Implications of inadequate water and sanitation infrastructure for community spread of COVID-19 in remote Alaskan communities

The novel coronavirus SARS-CoV-2, the causative agent of COVID-19, emerged in the human population in December 2019 and spread worldwide within a few short months. Much of the public health focus for preventing and mitigating the spread of COVID-19 has been on individual and collective behaviors, such as social distancing, mask-wearing, and hygiene. It is important to recognize that these behaviors and health outcomes occur within broader social and environmental contexts, and factors within local communities such as regional policy, historical context, cultural beliefs, and natural- and built environmental characteristics affect underlying population health and the spread of disease. For example, the COVID-19 pandemic has renewed attention to the importance of secure water and sanitation services in protecting human health; many remote Alaskan communities are particularly vulnerable to infectious disease transmission because of inadequate water and sanitation services. In addition, there are a number of socio-economic, physical, and infrastructure factors in rural Alaska (e.g., remoteness, household overcrowding, climate change impacts, limited medical facilities, and high prevalence of chronic diseases) that contribute to the potential for more severe COVID-19 disease outcomes in these predominantly Alaska Native communities.