Abstract:
In March 2020, the World Health Organization (WHO) issued a set of public guidelines for Coronavirus Disease
2019 (COVID-19) prevention measures that highlighted handwashing, physical distancing, and household
cleaning. These health behaviors are severely compromised in parts of the world that lack secure water supplies,
particularly in low- and middle-income countries (LMICs). We used empirical data gathered in 2017–2018 from
8,297 households in 29 sites across 23 LMICs to address the potential implications of water insecurity for COVID19 prevention and response. These data demonstrate how household water insecurity presents many pathways
for limiting personal and environmental hygiene, impeding physical distancing and exacerbating existing social
and health vulnerabilities that can lead to more severe COVID-19 outcomes. In the four weeks prior to survey
implementation, 45.9% of households in our sample either were unable to wash their hands or reported
borrowing water from others, which may undermine hygiene and physical distancing. Further, 70.9% of
households experienced one or more water-related problems that potentially undermine COVID-19 control
strategies or disease treatment, including insufficient water for bathing, laundering, or taking medication;
drinking unsafe water; going to sleep thirsty; or having little-to-no drinking water. These findings help identify
where water provision is most relevant to managing COVID-19 spread and outcomes.
