Open Defecation is Negatively Associated with COVID-19 Mortality in India

Jason Kerwin, University of Minnesota
Audrey Dorélien, University of Washington, Seattle
Divya Pandey, University of Minnesota

Early in the COVID-19 pandemic, scientists and policymakers advocated for the reduction of open defecation to curb the disease spread. However, SARS-CoV-2 is an airborne pathogen that can be transmitted by fecal aerosols, making poorly ventilated shared latrines a potential risk factor. Consequently, open defecation may mitigate COVID-19 transmission. Our study shows that district-level COVID-19 deaths in India are negatively, rather than positively, correlated with open defecation rates. We also show that access to private toilets is associated with reduced individual level mortality during the pandemic, but shared toilets do not show the same protective effect. Our results suggest that as with other diseases, private toilets reduce COVID-19 mortality, but the role of shared toilets and open defecation in relation to COVID-19 specifically is more nuanced. More broadly, our results show that public health measures must be targeted to the specific disease in question: what works for one disease may fail or even backfire when applied to others.

Keywords: Population, Shocks and Pandemics

See paper.