Coronavirus, environmental sanitation and the rainy season: How prepared are we?

Introduction

The rains are here and the changes in weather is gradually becoming evident. Since the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, Hubei Province of China, almost all regions of the world are battling with the scourge which is yet to diminish. Interestingly, most countries have reported cases across gradually-changing weather conditions amongst other public health determinants. Initially, the outbreak began in winter across several continents including Asia, Europe, America, and a few countries in Africa. With time, spring set in, and gradually summer is approaching, yet a good number of COVID-19 cases have been reported and still rising. Africa and for that matter, Ghana has two major seasons known as dry (harmattan) and wet (rainy) seasons. Ghana’s COVID-19 index case was reported on 12 March 2020 during the dry season and is still rising with an average active case around 63%.

COVID-19 and weather/climate nexus

It is noteworthy that some viruses causing respiratory infections such as coronaviruses or rhinovirus (RV) do so in the seasons in which they are most active especially in the spring and autumn. A number of research findings have reported the seasonality of viral activities by varying meteorological factors (temperature, dew point, relative humidity, and humidity range). Meanwhile, it is obvious from previous studies that variations in temperature, rainfall, and humidity can have profound impact on the transmission of infectious disease. The course of infectious diseases may be dependent on weather/climate patterns, pathogen prevalence/virulence, or host behavioral patterns. The question then is, are we ready as a country in these times where we have to deal with perennial flooding amidst the pandemic essentially because of our behaviours?

Fluctuations in viral infection patterns observed in seasonal flu and previous epidemics such as yellow fever provides some clue on how our immune system is able to resist respiratory infection. While we grapple with lack of Vitamin D (steroid hormone that regulates innate and adaptive immune responses) due to inadequate exposure to sunlight in cold weather conditions, it is also important to note that it has been linked to an increased rate of viral infection especially from person to person. Vitamin D acts as an immunomodulatory, anti-inflammatory, antimicrobial and antioxidant agent that suppresses immune-mediated disease progression. So, are we ready?

COVID-19 and environmental sanitation

One major area where the impact of COVID-19 will be much felt is environmental sanitation in Ghana, particularly in rural areas and low-income high-density urban areas. Environmental sanitation is defined by the National Environmental Sanitation Policy (2010) issued by the Ministry of Local Government and Rural Development (2010:2) as:

“Environmental sanitation is aimed at developing and maintaining a clean, safe and pleasant physical and natural environment in all human settlements, to promote the socio-cultural, economic and physical well-being of all sections of the population. It comprises a number of complementary activities, including the provision and maintenance of sanitary facilities, the provision of services, public education, community and individual action, regulation and legislation supported by clearly mandated institutions, adequate funding and research and development”.

However, for the purpose of this discussion, we limit ourselves to the problems of open defecation and poor solid waste disposal practices.

Open defecation is already one of the major problems in Ghana, with about 18% of the population practising open defecation (JMP, 2019); that is, defecating in bushes, beaches, backyard, gutters etc. According to the 2018 Multiple Indicator Cluster Survey by the Ghana Statistical Service, open defecation varies widely across the then 10 regions, with the Upper East (67%), Northern (57%) and Upper West (52%) reporting the highest proportions (GSS, 2018). This has serious impacts on human health and the environment. For example, it has been reported that poor sanitation is a major cause of morbidity and mortality situations in most developing countries, and is responsible for about 10 percent of the global burden of disease (UNICEF, 2016), accounting for about 1.7 million deaths every year, resulting mainly from diarrhoeal diseases, especially among children under the age of five years (Halim & Haider 2017). In addition, poor sanitation practices equally pollute the air and water bodies such as the sea, lagoons and rivers, thereby threatening environmental sustainability and sustainable livelihoods of many household (WHO/UNICEF, 2015). In Ghana, about 70-80% of all out-patient cases in the health facilities are sanitation-related.

On solid waste, Ghana has all the institutions, policies and regulations, yet almost all the cities and major towns are grappling with solid waste problems. For example, about 60-70% of solid wastes that are generated in the country do not get collected and properly disposed of, resulting from numerous factors ranging from inadequate financing to poor attitudes of residents. Meanwhile, uncollected solid wastes are a visible sign of the failure of municipal authorities to manage the problem, and like poor sanitation, they threaten both human health and the environment, through routes such as choked gutters, offensive smell, flooding, and outbreak of diseases including cholera, malaria, typhoid, dysentery etc.

Admittedly, the COVID-19 pandemic has contributed to the surge in solid waste generation in the country, resulting from increased use of disposable PPEs, disposable nose/face masks, tissue papers etc as well as increased use of plastics from restaurants and fast food joints (take-out or take-way as we call it in Ghana). However, the capacity of waste collection companies in terms of finance, infrastructure, logistics etc remains the same, and in some instances has even reduced during the pandemic. This poses serious challenges to the waste management institutions in terms of performance in this critical period.

Therefore, with the coming of the rains, the impacts of open defecation and poor waste collection are likely to be more severe as run-offs will wash faecal matter and uncollected municipal solid wastes (sometimes mixed with faecal matter and hazardous wastes) into streams and rivers, thereby contaminating them, and compromising the health of those who depend directly on surface water for household use, and posing threats to aquatic lives. More importantly, the coming of the rains will most likely increase the rate of decomposition of uncollected solid waste in houses and on the streets, leading to pest and rodent infestations and offensive odours. In addition, rainy seasons tend to reduce the amount of wastes collected and disposed of at final disposal sites due to reduced turnaround times of waste collection trucks, and frequent breakdown of collection trucks, as a result of poor roads leading to the final disposal sites. For people without household toilets, the rainy season presents an additional challenge of having to attend to the nature’s call when it is raining. Hence, most of them, particularly those in high-density urban areas may resort to the use of “flying toilets” (defecating into black polythene bags and throwing it on the streets or into gutters), leading to increase in sanitation-related illnesses.

One may argue that this unfortunately, or perhaps, unpleasant yearly ritual has always been with us for a long time, so why worry about it now? The fact is that COVID-19 spreads and kills faster when people have compromised immune system. Therefore, if incidence and prevalence of sanitation-related illnesses increase, it may further worsen the morbidity and mortality situation of COVID-19.

Moreover, with the coming of the rains, enforcement and compliance of COVID-19 restrictions may be seriously affected. For example, it will be difficult to observe social distancing when the rains fall during the day time, and it compels people to take cover under a shade, leading to congestions. Similarly, when the rain is falling, it will be difficult for drivers of passenger cars to comply with adequate spacing in the vehicles because the passengers themselves may have to literally ‘beg’ drivers to increase the number of passengers so that most people can be saved from the rains and arrive home on time. Worst of all, when the rain is falling, the Police might not even be available to enforce physical distancing and wearing of face masks in the vehicles and on the streets. Admittedly, the rainy season will indirectly compel people to ‘stay at home’ in most cases, but the challenges posed for enforcement and compliance far outweigh the benefits of letting a few people stay at home.

The way forward

We acknowledge the fact that much effort has been put into the fight against the novel COVID-19 by the government, researchers, non-governmental organization (NGOs), civil society organisations (CSOs), media, philanthropists, religious leaders and development partners. However, as the country is gradually ushering in the rainy seasons, we need to double our efforts to contain further and accelerated spread of the disease. In this regard, we propose that the following measures should be strengthened or instituted:

First, the disease has taught us what we should have been doing as part of our lifestyle: handwashing with soap, under running water. This intervention should be sustained as we enter the rainy season, because the season comes with its own challenges of worsening the spread of other sanitation-related illnesses, which compromise the immune system of otherwise healthy individuals. Unfortunately, our observation is that the momentum towards the compliance and enforcement of handwashing with soap is beginning to wane. Now, nost shops and facilities do not have the full complement of functional handwashing facilities as they used to have; either soap is missing, or there is no tissue. For those who have them, most do not strictly enforce handwashing before entry. We therefore call for enhanced public education and regular monitoring to ensure compliance.

Second, the government should support waste management companies in the country to ensure smooth operations of timely collection and disposal of solid wastes. Central government, as well as the metropolitan, municipal and district assemblies (MMDAs) who owe private waste management companies, should, as a matter of urgency, settle them to enable perform at optimal level. Also, MMDAs should improve the roads leading to the final disposal sites in order to reduce the rate at which waste collection trucks break down during the rainy season. In addition, the government should scale up monitoring of the waste management companies to ensure uninterrupted collection and transportation of wastes.

Moreover, since most people do not have household toilets, and open defecation is high in the country, there is the need to step the education on the need to build and use household toilets, and where appropriate the MMDAs should support the operation and maintenance of public toilets in order to make them affordable and convenient for users. This, in our view, may reduce the spread of sanitation-related illnesses, and for that matter the impact of COVID-19.