BACKGROUND Low-income countries have reduced health care system capacity and are therefore at risk of substantially higher COVID-19 case fatality rates than those currently seen in high-income countries. Handwashing is a key component of guidance to reduce transmission of the SARS-CoV-2 virus, responsible for the COVID-19 pandemic. Prior systematic reviews have indicated the effectiveness of handwashing to reduce transmission of respiratory viruses. In low-income countries, reduction of transmission is of paramount importance, but social distancing is challenged by high population densities and access to handwashing facilities with soap and water is limited. OBJECTIVES Our objective was to estimate global access to handwashing with soap and water to inform use of handwashing in the prevention of COVID-19 transmission. METHODS We utilized observational surveys and spatiotemporal Gaussian process regression modeling in the context of the Global Burden of Diseases, Injuries, and Risk Factors Study to estimate access to a handwashing station with available soap and water for 1,062 locations from 1990 to 2019. RESULTS Despite overall improvements from 1990 {33.6% [95% uncertainty interval (UI): 31.5, 35.6] without access} to 2019, globally in 2019, 2.02 (95% UI: 1.91, 2.14) billion people, 26.1% (95% UI: 24.7, 27.7) of the global population, lacked access to handwashing with available soap and water. More than 50% of the population in sub-Saharan Africa and Oceania were without access to handwashing in 2019, and in eight countries, 50 million or more persons lacked access. DISCUSSION For populations without handwashing access, immediate improvements in access or alternative strategies are urgently needed, and disparities in handwashing access should be incorporated into COVID-19 forecasting models when applied to low-income countries. https://doi.org/10.1289/EHP7200.

中文翻译：

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全球洗手：对低收入国家控制 COVID-19 的影响。

背景 低收入国家的卫生保健系统能力有所下降，因此与目前在高收入国家中看到的情况相比，COVID-19 病死率有大幅提高的风险。洗手是减少导致 COVID-19 大流行的 SARS-CoV-2 病毒传播指南的关键组成部分。先前的系统评价表明，洗手可有效减少呼吸道病毒的传播。在低收入国家，减少传播至关重要，但社会疏远受到高人口密度的挑战，使用肥皂和水洗手设施的机会有限。目标 我们的目标是估计全球使用肥皂和水洗手的情况，以告知使用洗手预防 COVID-19 传播的情况。方法 我们在全球疾病负担、伤害和风险因素研究的背景下利用观察性调查和时空高斯过程回归模型来估计 1990 年至 2019 年 1,062 个地点使用可用肥皂和水的洗手站的使用情况。从 1990 年 {33.6% [95% 不确定性区间 (UI): 31.5, 35.6] without access} 到 2019 年的改进，2019 年全球 2.02 (95% UI: 1.91, 2.14) 十亿人，26.1% (95% UI: 24.7) , 27.7) 的全球人口无法使用可用的肥皂和水洗手。2019 年，撒哈拉以南非洲和大洋洲超过 50% 的人口无法洗手，在八个国家，有 5000 万人或更多人无法洗手。讨论 对于无法洗手的人群，迫切需要立即改进获取或替代策略，并且在应用于低收入国家时，应将洗手获取方面的差异纳入 COVID-19 预测模型。https://doi.org/10.1289/EHP7200。