by Eklavya Tiwary and Vishakha Anbhore
Social distancing and quarantines are essential to ‘flatten the curve’ or slow the spread of the on-going pandemic. This is although, inefficient without proper sanitation and hygiene. In that essence, COVID-19 may be considered a WASH (water, sanitation, and hygiene) disease, requiring regular handwashing and alcohol sanitization of fomites. How then, are the 4.2 billion with no access to sanitation services and the 3 billion with no access to handwashing facilities (Matto), expected to remain immune to the disease?
Access to clean water and sanitation is a fantasy for many. Globally, over a billion people need to leave their homes to meet their sanitation needs. An estimate 9% defecate in the open and another 8% use shared facilities as their primary sanitation locations (Caruso and Freeman). Although there is no strict evidence yet whether sewage and fecal discharge is susceptible to the transfer of the novel coronavirus, emerging studies do indicate that it might just be possible. However, further research and study is required to validate these findings (Matto). The more imminent threat is that from shared facilities. Airborne and contact exposures of the virus through fomites like doors, and toilet and latrine surfaces could lead to rampant spread.
We saw this unfold in the slums of Mumbai in the early months of the nation-wide lockdown. Nearly 5.5 million are squandered in pockets of slums in the Ghatkopar-Kurla-Govandi-Mankhurd belt, the Dindoshi area in Malad and in the infamous Dharavi region. A massive boom in the count of the affected was partly due to the presence of mega community toilets for the slum-dwellers. With the absence of individual toilets per house, the slumdwellers are restricted to the shared facilities. 750 community toilets were constructed under the Slum Sanitation Program in 2001 which equate to 26,379 toilet seats. With the humongous populous, that calculates to one seat for 190 users. This burdening load is partially revived by some 30,000 free to use toilets by the Maharashtra Housing and Area Development Authority, commercial pay and use toilets, and those who defecate in the open. Additionally, a survey conducted in 2016 revealed that 58% of the SSP community toilets have no electricity and 78% have no water. By design, the MHADA toilets have neither water nor electricity as well. To top it all, the availability of soap or alcohol-based disinfectants, the crucial defenses against COVID-19, is nothing but a utopian vision (Desai).
The outbreak in Mumbai has clearly demonstrated why it is critical to make water and sanitation, effective barriers to the virus, accessible and affordable to all. To further prevent the spread of the virus, it becomes imperative to rework water and sanitation management systems. The World Health Organization’s Water Safety Plan (WSP) and Sanitation Safety Plan (SSP) should be revisited with a purely health related context. For the provision of safe uncontaminated drinking water, the very adaptable WSP that can be effectively applied across all socio-economic settings, should be adhered to. In terms of the sanitation chain, the SSP, which is also applicable across high- or low-income settings, ensures control measures that target health risks. These approaches are also within the capacity of small-scale or rural communities and thus ensure the safety of all exposed groups under the radar of the water and sanitation value chain (Matto).
With economies collapsing all over, it is now inarguable that the informal sector contributes to a large chunk of developing economies world-wide. Shouldn’t we then be obliged to ensure the most rudimentary standard of living to this demographic?
Caruso, Bethany A. and Freeman, Mathew C. “Shared Sanitation and the Spread of Covid-19: Risks and Steps.” Elsevier Public Health Emergency Collection, 2020, U.S National Library of Medicine, www.ncbi.nlm.nih.gov/pmc/articles/PMC7237180/
Desai, Dhaval. “Poor Sanitation in Mumbai’s Slums is Compounding the Covid19 Threat.” Observer Research Foundation, 16 May 2020. https://www.orfonline.org/expert-speak/poor-sanitation-in-mumbais-slums-is-compounding-the-covid-19-threat-66216/
Matto, Mahreen. “World Needs Water, Sanitation Plans to Mitigate Coronavirus Risk.” Down To Earth, 20 Apr. 2020, https://www.downtoearth.org.in/blog/water/world-needs-water-sanitation-plans-to-mitigate-coronavirus-risk-70552