another way to ensure volunteer work is beneficial to society at large is by means of ensuring rigorous training is available to equip volunteers with sufficient knowledge and know-how they required effectively navigate through their tasks amid the pandemic. Although several studies have examined volunteer training in the context of COVID-19, these investigations are largely focused on educational programs developed for medical students, ^17–19 evaluated in hypothetical settings as opposed to real-world scenarios. To ensure pandemic volunteers not only have the goodwill to help, but also the capability to deliver the intended help optimally, and ideally with little to no unintended consequences, society should ensure pandemic volunteers receive sufficient training before their deployment, and when possible, evaluation systems along the way to ensure that quality volunteer work is consistently delivered. For instance, government and health officials could develop training programs that are tailored to the unique needs and requirements of COVID-19 control and prevention, such as how to encourage the public’s adherence to COVID-19 testing and quarantining rules effectively and emphatically, especially with vulnerable populations such as pregnant women or older people with cognitive impairment.

Rigorous Mental Health Care and Performance Evaluations

In addition to offering tailored training programs to volunteers so that they can more competently accomplish their tasks, they should also be equipped with sufficient knowledge and know-how to protect their own mental and physical health while helping others. It was estimated that COVID-19 caused an additional 53.2 million cases of major depression and 76.2 million cases of anxiety disorders across the globe. ²⁰ Research further shows that COVID-19 first responders often face severe mental health challenges such as anxiety, depression, and post-traumatic stress disorder. ^21–23 Considering the fact that pandemic volunteers often face additional and complex layers of stressors compared with the general public (eg, greater workload, elevated COVID-19 risks, and more exposure to stressful circumstances), it is possible that their susceptibility to the adverse impacts of COVID-19 could be even more pronounced. ^23,24 To prevent health challenges such as physical burnout and psychological stress, systematic evaluations should be integrated into the volunteer training and vetting programs to ensure they are both physically and psychologically qualified to help. Overall, amid COVID-19, as pandemic volunteers often represent their broader community, if not society as a whole, how well they interact with members of the public could have an outsized impact on public trust and confidence in the government.

Conclusions

COVID-19 has been a testing time for humanity. Quality pandemic volunteer work could be a stabilizing force in times of great uncertainty. Depending on how well they carry out their duties, pandemic volunteers could either be guardian angels or a source of anger and anguish in society. To ensure pandemic volunteers serve as ambassadors of the best of humanity and solidarity, particularly amid challenging times like COVID-19, government officials and health experts need to establish timely and effective guardrails, such as tailored training programs, targeted regulations, timely mental health care, and thorough performance evaluations, not only to safeguard the quality of pandemic volunteer work, but also to protect the interests and integrity of society at large. After all, pandemic volunteers should, first and foremost, not incur harm; and then, be a reliable and radiant light of humanity even in the darkest hours of COVID-19.