October 19, 2020

Our hands play a key role in the transmission of COVID-19. While public health agencies have stressed the importance of frequent hand-washing to prevent the spread of the disease, a recent review has shown that deficiencies in water, sanitation and hygiene (WaSH) strategies are limiting the ability of people across the globe to adequately wash their hands and fight the pandemic.

Published in the Journal of Water, Sanitation, and Hygiene for Development, this comprehensive review is the first to look at how WaSH has impacted the global response to COVID-19. Emeritus Professor Jamie Bartram, PhD, and Adjunct Professor Clarissa Brocklehurst from the Water Institute at the UNC Gillings School of Global Public Health are among the authors.

Proper hand-washing is an effective means of interrupting viral transmission because it involves rubbing hands together with soap and running water, which inactivates the virus and removes it from our hands. While the necessary elements of good hand hygiene are available in many in high-income countries, barriers to access for vulnerable populations in high-, middle- and low-income countries leave many people at greater risk of infection.

Contaminated hands can transmit the virus by touching door handles, surfaces and other people. This creates a significant challenge for those who must travel long distances or frequent high-traffic areas to find a source of water or a place to wash their hands. Essential workers who cannot practice physical distancing or isolation are especially at risk, as well as those in health care facilities, people experiencing homelessness and communities that rely on public transportation.

Public health officials, policymakers and government leaders often assume that basic access to WaSH is available, but for many countries, this is far from true. Differences in urban and rural populations, as well as in wealth distribution, mean that even families in the same region may not have equivalent access to soap or running water. The review found an enormous disparity in the number of households around the world that had any type of soap, ranging from 20 to 99%. And while hand sanitizer may provide a convenient alternative, it, too, can be difficult for many populations to obtain.

The WaSH challenge is even greater in areas that do not have water piped to homes, schools or hospitals and must rely on communal sources for running water.

“In the current pandemic, we have seen water supply treated as an essential service,” the authors wrote, “however, there is little evidence for policy responses to increase access to, or reduce intermittence in, supply that would support households in accessing sufficient water and sustaining the hand-washing required.”

In examining the global response to COVID-19, the review identified several areas where improved WaSH practices could lead to better health outcomes. These range from identifying areas to improve hygiene behaviors in order to prevent transmission of respiratory pathogens to integrating WaSH into community infection tracing, such as wastewater surveillance.

Perhaps most importantly, the paper stresses the need for improved infrastructure in order to provide universal access to piped water. Governments should also adopt long-term strategies to make adequate WaSH available to populations around the globe on a consistent basis, not just as a temporary response to the existential threat of a pandemic.

“There have been very few pandemics in history in which better water supply, sanitation and hygiene have not been part of the solution,” stated Brocklehurst. “We are pleased that the Water Institute can be part of the battle against COVID-19.”

Starting Oct. 26, the Water Institute will host the week-long Water and Health Conference and will highlight the links between COVID-19 and WaSH throughout the opening day. Water Institute Director Aaron Salzberg, PhD, and Brocklehurst will both be hosting panel discussions on the WaSH response to COVID-19. Registration is free and available now.

Read the full paper online.

Contact the UNC Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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