COVID-19: The link between transmission, sanitation and hygiene services

Date: 31st March 2020

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GENEVA – In the wake of the Coronavirus disease, COVID-19, we are working to protect each other and our communities. Key to keeping healthy is having access to basic sanitation and hygiene. Yet globally, 2 billion people live without access to basic sanitation, 3 billion lack basic handwashing facilities at home (WHO).

People in least developed countries, people most left behind and least able respond, are impacted most by unsafe sanitation or absence of handwashing facilities. What are the links between transmission of diseases like COVID-19 and sanitation and hygiene services? We asked our Knowledge Management & Innovation Officer at WSSCC, this question as it relates to handwashing, sewer treatment and drinking-water.

Interviewer: WSSCC invests in behaviour change activities enabling many people in developing countries to improve their sanitation and adopt good hygiene practices. What can you tell us about how sanitation and hygiene can prevent the spread of COVID-19?

Knowledge management and innovation officer: Currently, there is no evidence about the survival of infectious COVID-19 virus in drinking-water or sewage (WHO). The risk of transmission of COVID-19 from the faeces of an infected person is unknown, and there have been no reports of transmission through the oral-faecal route (CDC). However, emerging studies are indicating the potential for the oral-faecal route as an alternate to the respiratory (coughing and sneezing) and contact transmission (Ong et. al 2020, Wu et al. 2020, Zang, et. al 2020), and previous studies on surrogates of the SARS coronavirus have found that they survived in water and sewage for up to several weeks under different conditions (Casanova et. al, 2009). It’s likely that more evidence will be published and interpreted into guidance in the coming weeks and months.

Ensuring human waste is safely contained, emptied, transported, and disposed or treated in line with the WHO’s Guidelines on Sanitation and Health is therefore an important precaution for preventing potential transmission of COVID-19. Some evidence indicates that the COVID-19 virus is likely to inactivate significantly faster than other viruses known for waterborne transmission (WHO).

Recent research has further found large and rapid inactivation of faecal bacteria in groundwater close to latrines (Ravenscroft et. al, 2017). For many rural communities where WSSCC and others support ongoing programmes, eliminating open defecation, ensuring safe containment – especially for child faeces and bedpans for the sick or elderly – and exploring practical and affordable options for safe on-site waste disposal are all critical for preventing potential oral-faecal transmission of COVID-19. But more critically, they are essential for blocking the spread of other pathogens that are already responsible for a large chunk of the global disease burden and disproportionally kill the poorest.

What we do know, however, is that handwashing with soap is essential. Because COVID-19 can be transmitted by contacting infective droplets and touching our noses, mouths, and eyes (or vice-versa), handwashing with soap is identified one of the most critical actions for stopping its spread (WHO, CDC).

However, handwashing with soap can be a notoriously difficult behaviour to engrain, especially when we touch our faces up to 23 times an hour. This includes healthcare settings, where 2 in 3 healthcare workers adhered to best handwashing practices on average (Global Handwashing Partnership).

As education alone is not enough to get these handwashing habits to stick, investments in innovative and scalable approaches for promoting handwashing behaviours in healthcare and non-healthcare settings are needed to prevent the spread of infectious diseases like COVID-19.

Interviewer: What are the implications of the COVID-19 pandemic for improving safe sanitation and hygiene services?

Knowledge management and innovation officer: One of the consequences of crises like the current pandemic is that social inequalities have been thrown into sharp relief by demonstrating that the people who keep our societies running are the most at risk: nurses, domestic and elderly care workers, teachers, delivery drivers, cleaners, and retail workers in grocery stores and gas stations, for example. So are sanitation workers, who are currently on the frontline of the pandemic.

In areas where on-site treatment is not possible, waste management is only as safe as the workers handling it. The critical job of handling waste is especially vital in a pandemic. Where sanitation workers continue with the necessary task of removing our household refuse, medical waste, and sludge from latrine pits and septic tanks, they may face elevated levels of risk (XinhuaNet,Bloomberg, CityLab).

In countries where municipalities have weak regulatory capacity, and where workers are unable to effectively organize for improved health and safety protections, sanitation workers may face even further risks – especially if they are disproportionally represented by vulnerable or historically marginalized groups.

A key component of pandemic-proofing societies is investing in the capacity of municipal regulators, elevating the collective voice of sanitation workers, and engraining key hygienic behaviours (especially handwashing and wearing personal protection equipment).

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