Open Defecation Is Negatively Associated with Reported COVID-19 Deaths in Rural India. Are Shared Toilets the Reason?

Jason Kerwin, Audrey M. Dorélien () and Divya Pandey ()
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Audrey M. Dorélien: University of Washington
Divya Pandey: University of Minnesota

No 18269, IZA Discussion Papers from Institute of Labor Economics (IZA)

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 (search for similar items in EconPapers)
JEL-codes: I15 I18 (search for similar items in EconPapers)
Date: 2025-11
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