News InOrder is completing its first year with this special edition. The global COVID-19 pandemic is close to completing two years. It has resulted in ~5 million reported deaths across the world and close to half a million deaths in India. It is still raging with nearly half a million daily positive cases being reported across the world. 

Towards the end of these two years, we are wiser and have more arsenal to use than we did back when the pandemic first broke out. However, we continue to struggle with many unknowns. Face mask, hand wash, and social distancing offer reasonable and consistent protection against all variants of the virus. Containment measures, if enforced effectively, are capable of preventing the spread. Vaccines of different make offer varying protection against hospitalizations and deaths. 

Many repurposed drugs, except steroids and to some extent Remedesivir, are found to be not useful. Monoclonal antibodies offer protection in the early phase of the illness. Variants continue to emerge with varying rates of infectivity and immune evading potency. Neutralizing antibodies decline over time after either vaccinations or natural infections. However, the duration of protection after vaccines or natural infection is yet to be ascertained. Breakthrough infections with existing and new variants continue to remain a possibility. The timeline for antiviral drug development is still unknown. 

We now have access to tests on demand and tests at home. We have enough personal protection equipment. Capacity for isolating and treating COVID positive patients has increased significantly. Home monitoring has become so ubiquitous that over-monitoring induced anxiety has become a new problem. Telemedicine has come of age in providing consultation on demand anytime and anywhere. Oxygen capacity is being rapidly ramped up. Current vaccination coverage rates and the growing capacity to vaccinate point to a likelihood that most of the eligible people will be vaccinated by the end of this year. Nearly three fourth of the population has evidence of immunity against Covid as per the latest nation-wide sero survey report. Social gatherings are increasing. More people are travelling. 

We are at the cross-roads on taking the next route. The devastating second wave dispelled the false optimism the country embraced after the first wave. People are deeply worried about the third wave. Given the facts above, which route should we take? Face mask, hand wash, and social distancing shall be the new normal, not only against COVID-19 but also against various respiratory pathogens and pollutants. Vaccination of all eligible, including children as and when the vaccines are approved for them, shall be the continuing priority. Strengthening public health, primary healthcare and acute care in districts and sub-districts shall be on top of policy agenda. We shall leverage the power of digital technologies for active disease surveillance and rapid response. Financial protection of the missing middle is the urgent need of the hour. 

Collaborative learning between states, between developed and developing nations, between researchers and practitioners, between public and private sectors, and between payers and providers shall make the leadership wiser to prevent the next pandemic and put rapid response systems in place, including financial and social protection against not only pandemics but also other crises induced by climate change, war and strife, and mass migrations. Utmost importance shall be given to human resources for health. Unlike infrastructure, it takes years to produce frontline health professionals competent to manage pandemics and other crises.  

Major reforms like Ayushman Bharat Health & Wellness Clinics (HWC) and Pradhan Mantri Jan Arogya Yojana (PMJAY) were introduced prior to the pandemic. The National Digital Health Mission (NDHM), rechristened as Ayushman Bharat Digital Mission (ABDM), was launched amidst the pandemic last year. COVID-19 has given a new found thrust to implement these reforms that have the potential to transform India’s health system if implemented effectively. 

There should not be any dilemma as to which road to take. We shall learn to live with COVID. We should make our health system strong and resilient to secure people’s health against future waves and future pandemics and climate change related crises. 

Dr Krishna Reddy Nallamalla

President, InOrder
Country Director, ACCESS Health International

Photo Credits: UNICEF India