Disease pattern in the era of handwashing, sanitising


Will we emerge from this healthier or too clean?

If there is something the Covid-19 pandemic has taught us, it is that you can hold someone’s life in your hands, literally. Your hands are a breeding ground for germs that cause diseases and without frequent and thorough washing you can easily transmit these.

Even with this knowledge, many people simply forget to wash their hands or ignore it. But, the new coronavirus pandemic has brought with it a new culture. People, young and old, are now washing their hands more frequently.

This simple technique has become one of the most effective ways countries are using to curb the spread of the disease that has brought the world to a standstill. The deadly virus has so far killed more than 160,000 people and infected over two million. In Kenya, 270 people had been infected and 14 deaths recorded by Sunday.

Will this frequent handwashing change Kenya’s disease pattern from the common cold, the flu, pneumonia and other respiratory infections to gut ailments? Will we see a decline in maternal deaths if doctors washed their hands more often? Are we likely to emerge from the pandemic healthier?

Experts now agree that should this handwashing culture become entrenched in societies, we can significantly slow down the rate of any pandemic and see a decline in the number of those who get sick and deaths.

Dr Walter Otieno, a paediatrician, says Kenya should expect a drastic change in the disease pattern, thanks to the Covid-19 pandemic.

“In western Kenya, diarrhoea is very common in children and I must admit that for the past two weeks, the number of parents visiting the clinic with sick children has reduced,” he tells HealthyNation. “This clearly tells you the germs causing sicknesses have reduced and with the frequent handwashing, the numbers will continue going down.”

A study done by the Centres for Disease Control and Prevention (CDC) in 2017 in western Kenya showed that handwashing can lower one’s risk of catching a respiratory illness, such as a common cold, by a whopping 45 per cent.

Teaching people about handwashing helps communities stay healthy and this reduces the number of people who get sick with diarrhoea by 23 to 40 per cent, says the CDC data. In people with weakened immune systems, this simple act reduces diarrhoeal illness by 58 per cent.

“Handwashing should always be our first line of defence. Currently, we are religiously washing our hands because we do not want to contract the new coronavirus, but we are unknowingly keeping most diseases at bay. I am sure that in the coming months, the number of children who will get sick because of germ-transmitted infections will have reduced,” says Dr Otieno.

This has a ripple effect because lower cases of disease will boost school attendance. The data shows that handwashing prevents absenteeism due to gastrointestinal illness in schoolchildren by 29 to 57 per cent.

Not washing hands harms children around the world and about 1.8 million of those under the age of five die each year from diarrhoeal diseases and pneumonia, the top two killers of young children globally.

Ms Elector Achieng, a mother, says handwashing has improved her daughter’s health.

Before schools were closed last month to stop the spread of Covid-19, her daughter spent two days a week out of school because of the flu and a cough. Since the schools were abruptly closed, Gianna has escaped the frequent hospital trips. Her mother attributes this to closely monitoring her daughter and partly due to ensuring the four-year-old frequently and thoroughly washes her hands.

“A month has gone by without taking her to the hospital for either a cough or the flu. She has not been taking the many antibiotics she used to,” she says.

Achieng says one would mistake her wall unit for a chemist because of the many drugs she has to give Gianna daily.

“My Gianna is now fine,” she says.

Achieng could be among thousands of parents and Kenyans celebrating the impact of handwashing in the last one month.

Should the trend continue, we are likely to see a decrease in mortality in some diseases and a healthier generation to come, with experts saying this is one of the many ways of battling antibiotic resistance.

Antibiotic resistance is rising to dangerously high levels in all parts of the world. New resistance mechanisms are emerging, threatening our ability to treat common infectious diseases.

A growing list of infections – such as pneumonia, tuberculosis, blood poisoning, gonorrhoea and foodborne diseases – are becoming harder, and sometimes impossible, to treat as antibiotics become less effective.

Antibiotic resistance leads to higher medical costs, prolonged hospital stays and increased mortality.

The world urgently needs to change the way it prescribes and uses antibiotics in order to stop this catastrophe. Even if new medicine is developed, without behaviour change, antibiotic resistance will remain a major threat.

According to Dr Marc Sprenger, director of World Health Oganization’s antimicrobial resistance secretariat, preventing sickness reduces the number of antibiotics people use and the likelihood that antibiotic resistance will develop.

A report released by WHO in 2018 showed that handwashing can prevent about 30 per cent of diarrhoea-related sicknesses and about 20 per cent of respiratory infections (colds).

“Some of the world’s most common and potentially most dangerous infections are proving drug-resistant,” adds Dr Sprenger. “This simple habit can also help save economies billions of dollars in working days that are otherwise lost to stomach upsets, colds and the flu.

With a worrying maternal death rate, Kenya could also save lives by enforcing stricter handwashing rules in delivery rooms.

Dr John Ong’ech, a leading obstetrician and gynaecologist at Kenyatta National Hospital, shared the same views on washing hands in delivery rooms.

“Washing of hands before attending to a patient is not a simple routine even if you have to put on gloves. It is a critical step in reducing infections and saving the lives of mothers and newborns. Handling mothers without washing hands leads to severe infections and even death,” he says.

According to WHO, globally, 30,000 women and 400,000 babies die every year from infections such as puerperal sepsis, often caused by lack of water, poor sanitation and poor handwashing practices.

Dr Ong’ech says it is crucial for any doctor to wash their hands before and after touching a patient, before medical procedures and after being exposed to bodily fluids.
“Now, we are more careful and we are likely to see a reduction in the number of infections globally and even in Kenya, something that should be continued with even though some facilities do not have access to water,” Dr Ong’ech tells HealthyNation.
Most countries will come out of the coronavirus pandemic having learnt the basics of hygiene and this will not only help reduce deaths, but also hospital admissions.
Data from Unicef shows that one in every four childhood deaths - some 1.4 million – under the age of five globally result from diarrhoea and pneumonia. “This is more than Aids, malaria and tuberculosis combined,” says Sam Stephens, head of Clean the World Foundation, which provides soap and hygiene education to vulnerable communities around the world.

“And just handwashing with soap can reduce death rates from these diseases by up to 65 per cent,” he says. “When people wash their hands in the right way at the right time, it can be more effective than medication, vaccine or even clean water, as a single intervention against pneumonia and diarrhoea.”
Washing hands well takes only about 20 seconds, costs next to nothing, and yet it can prevent serious diseases that can cost millions to treat, he adds.
Stephens, who has been working with over 4,000 children in Kenya in a soap programme in schools, says needy families have been the greatest beneficiaries.
“When the programme started some three years ago, a third of them would miss school even twice a month because of different illnesses. But, after they were taken through handwashing procedures, reported hygiene-related illnesses dropped. We saw a 45 per cent increase in attendance,” he says.
Data from the National Registry of Diseases shows after Kenya reported the first case of the new coronavirus on March 13, there was a spike in pneumonia, one of the complications of severe Covid-19.
From January until early February, the number of pneumonia cases were 137,667 before a dramatic increase to 195,504. While compilation of data for March is not complete, a Health ministry official suspects the numbers are still increasing. There was no such increase in the same period last year.
Pneumonia, that claimed 21,584 in 2017 alone, was long thought to be caused by bacteria, but the Pneumonia Etiology Research for Child Health study found that viruses caused most of the severe cases (61 per cent).
Dr Jeremiah Chakaya, a respiratory physician allied to the society, says it is very difficult to differentiate between Covid-19 and pneumonia. “Should people observe hand hygiene, we are likely to see a decrease of pneumonia cases in the coming months unlike what has been witnessed in the last three months,” he says.
The flu is another deadly ailment that can be prevented by handwashing. According to WHO, the 2018–2019 flu season was the longest in a decade, lasting a full 21 weeks from November to April.
“In many cases, infectious diseases, such as influenza, can be transmitted before a person has signs and symptoms of the disease. Handwashing can make sure you’re not unwittingly infecting yourself,” says Dr Chakaya.
Despite handwashing being a gold standard for health, researchers and experts have also warned that overdoing it can be harmful. They warned that over-washing can potentially lower our resistance to essential bacteria and becoming too clean possibly sets up people for even more health risks.
A research titled How being too clean might make us sick showed that the normal (healthy) bacteria that live on the skin are very important and washing does not remove them. However, over-washing removes these friendly bacteria.
“The bacteria are not affected by you washing your hands after visiting a toilet or while taking shower, but overdoing it can take a toll on your health,” shows the report.
Dr Samer Blockmon, an internal medicine specialist at the Georgia-based Piedmont Healthcare system, agrees that excessive handwashing can make you vulnerable to illness. “If you wash your hands too often, you are also removing the healthy oils and good bacteria that defend against disease. At an extreme, you start drying out the hands, you start damaging the skin,” he says.
How do you know you are over-washing your hands? If after washing your hands they are itchy, your skin flaky or there is pain and redness then you are overdoing it.