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It has been over two months since the Indian government imposed its first phase of lockdown to curb the novel coronavirus disease (COVID-19) spread. The lack of uniformity in the measures adopted and their implementation, however, may not have served the objective of containing the virus (SARS-CoV-2).
COVID-19 requires an emergency response from Urban Local Bodies (ULBs) and states on several fronts. Hygiene and cleanliness are the strongest weapons in any public health crisis — several cities initiated massive drives for sanitisation of public spaces, particularly in COVID-19 hotspots — and deployed a huge number of sanitation workers.
Door-to-door waste collection, emptying septic tanks, addressing safe disposal of bio-medical waste and household waste generated remains a top priority for all cities, especially those falling under contained/red zone areas.
Key government advisories have been issued by the central and state governments to address the emerging challenges of urban water and sanitation. Some private and public organisations working on the ground also issued practical and operational guidelines and created posters, reports and publications.
One such advisory was issued by the Ministry of Housing and Urban Affairs (MoHUA) titled Safe Management of Water Supply and Sanitation Services during COVID-19 crisis, April 2020.
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Adapted from NIUA and NFSSMA, 2020
Here is a review:
The hits
The advisory was intended not only for ULBs, but water supply and sewage practitioners and services providers who want to know more about the risk and practices associated with water supply and sewage in states/UTs.
It identified sanitation workers as a vulnerable frontline workers highlighting the potential for service providers to step up their performance and customer orientation.
It also mphasised on provision of safe water supply and sanitation services to protect human health during all infectious disease outbreaks, including COVID-19.
The advisory stressed that provision of consistent water and sewage management practices at ULBs will help prevent indirect human-to-human transmission of SARS-CoV-2 virus.
It prescribed conventional, centralised water treatment methods that use filtration and disinfection (chlorine, ultraviolet (UV) light and other oxidants) should deactivate SARS-CoV-2, but doesn’t confirm it.
It recommended that the acceptable limit of free residual chlorine in drinking water in India is 0.2 milligram/litre under normal conditions and should be at least 0.5 mg/L to protect against viral infection, according to the BIS Indian Standard for Drinking Water (IS 10500:2012). The WHO guidelines recommended that a residual concentration of free chlorine of ≥0.5 mg/L after at least 30 minutes of contact time at pH<8 shall be applied for the centralised disinfection during the outbreak. This has to be taken care of by all water supply utilities across India.
The misses
The nationwide lockdown was enforced on March 25 and the advisory was issued on April 20, which points to a delayed in response from the MoHUA.
The advisory was an adaptation of other international guidelines and misses the local context and specific issues such as non-conventional wastewater treatment.
It was intended for ULBs, water supply and sewerage boards and service providers, but did not not talk about sanitary workers employed in COVID-19 hotspots, quarantine facilities, hospitals and precautions that were needed.
The exposure and hazards associated with various steps of water and sanitation chain differ depending on the work and duties of workers. A comprehensive approach was expected from the advisory, especially at a time when the Union government has been running several programmes and schemes related to water and sanitation.
Ownership, enforcement and monitoring of guidelines in terms of 0.5 per cent residual chlorine was missing.
The advisory stated the virus was not detected in drinking-water supplies, and that based on current evidence, the risk to water supplies was low. At the same time, it talked about laboratory studies indicating that the virus could remain infectious in water-contaminated with faecal matter for days to weeks. Most Indian cities, due to intermittent water supply, have a higher chance of having sewage influx in water supply pipelines. But the advisory doesn’t say much on the issue.
The advisory talked about wastewater treatment approaches — centralised as well as decentralised and reuse of treated wastewater. However, it only touched upon the decentralised approach and lacked detailed instructions for decentralised wastewater treatment.
It said all wastewater treatment plants should have disinfection level of treatment. However, according to current scenario, most decentralised technologies offered secondary-level treatment to be used for non-potable purpose. The advisory did not elaborate whether they have to be retrofit/modified. If they have to be retrofit, then what about cost-economics? And how will it be possible in this crucial situation?
In general, it talked about usage of Personal Protective Equipment (PPEs) for wastewater workers but did not specify regular specific medicines/vaccinations to be administered to sanitation workers.
For users of community and public toilets, it recommended that facilities be properly maintained and cleaned, and all sanitary workers protected. But it failed to specify the types of protection required.
It talked about reuse of treated sewage for industries and agriculture to improve water availability and financial sustainability. It did not mention the precautions needed for safe reuse of treated water.
The advisory failed to talk about other aspects as well, such as ensuring PPEs, financial support, food and boarding support, training on PPEs and its usage, ban on sewer/septic tank entry to reduce exposure, regular health check-ups and timely medical attention and safety and protection.
Worldwide studies showed no evidence of COVID-19 faecal-oral transmission risk. But the same needs to be verified for Indian conditions and safety of operators of STPs, cleaners and operators of public and community toilets, septic tanks desludging operators and drivers should be prioritised. This needs to be done in a planned manner with detailed analysis of the situation, followed by subsequent guidelines on exposure in water supply and sanitation system.
The advisory was silent about funding of interventions suggested as well as capacity building of officials required for expected results. Most local bodies are doing things in their own capacity, with no proper standard or protocol to follow in place.
Key learnings
A whole gamut of advisories has been issued by various ministries such as the MoHUA, Central Pollution Control Board, Ministry of Health and Family Welfare etc. It would have been great if there were a nodal department or ministry coordinating with everyone bringing out such advisories and guidelines. Dissemination of information to stakeholders working on the ground is a big challenge and creates confusion.
India needs to be more prepared to deal with such emergencies and a dedicated policy is required. Proper allocation of budget in health and hygiene sector is also required.
Our approach has been more reactionary in nature and we can be better prepared for such situations. States such as Odisha and Kerala that regularly experience natural disasters like cyclone were better prepared. Some lessons can be taken from them.