COVID-19: urgent actions, critical reflections and future relevance of ‘WaSH’: lessons for the current and future pandemics

Abstract

The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels of water supply that support good hand hygiene and institutional cleaning, our understanding of hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries. This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where these factors are particularly important and identify key preventive contributions to disease control and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH, particularly the provision of reliable, continuous piped water on-premises for all households and settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to high-risk populations (such as the elderly and marginalised) and settings (such as healthcare facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and with other sectors in prevention efforts. More finance and better use of financing instruments would extend and improve WaSH services. The lessons outlined justify no-regrets investment by government during recovery from the current pandemic to improve day-to-day lives and as preparedness for future pandemics.

Water, Sanitation, and Hygiene Practices and Challenges during the COVID-19 Pandemic: A Cross-Sectional Study in Rural Odisha, India

“…First, adequate handwashing requires sufficient water availability from easily accessible and reliable sources, with household piped water being the highest level of access. 34 Second, physical isolation at home for individuals suspected to have COVID-19 as well as the general population during periods of strict lockdown have been promoted as measures to reduce transmission.…”

Water, sanitation, and hygiene practices and challenges during the COVID-19 pandemic: a cross-sectional study in rural Odisha, India

“…However, these measures are only feasible if there is adequate water, hygiene, and latrine facilities in a household; otherwise household members would need to access public locations to retrieve water, bathe, and defecate. 34 We found in our study that good WASH infrastructure enabled compliance with preventive measures like handwashing or staying home, as participants were able to use their latrine and wash their hands at home. A separate study in Tamil Nadu, India found that respondents of the same age, gender, and education who had access to a private toilet were more likely to report they increased the frequency of handwashing since the lockdown, 27 further suggesting that infrastructure played a role in COVID-19 handwashing practices.…”

“…Access to adequate WASH infrastructure can play a role in an individual's ability to comply with recommended COVID-19 preventative measures in two ways. First, adequate handwashing requires sufficient water availability from easily accessible and reliable sources, with household piped water being the highest level of access 34. Second, physical isolation at home for individuals suspected to have COVID-19 as well as the general population during periods of strict lockdown have been promoted as measures to reduce transmission.…”

How WASH Programming has Adapted to the COVID-19 Pandemic

“…A rapid response was called for, and actors across the globe worked quickly to develop sets of preventative measures to contain the disease. One mode of transmission identified early on in the crisis was via surfaces and objects (fomites) (Howard et al 2020). To combat this, hand hygiene was put forward as a key preventative measure and heralded as 'the first line of defence against the disease' (World Bank 2020).…”