@TechReport{iza:izadps:dp18269,
            	author={Kerwin, Jason and Dorélien, Audrey M. and Pandey, Divya},
            	title={Open Defecation Is Negatively Associated with Reported COVID-19 Deaths in Rural India. Are Shared Toilets the Reason?},
            	year={2025},
	month={Nov},
            	institution={Institute of Labor Economics (IZA)},
            	address={Bonn},
            	type={IZA Discussion Paper},
            	number={18269},
            	url={https://www.iza.org/publications/dp18269},
	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.},
	keywords={sanitation;open defecation;COVID-19;mortality},
            }