hice mi comentario, ya que uno de ustedes publico , si los sistemas sanitarios de los países  pobres no funcionan,  para que el uso  de  Mascarillas  de cirugía, mi respuesta a dicha afirmación es que no nos queda otro camino mas que jugar a la ruleta rusa con COVID 19, debido que no tenemos ni especialistas en cantidad  para monitorear los ventiladores mecánicos, que también son escasos, a nuestra población solo nos queda tomar las medidas de prevención al contagio vía respiratorio, ya que en las medidas de limpieza y desinfección no contamos con ingenieros sanitarios, creo ser el único de pregrado en el País, y los protocolos que mi gobierno publica son dictados por médicos, no por ingenieros sanitarios , necesarios en el monitoreo  y gestión de las medidas sanitarias para la población civil.otro problema mayor es el tema de agua y saneamiento, llevo 5 años conversando con las  autoridades y no cooperan . pero la banca multilateral si proporciona financiamiento utilizando salva guardas  ambientales y sociales internacionales, pero que dentro de nuestro país,  ni se conocen, menos para ponerlos en practica.

Elisabeth von Muench cambie el contexto, y a la vez pido se nos ayude en el tema agua y saneamiento.

+++++++++++
Translation provided by Deepl, added by moderator:

I made my comment, since one of you published, if the health systems of poor countries do not work, so that the use of surgical masks, my answer to that statement is that we have no other way but to play Russian roulette with COVID 19, because we do not even have specialists in quantity to monitor the mechanical fans, which are also scarce, The only thing left for our population to do is to take measures to prevent respiratory infection, since we do not have sanitary engineers for cleaning and disinfection measures. I believe I am the only undergraduate in the country, and the protocols that my government publishes are dictated by doctors, not by sanitary engineers, which are necessary in the monitoring and management of sanitary measures for the civilian population. Another major problem is the issue of water and sanitation, I have been talking to the authorities for five years and they do not cooperate. But the multilateral banks do provide financing using international environmental and social safeguards, but within our country they are not even known, much less put them into practice.

Elisabeth von Muench changes the context, and at the same time I ask for help in the issue of water and sanitation

Señoras y señores, disculpen, pero esto no es una controversia entre los políticos, el problema es la higiene pública para hacer frente a esta y cualquier otra pandemia.

Translation (using Google translate) added by moderator:
Ladies and gentlemen, excuse me, but this is not a controversy between politicians, the problem is public hygiene to deal with this and any other pandemics

Hi Christoph
Thanks for that front-line update. 
Excellent work you are doing in Brazil and Peru.

After Ebola in Liberia I know the water supply coverage was significantly increased. And this has most probably reduced other contagious diseases like pneumoccal pneumonia which is constantly taking lives around the world at much higher rates than COVID.

Do take a look at the WASH Cluster site. This is the global center for WASH response.  washcluster.net/
They have a technical helpdesk that could get involved in the response in Brazil and Peru to avoid what has happened in Ecuador.

Best wishes  

Hi Arno,

Well I will not repeat what I wrote above to Elisabeth, a lot applies also to your post.  

We have to discuss the sanitation answer toCOVID 19. The rest of the discussion has to take place elsewhere.
So What did I do? I organized the setup to a 3 step webinar for the water and sanitation providers on COVID 19 which now is held first by Ministry of regional development in Brazil with GIZ and than it will be repeated in Peru. The first
two webinars are available here. (in Portuguese, first webinar with simultaneous translation from/to German, one presentation in English) 

The third webinar will happen on Monday and part of it is directed directly to measures water and santiation providers could take for the most vulnerable areas which have no or intermittend access to water.  These should be our themes here. 

And another aspect I am going after…. For areas where there is no clean water.. Is it ok to use
reused water, greywater with soap for handwashing?
The answer erybody is giving .. Probably yes as COVID 19 dies of due to the soap, so handwashing 20 seconds
with soapy water, even if used by others before, should be ok. Not recommendable but better than nothing.

The aspect of using ashes for “handwashing” is not as clear.. there are some people who say yes .. it is valid as the high pH might kill the Virus, others say it is not effective.

So 2 areas we could concentrate on.

And another.

I know that Liberia had handwashing stations during Ebola. I am trying to get information
regarding, so I wrote in other forums and to other colleagues:

Recently, I read something about such stations in public places in Liberia in the context of Ebola. Hence, my attempt to look out
for experiences and lessons in African countries.
 
Regarding these handwashing facilities our concrete questions are:
- Vandalism: If I put these stations somewhere, how do I prevent them from being dismantled or stolen? How was / is this guaranteed in African countries; is there someone standing next to it or are they set up in public places with ‘social control’? In our opinion, water taps, soap, the water container as well as the iron of the rack are endangered. What are the experiences in Africa?

- Maintenance: how long does a container last, i.e. how often does it need to be refilled? What is a recommended container size?

- Costs: Did the water companies in Africa set such stations up out of goodwill? Or were there any governmental programmes, if so...how are they paid - per washing station, per refill, per m³…?

- Technically: what size of tank has proven useful? What kind of taps (considering the risk of people leaving the water running)? Are foot pumps good or do they brake too quickly?

I poked around .. did nor find anything helpful inSUSANA and went to other forums.

THAT would be the “right” focus in my understanding and not some publications which take time to answer as “someone is wrong in the
internet” but in this case unfortunately in the Forum I take part in.

Hopefully we come back to the above pointed out questions.

And ---no -- Elisabeth I think  this should stay in the same thread as my aim is to highlight what we could/should discuss.

Christoph

Hi Elisabeth,
You got me completely right… I am very angry… and when you get angry .. yes you get aggressive, but out of a feeling that something you appreciated is going down (this Forum) … in my view unnecessary.

And yes Iam annoyed with you, as you are fueling a discussion which … I repeat... is wrong in this forum.. Our opinions and bits and pieces we get from somewhere are not “worth” to be published in a scientific, hands on, practical … and normally thoughtful forum… THAT is the critical point.
The authors of this piece (although I think they are wrong) have every right of the world to express their opinions…. And they might be as well based on a lot of thinking…. But you and me have our personal and not professional opinions about this,  and these should not be subject in a forum like this. We are in this Forum for our professional views. We can exchange privately why I think the expressed ideas are wrong. Yes I admit my expressions are hard…. BUT TO MAKE VERY CLEAR that the posted idea is not a professional (sanitation) opinion. This Forum has its reputation for professional advice and thoughts, and if somebody finds this post and does not reflect they might take a wrong impression… and if I leave it like that just to be polite – I have my share in it. So I send a strong signal that this is not the case.

Side observation: as this thread it is not deleted until now…. Have a look to Equador and see what happens in Guayaquil when there are LOTS of death in the same moment .. and the think about the side effects of other diseases by not being able to manage lots of death in the same moment.

Hoping that this thread  will be eliminated
Regards
Christoph

Christoph
One of the reasons I introduced this thread was to attempt to bring to SuSanA the bigger picture. Indeed health issues of this proportion affect the entire human health care system from personal hygiene to intensive care but also other life-critical systems such as water and sanitation - from hand-washing to plumbing and sewage systems to monitoring COVID in wastewater and sludge, etc. But also of key importance is to put some mature thoughts together regarding how the overall response has been unfolding especially in countries with inadequate health care systems, high density slum housing with lacking WASH capacities, subsistence urban and peri-urban economies, high background disease burdens, etc. 

So in many ways it is refreshing to read from a Yale scholar with first hand experience this alternative perspective calling for a more selective and goal-oriented approach to keeping the number of infections and fatalities down - unlike the "war on COVID" lockdowns. Indeed the experience in India is a telling one where a country-wide 3-week lockdown forced the poorest of the population to scramble from the cities to their original villages. The intense crowding that this caused can only have aggravated transmission. www.aljazeera.com/indepth/inpictures/pic...200329133626495.html
www.hrw.org/news/2020/03/27/india-covid-...kdown-puts-poor-risk
The informal economy in India still accounts for more than 80 per cent of non-agricultural employment.  www.ilo.org/newdelhi/areasofwork/informa...y/lang--en/index.htm

So with all this as background, SuSanA should then be able to focus on how the already dysfunctional sanitation systems of the world (ca 4.5 billion people - UNC) have become even more serious sources of pathogens and pollution during the COVID pandemic with absent sanitation workers. Let alone the increased risk of possible COVID transmission, the already mammoth risks of unsafe water and sanitation we are all familiar with (including child diarrhoeal diseases, parasites, AMR superbugs, etc.) need to be communicated, especially now when the world is listening.      

Regards

Hi Christoph,

I am finding the tone of your post rather aggressive. Is that really called for? The question of whether this thread should be "allowed" on this forum has already been addressed earlier in the thread. Note it wasn't me who started this thread but after careful consideration I (in my role as moderator) decided that we can deviate from the rule here - as an exception. (Our Rule 8 is: "Do not write “off-topic” posts, i.e. posts with insufficient relationship to sustainable sanitation."   forum.susana.org/forum/rules )  Every now again a rule can be broken though. There have been other "borderline" discussion threads which are only indirectly related to sanitation, e.g. the thread about reducing air travel to site visits and conference to reduce CO2 emissions (forum.susana.org/39-miscellaneous-any-ot...-worth-in-some-cases).

Covid and the lockdowns have had such a profound impact on all our lives that I think it should be acceptable to allow this space here (just one thread!) to discuss general aspects and how the lockdowns affect low income people in developing countries (one of our main target groups for sanitation access). Based on the posts that others have made in this thread so far, I got the impression that I am not on my own to appreciate that we can have these discussions here. If you dislike this thread because it is not purely about sanitation for once then nobody is forcing you to read the posts here. And don't worry, this will be an exception, we are not going to have lots more "off topic" threads in futures. I will also raise this at our next Forum Practice Group meeting which happens to take place this Monday evening. I will report back what the other people in the Forum Practice Group think (it consists of the three moderators, Brian Reed, the SuSanA secretariat and Sean Furey from Skat).

Your second criticism is about the paper that I posted the link for: "Poor Countries Need to Think Twice About Social Distancing". Here I don't understand why you are attacking me for an article that someone else wrote. It's fine to disagree with the authors but I don't think it's fine to say "For me a completely disgusting piece, written from somebody in quarantine fever.". No need to launch a personal attack on the authors like that. 

As far as I know, one of the authors (Ahmed Mushfiq Mobarak) knows the situation in Bangladesh very well. He has also posted here on the forum in the past: 
forum.susana.org/publications-and-webina...hout-subsidies#12990

I will invite him to reply to your criticisms directly in this thread although I can't garantuee that he will do so. Firstly, because he's flat out (he replied to me recently saying "Really busy with Bangladesh 's Corona response") secondly because from the tone of your post it seems that you are not interested in a friendly exchange of arguments which might be offputting for the author to respond.

Let's keep the tone nice and civil, yes?

Regards,
Elisabeth

Dear Elisabeth,

this piece is completely wrong. I have to say SUSANA is clearly not the place to discuss this, as it is not our core knowledge .. at least I thought so. We could discuss answer to Covid 19 by water companies, or sanitation and handwashing .. ok .. .but these general discussions remember myself of my football whatsapp group, where there is a lot of unreflected "fecal matter".

This said..I will say what Joe Turner said earlier … there is no reason why you should listen to me… but as one of the first contributors to this forum, I am very sad about the way this is going. And I feel I can not let stay this opinion without answering …

I don’t understand you. I know you as somebody who is thoughtful.

The authors are juggling with numbers in a way which is disgusting…. And on assumptions which are not logic.

They state (and in many cases they might be right) that the number of hospital beds in poor countries is so low, that
the system will be overwhelmed anyhow…… But if so .....why do they suggest to wear masks?… The reason for masks is 
to slow the spread of the virus … but if there (as they say) is no difference(hope) ..... as the system
will collapse anyhow? Why to use masks... NOT LOGIC.

The curve they present in figure one is not logic if the system is imediately overwhelmed.. therefore the figures for unmitigated/social distancing and social distancing+ would be the same ..(as by the logic of the authors the system has collapsed)



But than they go to a thinking about costs for distancing…
“the estimated dollar value of total losses from deaths under each intervention scenario when the Viscus i and
Masterman (2017) VSL estimates are embedded in the Imperial College mortality predictions.“
 
And conclude there is no montetary loss???? What for this figure??  What kind of question is this?…
What  is the total cost of COVID-19 mortality in the country relative to that country’s own
GDP?
 
For me a completely disgusting piece, written from somebody in quarantine fever.
 
But again the question Heike made earlier … Why here, why in this forum and why this generalization … Each country has its one
situation and has to be treated seperately.. .But for sure whatever country there is....this “scientific” article is no
helpful for anybody.

I would like to add.. my personal opinion is that even low income countries have to try there best to avoid collapse for the best... but again citing Joe... "why should any body listen to me" ... and if things keep on going like this ... my opinion is  - why should anybody listen to this forum- .
 
An annoyed Christoph

My NGO works in Ethiopia, and one way that we are reaching rural communities in a safe way (with socially distancing) is by using a van with a loudspeaker. We also place large banners in communal settings with prevention advice and have been advocating with religious leaders to promote messages and behaviors during their services. Attached is an image from rural Tigray of a church service with social distancing 

Hi Charlotte, 
Thanks for this feedback from Kenya which is very interesting. I assume the curfew has exemptions for essential workers?

Dear all,
I came across this very relevant article and study from BY  AHMED MUSHFIQ MOBARAK ,  ZACHARY BARNETT-HOWELL . 

Title: Poor Countries Need to Think Twice About Social Distancing
Subtitle: Policies imposed in rich countries to fight the coronavirus could have adverse effects in low-income nations—potentially endangering more lives than they save.

Link:  foreignpolicy.com/2020/04/10/poor-countr...tancing-coronavirus/

Link to the full study at Yale University:  yrise.yale.edu/covid-19/

I copy the conclusions section from the opinion piece which I find very good:

Leaders in Africa, South Asia, and Latin America need to look carefully at alternative policies, including harm-reduction measures that allow people in low-income countries to minimize their risk from COVID-19 while preserving their ability to put food on the table.

Some possibilities include: a universal mask-wearing requirement when workers leave their homes (as masks and homemade face coverings are comparatively cheap, and such a policy is likely feasible for almost all countries to implement); targeted social isolation of the elderly and other at-risk groups, while permitting productive individuals with lower-risk profiles to continue working; improving access to clean water, hand-washing, and sanitation, and other policies to decrease the viral load; and widespread social influence and information campaigns to encourage behaviors that slow the spread of disease but do not undermine economic livelihoods. This could include restrictions on the size of religious and social gatherings or programs to encourage community and religious leaders to endorse safer behaviors and communicate them clearly.

The coronavirus pandemic represents a serious threat to the entire world, but that threat takes on a different shape in each country. Furthermore, the capacity of societies to respond and to endure the disruption and costs of social distancing vary greatly. The benefits of each policy must be carefully weighed against the economic costs and risks imposed on a particular society. While policymakers must think carefully about these differences, they must also act quickly, as both the disease and the measures imposed to contain it are already causing suffering throughout the world.

Regards,
Elisabeth

Dear all,

I could try and shed light on what is currently happening in Kenya to help curb the COVID-19. First, I would definitely commend the government and especially the Ministry of Health which has been tasked to handle it. As a country which has majority of its citizens living under a dollar a day, the measures that have been put it place are trying to accommodate them. In brief:
- As of today, 8827 people have been tested,216 cases have been confirmed, 41 recoveries have been made and unfortunately 9 people have died.
-The ministry is giving daily updates which I find very good as it is keeping people abreast with information.
-There is a curfew which starts at 7pm and ends at 5am countrywide. This has generally been adhered to although we have had instances of police brutality trying to handle the rowdy citizens. There is also a cessation of movement in 4 counties. So travel has generally slowed down.
-The fact that there is no complete lock down is putting the country at an ease. People can still go out and fend for themselves even though it is for a short time. There are rumors that the government is planning a scheme to help in giving out food to some parts of the country.
However, at the moment it is just a wait and see scenario.We are hoping for best and that the curve will be flattened soon.

Regards
Charlotte

One small example in one African country I recently visited: although internet was available, it cost a lot more to access certain websites than others. One could purchase data to visit facebook, youtube and whatsapp at a different rate to other websites. Which is obviously important if you are needing to download things, find information etc. The latter might be possible, but there is an obvious barrier.

Postage is also a problem, and in this specific context, the likely only way to ensure that the community we visited had the information that they needed was for someone to physically take it, perhaps on a prepared hard-drive.

Which seems quite hard to process: there is local internet access and the information is fully accessible online to be downloaded. But ultimately, neither of these two things would appear to reduce the need for physical meetings for the foreseeable future.