To fight the coronavirus, wash your hands and support clean water access around the world
When people ask how to protect themselves against the spread of COVID-19, one of the first suggestions from doctors is washing your hands. Here are the do's and don'ts. USA TODAY
We can’t build a wall around a germ. But we can wash our hands, and our government can help countries trying to improve their health facilities.
Never has my odd obsession with the lack of access to safe water, toilets and soap around the world become more relevant to the headlines. Because nowhere is the absence of WASH (water/sanitation/hygiene) more abominable than in hundreds of thousands of health care facilities where infections are supposed to go to die.
With all this hand-wringing about the new coronavirus, two things need to happen.
First, this virus has no cure, no vaccine, no treatment other than resting, hydrating, cough medicine and pain relief. You get sick, you feel crummy. You wait it out and try not to get anyone else sick. But the better option is to not get sick in the first place. There are only two ways to be on the offensive: Avoid sick people, which makes a big presumption that they and you know they’re sick, and — the single most important thing you can do — wash your hands.
Many illnesses start when hands become contaminated with disease-causing bacteria and viruses, including the coronavirus. Contamination happens all around us, every day — after using the toilet, shaking hands, coughing, sneezing, changing a diaper and touching contaminated surfaces. (If you want to get grossed out, consider that germs from a cough can travel as far as 13 feet, and though most of the bacteria die within 10 seconds, some survive up to 45 minutes, leaving plenty of time to spread disease.)
Global health facilities fall short
All of us subconsciously touch our hands to our eyes, nose and mouth, giving germs access to our bodies, making us sick. Hand washing with soap effectively removes bacteria and viruses before they can enter our body and spread to others.
Second, the world is finally waking up, nearly 200 years after Florence Nightingale found that 10 times more soldiers were dying of typhus, typhoid, cholera and dysentery than from wounds sustained in battle, due to unsanitary conditions in hospitals.
The first United Nations global baseline report, released in 2019, analyzed data from over 560,000 health care facilities in 125 countries and shows the widespread lack of safe health care:
►2 billion people must rely on facilities that lack basic water services and 1.5 billion people on facilities without sanitation service.
►49% of facilities in sub-Saharan Africa lack basic water services.
►64% of health care facilities in Eastern and Southeastern Asia lack basic hygiene services.
This report means that the ability to prevent and contain any number of outbreaks, including coronavirus, the most recent, is deeply, deeply compromised.
During the 2014-16 Ebola outbreak that also put the world on edge, Ebola killed 11,000 people, in part because family members were handling the bodies of the sick and deceased, but they did not have access to water and soap to adequately wash their hands.
The toll was deadliest for medical workers. Ebola deaths were 103 times higher in health care workers in Sierra Leone than in the general population and 42 times higher in Guinea. Liberia lost 8% of its health workforce, in part because they did not have access to adequate WASH, according to the U.S. Centers for Disease Control and Prevention.
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The situation has not improved. In the Democratic Republic of the Congo, where Ebola is still killing and threatening its neighbors, 50% of health care facilities have no water, 59% have no sanitation services, and just 62% have soap and water or hand sanitizer at points of care.
As for the Wuhan coronavirus, more than 3,000 Chinese health care workers have come down with it. Could a lack of hand washing again be a contributing factor?
Global health is our health
According to the World Health Organization and Lancet data, nearly 1 in 6 patients acquires an infection inside a health care facility in developing countries and 1 in 15 acquires a hospital infection in developed nations that they didn’t have on arrival. Notably, according to WHO, 61% of health workers do not adhere to recommended hand hygiene practices.
Hygiene behavior change is needed. As is soap and water.
We can’t build a wall around a germ. But our government can take action. In January, WHO Director-General Tedros Adhanom Ghebreyesus cited the absence of water, toilets, soap and waste management in health care facilities among the most urgent global challenges this decade.
Our government would be wise to help countries trying to improve their health facilities. Each of us can make sure that our member of Congress, which holds the power of the purse, knows that we understand that global health is our health. Congress must commit American technical support and resources, including funding.
If you have access to soap and water, and if you are reading this you likely do, use it. Don’t scoff and wait for a vaccine that is at least 18 months away, if it exists at all. Hand washing is the single most effective means of removing germs, avoiding getting sick and preventing the spread of infection to others.
As WHO's Tedros said, "If you can't do the basics, forget the rest. Prevention, prevention, prevention."