Will COVID19 Teach Us the Importance of Handwashing with Soap - Lesson From 1847

About 60% of Indians wash their hands using only water, just 36% wash their hands with soap before meals and 74% wash them with soap after defecating (National Sample Survey 2018), a tragic and alarming fact with the coronavirus disease, also known as COVID-19, shaking the whole world.

Unfortunately, at present there is no specific treatment or vaccination for the newly identified viral disease, and therefore as suggested by experts the best way protect oneself is frequent handwashing with soap for at least 20 seconds apart from other preventive measures.

A lockdown is an extreme step for any society to take, and is not feasible every time an infectious disease spreads through air or water or touch. The importance of public health measures thus needs to be understood and religiously adopted. Washing hands with soap is such a simple act, and an essential step in preventing infectious disease transmission and saving lives.

In a densely populous society like India’s with 455 people living per square kilometer any infectious disease can spread easily from person to person. India is home to half the world’s pneumonia deaths, a disease which in absolute numbers kills 3.7 lakh children per year here. It is home to a quarter of the 525,000 children under the age of five who die worldwide each year of diarrhoea, the second leading cause of death among children.

Overall, despite the fact that India has one of the fastest growing GDPs, the country still faces a 30% burden of infectious diseases (John et al, 2011). These numbers are overwhelming but many people remain unaware of this situation.

The good news is these diseases are preventable and treatable. Various studies support the importance of hand hygiene in reducing the risk of cross-transmission of infections, and most infectious diseases like pneumonia and other respiratory diseases, cholera, typhoid, and diarrhoea can easily be prevented.

Handwashing with soap at critical times—including before eating or preparing food, and after using the toilet—can reduce diarrhoea rates by more than 40% (UNICEF) and respiratory illnesses like colds by 16-21% (CDC). It can reduce pneumonia in children by 25% (Washadvocate, 2012).

Additionally, handwashing with soap has been found to be a critical measure in controlling pandemic outbreaks; several studies conducted during the SARS outbreak in 2006 suggest that washing hands more than 10 times a day can cut the spread of the virus by 55%.

Handwashing with soap is not a new concept. Its primary role in infection control was first pointed out in 1847 by a Hungarian physician named Ignaz Semmelweis. The practice has been promoted by governments and NGOs for decades as a highly cost-effective public health measure.

Interestingly, various studies have found that even health professionals like nurses and doctors in India don’t always practise hand hygiene. A study conducted by Modi PD et al in 2017 found that among Indian medical graduates 57% of respondents had never received any formal training in hand hygiene. Another study conducted the same year by Gupta AKB et al found that only 14% of healthcare workers adhered to hand hygiene.

Researchers say our hands probably carry thousands of different bacteria from more than 100 species. Many are not pathogens. But the few rogue ones are enough to land you with shivering, viral fever in the rains (Holla, 2013).

If this fact does not motivate Indians to practice handwashing with soap, another factor they should consider is that the Indian medical care system is dominated by expensive private service providers which are mostly financed through out-of-pocket expenditure, which means it is individuals and their family who must bear the burden of catastrophic health expenditure when one of them falls ill.

Every year some 50 million Indians are pushed into poverty because of medical expenses (Zodpey and Farooqui, 2018). In 2015 two-thirds of payments for medical care were made out of pocket (NHIPI, 2016). Also, the quality of services one gets in free public hospitals, with one doctor for every 11,082 patients, is not hidden from anyone (Bhusan, 2020).

It is high time therefore that we Indians including healthcare professionals started behaving more responsibly, and understand that India can only win over infectious diseases, including long-lived ones like diarrhoea and pneumonia, if everyone strictly adheres to hygiene, handwashing with soap in particular—not only during the crisis situation like SARS or COVID-19 but as learnt and ingrained behaviour.

If each person takes it seriously and changes their behaviour, the burden of infectious diseases will automatically come down. Apart from the government and civil society, it is we, the public, who can bring sustainable positive change.

In the coming days it will be really interesting to see if there is a surge in the proportion of people practising proper handwashing with soap post-Corona.

Beauty Kumari is a Commonwealth scholar of global health policy at the London School of Economics and Political Science

Cover: 2.2 billion people around the world do not have safely managed drinking water, while 4.2 billion go without safe sanitation services and three billion lack basic handwashing facilities (UN and WHO 2019)