Michael Brauer1,2, Jeff T Zhao1, Fiona B Bennitt1, Jeffrey D Stanaway1. 1. Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA. 2. School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada.
We welcome the comments of Freeman and Caruso regarding our paper (Brauer et al. 2020) and share the concerns they have expressed regarding access and the need for local, accessible solutions to handwashing access in water-scarce communities.For the purposes of our study, we intentionally distinguished our estimates of handwashing access from measures of access to drinking water. We defined handwashing access as the “availability of a handwashing facility with soap and water on [household] premises” as indicated by a surveyor who visited the handwashing facility and observed if water and soap were present. Further, as indicated in our paper, we did not include access to public (nonhousehold) handwashing facilities.We agree with Freeman and Caruso that gathering and waiting at communal handwashing locations may present a risk for COVID-19 transmission.