Preparing for the next pandemic: Investing in WASH

Photo by CDC on Unsplash

While much is being done to explore therapeutics and vaccines for the new coronavirus disease, including the new Therapeutics Accelerator and the SOLIDARITY project, little has been said or done about ramping up the work on improving water, sanitation and hygiene (WASH).

Save for Rwanda, that seems to have once again surpassed everyone in their installation of wash basins near bus stops, countries are failing to invest on hygiene improvement infrastructure.

The provision of safe water, sanitation, and hygienic conditions is essential to protecting human health during all infectious disease outbreaks, including the COVID-19 outbreak. Ensuring good and consistently applied water, sanitation and waste management practices in communities, homes, schools, marketplaces, and health care facilities will help prevent human-to-human transmission of the COVID-19 virus. Note that such WASH investments are not only preparing us for novel diseases but also from water-borne cholera and other diseased. In light of the events today, I am highlighting the most important information concerning WASH and the COVID-19 virus here.

The importance of water, soap and hand hygiene

• While much of the transmission is taking place when infected people sneeze or cough, there is also some transmission that takes place through touching surfaces that carry the virus and then touching our faces. As a result, frequent and proper hand hygiene will be an important measure that can be used to prevent infection with the COVID-19 virus. Note that the primary transmission taking place is directly — through human-human contact and not indirectly through surfaces. Nonetheless, more frequent and regular hand hygiene and disinfection will facilitate rapid die-off the COVID-19 virus. Many co-benefits will also be realized by safely managing water and sanitation services.

The need for washing stations in slums and homeless shelters

• While regular hand washing is important in preventing the spread of COVID-19, access to water can become a problem in informal settlements which don’t have access to drinking water, let alone water for cleaning their hands (for 5 minutes!). Creating awareness in these areas is not enough. Setting up wash basins is necessary in the slums and areas where homeless are clustered. This is true for both developing and developed countries.

There is no transmission through drinking water

• COVID-19 is NOT a waterborne disease. That means the COVID-19 virus has not been detected in drinking-water supplies, and based on current evidence, the risk to water supplies is low. However, earlier laboratory studies of surrogate coronaviruses that took place in well-controlled environments indicated that the virus could remain infectious in water that was contaminated with faeces with the coronavirus for days to weeks. Moreover, the virus has been found in the faeces of some people and fecal contamination of water can occur. That being said, conventional, centralized water treatment methods that use filtration and disinfection should inactivate the COVID-19 virus. Other human coronaviruses have been shown to be sensitive to chlorination and disinfection with ultraviolet (UV) light. Also, unlike other viruses with protein coats, enveloped viruses like SARS-CoV-2 are surrounded by a lipid host cell membrane, is likely to be more sensitive to chlorine and other oxidant disinfection processes.

Wastewater testing can be used as an indicator to assess community spread

• In Netherlands, monitoring wastewater has been a good strategy for detecting whether specific viral infections are present in a population. The National Institute for Public Health and the Environment has previously used this approach to detect the presence of norovirus, antibiotic-resistant bacteria, the poliovirus and the measles virus in wastewater. Recently, the novel coronavirus has been detected in wastewater in the Netherlands. Using molecular methods, the virus that causes COVID-19 was detected in wastewater at Amsterdam Schiphol Airport, in Tilburg and at the wastewater treatment plant in Kaatsheuvel. The reason is that a small percentage of patients with COVID-19 have the novel coronavirus in their gastrointestinal tract, and thus excrete it in their faeces. When their stool is flushed down the toilet, it ends up in the sewer, and then in the wastewater. Such a method could be used in other places to assess the spread of the virus.

Pandemic Preparedness Funding must consider WASH investments

• One good thing that may come out of this virus is that we spend some money investing in healthcare and pandemic preparedness. We have no idea when the next one will strike but we know we will need to make some preparations. The next one may or may not be a bat virus and it may be water borne. In either case, it will be necessary to boost investments in WASH to ensure that maximum hygiene practices exist along with reliable water supply. This is especially in Asia and sub-saharan Africa where water supply is intermittent, unreliable and sanitation systems are dismal. Thus such WASH investments will protect the population from a vast number of waterborne illnesses — which would otherwise create stress on the healthcare. This small and single investment can have huge impacts on health outcomes. Moreover, by reducing the burden on the existing health care system, health care professionals will be more able to address novel diseased.