ABSTRACT
Background: Shared water facilities are widespread in resource-poor settings within low- and middle-income countries. Since gathering water is essential, shared water sites may act as an important COVID-19 transmission pathway, despite stay-at-home recommendations. This analysis explores conditions under which shared water facility utilization may influence COVID-19 transmission.Methods: We developed two SEIR transmission models to explore COVID-19 dynamics. The first describes an urban setting, where multiple water sites are shared within a community, and the second describes a rural setting, where a single water site is shared among communities. We explored COVID-19 mitigation strategies including social distancing and adding additional water sites.Findings: Increased water site availability and social distancing independently attenuate attack rate and peak outbreak size through density reduction. In combination, these conditions result in interactive risk reductions. When water sharing intensity is high, risks are high regardless of the degree of social distancing. Even moderate reductions in water sharing, can enhance the effectiveness of social distancing. In rural contexts, we observe similar but weaker effects.Interpretation: Enforced social distancing and density reduction at shared water sites can be an effective and relatively inexpensive mitigation effort to reduce the risk of COVID-19 transmission. Building additional water sites is more expensive but can increase the effectiveness of social distancing efforts at the water sites. As respiratory pathogen outbreaks — and potentially novel pandemics — will continue, infrastructure planning should consider the health benefits associated with respiratory transmission reduction when prioritizing investments. Funding: The Bill & Melinda Gates Foundation. Declaration of Interest: The authors do not report any conflicts of interest.