‘Wash your hands and stay home’ is impossible for millions

Public health experts fear that a disastrous spike in COVID-19 cases in many low- and middle-income countries may be looming. Across Africa and Southeast Asia, for example, there are currently around 75,000 confirmed cases, far fewer than the nearly one million cases in the US. The difference between containment and widespread outbreak of COVID-19 may depend on our response to another global crisis: water insecurity.

Millions of families around the world do not have piped water in their homes. Millions of more experience interruptions to their water at home for a variety of reasons, ranging from seasonal fluctuations in groundwater levels to shutoffs due to non-payment. No matter the cause, the outcome is the same: someone has to go and fetch water — and it’s usually women and children. The public water sources to which they travel are often crowded, and thus a risk of COVID-19 transmission.

When water is limited, handwashing is also compromised. While current hydrologic data can be used to estimate the risk of water scarcity, they cannot pinpoint which households are actually experiencing issues with water. In an effort to develop a tool that could easily identify these individuals, our team of over 40 scientists recently collected the most comprehensive data on household water security to date.

What we found is alarming: nearly one in four randomly selected households were unable to wash their hands in the prior month because of problems with water.

At a number of sites in South America, East Asia, and sub-Saharan Africa, more than half of the population were unable to wash their hands in the prior month. The situation was particularly dire in Punjab, Pakistan, where 30 percent of families reported that issues with water meant that they could never wash their hands. Sometimes this was because the available water was too dirty. Other times the little water they had was used for drinking and cooking instead of washing.

To maintain personal hygiene when water was limited, some households borrowed resources while others relied on the support of friends and family. As one man in Labuan Bajo, Indonesia reported, “When we have neither water nor money, we bathe and wash at a relative’s house.” If strict social distancing measures are enforced, it is unclear if, or how, he and others in a similar situation would be able to access clean water. 

Similar barriers to handwashing and staying in place also affect families in the United States. In fact, an estimated 15 million Americans experienced a water shutoff due to failure to pay in 2016 while many Native communities do not have access to safe water. The water-related issue is so common in the U.S. that many governors, from New York to California, have barred utility providers from cutting water services during the pandemic.

The inability to wash hands also plagues health care workers. Basic water services are not accessible to an estimated on in four medical personnel serving on the frontlines of the COVID-19 crisis. This means that doctors, nurses, and other staff cannot wash their hands with soap and water after coming into close contact with patients. 

The World Health Organization has announced that securing reliable access to sufficient water is critical for preventing further spread of COVID-19. Governments are providing support by offering provisions to help low-income families pay their water bills. International agencies, including CARE and Oxfam, are also working to directly provide soap, water, and educational materials to at-risk communities. At the local level, smaller social enterprises are leveraging resources to provide simple handwashing devices. These stopgap measures, although critical, will not be enough. 

Available evidence suggests that swift, significant, and sustained investments in both water infrastructure and governance are needed to ensure that individuals everywhere can wash their hands. Increased funding for the more robust and systematic data collection on water security will be instrumental to maximize the impact of these investments. 

The Household Water Insecurity Experiences (HWISE) Scale can help with this; it is a useful tool for identifying exactly where water access and use are problematic. The brief survey takes less than three minutes to complete and captures the information that policymakers and program developers need to identify vulnerable populations and best target resources to achieve water security.

The HWISE Scale is currently being implemented in nationally representative surveys in India and all countries in Africa through the Gallup World Poll. But we need information on household water insecurity everywhere, including in the United States. With robust data to guide investment, we can both address this crisis head-on and better prepare for future disasters.

Sera Young is a Carnegie fellow and an associate professor of Anthropology and Global Health at Northwestern University, Follow her on Twitter: @profserayoung. Joshua Miller is a research coordinator in the Department of Anthropology at Northwestern University. Follow him on Twitter: @joshdoesscience.