key: cord-1026286-f4f9xafn authors: Balsarkar, Geetha title: From the “New Normal” to a “New Future”: A Sustainable Response to COVID-19 date: 2021-07-21 journal: J Obstet Gynaecol India DOI: 10.1007/s13224-021-01527-5 sha: cc433e7cff9e4aa049222ae8d13db0e462b3f6ad doc_id: 1026286 cord_uid: f4f9xafn nan We are fifteen months into the COVID-19 pandemic and infections and deaths are waxing and waning in many parts of the world. There are now more than 48, 786 new confirmed cases in a day in India, total cases of 3.04 crores and over 3.98 lakhs death in all. For the first time in the history of mankind, there has been such drastic behavioural change in humans. The coronavirus pandemic has drastically changed the way common people live, interact, and work. Social distancing, facial masks, and hand sanitization have to be followed in any closed space. Rules of communication and etiquette have been modified in personal growth, social life, and the business world, and even in medical communication. Beside changing social and work ethics like finishing all outdoor activities like shopping and work in one go before reaching home, measures taken to contain the virus have also reshaped greetings and the rules of everyday etiquette. The pandemic brought about a significant change in living from greetings from far to handshaking, table and seating arrangements with social distancing, entertainment culture in open air, artistic activities rekindled while at home isolation, sports activities in open environment, and most importantly, professional behaviour codes of conduct. Expensive clothes, hair, makeup, and accessories will be replaced by simplicity and pastels, and natural colours will be preferred more in clothes. Most consultants counsel one reliable relative in addition to the patient consistently and the number of relatives accompanying the patient is reduced to one. Instructions are given in clear writing to reduce time with the patient. Question and answers are to be kept at a minimum. Before procedures, Covid testing of nasal swab by RTPCR is advisable to prevent untoward outcome of the surgery. Unnecessary exposure of the patient in the hospital is reduced. India has low COVID-19 figures today compared to April and May, because of multiple pronged approaches. As we have built up our capacities and mechanisms for emergency response to the peak of the pandemic, we are also preventing unnecessary hospitalization and improving turnover of patients. Those asymptomatic patients who can be managed at home are also attended to at home. However, as the pandemic in India is entering a "new phase" of the outbreak, we are on the brink of a third wave and governments and individuals need to take further responsibility and further actions to mitigate risk of infection and minimize transmission while maintaining social and economic activities at the same time. Vaccination also plays an important role in improving herd immunity. The Government of India on 19th May 2021 gave its approval to administer vaccination to lactating women who wish to take the dose. The Federation of Obstetric and Gynaecological Societies of India and The National Expert group on vaccine administration for COVID-19 state that "benefits outweigh the risks" and therefore women who breastfeed must be educated about the vaccine and given the choice to make informed decision. Many paediatricians across the country believe vaccinating the lactating mothers would help provide infants with antibodies via breast milk. This would further help build relative immunity against the virus in these children. Five and a half months into immunization programme against COVID-19, pregnant Indian women have been allowed vaccination, paving the way for the entire adult population of the country to be vaccinated. A total of 33.57 crore vaccine doses have been administered till date in India. While several countries have managed to contain outbreaks early on in the first phase, many are now tackling new surges. For India, these new clusters in the second wave were larger and more complex than their initial outbreaks. We are on the brink of a new third wave now. In recent times, young and healthy people in their 20 s, 30 s and 40 s who were previously isolated at home for long have been driving virus transmission-young adults who are socially and economically active, mobile and returning to work. Many are often asymptomatic or present only mild symptoms if infected and, therefore, may unknowingly spread the virus to co-workers, elderly family members and others. These transmissions remain challenging to detect, despite improved surveillance, expanded testing and screening programs, better laboratory capacity and increased health care-seeking practices. Relaxed control measures, declining risk perception and the understandable desire to return to normalcy have led to reduced protective behaviours and more social and workplace interactions, often in confined, close-contact and crowded settings, where the virus spreads efficiently. This is known as Covid fatigue. These trends of waxing and waning infection pose worrying risks, particularly to vulnerable and disadvantaged groups: older people, people with chronic conditions and/or disabilities, people living in populous urban slum areas or rural areas and others who are marginalized and have limited access to information and services. If not immediately tracked and traced, infections among some of these populations can result in more severe and fatal outcomes. In response to these emerging trends, many states in India are starting to explore more economically sustainable and targeted response models that proactively work to suppress new COVID-19 outbreaks while reviving their economies and societies, rather than taking a reactive approach to outbreaks and having to repeat nation-wide "lockdowns". In the short term, governments should continue strengthening public health and health system capacity, especially the early random screening and detection of and targeted response to asymptomatic transmission among younger populations. Experience suggests that rapid detection coupled with robust contact tracing can control clusters of infection. In parallel, we should continue strengthening the capacity of their health care systems, including health facilities to ensure enough space and equipment to care for people who are severely sick, and intermediate facilities or home quarantine for those who have milder symptoms. A strong public health and health care system enables countries to accommodate more infection without overwhelming the health system and having to trigger drastic public health measures. Preventing COVID-19 transmission is heavily dependent on public compliance and private sector cooperation with the government to suppress human-to-human transmission. India has adopted new social behaviours to prevent infection, such as mask-wearing, physical distancing, teleworking and hand hygiene as part of daily life. Now, the challenge is to make these new behaviours part of our everyday habits. It is in public interest to improved understanding of individual responsibility and, subsequently, a greater willingness to adopt infection prevention practices as part of "the new normal". Embedding these practices as part of our "new normal" can be a stepping stone to a "new future", with benefits for other health issues, far beyond the response to Recognizing that the virus will be with us for a long time, governments should also use this opportunity to invest in health systems, which can benefit all populations beyond COVID-19, as well as prepare for future public health emergencies. These investments may include (1) capitalizing on COVID-19 pandemic-induced enhancements to surveillance, laboratory, risk communications and other core capacities, (2) backcasting to identify gaps and steer resources to future health needs like genetic sequencing and contact tracing with Information Technology, (3) building on COVID-19 innovations to accelerate recovery and address other pressing health problems and (4) strengthening multi-sector collaboration to improve health services and reduce health inequity. (5) Improve vaccination for all communicable diseases in addition to COVID-19. After 15 months of the pandemic, we are starting to see a way to restore health, economies and societies together. Long-term planning and investments will enable us to rebuild more resilient societies and help achieve our common vision to become the healthiest and safest country Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. From the "New Normal" to a Dr. Geetha Balsarkar is a Professor at Seth G.S. Medical College and Nowrosjee Wadia Maternity Hospital, Mumbai, India. She is a Librarian of Mumbai Obstetrics Gynecology Society, President of Menopause Society, Mumbai Branch, President of AMWI, Mumbai Branch, and Editor-In-Chief, Journal of Obstetrics and Gynecology of India, FOGSI Journal. She has undergone training for the PPI-UCD program and is also the faculty member of many training programmes as well. She has over 18 years of teaching experience and is actively working on FIGO FOGSI Project of PPIUCD in India. She is a recipient of the prestigious Hargobind Foundation for the study of Fetal Medicine in 2008 at St. George's Hospital, London.