Ebola, Water, Sanitation, and Hygiene

A few thoughts/data points on the linkages between Ebola and WASH:

Summary: Safe drinking water, sanitation, and hygiene (WASH) are important in treating patients infected with Ebola and in preventing the transmission of Ebola (and other infectious diseases). WASH is vital at household, community, and health facility levels. Longterm, sustainable public health and WASH infrastructure are important to better prepare communities, particularly in West Africa, for the next occurrence of such diseases.

From An Open Memo on Ebola and Water:

·         Water Supply Needs and Usage:

o   Any medical facility, hospital, field station, isolation unit must have a supply of fresh water that is adequate in flow volume and quality. This requirement, and the need to develop such a reliable supply in advance of facility construction or placement, is as or more vital than the need for reliable electricity. . .

o   While . . . data suggest that emergency minimum water supply volumes on the order of 150 to 200 liters per person per day might be sufficient, it should be a top priority to inquire of current medical facilities in Liberia, Guinea, and other affected areas of West Africa for specific data and insights on their current level of water use as well as the end uses of that water (washing, sanitation, sterilization of equipment, cooking, etc.).

o   A wide range of water-treatment systems can ensure that water supply is safe, including chlorine-based treatments, ultraviolet light treatment, and top-quality reverse osmosis membrane systems. The CDC provides a short overview of various treatment options and their ability to remove viruses here. Before choosing a water-treatment system, . . .confirm that they are designed and can be operated to specifically remove or inactivate Ebola-type viruses with high reliability.

·         Water that may be contaminated with Ebola virus:

o   A separate water-quality risk is that during patient care and treatment, contaminated fluids, including water, will have to be reliable handled, treated, and neutralized.

o   According to the World Health Organization, Public Health Agency of Canada, and the US Centers for Disease Control and Prevention, Ebola virus is known to be susceptible to solutions of chlorine bleach, germicidal chemicals, gamma radiation, sufficient ultraviolet C light exposure, some soaps, alcohol-based sanitizer (at least 60% concentration), and by boiling water.

From Handwashing and Ebola: The Facts:

·         Ebola virus is present in all body fluids of an infected person, and once they become symptomatic, is transmitted by direct contact with these body fluids, including blood, sweat, vomit, diarrhea, urine, saliva, tears, semen and breast milk.

·         Direct contact may involve directly touching infected body fluids, or touching items and surfaces like doorknobs that have been recently contaminated with these infected fluids. Once it is on your hands, Ebola virus can enter your body through breaks in the skin of your hands, or when you touch your eyes, nose or mouth (mucous membranes). Similarly, if you are wearing gloves that have Ebola virus on them, Ebola virus can enter your body if you touch your eyes, nose or mouth with your gloved hands. Finally, when you remove gloves that may have Ebola virus on them, you must wash your hands immediately in case any Ebola virus on your gloves or other protective clothing is transferred to your bare hands during removal.

Newspaper Articles/Blogs

·         Professor Taylor of the University of Brighton said: "Our Environment and Public Health Research Group is currently developing low-cost ways to disinfect human waste following disease outbreaks,” and is advising the World Health Organization (WHO) to help control the spread of the disease. Source: University scientists help tackle Ebola

·         Médecins Sans Frontières epidemiologist Kamiliny Kalahne said outbreaks usually spread in areas where hospitals have poor infection control and limited access to resources such as running water. "People who become sick with it almost always know how they got sick: because they looked after someone in their family who was very sick -- who had diarrhea, vomiting and bleeding -- or because they were health staff who had a lot of contact with a sick patient," she said. Source: Ebola virus: Nine things to know about the killer disease.

·         As recently described by Laurie Garrett of the Council of Foreign Relations, the Ebola virus in West Africa should be tackled the same way it was done in 1976:  with soap, clean water, protective gear, safe medical practices, and quarantine; technology and vaccines are of no use. Source: The Ebola Threat: A “new normal”? (The World Bank)

·         Should hygiene be more of a priority for donors than health care? (Devex) UNICEF staff hands out soap and chlorine in Conakry to prevent the spread of Ebola in Guinea.

·         Interventions to Control Virus Transmission during an Outbreak of Ebola Hemorrhagic Fever: Experience from Kikwit, Democratic Republic of the Congo, 1995 (The Journal of Infectious Diseases)

Further Reading:

·         There are a number of resources here (http://www.medbox.org/ebola-toolbox/listing?q=water&sort) regarding the importance of water, sanitation, and general hygiene to treat and prevent the spread of Ebola.