TY  - RPRT
        AU  - Kerwin, Jason
AU  - Dorélien, Audrey M.
AU  - Pandey, Divya
        TI  - Open Defecation Is Negatively Associated with Reported COVID-19 Deaths in Rural India. Are Shared Toilets the Reason?
        PY  - 2025/Nov/
        PB  - Institute of Labor Economics (IZA)
        CY  - Bonn
        T2  - IZA Discussion Paper
        IS  - 18269
        UR  - https://www.iza.org/publications/dp18269
        AB  - 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.
        KW  - sanitation
KW  - open defecation
KW  - COVID-19
KW  - mortality
        ER  -