Study links limited water resources, COVID-19 risk in rural Alaska

July 14, 2021

Limited water and sanitation resources in many Alaska villages could boost the risk of COVID-19 spread, leading to a greater potential for community transmission of the virus in rural areas.

A diverse team of environmental engineers, microbiologists and public health experts analyzed some of the COVID-19 risk factors in rural Alaska during the height of the pandemic last year. Much of their work focused on the roughly 30 percent of Alaska villages that are remote and lack sewer and water infrastructure, which include about 3,300 homes without modern plumbing.

Their focus on the lack of water resources as a risk factor for disease transmission contrasts with much of the public health messaging on preventing COVID-19, which has emphasized limiting aerosol and close-contact spread of the virus through behaviors like social distancing, wearing masks, and access to testing.

Data from Alaska’s unplumbed communities indicates that limited water resources are also often connected to higher rates of respiratory illnesses. In many of these communities access to public water services is limited to community washeterias, which also enhances close-contact risks for virus transmission.

Rates of pneumonia are 30 percent higher among infants in remote Alaska communities without modern plumbing, and the rate of respiratory syncytial virus is 3.4 times greater. Last fall Alaska’s rural regions routinely had COVID-19 rates considered “high” or “very high” by the Center for Disease Control.

“We’re taught as environmental engineers to separate the humans from the hazard, and that’s obviously not always done in rural Alaska communities,” said David Barnes, professor of civil and environmental engineering at the University of Alaska Fairbanks and a contributor to the study. “If your immune system is stressed because of other factors in your community, you may be especially vulnerable.”

A person in a typical rural Alaska household without running water uses less than 5 gallons of water per day, much less than the minimum standard of 13.2 gallons the World Health Organization recommends for maintaining a healthy hygiene. While the fecal-oral route for COVID-19 transmission has not been established, the practice of reusing washbasin water and exposure to untreated waste could be among the factors that increase risk of COVID-19 transmission and disease severity in such households, according to the study.

The lack of water and sewer infrastructure is one of several factors that put many Alaska villages in danger of outbreaks. Many homes are overcrowded, medical facilities are limited, and communities are often remote. Similar problems extend throughout rural areas of the Circumpolar North as well as some tribal areas in the Lower 48.

The study’s authors argue that the pandemic underscores the health consequences of inadequate water and sanitation resources in these environments. Some rural communities have waived fees, subsidized water utility bills, and worked to reconnect homes to plumbing where it is available during the pandemic. Federal COVID-19 relief funding could also be used to build water and sewer networks and increase access to water resources. In addition, testing of wastewater itself has provided an early warning of community spread of the virus.

“A lot of this problem has to do with the lack of appropriate water and sanitation infrastructure,” said Srijan Aggarwal, a UAF associate professor of environmental engineering and the lead for this study. “Some of these are short-term issues, but most of these concerns need to be addressed by long-term policies and investments for improving water and sanitation infrastructure across rural Alaska.”

The study is published in the new issue of the journal Science of the Total Environment. Along with Barnes and Aggarwal, authors included Subhabrata Dev and Devin Drown, University of Alaska Fairbanks; Eric Bortz, Brandon Briggs, Aaron Dotson and Micah Hahn, University of Alaska Anchorage; Laura Eichelberger and Tricia Howe, Alaska Native Tribal Health Consortium; Patricia Cochran, Alaska Native Science Commission; and Kaitlin Mattos, University of Colorado Boulder and Alaska Native Tribal Health Consortium.

NOTE TO EDITORS: An abstract of the Total Environment paper is at https://www.sciencedirect.com/science/article/pii/S0048969721009098. A PDF of the full paper is available upon request.

ADDITIONAL CONTACTS: Srijan Aggarwal, 907-474-6120, saggarwal@alaska.edu; David Barnes, 907-474-6126, dlbarnes@alaska.edu; Laura Eichelberger, lpeichelberger@anthc.org