Without access to soap and clean water, more than 2 billion people in low- and middle-income nations - a quarter of the world's population - have a greater likelihood of acquiring and transmitting the coronavirus than those in wealthy countries.
That's the conclusion of a new study by the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine.
More than 50% of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing, according to the study published last week in the journal Environmental Health Perspectives.
"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Dr. Michael Brauer, a professor at IHME, which currently has one of the world's leading models of the coronavirus of the pandemic.
In 46 countries, more than half of people lacked access to soap and clean water. In Nigeria, China, Ethiopia, Democratic Republic of the Congo, Bangladesh, Pakistan, India, and Indonesia, more than 50 million persons in each were estimated to be without handwashing access.
Temporary fixes, such as hand sanitizer or water trucks, are just that - temporary fixes. But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access."
Dr. Michael Brauer, Professor at IHME
Even with 25 percent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019, Brauer said. Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation.
The paper does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.
Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus.
Brauer, M., et al. (2020) Global Access to Handwashing: Implications for COVID-19 Control in Low-Income Countries. Environmental Health Perspectives. doi.org/10.1289/EHP7200.