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

For rural Tanzanians, water has a social value too

by Lena Farré, recent Post-Graduate from University of Basel, Switzerland, summarises the findings of her Masters degree thesis

This exploratory case study carried out in the Kilombero Valley in southwestern Tanzania shows the mechanisms and challenges communities of a rural village face while seeking water access and maintaining their water pumps. The Tanzanian Government and non-governmental organizations follow a Demand Responsive Approach (DRA). According to the water source providers, communities should demand, own, and maintain their water sources as well as contribute to implementing costs in cash or labour. This participatory approach has been criticised to shift the states responsibility to provide water service towards the community level. To design better policies for interventions that will ensure a sustainable and equitable water provision, it is necessary to understand how communities themselves perceive and deal with this implemented community management system. Here, three key findings are presented, which must be taken stronger into consideration when formulating recommendations for practitioners, since they have been found in other case studies as well.

1.      Women bear the most time and physical strength consuming tasks

While men mostly get the leading position within a water source committee, the role of the secretary or treasurer is mainly given to women. Women are responsible for the house-to-house monthly fee collection from the families using the water sources. Most social conflicts between the committees and the water source users are linked to the monetary contribution. This results in women being directly exposed to these conflicts and therefore less willing to participate actively in the committees.

2.      Mutual mistrust and low transparency

The vulnerable livelihood of the community makes water source users and committee member mistrust each other concerning the payment or safe guarding of the maintenance fees. The need for a sudden financial resource, was mentioned as a reason why water source users doubted that committee members put the entire collected amount of cash onto a bank account. Furthermore, the ability of the committees to control and record the payments of the water source users are restricted due to different reasons: A lack of administrative and accounting skills and remoteness of widely dispersed settlements challenges communication flows. The organization of meetings between water source committees and water users is therefore also difficult. This low transparency fuels mutual mistrust.

3.       Social mechanisms to equalize water access exists

Sanctions such as imposed fines or denied access are assumed to push users to pay their monthly fees. However, they were rarely applied. The committee members often grant exemptions after evaluating the socio-economic situations of the water users. Conflicts between the committees and the users occurred if a household is assumed to be able to pay but refuses it. Private water sources within the community caused conflicts as well. Households who purchased a private one feel under pressure to share it with their neighbours. The system of sanctioning community members for not contributing the payment fees or getting a private water source correspond to market rules. However, water is perceived as a free good by many people. Hence, denying water access to a fellow member of the community transgresses cultural norms and behaviour. Sharing water and preventing someone from getting a private water source, are social mechanisms to equalize water access on the village level.

Behaviour based on the social value of water need to be acknowledged

If a sustainable water source management shall be achieved – community mechanisms have to be understood and acknowledged. Sharing water, conflict avoidance and other behaviour which equalizes access amongst the community members can be seen as obstacles towards the community management of water sources within a Demand Responsive Approach. However, it is suggested to evaluate these social structures positively, allowing the poorest of the community to access water. The government’s responsibility to provide water access and to accomplish the Human Right to Water for its citizens should nevertheless not be denied.

The study showed that the potential of collectively managing water sources based on a barely existing consumer culture must be questioned. Additionally, it is recommended to focus more on the understanding of the social values that water has within a rural community. How they look like in more detail within a rural, Tanzanian community is presented in the study.

CM_in_Tanzania

Download the Thesis report from the RWSN website

Have you recent done research on rural water supply and would like it featured through RWSN? Contact the Secretariat for details.

WEDC Vacancy: Research Associate in Sanitation and Water

Fixed-term for 18 months

A good opportunity to undertake innovative research on sanitation and water in developing countries at the internationally renown WEDC (Water Engineering and Development Centre). The role will include: supporting and managing assessments and research on the sustainability aspects of the DFID funded South Asia rural WASH results project. Other work will include research on improving water security for the poor in slums.

A good masters degree in water and sanitation or related subject is essential, as are excellent communication and analytical skills, the ability to carry out research, write reports and a willingness to travel. Practical experience of work on projects or related research in developing countries would be highly advantageous, as well as working as part of a team.

Informal enquiries should be made to Kevin Sansom at WEDC – K.R.Sansom@lboro.ac.uk or by telephone on +44 (0)1509 222885 or 222617.

Application closing date: 13 October 2016.

FULL DETAILS: http://wedc.lu/ra-vacancy

Handpump standardisation in sub-Saharan Africa: Seeking a champion

by Jess MacArthur, IDE Bangladesh

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Download the new RWSN Publication “Handpump standardisation in sub-Saharan African”

As a millennial, I have to admit: I really enjoy technology and innovation. I love to read innovation blogs and to dissect innovation theory. So just over two years ago as I began researching how innovation intersects development in the world of handpumps, I felt a bit stumped. An estimated 184 million people in sub-Saharan Africa (SSA) today rely on handpumps for their domestic water and many of these use designs that were developed before I was born. Yes, that makes me young and maybe that make you feel old. But mostly, it made me sit back and think. Is this beneficial or is this concerning? At the time I was helping Water4 navigate the policy-sphere around new handpump integration.  I wanted to know why certain handpumps have more dominance in certain areas and how innovators can pilot in the sector with both evolutionary and revolutionary designs.

Continue reading “Handpump standardisation in sub-Saharan Africa: Seeking a champion”

Out today: Addressing arsenic and fluoride in drinking water – Geogenic Contamination Handbook

by Dr Annette Johnson and Anja Bretzler, Swiss Federal Institute of Aquatic Science and Technology (Eawag) – www.wrq.eawag.ch

Researchers at Eawag have been involved in finding technological solutions for arsenic-contaminated drinking water over the last decades. When we also started looking at fluoride contamination in drinking water we soon came to realise how enormous the problem was and how that challenges to long-term mitigation were the same irrespective of contaminant.
Continue reading “Out today: Addressing arsenic and fluoride in drinking water – Geogenic Contamination Handbook”

Rural Water Supply – new publications and resources (December 2014)

For each RWSN newsletter we compile new resources and publications emerging from governments, academic research, NGOs and networks. If we have missed anything or would like to keep us informed in future then please contact sean.furey (at) skat.ch

To read the latest compilation click below to read the full article.

Continue reading “Rural Water Supply – new publications and resources (December 2014)”