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Open Defecation Is Negatively Associated with Reported COVID-19 Deaths in Rural India. Are Shared Toilets the Reason?

Author

Listed:
  • Kerwin, Jason

    (University of Washington)

  • Dorélien, Audrey M.

    (University of Washington)

  • Pandey, Divya

    (University of Minnesota)

Abstract

Early in the COVID-19 pandemic, scientists and policymakers advocated for the reduction of open defecation to curb the disease’s 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 reported COVID-19 deaths in India are negatively, rather than positively, correlated with district-level open defecation rates in rural areas. 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.

Suggested Citation

  • Kerwin, Jason & Dorélien, Audrey M. & Pandey, Divya, 2025. "Open Defecation Is Negatively Associated with Reported COVID-19 Deaths in Rural India. Are Shared Toilets the Reason?," IZA Discussion Papers 18269, IZA Network @ LISER.
    • Handle: RePEc:iza:izadps:dp18269
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    References listed on IDEAS

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    1. Malani, Anup & Ramachandran, Sabareesh, 2022. "Using household rosters from survey data to estimate all-cause excess death rates during the COVID pandemic in India," Journal of Development Economics, Elsevier, vol. 159(C).
    2. Michael Geruso & Dean Spears, 2018. "Neighborhood Sanitation and Infant Mortality," American Economic Journal: Applied Economics, American Economic Association, vol. 10(2), pages 125-162, April.
    3. Spears, Dean, 2020. "Exposure to open defecation can account for the Indian enigma of child height," Journal of Development Economics, Elsevier, vol. 146(C).
    4. Derek Headey & Giordano Palloni, 2019. "Water, Sanitation, and Child Health: Evidence From Subnational Panel Data in 59 Countries," Demography, Springer;Population Association of America (PAA), vol. 56(2), pages 729-752, April.
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    JEL classification:

    • I15 - Health, Education, and Welfare - - Health - - - Health and Economic Development
    • I18 - Health, Education, and Welfare - - Health - - - Government Policy; Regulation; Public Health

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