Optimizing community hand hygiene interventions to combat COVID-19

Principal Investigator : Ben Cooper, MAEMOD

Project Status : On-going

Project Summary

Handwashing is a central component of plans to reduce transmission of COVID-19. There are good reasons for thinking that if hand hygiene behaviour in the community can be changed substantially and such changes sustained, there is potential for a large reduction in the effective reproduction number of COVID-19. This would be expected to lead to reductions in mortality and in demands on health services. Changing behaviour, however, is hard and community hand hygiene interventions which have failed to have an impact on the transmission of other respiratory pathogens appear to have failed largely because they failed to achieve hoped for changes in behaviour. Almost all current handwashing recommendations (e.g. from WHO, CDC, ECDC, etc) are to wash hands “often”, but without specific messages or interventions targeting behaviour change or an indication of what “often” means. It is unclear whether these public health messages will be sufficient to bring about the large changes in behaviour that are needed to have a substantial impact on the epidemic course in different countries. LMICs have limited infection prevention and control capacity, and there is a need for community engagement to inform low cost and potentially high impact community interventions to reduce transmission. Smartphones are ubiquitous in LMICs, and are amongst the most important sources of information for a large number of people. They have proved useful for understanding health seeking behaviour in other epidemic emergencies and can hypothetically be used to trial different interventions and messaging to improve handwashing behaviour, and ultimately help to improve national handwashing interventions.