To control Covid-19, address water, sanitation, hygiene and waste issues
The Coronavirus outbreak has laid bare the fault lines in human habits and habitations. Though it has affected millions across the world, it is the densely populated areas of large cities that have borne the brunt most. The outbreak highlights our shortcomings in addressing urban densification, growth, and adverse public health outcomes, which are further intensified by inadequate drinking water, sanitation and hygiene practices.
A March 19 World Health Organization guideline outlines the risks the water, sanitation and hygiene (WASH) practitioners and providers, as well as policymakers and health care workers, face during the coronavirus crisis. The guideline summarises the findings of some of the ongoing researches on Covid-19 which have so far confirmed two main routes of transmission of the virus – contact and respiratory. Health professionals have so far emphasised on avoiding direct contact with infected people and wearing masks in their proximity. These prescriptions have been brought to the public’s notice through sustained advertising and instructions communicated through media. Though the medium of transmission are confirmed for two modes, WHO cautions people about the likelihood of the virus’ survival in drinking water and sewage for a limited number of days.
The virus, with a fragile outer membrane that upon breaking renders it inactive, is not known to transmit through drinking water and sewage, but studies corroborate that they may survive in water for two days. Reports also confirm that 2-10% of people infected with Covid-19 suffer from diarrhoea and have viral RNA fragments in their faeces. That uncertainty should make us cautious. The WHO guidelines, which the UN body calls “interim”, lay down preventive WASH and waste management practices to ensure the safety of sanitation and health care workers. But how far such measures are implemented in practice remains debatable.
There are three major corollaries for India in the WHO guidelines.
First, provided the research on Covid-19 don’t corroborate water and fecal-oral as transmission mediums for the pathogen, India is still highly vulnerable. Given the ubiquity of dense neighbourhoods in the urban and peri-urban areas of India, contact and respiratory transmission are unavoidable. This was witnessed in the post-lockdown exodus of migrant labourers from large cities such as Delhi, Mumbai, and Ahmedabad .
Second, if you consider even the slightest possibility of water and/or faecal-oral transmission, India would turn into a Covid-19 hotbed. The majority of the households in most of our cities doesn’t have piped water supply or sewer connections. Even in the cities where their coverage is better, water pipelines are old, which are a common cause of water-borne diseases such as typhoid, diarrhoea and jaundice.
The sewage treatment plants are few, most of them are partially functional – treating sewage much lower than their installed capacities – and many of them dysfunctional. Most of urban India and almost all of rural India are largely reliant on groundwater sources for drinking and on-site sanitation systems such as septic tanks and pits, often flouting the basic design standards. Safe drinking water and treatment of waste remain a distant dream. This makes a wide range of people vulnerable to Covid-19, if the virus survives for long enough in water and the faecal matter.
Sanitation workers are the most vulnerable, as states across the country have invoked the Essential Services Acts, which necessitates the continuation of the solid and liquid waste collection during the lockdown. New research shows that hospital waste has multiplied during the lockdown, necessitating proper disposal of potentially infected waste. But the unavailability of protective gear such as gloves and masks or soaps and sanitisers intensifies their vulnerability. In addition to that, they are not trained to operate under epidemic outbreaks.
Third, irrespective of the virus’ medium of transmission, India’s health care workers find themselves in a precarious position. While providing care and treatment to the serious cases, the health-care workers operate in close proximity with each other and patients. Naturally, shortages of protective gear such as masks and gloves and sanitisers have invoked both anger and exasperation among the health workers across the country. To make matters worse, they, like sanitation workers, are often stigmatised as a carrier of the virus.
The coronavirus outbreak should serve as a wake-up call for authorities and policymakers to scale up the WASH and waste management infrastructure and services across the country.
Aditya Bhol is a senior research associate with the Scaling City Institutions for India initiative under the Urbanisation vertical at the Centre for Policy Research, New Delhi
The views expressed are personal