The ongoing 2nd wave of covid19 in India is a direct consequence of abandoning CAB widely. With extensive infection and death within the family and friends circle - I write this with some sadness and realization. 
Cultural Dimension:

1. Closing Nose and Mouth during cough, sneeze and clearing the nose is foundation to CAB - Not adopted as culture
2. Spitting is still a big social behavior in public and private 
3. Clinging on to one another in a queue is kind of norm. Never one sees a line of people maintaining breathing distance. Following a queue and keeping distance (without intruding in the gaps) needed.

• All these can be spread by systematic poster campaigns. 1000s of flex boards are used for all kinds of political messaging. Small clear messages can be designed and followed at every possible place needing this guidance
• Such flex posters (A4-A3 size) can be made as public service and obtained free of cost (or nominal cost) at every state level (Language group)

Status Dimension:

1. The well educated, upmarket, largely young (<50y), and well informed are opting to violate CAB. They are seen as 'models' by others and such behavior spreads as 'intelligent choice'. They can not be argued into CAB nor stopped from influencing others. Like smoking and social drinking - this is "cool" trend. I don't know how these "influencers" can be influenced
2. It is far easier to ask CAB violators from lower rung of society to follow. They listen and often pull up their - unfortunately dirty mask. This section need access to quality mask free of cost or at right price. Not education! 
3. The celebrity influencer group - from all facets of life - especially, "religion" are going to be important in driving the change towards following CAB. They all need to 'be the change they wish to see'. This as a social movement can be effective.

• All celebrities to be encouraged to come on TV slots to spread CAB.
• Under CSR the allocation of time can be shown (Law to allow this)
• Like 'Being Human' and other such brands - "I follow CAB" - T-Shirts can be designed and produced. Celebrities can endorse them. 

Information Asymmetry

1. Fake News, Fake Narrative and Dubious information spread is most VIRULENT in this time of Pandemic. This is a much bigger pandemic to address. 
2. At various levels, authentic data, information, Q&A, Counselling (numbers & email) need to be built to continuously supply more reliable information. Building through crowd sourcing, this needs some mechanism to prevent political ideological sabotage. 

• Certification programs (courses) to check information, Standard framework for publishing it online are needed
• Classification structure and blind verification need to be quickly built and continuously refined. 

Lawlessness

1. Hospitals entering into deals with brokers, fake oxygen, spurious medicines, unscrupulous callers asking cash to serve the patients in isolation - all are known. Weak law is an open invitation for these nefarious activities. This is a long term problem for India. 

• Government need to publish such violations and enforce a rapid judicial system to punish them. This needs wide publicity. 

Bottom line - Covid is here to stay. Life has changed and to Live, we need to change. 

Background
As the second wave of COVID-19 pandemic continues to sweep across India, preventing infection is imperative. Greater understanding of how the disease spread has necessitated expansion of the preventive measures suggested that were learnt and promoted in the early stages of the pandemic in 2020. Collectively called COVID-19 Appropriate Behaviour (CAB), these measures together offer protection from COVID-19.

WaterAid India, UNICEF, IRC, WHO, the India Sanitation Coalition and the SuSanA India Chapter have taken the initiative to promote CABs through civil society organizations, SHGs, youth groups and local government institutions to aimed at supporting the government health system because:

• COVID-19 is a highly infectious disease that can spread easily through respiratory and contact routes.
• COVID-19 spreads through respiratory droplets when an infected person exhales, coughs, sneezes or speaks which can infect others if inhaled. People can also be infected by touching a contaminated surface and then their eyes, mouth or nose
• New evidence suggests that coronavirus in respiratory droplets may remain suspended in air in closed
  rooms and poorly ventilated rooms for hours. The Coronavirus strains infecting the population in 2021 are many time more infectious than the those in 2020
• As the first wave of the pandemic came to some level of control towards the end of 2020 and early 2021, the practice of COVID appropriate behaviour decreased among the public, enhancing susceptibility to infection
• While extensive testing is needed to identify cases for appropriate treatment, testing facilities across the country are highly overburdened
• More than 85 per cent COVID-19cases do not need hospitalization but can be easily handled with treatment at home. Only moderate or severe cases require medical care. Preventing infections and hospitalizations will ease burden on a strained and overburdened health system
• Vaccination is critical to contain COVID-19 and reduces the severity of the disease, the risk of transmission as well as mortality. It provides comprehensive protection when coupled with CABs

COVID-19 Appropriate Behaviour


The following CABs can be promoted and followed:
Consistent and correct use of well-fitting masks in the following situations:

• Anywhere outside the home: Public places, educational institutions, places of work,places of worship, health care facilities, transport hubs
• In the presence of others (apart from immediately family)
• Presenting with symptoms or when diagnosed with COVID-1p
• After exposure to a suspected or confirmed case 
• When caring for a COVID-19 patient
• Children should be encouraged to wear masks when out of the home, and within the home if there is a suspected or confirmed case
• Double-masking (use of a triple layer cloth mask with a medical mask) can be considered outside the home.

Washing hands with soap and water thoroughly (for at least 40 seconds) every 3-4 hours and necessarily at these times: (If soap and water are not available, alcohol-based hand rubs must be used well to clean hands)

• After returning from outside, and after contact with any other person
• After sneezing, coughing, blowing nose  
• After toilet use, cleaning a child’s bottom, disposing child faeces
• Before cooking, eating, serving food and before feeding children (including breastfeeding)
• Before and after tending to a sick person at home

Maintain respiratory hygiene – cover mouth and nose when sneezing and coughing (with the inside of the elbow or with cloth), do not remove mask to sneeze and cough. Wash hands with soap, and thoroughly wash any cloth used with soap.

Physical distance of 6 feet, to the extent possible, in public spaces with other people

Avoid closed or poorly ventilated spaces, and crowded settings. Gatherings should only be conducted in open spaces with a limited number of people who are at a distance from each other

Timely detection of symptoms and/or exposure to a COVID-19 case (suspected or confirmed), with testing and appropriate action (e.g., quarantine while awaiting test results, self-isolation if home care is possible)

Steps to promote CABs
Organizations have developed innovative strategies, tools and materials to reach masses in different parts of the country through multiple
channels: mass media, WhatsApp, Facebook, Twitter and inter-personal communication. Shared widely, these can help to address emerging issues related to adherence to CABs and counter information overload and fatigue, and cover critical gaps. Suitable channels of direct communication must be used to reach vulnerable and marginalized groups as well as those who may have limited access to mass and digital media (e.g., adivasi populations, girls and women, seasonal migrants, those with limited mobile phone access). Some options are

• Community based groups such as women’s groups, youth clubs, student groups, farmer groups, local government members, and resident welfare associations 
• Credible, trusted and influential local leaders who are powerful agents of change, providing personal testimonials, practical solutions and reassurance

Experience from behaviour change communication for COVID-19 prevention suggest the following approaches:

• Communicate evidence-based solutions or recommendations simply and effectively (e.g., visually showing how CABs work to protect against the virus)  
• Highlight and visualize compliance with CABs (not non-compliance)
• Emphasize CABs as a positive, desirable social norm, practiced by many in the community with benefits for the individual and community (and avoid communication of punishment/censure/sanctions for non-compliance)
• Provide “how to” information that provides clear guidance on new protective actions (e.g., visual posters/videos on double masking, how to quarantine or self-isolate)
• Visual cues and nudges placed appropriately can reinforce CABs (e.g., circles for physical distancing, handwashing massage near handwashing station, mask use poster in transport hubs)
• Ensure availability of masks in rural areas and small towns by locally producing triple layer cloth masks, with IEC on how to use and maintain masks
• Provide guidance on hygiene practices and establish handwashing facilities with soap 
• Provide simple options for ventilating commonly used spaces (at the household, community level, and in health facilities and facilities used for vaccination, treatment)
• Avoid any negative or punitive messaging

Webinar to promote CABs
The SuSanA India Chapter, WaterAid India, IRC, UNICEF, WHO, the Sphere Academy and ISC conducted a webinar on 5 May 2021, World Hand Hygiene Day with experts from public health, WASH and disaster management. The objective was to reach civil society organizations from across India with a Call to Action. Speakers urged CSOs, local government institutions and other local networks to prioritize messaging on CABs, address the need for new or more nuanced messaging, and use effective channels to reach communities directly, especially in rural and small towns. You can read more in the attachment.

The thematic discussion
Following the webinar, we are initiating a thematic discussion on the topic. It will be divided into two parts. In the first, we are eliciting examples of how CSOs, SHGs, LGIs, youth clubs, local leaders, etc., have promoted CABs in their communities. Please provide as much information you can from your experience in the field on how these organizations have promoted CABs. In the first part, to be open from 10 – 15 May, we want to understand the following
A)  What messages promoted, how, with whom, and at what scale?
B )  What were the successes and challenges faced during these CAB interventions, and how were they addressed?
C)  What would your top 3-5 recommendations be for other organizations working on CABs?

In the second part, to be open from 16-22 May, we would like to cover the issue of managing and disposing  bio-medical waste from households that have had a COVID-19 patient. We will seek views on whether existing rules for managing such waste are adequate, or are additional provisions needed given the contagious nature of the disease, and the non-biodegradable nature of most such waste (personal protection equipment, masks, gloves, face shields, etc). We want to understand what successes and challenges have come up and the lessons therefrom.
 
The information from the webinar and discussion will help us fine-tune our approach to promote CABs. It will also help the Government of India and states to engage constructively with CSOs, SHGs, LGIs, help us fine-tune our approach to promote CABs. It will also help the  Government of India and states to engage constructively with CSOs, SHGs, LGIs, youth clubs, local leaders, etc., to cope with the challenge posed by the second COVID-19 wave.