Brauer et al. (2020) estimate that over 2 billion people lack access to household handwashing facilities, amplifying critical questions for COVID-19 prevention measures in low-income counties. Despite these dire figures, the situation may be far worse, given unreliable and costly access to water and soap in households, schools, and health care facilities. The current World Health Organization COVID-19 guidance on hand hygiene (WHO 2020) will be infeasible for many and requires updating to support resource-poor settings.
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