Ensuring adequate environmental health solution and access to clean water, sanitation and hygiene (WASH) are critical elements to public health. COVID-19 has reaffirmed that implementing WASH in all settings is the need of the hour. Progress, environment, good health and peace are interrelated. COVID-19 has taught us once again to focus on finding out solutions for public health, specifically sustainable environmental health to strengthen peace locally and globally.
Global assessment conducted by the WHO and UNICEF in 2015 reported that almost forty percent of healthcare facilities lacked water, nineteen percent were without sufficient sanitation and thirty five percent lacked hand hygiene goods. Overall, global scenario reveals that more than one billion people worldwide, i.e. one in six, do not have access to safe drinking water and 2.4 billion people i.e. one in three, do not have access to sanitary facilities.
Another concern is that nearly forty percent did not possess the facility to manage healthcare wastes safely. Reports are available which reveals that around fifteen percent of patients develop infections during hospital stay.
Water, sanitation and hygiene related patient safety in healthcare facilities in developing countries has been already a matter of great concern and needed urgent attention. Adding to this already stressed poor safety scenario, more than two billion people are slowly losing their accessibility to fresh water resources and are increasingly becoming so, according to United Nation’s report.
With Coronavirus persisting in today’s world, washing hands is emerging as a difficult challenge in many developing nations due to inaccessibility of clean water or sanitation, in general. In an infectious disease outbreak including Covid-19, the provision of safe water, sanitation and hygienic condition has become more essential. Safely managed water, sanitation and hygiene is declared as the most cost-effective strategy by the World Health Organization. WASH serves as the barriers to human-to-human transmission in homes, communities, health care facilities, schools and other public spaces. Safely managed wash services are also critical to mitigate secondary infections on community livelihood and well-being post Covid-19.
The Covid-19 outbreak has not only highlighted the importance of sanitation and hygienic practice but has also brought upon many challenges especially in urban areas such as urban densification. Reportedly, the people in dense area are more prone to getting infected. Along with it, the adverse public health which are further intensified by inadequate drinking water, sanitation and hygiene have been openly challenged.
Although, till today, the main route of transmission of SARS-Cov-2 has been reported to be only respiratory droplets and direct contact, WHO has cautioned about the possibility of Virus’s survival in drinking water and sewage for a limited number of days. In fact, RNA fragment of SARS-Cov-2 has been detected in untreated sewage and sludge in a number of countries and municipalities. Though little evidence is available, some data suggests that transmission via faeces is possible. There are reports that confirm that 2-10% people infected with Covid-19 suffers from Diarrhea and have viral RNA fragments in their faeces.
Therefore, wastewater and sludge must be contained and treated in well-defined and managed wastewater or faecal/Sludge treatment plants. Such treatment should include all the physical, biological and chemical processes such as retention time, dilution, oxidation, sunlight, elevated pH, and biological activity to reduce the potential risk of exposure and to reduce the pathogen. In several reports, it is suggested for a final disinfection step, if existing treatment plants are not optimized to remove viruses.
Considering the slim possibility of the virus, getting transmitted through untreated water or wastewater, in general, India will become the epicenter of Covid-19. This is because majority of Indian households in urban and rural areas do not have piped-water supply or adequate sewer connections. The numbers of sewage treatment plants are very few with most of them only partially functional.
Most Indian households are therefore, heavily reliant on ground water for drinking while the sanitation system in every households mostly includes septic tanks and pits which do not even meet the basic standards. Owing to such situation, it is evident that India is among the most vulnerable nations for Covid-19 if the virus survives long enough in the water and in the faeces.
Therefore, it is crucial to keep water sources and supplies safe. The water should be treated at the point of distribution, collection or consumption; and ensure that those treated water are safely stored even at home. The concentration of SARS-CoV-2 can also be significantly reduced by utilizing conventional filtration and disinfection. In view of considering the fact that, other human coronaviruses have been exposed to be susceptible to chlorination and disinfection with ultraviolet light treatment, appropriate amount of chlorine should be maintained throughout the distribution system even while distributing via water trucks or any other alternative transport systems such as bicycle, cart, etc. For effective water treatment, adequate stocks of chemical additives and consumable reagents to test the water-quality must be ensured.
Household water treatment such as boiling or using high-performing ultrafiltration or nanomembrane filters, solar irradiation, ultraviolet (UV) irradiation and sodium hypochlorite or correctly optimized other such chlorine products should also be utilized in places, especially rural areas where centralized water treatment and tap water supplies are not accessible.
Apart from water and excretions, management of waste including the health care waste, waste generated at home, greywater or dirty water from washing and cleaning are another critical measure that needs to be taken up.
The infectious waste produced during patient care, including those with confirmed COVID-19 infections such as sharps, bandages, pathological waste should be collected safely and properly treated before disposal. High temperature, dual chamber incineration or autoclaving must be encouraged to treat such waste. Once the waste is displaced from original location or moved away, identification, segregation and treatment of the waste becomes a severe critical issue.
It is worthy to mention that disposing of such waste in the water sources must be avoided.
The novel coronavirus outbreak has reaffirmed the importance of ensuring access of clean water and sanitation in public health. Water, sanitation and hygiene should be accessible in all settings. Therefore, this outbreak calls for radical reformation in the policy-making in scaling up the WASH and waste management infrastructure and services across the country.
Developing countries like India should not only focus solely on infrastructure solutions but rework even on water and sanitation management systems. Implementation of water safety plan (WSP) and sanitary safety plan (SSP) must be given utmost priority by the entire nation. In conclusion, this time has taught the people of this blue planet, consciously and responsibly to believe that “Now more than ever, we need a safer world. Now more than ever, we need a fairer world…” (WHO Director General) and we would like to add that now more than ever we need a stronger WASH system for all, leaving no one behind.
Dr. Nirmala Devi is Assistant Professor and Arenjungla Kichu is Junior Research Fellow at National Institute of Technology Nagaland, Chumukedima, Dimapur. Email @ nirmaladevi2040@gmail.com