COVID-19: Open defecation, waste collection emerging concerns in spread

As the coronavirus crisis continues to spread, creating fatalities, SADE OGUNTOLA, with experts’ views, writes on the possibility of infection transmission through open defecation and improperly managed household wastes.

As the COVID-19 pandemic ravages the world, reasons behind its rapid spread remains largely unknown.

Recent data from the Centres for Disease Control and Prevention indicates that approximately 25 per cent of infected patients may not have clinical signs or symptoms but may still be viral shedders.

A percentage of patients with an asymptomatic preface may also have viral shedding for about two to three days before they develop the more classic respiratory illness.

Researchers have detected coronavirus in specimens other than nose-throat swabs and sputum samples, raising the possibility that the disease may spread through additional routes such as the feces, sputum, blood and inanimate objects.

The Chinese scientists, in the JAMA study, found the highest viral loads in sputum, with moderate loads in nose-throat swabs, the most common way to confirm infection. Some of the fecal samples had high viral loads as well.

But the rapid spread of the disease in the community may also be linked to poor household waste disposal and handling, including the human-to-human transmission between family members of household waste workers and the community.

The World Health Organisation says that coronavirus on the surface can easily be cleaned with common household disinfectants which will kill the virus.

Furthermore, it says that the virus can survive for up to 72 hours on plastic and stainless steel, less than four hours on copper and less than 24 hours on cardboard.

In many developing countries, dump sites are the main source of economic livelihoods to many waste pickers. And this process exposes the picker to many risks including infection and respiratory complications from fumes or dust from waste materials, especially when waste is being dumped or compacted.

In Nepal, researchers assessed the risk of COVID-19 for household waste workers and found that waste workers and waste pickers had a high risk of exposure to the virus.

The analysis further suspected that the re-transmission of the coronavirus from waste workers/pickers to the community may make control of the infection difficult.

The 2020 study in the International Journal of Multidisciplinary Sciences and Advanced Technology established the fact that the government’s priority to health sector alone cannot reduce the COVID-19 vulnerability if the waste management sector is not prioritised equally.

As majority of the population have been at home all over the world, it is immensely important to care about the transmission of the virus to waste workers from medical waste that may be contaminated with the virus.

Some reusable materials are taken by waste pickers or sold at informal markets.  In both the cases, there has been a high risk of exposure to the individual or community towards droplets containing the virus.

Waste materials which fall off while in loaded in trucks can also make the environment susceptible to the infection due to the liquid leakage and waste falling off the trucks.

Professor Godson Ana, head, Department of Environmental Health Sciences, Faculty of Public Health, University of Ibadan, stated that waste collectors and pickers are exposed to coronavirus because open defecation in Nigeria is high and the possibility of also getting exposed to feces or wastes from infected individuals in the community.

According to him, exposure to infected waste such as facemasks is becoming worrisome and something that environmental health experts are looking at very serious. He added that there was the need to guide against any possibility of getting contaminated either by fecal matter or waste products, just as he cautioned children against playing with contaminated face masks.

“We need to maintain a high hygiene condition, in terms of where waste is being disposed of and the places upon which we tread,” he said.

Dr Adeola Fowotade, a consultant virologist at the University College Hospital (UCH), Ibadan, also acknowledged the possibility of transmission of Coronavirus through poor waste handling.

Currently, people who are infected are in isolation at homes, generating wastes and discarding them into open bins that are placed outside their homes.

Waste disposal companies are contracted to carry the waste and sometimes when they come, the workers are not properly dressed for the job. Also, in the process of trying to empty the waste into their vehicles, generated aerosols are inhaled, thereby putting them at risk of infection.

“It is common to see scavengers pick things from dustbins in many communities. When they do it most times, they don’t even wear a face mask or anything that can protect them. That itself puts them at some risk of infection.  Even though we have not quantified how much these practices contribute to community transmission of COVID-19, there is no doubt that this is contributory in most parts of Nigeria,” she added.

On open dumping of feces and open defecation, the virologist condemned the practice, calling it a risk for community spread of the virus, especially because studies have established that the virus can be shed in stool.

She stated that it was evident that there is a community spread of the virus in major cities of Nigeria such as Kano, Lagos and Abuja. Nonetheless, she added that some habits and cultural practices also contributed to the spread.

“We are very warm and loving as a people and we don’t believe in physical distancing or social distancing. That made nonsense of the entire law of keeping safe distances from other people.

“People still go visiting others in their homes without wearing masks; people still hold hands. They cough without putting it in a bent elbow. They behave as though there is no pandemic. Our behaviour is very poor. Most times, people turn up at clinics after they have probably self-medicated at home. While doing that, they continue to transmit the virus all over the place. In markets, the water and soap are merely on display; people do not use them. That by itself does not help,” she said.

Dr Taiwo Ladipo, Incident Manager, COVID-19 response in Oyo State, stated that the state’s Emergency Response Team on COVID-19 has been talking to waste managers to ensure they do not have physical contact with wastes since they, like health workers, could be exposed to the virus.

Although feces and household wastes are possible routes for community transmission of the infection, he assured that the possibility of contacting the infection through this means is certainly low.

Dr Samuel Akingbehin, National President, Environmental Health Officers Association of Nigeria (EHOAN), however, said waste handlers and pickers are exposed to diarrheal and skin diseases in the discharge of their duty.

Although coronavirus has not been proven to be transmittable through contact with house wastes, he said the possibility of contacting it from hospital wastes however cannot be ruled out.

Dr Akingbehin added, “That is why personal hygiene and environmental sanitation remains the most important weapon to overcome infectious diseases, including COVID-19 globally.”

He said people in cleaning services must use work gears, including gloves, and always take their bath while also ensuring change of clothes after work.

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