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Saving Lives and Livelihoods Amidst a Once-in-a-Century Crisis 11

Box 3: How Handwashing began as a Medical Experiment

Due to COVID-19, handwashing received attention once more after nearly 170 years. It may
be unbelievable today, but nearly 200 years ago, doctors did not wear gloves for surgeries
and the concept of germs was not known. The germ theory was proposed by Louis Pasteur
in 1885.

It all started when a young Hungarian physician Ignaz Semmelweis in the obstetrics
department of Vienna Hospital is 1846 found, to his surprise, that the mortality rate of his
division was sevenfold higher than that of another obstetrics division staffed exclusively
by midwives. Upon further investigation, he found that the physicians would start their day
by conducting autopsies and then proceeding to labour rooms for conducting deliveries,
without cleaning their hands. The nurses and midwives, on the other hand, started their days
with deliveries. He then introduced a handwashing policy for all physicians and medical
students before they entered the labour room, and within a year, the mortality was brought
down to one-sixth of the former number. This was the first scientific proof that handwashing
helped in preventing infection, though this did not immediately become popular among
doctors. Today, Ignaz Semmelweis is considered the father of hand hygiene and infection
control in hospitals.

During the SARS outbreak in 2002-04, the authorities in Hong Kong had advised the public
to wash their hands to prevent the spread of the disease. During the COVID-19 pandemic,
handwashing has come to the rescue once again. Handwashing is considered a proven and
among the most cost-effective public health interventions along with vaccination. This was
recognised under the Swachh Bharat Mission in India with a focus to develop the habit of
handwashing early at schools under Swachh Bharat: Swachh Vidyalaya.

1.15 The evidence comparing the containment policies of 21 cities during the 1918 H1N1
influenza pandemic shows that social distancing policies reduce transmission (Markel et al.,
2007). The scatterplots in Figure 6 display the impact of (i) public health response time, which
is shown as the number of days compared to the overall average; negative and lower values thus
imply early lockdown while higher values imply a slow response, and (ii) the intensity of the
lockdown as measured by the number of days the lockdown was employed. The figure shows
that cities that implemented lockdowns earlier delayed the time to peak mortality, reduced the
magnitude of the peak mortality as well as the total mortality burden. Similarly, cities that had a
more intense lockdown also reduced their total mortality.

1.16 Hatchett et al., 2007 showed that cities in which multiple interventions were implemented
at an early phase of the epidemic had peak death rates ~50 per cent lower than those that did not
and had less-steep epidemic curves. For COVID-19 too, evidence showed that a combination
of three interventions (face masks, physical distancing and handwashing) works better than a
single intervention (D.Chu et al, 2020). The chances of infection were around 13 per cent when
people maintained a distance of one metre – that reduced to a fifth, that is 2.6 per cent, when a
distance of more than one metre was maintained.