Richard Carter, editor of Waterlines journal and WASH consultant, worked with the publishing team to put together a collection of WASH resources to guide community response to the global COVID-19 pandemic. These books and articles have been made temporarily FREE to access.
The virus known as SARS-cov-2 and the severe acute respiratory disease COVID-19 which it can cause, represent the most extensive global public health emergency of recent times. All countries face exceptional challenges at this time, although the nature of the crisis will vary by country and region.
In general, low- and lower-middle income countries tend to have a greater proportion of their populations in the younger age ranges; conversely, a smaller proportion of these countries are elderly. This is in contrast to the high-income countries, where populations are generally skewed toward the older age ranges. This matters, since the mortality rate from the disease is higher in older age groups. It seems that younger people generally (but not always) tend to experience milder symptoms, from which they may readily recover.
Health Care facilities
On the other hand, the number of hospital beds, the number of intensive care facilities, and the number of ventilators (needed for treatment of patients with severe symptoms) all tend to be lower in low- and lower-middle income countries than in the wealthier countries. It would not take many acute cases of the disease to quickly overwhelm health systems in such countries.
A third contrast between lower-income and wealthier countries lies in the amount of social contact that the elderly have with their peers and with younger generations. This social contact tends to be higher in lower-income countries, while in wealthy countries it tends to reduce sharply with age.
A complex set of interactions
All these, and many other country-specific and community-specific factors, combine to explain the way that the virus would multiply in the population, were no measures taken to mitigate or suppress the infection. A recent paper (Walker et al, 26th March 2020) estimates that in the absence of interventions, COVID-19 would result in 7.0 billion cases of the disease and 40 million deaths globally in 2020. For comparison, the global population in March 2020 was 7.8 billion; and in the absence of COVID-19, the global number of deaths in 2017 was about 56 million.
As a consequence of projections such as these, all countries are implementing measures to mitigate, or to suppress, COVID19 transmission.
Mitigation strategies involve shielding the elderly and other vulnerable individuals (those with underlying health conditions which would render them most susceptible to the most severe symptoms), and reducing social contact in the rest of the population. Such measures are judged insufficient to prevent the health systems of all countries becoming overwhelmed; this would be felt especially in lower-income countries with lower-capacity health systems.
Suppression of infection is thought to be only achievable through a combination of targeted and wide-scale testing, isolation of cases, and strict application of so-called ‘social distancing’ – physical separation and non-contact with people outside the immediate household – together with regular individual hand-washing.
What can individuals do?
The best ways by which individuals can protect themselves are (a) to wash hands regularly, thoroughly, and frequently with soap and water; (b) to regularly clean household surfaces with chlorine-based disinfectant solution; (c) to maintain physical distance of at least two metres from people outside the immediate household; (d) to avoid meeting places where many people assemble; (e) to self-isolate at home if you or a member of your household display symptoms (initially a dry cough and fever, perhaps worsening to more serious breathing difficulties). Of course, several of these measures present real difficulties for both rural and urban households in lower-income countries.
What can those who serve them do?
Some widely important elements in interventions to reduce transmission of COVID-19 are: the availability of sufficient domestic water, near to the home, to permit good household hygiene; the widespread, frequent and effective practice of handwashing with soap and water; and the need for accessible, simple, clear messaging around hygiene and physical distancing.
All local governments, NGOs and private sector organisations which have programmes to provide household water and sanitation, and to promote hygiene, should continue and step up such work, subject to precautions about physical distancing and the avoidance of social contact. This may mean placing a greater emphasis on the use of radio, social media and telephone communication (for example) rather than physical meetings. Emphasising the importance of household- and personal (hand-) hygiene is clearly of particular importance.
We hope that the materials which we are making available here will be of particular use to organisations seeking scientific understanding of this new infection and guidance on how best to support the communities they serve.
Patrick GT Walker, Charles Whittaker, Oliver Watson et al. The Global Impact of COVID-19 and Strategies for Mitigation and Suppression. WHO Collaborating Centre for Infectious Disease Modelling, MRC Centre for Global Infectious Disease Analysis, Abdul Latif Jameel Institute for Disease and Emergency Analytics, Imperial College London (2020) https://www.imperial.ac.uk/media/imperial-college/medicine/sph/ide/gida-fellowships/Imperial-College-COVID19-Global-Impact-26-03-2020.pdf
Much of the scientific evidence which I have used in this introduction rests on papers produced by the Imperial College (London) COVID-19 Response Team. They are available on-line here: https://www.imperial.ac.uk/mrc-global-infectious-disease-analysis/news–wuhan-coronavirus/