To control Covid-19, address water, sanitation, hygiene and waste issues: analysis
The coronavirus outbreak has exposed flaws in human habits and habits. Although it has affected millions worldwide, it is the densely populated areas of large cities that have suffered the most. The outbreak highlights our deficiencies in addressing urban densification, growth and adverse public health outcomes, which are further exacerbated by inadequate drinking water, sanitation and hygiene practices.
A March 19 World Health Organization guideline outlines the risks faced by water, sanitation, and hygiene (WASH) professionals and providers, as well as policy makers and health workers during the coronavirus crisis . The guide summarizes the findings of some of the ongoing research on Covid-19 that so far has confirmed two main routes of virus transmission: contact and respiratory. Health professionals so far have emphasized avoiding direct contact with infected people and wearing masks nearby. These recipes have been made known to the public through sustained announcements and instructions communicated through the media. Although the transmission medium is confirmed for two modes, the WHO warns people about the probability of survival of the virus in drinking water and wastewater for a limited number of days.
The virus, with a fragile outer membrane that breaks it to leave it dormant, is not known to spread through drinking water and sewage, but studies confirm that it can survive in water for two days. Reports also confirm that 2 to 10% of people infected with Covid-19 suffer from diarrhea and have fragments of viral RNA in their stool. That uncertainty should make us cautious. The WHO guidelines, which the UN agency calls “provisional”, establish preventive WASH and waste management practices to ensure the safety of sanitation and healthcare workers. But the extent to which such measures are implemented in practice remains debatable.
There are three main corollaries for India in the WHO guidelines.
First, as long as research on Covid-19 does not corroborate water and fecal-oral media as a transmission medium for the pathogen, India remains highly vulnerable. Given the ubiquity of dense neighborhoods in urban and peri-urban areas of India, contact and respiratory transmission are unavoidable. This was seen in the post-closure exodus of migrant workers from major cities such as Delhi, Mumbai and Ahmedabad.
Second, if you consider even the slightest possibility of water and / or fecal-oral transmission, India would become a Covid-19 hotbed. Most homes in most of our cities do not have a water supply through pipes or sewer connections. Even in cities where coverage is better, water pipes are old, which are a common cause of waterborne illness, such as typhoid fever, diarrhea, and jaundice.
Wastewater treatment plants are few, most of them are partially functional (they treat wastewater much lower than their installed capacities) and many of them are dysfunctional. Most of urban India and almost all of rural India rely heavily on groundwater sources for drinking and on-site sanitation systems, such as septic tanks and wells, often ignoring basic design standards. Drinking water and waste treatment remain a distant dream. This makes a wide range of people vulnerable to Covid-19, if the virus survives long enough in water and stool.
Sanitation workers are the most vulnerable, as states across the country have invoked the Essential Services Acts, which require continued collection of solid and liquid waste during shutdown. New research shows that hospital waste has multiplied during closure, requiring proper disposal of potentially infected waste. But the lack of protective equipment like gloves and masks or soaps and disinfectants intensifies their vulnerability. In addition to that, they are not trained to operate under epidemic outbreaks.
Third, regardless of the means of transmission of the virus, Indian health workers are in a precarious position. While providing care and treatment for severe cases, health workers work closely with each other and with patients. Naturally, the shortage of protective equipment, such as masks, gloves, and disinfectants, has caused anger and exasperation among health workers across the country. To make matters worse, they, like sanitation workers, are often stigmatized as carriers of the virus.
The coronavirus outbreak should serve as a wake-up call for authorities and policy makers to expand WASH and waste management infrastructure and services across the country.
Aditya Bhol is Senior Research Associate of the Scaling City Institutions for India initiative under the Urbanization verticalization at the Policy Research Center, New Delhi
The opinions expressed are personal.