World needs water, sanitation plans to mitigate coronavirus risk

The novel coronavirus disease (COVID-19) outbreak has shown the importance of water in public health, with almost the entire world under lockdown. It also shows how much more is needed to be done to ensure access of clean water and sanitation to all, as a human right and as a critical element to protect human health during health crises.

COVID-19 may be considered partly a water, sanitation and hygiene (WASH) disease, needing precautionary measures like regular washing of hands, as safely managed WASH services are integral in preventing and protecting human health during outbreaks of infectious disease, including the ongoing pandemic.

Access to clean water and sanitation is not a reality for billions around the world. Around 2.2 billion people around the world do not have access to safely managed drinking water services, while 4.2 billion people do not have sanitation services and 3 billion lack basic handwashing facilities, according to the World Health Organization (WHO).

The United Nations health body said there is no evidence yet for the survival of the virus (SARS-CoV-2) in drinking water or sewage.

The risk of transmission of the disease from the faeces of an infected person is unknown, with no reports of transmission through the oral-faecal route. Emerging studies, however, indicate the potential for the oral-faecal route as an alternative to respiratory and contact transmission.

The possibility of the virus in sewage is indicated by initial investigations by the KWR Water Research Institute in the Netherlands and a dozen other organisations.

Research showed there is no possibility of the presence of the virus in drinking water after adequate dosage with chlorine and ultra-violet irradiation.

Previous studies on surrogates of the SARS coronavirus, however, suggest they survive in water and sewage for up to several weeks under different conditions. More data and analysis is needed to validate these findings.

The disease outbreak demonstrates why water and sanitation — being an effective barrier against the virus — must be available, accessible and affordable to all.

A lack of these can be a significant vector / pathway in the transmission of the virus, if proper hygiene is not followed.

The need of the hour is to rework water and sanitation management systems instead of focusing solely on infrastructure solutions for water and sanitation challenges — as is usually seen in developing countries.

Nobody wants to sit at home when the next pandemic arrives. It, thus, becomes imperative to become proactive now to stop the next outbreak.

These sectors must be looked at from a health perspective to understand current practices and understand the health risks posed, including identifying those who may be the most affected by such risks and only then approach water and sanitation improvement to mitigate these risks.

This is, thus, the time to revisit and think of implementing water safety plan (WSP) and sanitation safety plan (SSP) approaches, to ensure safe and efficient management of water supply and sanitation services.

WHO guidelines for drinking water quality recommend WSPs as the most effective means of consistently ensuring the safety and acceptability of any drinking water supply.

WSPs required a risk assessment covering all steps in water supply — from catchment to consumer — followed by implementation and monitoring of risk management control measures and a focus on high-priority risks.

The WSP approach allows incremental improvements to be implemented systematically over time, wherever risks cannot be immediately addressed.

WSPs should be implemented within a public health context, responding to clear health-based targets and quality-checks.

WSPs are adaptable to all kinds of water supply and may be effectively applied in all socio-economic settings. The WSP approach is increasingly being adopted globally as a best practice for the provision of safe drinking water.

Better sanitation is said to be one of the key elements in managing the spread of COVID-19.

Ensuring that human waste is collected, transported and handled safely is, thus, an important precaution for preventing transmission of the virus.

Management and investments in improvements on sanitation systems should be made based on adequate understanding of actual health risks posed by the systems and how these risks can be better managed. It is here that SSP plays a vital role.

The approach is a means to reduce the risk of contracting pathogens and microbial vectors associated across the entire sanitation chain.

It is a tool based on risk-based principles, with the underlying purpose to protect public health.

The SSP approach supported the implementation and recommendation of WHO’s 2018 guidelines on sanitation and health and ensured universal access to safe systems along the entire sanitation service chain. It is also in line with the WHO’s 2006 guidelines for the safe use of wastewater, excreta and greywater.

Water and Sanitation Safety Plan

Source: Professor Thor Axel Stenstrom, 2013

The approach ensures control measures target the greatest health risks and emphasised incremental improvement over time. It is applicable in high and low resource surroundings. It may be used both at the planning stage for new schemes and to improve the performance of existing systems.

Considering similarities in the WSP and SSP’s systematic approach and overlap in goal and purpose, one may question the degree to which they may be integrated and in which situations they may be beneficial.

There seem to be several associations, as both deal with the environmental aspects of water resources and hygiene: SSP focuses on reducing exposure of excreta and wastewater to the human population and WSP aims at reducing contaminants in source water to a safe and acceptable level to supply drinking water.

This seems a smart idea to bring SSP and WSP together. There is, however, a concern that having too many stakeholders may lead to endless conversations.

In small-scale community systems — often rural or peri-urban — there is less capacity, scarce resources along with poorly defined roles and responsibilities. An integrated approach of SSP and WSP may add much value.

The important point here is that this combined approach is still manageable by small-scale operators and communities.

One of the implications of crises like the current pandemic is that social disparities were thrown into sharp relief: Those who keep societies running face the most health risks.

The above approaches take care of all exposed groups who come under the radar of the water and sanitation value chain, be it municipal service providers or sanitation workers on the frontline of the pandemic.

The need is to:

• have a policy and regulatory framework to ensure consistent and sustainably safe and secure sanitation, with a legislative framework for a policy on SSPs.
• promote collaborative and collective efforts to ensure sustainable implementation of the plans
• involve multiple stakeholders, essential in rethinking and acting for improved WASH services

Though research over the presence of the virus in sewage and treated water is in a nascent stage, it will be too late to wait for the validation of such research.

The role of WSP and SSP, in such situations, becomes more prominent to safeguard the heath of the people working in the water and sanitation sector in the fight against any pandemic.