Les populations rurales peuvent-elles payer pour l’eau en temps de crise ?

Les co-auteurs de ce blog invité sont le Professeur Rob Hope (REACH Programme) et le Dr Guy Hutton (UNICEF). Une version de ce blog an anglais est disponible sur le site web du programme REACH.

Rendre l’eau potable abordable pour les populations rurales a toujours été un défi. La COVID-19 exerce des pressions urgentes sur les gouvernements, les prestataires de services et les utilisateurs d’eau en milieu rural qui ont des besoins prioritaires en eau pour se laver les mains à la maison, dans les écoles et dans les établissements de santé.

Le 23 juin, le programme REACH et l’UNICEF ont organisé un webinaire en partenariat avec le RWSN afin de présenter de nouvelles données sur l’évolution de la demande et des revenus de l’eau, et d’étudier comment mesurer l’accessibilité économique de l’eau dans le but d’améliorer les réponses politiques et programmatiques. Le webinaire complet est accessible ici.

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Nous avons identifié cinq leçons clés que nous présentons ci-dessous, en réponse à la question: Les populations rurales peuvent-elles payer pour l’eau en temps de crise ?

Leçon 1 – Cela est possible. L’expérience de la République centrafricaine (RCA) a mis en évidence un modèle de prestation de services professionnels qui a permis de fournir des services d’eau fiables pendant de nombreuses années à échelle, malgré la guerre civile et la stagnation économique. Des pays comme l’Inde sont en train d’étendre une plateforme de suivi pour améliorer les réponses, soutenue par des prestataires de services gouvernementaux établis sur place.

Leçon 2C’est plus difficile en temps de crise. Les pays sans données et sans réseau de prestataires de services responsabilisés sont confrontés à des choix plus difficiles. L’approvisionnement en eau, imposé par la loi, les politiques et la réglementation, est limité en l’absence de prestataires de services déjà établis au niveau local. Les prestataires informels, tels que les vendeurs, peuvent desservir des populations éloignées en temps normal, mais leur capacité à fournir de l’eau pendant la pandémie de la COVID-19 est limitée en raison des restrictions de voyage. Les règles doivent rester souples.

 

Leçon 3 – Les populations pauvres sont les plus vulnérables. Les données mondiales ont illustré les coûts plus élevés que payent les groupes aux revenus les plus faibles au Ghana, au Cambodge, au Pakistan et en Zambie, ainsi que les coûts importants liés au temps passé à transporter de l’eau, qui sont plus élevés pour les déciles aux revenus les plus faibles. La conception de tarifs mensuels plutôt que volumétriques peut éviter une contrainte de revenu liée à l’augmentation de l’eau pour les besoins d’hygiène. Les inondations et les sécheresses présentent un risque supplémentaire important. Le suivi des données est ainsi un outil clé permettant de fournir une alerte précoce pour cibler les ressources afin de limiter les dommages.

Leçon 4 – Assurer un financement durable. Une eau fiable peut coûter moins d’un dollar par personne et par an. Mais cela nécessite une subvention pour les prestataires de services locaux et les utilisateurs d’eau ont besoin d’un soutien pour maintenir les services en fonctionnement. Une large proportion des populations rurales ne paie pas l’eau aujourd’hui par choix ou en raison d’inégalités. Il a été noté que les gouvernements ne peuvent pas se permettre de ne pas assurer l’accès à l’eau pour les populations. Mais une “eau gratuite” causerait plus de tort, mettant en péril la capacité des prestataires à fournir et à maintenir des services pour tous. Il s’agit là de choix difficiles et les décisions dépendront du contexte.

Leçon 5 – Mieux reconstruire. La COVID-19 a mis en évidence les faiblesses connues de l’ approvisionnement en eau en milieu rural. Investir dans des prestataires de services locaux et responsabilisés est un élément clé de toute stratégie de durabilité. Les écoles et les établissements de santé sont au cœur de ce vaste réseau de services et constituent une priorité essentielle. Ces institutions partagent souvent des infrastructures hydrauliques avec les communautés rurales, et  pourraient constituer un élément central et stratégique de l’approvisionnement en eau pour tous.

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Le webinaire s’est déroulé en deux parties sur une durée d’une heure et demie. Tout d’abord, un aperçu du débat et des caractéristiques de l’accessibilité financière par le professeur Rob Hope (Université d’Oxford), présenté par Alice Chautard avant les présentations du Dr Guy Hutton (UNICEF), Andrew Armstrong (Université d’Oxford)et le Dr Sonia Hoque (Université d’Oxford). Cette présentation a été suivie par une session de questions-réponses facilitée par Alice Chautard. Le webinaire complet est accessible ici.

Si vous avez des questions ou des commentaires, n’hésitez pas à nous écrire : reach@water.ox.ac.uk et vous pouvez nous trouver sur Twitter @REACHWater @UNICEFWater @RuralWaterNet. Crédits photo: Mary Musenya Sammy et Cliff Nyaga.

A “C” diagram to identify Covid19 transmission routes

This is a guest blog by RWSN Member Rajan Pandey, WASH and Environment Expert in Nepal.

Colleagues and I have devised a “C” line diagram similar to the “F” diagram the global WASH community uses during ODF campaigns to identify transmission routes for feces.

A group of WASH volunteers here in Nepal prepared this for free use. Anyone around the world can use it or improve/ contextualize it as well to suit their need. Please free free to share feedback with Rajan Pandey as a comment to this blog.

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No chance for Corona: How kids can help beat the virus

The “No chance for Corona” comic is currently being translated into more than 25 languages

by Kerstin Bandsom, Welthungerhilfe

Although children and adolescents rarely fall seriously ill with COVID-19, they are nevertheless extremely affected by the pandemic. Instead of playing outside, going to school, doing sports and meeting friends, they are now locked up with their parents all day, often in very confined spaces. In addition, they are worried about their family, their friends and themselves. Together, Welthungerhilfe and WASH United want to ensure that children and adolescents understand why their normal lives are being so drastically restricted and what they can do to protect themselves, their family and their friends from Corona. To this end, we have worked closely with an expert from the Institute for Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin to develop a comic strip that can be used around the world to educate children and adolescents between the ages of 10 and 14 about Corona.

The “No chance for Corona” comic is currently being translated into more than 25 languages and is available for download here . On 13 April, the comic will also be available as an educational video to reach even more children and adolescents. The comic can be used, reproduced and disseminated for non-commercial purposes without limitation. Changes to the comic are not permitted. You are encouraged to use the comic and video as widely as possible.
Contact: info@welthungerhilfe.de

Aucune chance pour le Corona

Bien que les enfants et les jeunes tombent rarement malades du COVID-19, ils sont néanmoins extrêmement touchés par la pandémie. Au lieu de jouer dehors, d’aller à l’école, de faire du sport et de rencontrer leurs amis, ils sont désormais confinés avec leurs parents toute la journée. De plus, ils s’inquiètent pour leur famille, leurs amis et eux-mêmes. Avec son partenaire WASH United, la Welthungerhilfe veut s’assurer que les enfants et les jeunes comprennent pourquoi leur vie habituelle est considérablement restreinte et ce qu’ils peuvent faire pour se protéger, ainsi que leur famille et leurs amis, contre le Corona. Pour cela, nous avons travaillé en étroite collaboration avec un expert, de l’Institut d’hygiène et de médecine environnementale, Charité Universitätsmedizin Berlin, afin de mettre au point une bande dessinée générique. Celle-ci pourra être utilisée dans le monde entier pour sensibiliser les enfants et les jeunes de 10 à 14 ans au Corona. La bande dessinée “Aucune chance pour le Corona” est actuellement en cours de traduction dans plus de 25 langues et peut être téléchargée ici. Le 13 avril, la bande dessinée sera également disponible sous forme de vidéo éducative afin. La bande dessinée peut être utilisée, reproduite et diffusée à des fins non commerciales sans limitation. L’utilisation commerciale de la bande dessinée est interdite. Les modifications de la bande dessinée ne sont pas autorisées. Nous souhaitons vous encourager à utiliser la bande dessinée et la vidéo aussi largement que possible. Veuillez partager la ressource par

Putting equality, inclusion and rights at the centre of a COVID-19 water, sanitation and hygiene response

This is a guest blog by Priya Nath (RWSN Theme Leader) and Louisa Gosling (RWSN Chair). It is reposted from the WaterAid blog with thanks. The original post is available here.

The poorest and least powerful sections of all societies are likely to be worst affected in crises, but we can work to alleviate inequalities through our response. Priya Nath and Louisa Gosling highlight how our emergency response to the coronavirus pandemic can mitigate new and existing vulnerabilities among people affected.

Handwashing with soap is the first line of defence in tackling the COVID-19 pandemic. Yet inequalities abound in access to water, sanitation and hygiene (WASH), services, and following the advice to wash your hands with soap regularly is not as easy for some as it may sound.

Years of experience and evidence show that income, economic context and landlessness; age, disability and health status; geographical location; and ethnicity, race, religion and gender all play huge roles in determining whether individuals, households and communities have appropriate, available, affordable and accessible WASH. At WaterAid, we have committed to tackling inequalities in all aspects of WASH access.

The way we approach the current extraordinary global health crisis can be no different. Tackling new and existing inequalities must be central to our emergency response to coronavirus. During the global COVID-19 pandemic, life-saving clean water for hygiene, safe sanitation and basic healthcare is more critical than ever. And delivering equitable, empowering WASH responses for all is fundamental.

In our support of COVID-19 responses through WASH we are both drawing on what we already know and learning new ways to reach the most marginalised and the most burdened.

What we already know about tackling inequalities in WASH and emergency contexts

1. Gender inequality is exacerbated in health emergencies and economic crises, so must be tackled in all response efforts

As schools close and families head into lockdown, domestic chores and caring responsibilities increase greatly. At the same time, increased calls for washing hands, as well as for cleaning and sanitising, multiply the need for water. Because of gender divisions of labour, it is women and girls who will have to collect this extra water, perform more labour and do more caring for people who become sick.

For the 29% of people who do not have water inside their home, the additional long journeys to water sources caused by increased demand for water will mean more chances of contact with others at waterpoints or kiosks. And for many it will mean spending more of their already scarce resources on buying water at an unaffordable cost.

Women queue up to collect water from the common water source in Anna Nagar Basti, Hyderabad, India.

WaterAid/ Ronny Sen
Women queue up to collect water from the common water source in Anna Nagar Basti, Hyderabad, India.

Meanwhile, an estimated 70% of the global health and social care workforce are women. As the coronavirus pandemic spreads, these frontline workers face increased pressure and exposure to the virus, often with little personal protective equipment. This in the context of two out of every five healthcare facilities globally lacking handwashing facilities, and 55% in least developed countries lacking basic water supplies.

Health crises also increase risks of violence and harassment of frontline health workers, particularly women nurses. Amid the Ebola outbreak in the Democratic Republic of Congo, for example, the World Health Organization documented attacks on more than 300 healthcare facilities in 2019, leaving six workers and patients dead and 70 wounded.

During times of enforced isolation and closure of many public facilities, women and girls’ ability to manage menstruation can be compromised in communities and households. Finding a clean and private space to change and wash while remaining indoors for much of the time with their family, and accessing menstrual materials and water, can be difficult.

Finally, isolation measures, the inability to access previous social support systems and increases in financial and other stresses are increasing the risks of violence against women everywhere (download report PDF). Although not directly connected to WASH, this has implications for women’s ability to access essential services, and must be factored into our response, to ensure people’s safety and security when accessing WASH and other services.

You can read more about the gendered impacts of the COVID-19 pandemic in this article published in The Lancet.

2. Marginalised people become even more vulnerable during a crisis

People with chronic health issues, such as HIV, or other health conditions are dealing with increased fear of acquiring COVID-19, while often already experiencing social stigma and exclusion based on their health status. In an environment where misconceptions around HIV transmission or general discrimination might already prevent them from using communal WASH facilities, crises have the potential to exacerbate the situation, making handwashing and maintaining treatments even harder. Additionally they face the real risk of disruption to essential life-saving services, and concerns over whether they will be able to access treatment for COVID-19 on an equal basis to others.

More than a billion people globally live with disabilities, the rates higher in low-income countries and among those living in poverty or belonging to ethnic minorities. Once again, the health and social inequalities they already face are intensified in crises. For someone with a physical impairment, accessing clean water frequently can be a challenge because of distance, inaccessible infrastructure or reliance on others.

People with disabilities are often already isolated from the outside world, missing out on public health campaigns geared towards people who move around. And public health and information campaigns are rarely targeted to their specific requirements. Those who rely on a carer to help them with daily tasks face either the risk of added exposure to the virus through their carer, or an inability to get the help they need more than ever in challenging times.

Reuben J. Yankan, Director of the Disable Camp 17th Street Community, who is visually impaired, being helped down the steps from a public toilet by Timothy Kpeh, Executive Director for Peace, Education, Transparency, & Development in Sinkor, Monrovia, Liberia.

WaterAid/ Ahmed Jallanzo
Reuben J. Yankan, Director of the Disable Camp 17th Street Community, who is visually impaired, is helped down the steps from a public toilet by Timothy Kpeh.

 

Equally, public health messaging and calls to stay inside are hard to follow for people who have little or no access to WASH facilities; those who rely on daily wages to survive; those living in densely populated informal settlements or refugee camps; and street dwellers. This puts them at greater risk of not only COVID-19, but also harsh punishment by authorities. For example, we are already seeing a response that includes clearance of informal markets and housing in the name of ‘sanitisation’ in some places. The Ebola crisis in Monrovia in 2014 set a precedent for quarantining entire informal settlements that were deemed a ‘health risk’. This a deep injustice.

Our response efforts can mitigate both existing and new vulnerabilities

While the poorest and least powerful are likely to be worst affected in crisis situations, we can work to alleviate the inequality through our response:

  1. Support governments and other WASH actors to deliver the human right to water and sanitation as a central part of response efforts, provided in a way that is non-discriminatory and accessible to all.
  2. Develop crisis responses alongside the affected communities rather than for them, to ensure solutions meet cultural, social and religious challenges. Disability rights, women’s rights and indigenous rights groups, to name a few, are best placed to help us shape our response in a way that is empowering, does no harm and responds to real requirements.
  3. Tackle and confront any discrimination and stigmatisation in response efforts, related to factors such as age, gender, race, ethnicity, socio-economic status, livelihood type and caste. We must closely monitor our messaging, images and approaches to ensure they are not inadvertently fuelling discrimination.
  4. Promote collection of water, cleanliness of water and sanitation facilities and practising of hygiene as the responsibility of all – not just women.
  5. Recognise the obligations and responsibility of government and sector actors to respond; do not make this an issue of individual action or responsibility.
  6. Ensure we are collecting and disaggregating data to understand differing impacts on all parts of the population. At minimum age, disability, gender and location disaggregation is needed.

Read UNICEF’s COVID-19 Considerations for Children and Adults with Disabilities (PDF) guide.

Our simple list of dos and don’ts

As initial responses, including ours, rely heavily on visual and mass media public communications, it is vital that these are respectful and do no harm. Our list of actions to take and avoid can help.

Do: Use images and messaging that show responsibility for hygiene behaviours can be equally distributed.

  • Ensure images are gender balanced.
  • Include males in images of household & community hygiene practices to show collective responsibility.

Don’t

  • Do not reinforce gender or other stereotypes – i.e. do not show only women doing washing, cleaning or looking after children.

Do: Frame messaging that builds community spirit, support and collective action.

  • Use terms like ‘us’, ’we, ‘together as a community’, ‘altogether we can, etc.
  • Use images that show people helping each other.
  • Demonstrate sector/government response and duties, not just individual responsibility.

Don’t

  • Do not focus only on individualistic messages, which reinforce individualistic responses and actions.
  • Do not use emotional triggers such as shame, guilt or fear – we have a responsibility to avoid promoting further hysteria or blame.
  • Avoid emotional or negative language.

Do: Portray people in all their diversity.

  • Communities are made up of women, men, children, people with impairments, people of different ethnic or religious identifies, etc – reflect this reality in your communications to improve uptake.

Don’t

  • Do not blame or associate individual factors such as gender, ethnicity, religion, age, impairment, health or poverty status with reasons for infection or contagion.
  • Avoid messaging, images or implementation approaches that unintentionally stigmatise, ostracise or cause abuse for certain people.

Do: Acknowledge and respond to the diverse needs of communities.

  • Demonstrate how assistive devices can be used.
  • Demonstrate solutions that are relevant in low-income settlements, in rural and water scarce areas.
  • The Compendium of accessible WASH technologies has illustrations and descriptions you can adapt.

Don’t

  • Avoid blanket approaches that suggest that everyone can change behaviours without any specific adaptations.
  • Do not direct messaging or responsibility for ‘change of behaviour’ at one group of people, e.g. mothers, instead talk about parents caring for children.
  • Do not misrepresent the number of people who have a clean water supply or access to soap.

Do: Adapt communications to suit different target groups.

  • Consider the communication and learning abilities of all people, including people with visual, hearing and intellectual impairments.
  • Plan channels for information to reach all, especially those doing caring duties, sanitation work, etc.
  • Takeaway materials can reinforce messages and make up for some short-term memory loss among older people or people with disabilities.
  • These should be easy to read, large script, high contrast between text and paper, on non-glare/glossy paper, in local languages/dialects, highly visual​​​​.

Don’t

  • o not exclude anyone. Not being inclusive of all can lead to fear, shame and blame.
  • Do not portray informal settlements or slum areas as ‘vectors of disease’, or poorer areas of the city as being unable to keep clean. This reinforces stigma and increases the chance of a negative reaction. For example, there have already been cases of informal housing being cleared in the name of ‘sanitisation’. The solution lies in guaranteeing adequate and safe levels of service for all, rather than reinforcing stigma towards certain parts of the population.

Do: As part of our do no harm approach, do a risk assessment before and throughout communications campaigns

  • Monitor backlash on social media, such as racist comments and immediately delete as needed.
  • Check that it does not amplify or put blame on one group (or if audience is interpreting it that way).
  • List who is likely to miss out on the communication because of language, ability, culture or gender, and come up with strategies for how they could be included.

Don’t

  • Do not ostracise or promote ‘calling out’ of people or parts of the population. This may encourage vigilante tactics or backlash.
  • Avoid terms such as ‘victim’, ‘infecting’ or ‘spreading to others’.
  • Do not tolerate any racist, bigoted or blaming comments on social media and have a strategy for monitoring these.

Follow us on our journey through the response

As we support community, national and global responses to the coronavirus pandemic, we need to draw on what we already know, keep learning from others and ultimately improve the way in which response work reaches and addresses the needs of the most marginalised, the most burdened and those further away from life-saving clean water for hygiene, safe sanitation and basic healthcare.

At WaterAid, we are putting these principles into action, applying them to our COVID-19 response efforts, details of which you can read in this blog. We look forward to sharing lessons and challenges along the way.

Priya Nath is Equality, Inclusion and Rights Advisor and Louisa Gosling is Senior WASH Manager – Accountability and Rights, both at WaterAid UK.

Photo credit: WaterAid/ Ronny Sen

 

 

 

WaSH and Coronavirus – knowns, unknowns, and implications for monitoring and management

A novel coronavirus emerged in Wuhan, China in late 2019. The novel coronavirus, SARS-CoV-2 (or COVID-19), is believed to have originated in bats, and has rapidly progressed to a global pandemic that has infected hundreds of thousands of individuals (1, 2).

Author: Dr. Michael B. Fisher, University of North Carolina at Chapel Hill. Acknowledgement to Dr. Mark Sobsey for critical review and input.

Ensuring adequate water, sanitation, and hygiene measures is essential to controlling the spread of COVID-19 (1), but much remains unknown with respect to the optimizing and quantifying the impacts of WaSH interventions and best practices in combating the current COVID-19 pandemic.

Water and Hygiene
Adequate hand and personal hygiene prevent COVID-19 transmission. Handwashing with soap (3) or alcohol-based hand sanitizer (4) is an effective means to disrupt transmission, along with social distancing, identification and isolation of cases, contact tracing and follow-up, etc. Adequate quantities of available water are essential to maintaining hand hygiene and personal hygiene (5). While these universal prevention measures are well-known, the relative impact of hand hygiene as compared to other infection prevention and control measures such as social distancing, surface disinfection, etc., as a means of slowing COVID-19 transmission has not yet been characterized. However, the availability of water and cleaning products such as soap and chlorine are essential for basic hygiene and infection prevention measures such as hand washing, surface disinfection, and laundry, and should be regarded as universal prerequisites for effective control of the COVID-19 pandemic and other outbreaks (1).

Waterborne transmission has not been documented, and the survival of COVID-19 in water remains unknown (but the virus is thought to persist for hours to days); however, WHO advises that waterborne transmission is unlikely based on available evidence for other similar viruses, and current best practices for safe management of drinking water should be sufficient during the COVID-19 outbreak (1). In addition to direct waterborne transmission, person-to-person transmission may be a concern at communal water sources, where crowding may lead to direct and indirect contact between individuals. Guidelines for practicing appropriate social distancing while accessing communal water sources have not yet been developed, but general social distancing and hand hygiene guidelines may be applicable here as well. The extent to which communal water sources may be hotspots for person-to-person COVID-19 transmission is currently unknown.

IMG_5793
Northern Ghana, between 2011 and 2014

Surface disinfection
The persistence of COVID-19 on surfaces and hands under different environmental conditions is being actively studied. Available evidence suggests that the virus can likely persist and remain infectious for up to 3 days on many surfaces (6). Chlorine rapidly inactivates COVID-19 and other viruses on contact. Current recommendations indicate that a dilute chlorine solution (e.g. 0.1% free chlorine, which can be prepared by adding one part household bleach [~5% free chlorine] to 49 parts water- i.e. 20 mL of bleach per liter, 7) or a 70% ethyl alcohol solution can be used for surface disinfection at least once per day (1, 8). However, further validation of best practices for optimal surface disinfection and optimal cleaning frequencies to prevent COVID-19 transmission may be useful to review and/or refine this guidance.

Sanitation
COVID-19 RNA has been detected in the feces of infected individuals (9), but it is not yet known whether infectious virus is also shed in feces. Furthermore, the survival of COVID-19 in feces and wastewater has not yet been characterized. To date, transmission of the virus via feces/wastewater has not been documented, and risk of transmission by this pathway is believed to be relatively low (10). Current WHO recommendations on safe management of human excreta are therefore currently deemed sufficient for preventing fecal-oral transmission of COVID-19. However, where sanitation facilities are shared between known COVID-19 cases and those without symptoms, additional precautions may be warranted- specifically, the facilities should be disinfected at least twice daily by a trained worker wearing suitable personal protective equipment (PPE, 1). Furthermore, adequate plumbing of flush toilets is needed to prevent backflow and/or aerosolization of excreta, which may contribute to COVID-19 transmission by aersosols (1). Where these recommendations are not implemented, the extent to which unsafe management of excreta may contribute to COVID-19 transmission has not yet been quantified. Furthermore, the extent to which sanitation workers may be at risk from transmission of COVID-19 through the feces of infected persons likewise remains unknown. The use of PPE and frequent handwashing should reduce risks to sanitation workers; where latrines that may contain excreta from infected individuals must be emptied, hydrated lime may be added to disinfect the excreta prior to emptying (1).

While available evidence is sufficient to reinforce the need for adequate water, sanitation, hygiene, and cleaning services and methods to prevent COVID-19 transmission in homes, communities, and health care facilities, many important questions still remain unanswered.

  • How is your organization confronting the current COVID-19 pandemic?
  • Are you involved in work to answer any of these WaSH-related questions?
  • What next steps are needed to inform efforts by rural water supply implementers and rural environmental health professionals to combat the current coronavirus pandemic?
  • What additional monitoring activities (if any) are needed for an effective COVID-19 response where you work?

Share your responses by joining the RWSN e-discussion: Responding to the current COVID-19 crisis: questions, resources, and implications for rural water supply at the operational level

 

References
1. World Health Organization. (2020). Water, sanitation, hygiene and waste management for COVID-19: technical brief, 03 March 2020 (No. WHO/2019-NcOV/IPC_WASH/2020.1). World Health Organization. https://globalhandwashing.org/wp-content/uploads/2020/03/WHO-2019-NcOV-IPC_WASH-2020.1-eng-5.pdf
2. Perlman, S. (2020). Another decade, another coronavirus. https://www.nejm.org/doi/full/10.1056/NEJMe2001126
3. Centers for Disease Control and Prevention. (2020). Interim infection prevention and control recommendations for patients with confirmed 2019 novel coronavirus (2019-nCoV) or persons under investigation for 2019-nCoV in healthcare settings. https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
4. Siddharta, A., Pfaender, S., Vielle, N. J., Dijkman, R., Friesland, M., Becker, B., … & Brill, F. H. (2017). Virucidal activity of WHO-recommended formulations against enveloped viruses including Zika, Ebola and emerging Coronaviruses. The Journal of infectious diseases. https://academic.oup.com/jid/article/215/6/902/2965582
5. Pickering, A. J., Davis, J., Blum, A. G., Scalmanini, J., Oyier, B., Okoth, G., … & Ram, P. K. (2013). Access to waterless hand sanitizer improves student hand hygiene behavior in primary schools in Nairobi, Kenya. The American journal of tropical medicine and hygiene, 89(3), 411-418. https://www.ajtmh.org/content/journals/10.4269/ajtmh.13-0008
6. van Doremalen, N., Bushmaker, T., Morris, D. H., Holbrook, M. G., Gamble, A., Williamson, B. N., … & Lloyd-Smith, J. O. (2020). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine. https://www.nejm.org/doi/full/10.1056/NEJMc2004973?query=recirc_mostViewed_railB_article
7. https://www.who.int/publications-detail/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-and-management-of-contacts
8. Zhang, J., Wang, S., & Xue, Y. (2020). Fecal specimen diagnosis 2019 Novel Coronavirus–Infected Pneumonia. Journal of Medical Virology. https://onlinelibrary.wiley.com/doi/full/10.1002/jmv.25742
9. Kampf, G., Todt, D., Pfaender, S., & Steinmann, E. (2020). Persistence of coronaviruses on inanimate surfaces and its inactivation with biocidal agents. Journal of Hospital Infection. https://www.sciencedirect.com/science/article/pii/S0195670120300463
10. US Centers for Disease Control and Prevention, 2020. Water Transmission and COVID-19 Drinking Water, Recreational Water and Wastewater: What You Need to Know. Website, accessed March 25, 2020. https://www.cdc.gov/coronavirus/2019-ncov/php/water.html