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The role of WASH in COVID-19

Back to public health engineering basics

30 June 2020

The impact of the COVID-19 pandemic highlights just how important water, sanitation, and hygiene (WASH) are to the human population.

Personal hygiene, including handwashing, is hugely important in limiting the spread of disease – governments have even embedded hand washing into their key messages. Household hygiene, keeping our homes clean, is also crucial, particularly when viruses can survive on inert surfaces. To practice good hygiene, we need access to water and soap, something that many communities go without. The absence of readily available water supplies at home constrains this ability, and if communities therefore access their water by travelling to collect it, that renders physical distancing from others virtually impossible. What happens when places like health centres, hospitals, prisons, orphanages, and care homes don’t have access to an adequate supply of water and can’t practice good hygiene? 50% of health centres in Africa don’t have a basic water supply.

Infections present a risk to everybody when they cannot be controlled at a household level. The pandemic demonstrates that what appears to be a water access issue primarily has direct health and economic implications for society at large – the infrastructure/WASH and public health/disease sectors are inextricably intertwined. It shows us, and policy makers, WASH is not a charity sector or a ‘good thing to do’ – it should be a fundamental part of funding and planning.

COVID-19 is a wakeup call, and if there is any kind of silver lining from the pandemic, it may be the recognition of the importance of water, sanitation, and hygiene.

Professor Barbara Evans is one of the Hub’s Co-Investigators, working on developing effective strategies for delivering sustained high-quality equitable water and sanitation. In this webinar Prof Evans leads us through the implications of the COVID-19 pandemic on WASH and public health engineering and planning.

Johan Pasos-Panqueva and Tatiana Zuñiga-Burgos, Hub doctoral researchers at the University of Leeds, offer a commentary on this webinar below.


Our speaker, Professor Barbara Evans explains the challenges with new diseases like COVID-19, as we cannot count on any one model to use in our response to a new outbreak. The use of empirical models is one option, as shown by the UPC research group ‘Computational Biology and Complex systems group (BIOCOM-SC)’. Led by Blas Echebarria and directed by Clara Prats [1], the group has made some good progress at predicting the final number of cases and reproduction rates. Nonetheless, the largest burdens of disease are often not caused by outbreaks, but by long periods of endemic disease. Poor health data represents a challenge to determining risk factors associated with pre-existent health conditions in certain groups of society. In this sense, our role as public health engineers is to secure adequate infrastructure and promote behavioural change interventions.

Previous experience with other water or excreta-related diseases and current evidence on SARS-CoV-2 presence in excreta samples, serves as a starting point for considering this virus as a Type 1 pathogen by the WASH sector. This means that as a virus, it is short lived and cannot multiply – it works by penetrating living cells and is non latent. SARS-CoV-2 spreads in droplets from the nose or mouth, which is why controlling aerosols is vital. As it has a low infective dose, avoiding contact with other people by physical distancing works to reduce the odds of the virus finding a new host, as well as frequent handwashing. It has been found that handwashing with soap is especially effective in both killing and removing the pathogen, but what are the implications of more frequent handwashing for the WASH sector?

As hands offer a protection to the virus due to their creases and folds, handwashing in this case is not as straightforward as it may initially appear. It needs to be maintained for at least 20 seconds to be effective, meaning that the average handwashing session can use between 0.5 to 2 litres of water. The absence of readily available water supplies at home constrains this ability for some communities, raising the profile of the global lack of water equity. In the long run, the pandemic could provide the grounds for a new economic appraisal of the societal value of piped water supply at home, which has implications for society at large.

People around the world are still getting sick from other excreta and water related diseases – COVID-19 is not the only health risk that some populations are dealing with – and toilets are also still inadequate in many locations. The WASH sector still struggles to provide safe water and sanitation for all.

In conclusion, SARS-CoV-2 is a wakeup call because it breaks the rich/poor barrier, which is not the case for a lot of excreta and water-related diseases, which tend to mostly affect people living in precarious conditions. In this sense, providing adequate reliable water supplies and soap for households, schools, hospitals and health centres, prisons and markets is more than just ‘for charity’ – it is about about giving human beings the right to protect themselves. Thus, decision makers and stakeholders need to be conscious about the cost-effective benefits of investing on water access to save on the consequences of not doing it.

[1] Based at the UPC Technology Centre of the Universitat Politècnica de Catalunya (CIT UPC)

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