Covid-19: Recommendations for Prevention and Response
This resource is intended to synthesize currently available evidence and guidance on SARS-CoV-2 virus and COVID-19 disease occurrence, transmission, and management in the context of water, sanitation, and hygiene (WaSH) and environmental health. In addition, it includes links to selected documents, guidance, and resources relevant to these topics for WaSH and environmental health practitioners, policy stakeholders, and researchers. It also provides links to selected online discussion forums and groups that may be relevant to these stakeholders.
This resource will be updated periodically and was last updated on July 27, 2020.
COVID-19 in Context 1
Coronavirus disease or COVID-19 is caused when a person becomes infected with the novel SARS-CoV-2 coronavirus. This illness originated in the Chinese city of Wuhan in late 2019 and has since spread throughout the world. Most people infected with the virus experience mild to moderate respiratory symptoms and require little to no special treatment to ensure their recovery although a proportion of those infected (especially those with underlying health conditions such as diabetes, cardiovascular disease, chronic respiratory disease, and certain cancers) can go on to develop serious illness that can be fatal if they do not promptly receive specialized care at a hospital. Below is a collection of information regarding the characteristics of the virus as they relate to the context of WaSH and environmental health.
- The main route of transmission for COVID-19 is thought to be through direct contact with large respiratory droplets emitted when an infected person coughs, talks, or sneezes.
- People infected with COVID-19 can contaminate their immediate environment with the virus and there is evidence to indicate that SARS-COV-2 can be transmitted indirectly via contact with contaminated surfaces.
- COVID-19 persistence on surfaces requires further characterization, but seems likely to behave like other coronaviruses. A study conducted by the National Institute of Allergy and Infectious diseases indicated that under controlled laboratory conditions (21-23°C and 40% relative humidity) viable SARS-CoV-2 virus was detected for up to 72 hours on plastic, 48 hours on stainless steel, and 24 hours on cardboard after application to these media.
- Limited information regarding SARS-CoV-2 susceptibility to disinfection is currently available, however a study conducted by researchers at the University of Hong Kong indicated the virus is susceptible to standard disinfection methods and materials. For all disinfectants tested except hand soap solution, addition of the substance at working concentration to 15 μL of SARS-CoV-2 culture rendered the virus undetectable after a 5-minute incubation period at 22° C under laboratory conditions. A recently published review of the susceptibility of other human coronaviruses found effective inactivation of HCoV (within 1 minute under ambient conditions) using common disinfectants such as 70% ethanol, 0.1% sodium hypochlorite, and hydrogen peroxide.
- WHO warns that airborne transmission of COVID-19 is possible in healthcare facilities when aerosol generating procedures (AGPs) are performed. While the potential for COVID-19 transmission via aerosols requires further investigation and cannot be ruled out in poorly ventilated indoor spaces, there is no credible evidence to indicate that that this mode of transmission constitutes a significant source of exposure in other contexts at this time.
- There have been no reports of fecal-oral transmission of COVID-19 to date. While the risk of catching COVID-19 from the feces of an infected person appears to be low, there are conflicting reports regarding the persistence of live SARS-CoV-2 in feces. Given that the COVID-19 virus is rapidly inactivated by chemical agents in the colon, this transmission pathway is likely of little significance to viral spread.
- There has been no evidence of SARS-CoV-2 presence as infectious virus or survival in drinking water and no documented COVID-19 transmission through drinking or wastewater. The virus is likely to become inactivated significantly faster than non-enveloped human enteric viruses with known waterborne transmission and standard treatment methods and disinfection procedures are expected to be effective at mitigating any potential risk of infection from this pathway.
- SARS-CoV-2 RNA is readily detectable in untreated wastewater and efforts are currently underway across the globe to assess COVID-19 sewage surveillance as a potentially important tool for monitoring population and community infection trends.
- Hand hygiene is an effective strategy to reduce the transmission of COVID-19. Access to sufficient quantities of water and soap, alcohol-based hand rub, and/or hygiene materials are needed to facilitate regular, effective handwashing.
- Limiting face-to-face contact with others in public spaces through social distancing and masking is vital for reducing SARS-CoV-2 transmission in these spaces. Masking provides a means of “source control” by reducing the number of particles emitted by people infected with COVID-19 as well as offering some measure of protection from personal exposure for those who are uninfected.
- In order to protect healthcare workers in close contact with patients, it is important to characterize effective decontamination and disinfection methods for filtering facepiece respirators such as the N95 in order to enable their reuse and continued availability in times of shortage.
WaSH and Environmental Health Implementers:
- Access to safely managed sanitation services is crucial to ensuring potentially infectious waste is disposed of safely.
- COVID-19 highlights the importance of on-plot water and sanitation service delivery – the WaSH sector must continue to strive to provide on-plot service in order to mitigate risk of viral transmission posed by queuing and congregating at water points.
- Prioritize sustaining and expanding WaSH services in healthcare facilities (HCFs) and schools, as well as community WaSH infrastructure. Infection prevention and control is one of the eight pillars described in the WHO’s COVID-19 Strategic Preparedness and Response Plan.
Health Systems Response:
- In order to streamline coordinated crisis response, systems must be established to ensure cross-sectoral coordination and collaboration. Governments, NGOs, and the private sector must work together to mitigate the effects of the pandemic efficiently.
- In responding to COVID-19, policymakers and planners should consider investing in safely managed water and sanitation service delivery, as well as hygiene promotion and infrastructure, because these measures constitute “no-regrets” solutions proven to benefit overall public health while simultaneously mitigating risk associated with the transmission of other infectious diseases.
Additional WaSH and Environmental Health Guidance by Topic
Resources for Monitoring Scientific Updates on the Novel Coronavirus
- IS Global: COVID-19 Scientific Updates
- NIH: News Releases Related to Coronavirus (COVID-19)
- Nature: Coronavirus Research Updates
- WHO: Coronavirus disease (COVID-2019) situation reports
- CDC: Coronavirus Disease 2019 (COVID-19) What’s New
- Coronavirus- World Health Organization
- UNICEF Technical Note on WaSH Programme Contribution to COVID-19 Prevention and Response
- WHO Scientific Brief: Transmission of SARS-CoV-2: Implications for Infection Prevention Precautions
- WHO Interim Guidance: Water, sanitation, hygiene, and waste management for the COVID-19 virus
- CDC: How to Protect Yourself and Others
- WHO: Coronavirus disease (COVID-19) advice for the public
- WHO: 14 April 2020 COVID-19 Strategy Update
- Howard et al. COVID-19: urgent actions, critical reflections and future relevance of ‘WaSH’: lessons for the current and future pandemics. Journal of Water, Sanitation and Hygiene for Development washdev2020218. doi: https://doi.org/10.2166/washdev.2020.218 (Water Institute Faculty Jamie Bartram and Clarissa Brocklehurst are coauthors of this review).