As the world pays a well due tribute to the sacrifice and relentless work of health workers on the frontline of the global health crisis, millions more continue to provide vital public services keeping the world going.
Water and sanitation workers are among them, playing a fundamental role to halt the pandemic, providing on the one hand potable water to safely handwash, drink, clean, cook and eat; on the other hand treating household and industrial wastewaters, stopping many other diseases that spread through water such as it was the case of cholera in the 19th century.
PSI has celebrated the role and commitment of water and sanitation professionals who keep everyone safe on 22 March World Water Day 2020, reminding that water and sanitation are a human right, a right that 2.4 billion people do not yet have adequate access to, while 3 billion are unable to properly wash hands, an even greater tragedy in times of pandemic.
Often invisible to the wider public, sanitation work is largely carried out underground through the hidden labyrinths of sewerage systems and in high-security water treatment plants and installations placed in a confined atmosphere to protect populations, local residents and the environment from effluents and contamination. As a result, few know what sanitation workers really do.
“Sanitation is often regarded as the poor sibling of water services, but that is a major mistake. Without sanitation, drinking water would be drawn from lakes, rivers and aquifers that are polluted by human activities. In the absence of proper sanitation services, the fauna and flora of lakes, rivers, groundwater and other aquatic environments are seriously contaminated. Water and sanitation services are both critical to protect public health and work in synergy and coordination with each other, including with solid waste collection and disposal” says Didier Dumont, National coordinator for Water and Sanitation services at French CGT Public Services trade union federation and an employee of SIAAP, the public sanitation utility of Ile-de-France, covering sewage and waste water for a dense urban territory of over 12 million users, employing nearly 2,000 people who operate the two largest wastewater treatment plants in Europe.
The sanitation workers and CGT union members knew from their previous experience with SARS and H1N1 that some viruses and coronaviruses can survive in faeces and waste water up to between 2 hours up to 9 days. While no definitive studies have been carried out, it is well possible that this is also the case for Covid-19.
"Although contact with sewage does not appear to be a primary source of contamination in previous epidemics and for scientists and doctors direct contact between people remains the main modality of Covid-19 transmission, nothing rules out that contamination through contact with or splashing of sewage water - or even simply breathing in the moisture-laden and confined atmosphere of sewage systems - is impossible as no studies have been completed that demonstrate it," says Dumont referring to the precautionary principle.
“The absence of research on Covid-19 in wastewater is in no way reassuring for us sewage workers, especially since we know that studies confirm that it is found in the stools of affected people. For the CGT union, the precautionary principle must prevail and it is therefore necessary to increase safety and security levels for all," he adds.
Under normal conditions sanitation workers use FFP2 during four hours or FFP3 masks that need changing them every two hours
As sanitation workers are in direct contact with a high-risk working environment, the CGT Public Services union federation wrote to the French Government requesting to carry out a systematic testing of sewage for Covid-19.
This is a critical move to know the virus longevity and quantify its “viral charge” in water, as well as to follow the pandemic evolution curve in the population. To date the union request remains unanswered, even if other countries like Switzerland and the Netherlands have already adopted this procedure to collect data to fight the current pandemic, but also to develop an early warning system for future epidemics.
Although other human coronaviruses are eliminated through chlorination, liquid ozone and ultraviolet light disinfection (UV), the lack of definitive scientific evidence on the virus survival in untreated and waste waters represents a major concern for both public and workers’ health alike.
The life expectancy of sanitation workers is considerably lower than that of the average population as they are exposed to a large number of threats in their work environment. “Sewers are highly humid environments where microparticles of faecal matter as well as of domestic and industrial pollutants remain in suspension for long, posing a major occupational health and safety threat for workers exposed to a cocktail composed of high concentrations of viral and bacteriological charges, dangerous gases such as the deadly H2S, heavy metals, pesticides and medical waste,” explains Dumont.
This high-risk working environment requires a higher replacement frequency for personal protective equipment (PPE). Under normal conditions sanitation workers use FFP2 during four hours or FFP3 masks that need changing them every two hours due to high moisture levels. In addition, they must wear gloves, safety boots, full body suits with goggles or visors and the mask for the face, which complete their PPE.
As well, some tasks can only be carried out with even more complete PPE such as Self-Contained Breathing Apparatus (SCBA), which includes an independent individual breathing system connected to an air tank. This equipment is also used by firefighters during rescue operations. Besides operations such as plumbing, network maintenance (cleaning, pumping, etc.) and water treatment operations, further threats under the current pandemic loom around work equipment and material cleaning (e.g. work uniforms, protective equipment, tools, etc.).
The pandemic outbreak has posed further health and safety threats for sanitation workers.
“As people increasingly resort to single use, disposable masks, plastic gloves and single-use disinfectant wipes, many regrettably flush them down toilets and throw them into gutters plugging sewage pipes, making the work of sewage workers heavier and more dangerous, adding to the large amount of dangerous plastic bags clusters that end up in water and gutters in regular times. This is especially worrying as it is now clear that Covid-19 can survive for some time on plastic and fat, two substances that are largely present in sewage,” adds Dumont.
A clear call and message by the authorities to the population to properly dispose of their masks, gloves and wipes would be very much in order. He also urges to restrain from using pressurised air cleaners neither on sewage network and treatment plant floors or in public space cleaning because they lift the particles present on the ground – that can carry viruses - in suspension in the air, creating aerosols that are dangerous for street cleaning workers - often poorly protected - and for the public.
Under the current context, the CGT union demands that the French Government and sanitation utility management takes adequate measures to effectively protect the safety and health of workers and users alike, by applying specific, adapted measures to sanitation workers, whose tasks are particularly challenging compared to other professions.
The union especially demands :
An adequate supply of PPE (FFP3 masks as well as integral body protection uniforms with independent personal ventilation systems)
More frequent shift rotation as the union considers this time to coincide with the time of workers’ exposure to the virus
Increased rest periods to make up for the extra stress and constraints linked to heavy PPE use
To these asks caused by the Covid-19 emergency, the union adds pre-existing priorities, in particular:
To carry out epidemiological studies on the air breathed by workers in sewerage network confined atmospheres saturated by gas and other pollutant mixes
A halt to the abolition of the specific pension scheme pursued by the French Government, and in particular the one on sewage workers’ pension scheme that should be extended to all sanitation workers, whether public or private, subject to the only condition of having worked for ten years in these sewage networks.
“The pandemic is also having a big environmental footprint,” adds Dumont. As waste recycling services are now halted for safety reasons, the only way to safely dispose of all inorganic waste, including of used masks, gloves, plastics is either to incinerate or to put them in landfills. As incinerator capacity is rapidly filled the landfill option seems to be the most likely to deal with the surge in waste.
In addition, the usual recycling of residues from sewage (sludge) mainly through agricultural recovery, in this period of Covid-19 pandemic, would only be possible for sludge that has undergone a hygienisation protocol which is about 70% of what is usually recovered in normal times. The rest must be dehydrated and incinerated. Yet another collateral emergency caused by the pandemic that needs to be swiftly addressed.
The Covid-19 pandemic exemplifies and amplifies the risks of exposures taken by sanitation workers to service present and future population’s needs and for the protection of the environment: in short for our public health and for the planet.
WHO, Water, sanitation, hygiene and waste management for COVID-19 Technical brief WHO/2019-nCoV/IPC_WASH/2020.2 19 March 2020 (EN)
INRS, Interventions en espaces confinés dans les ouvrages d'assainissement Obligations de sécurité, March 2010 (FR)
Haut Conseil de la santé publique, Avis relatif à la réduction du risque de transmission du SARS-CoV-2 par la ventilation et à la gestion des effluents des patients COVID-19, 17 mars 2020 (FR)
Agence nationale de sécurité sanitaire, Covid-19 : les boues de stations d’épuration produites pendant l’épidémie ne peuvent être épandues qu’après hygiénisation 2 avril 2020 (FR)