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More than 50 million people in India do not have access to effective handwashing, putting them at a greater risk of acquiring and transmitting the novel coronavirus, according to a study.

Researchers from the Institute for Health Metrics and Evaluation (IHME) at the University of Washington in the US found that without access to soap and clean water, over 2 billion people in low- and middle-income nations -- a quarter of the world's population -- have a greater likelihood of transmitting the coronavirus than those in wealthy countries.

According to the study, published in the journal Environmental Health Perspectives, more than 50 per cent of the people in sub-Saharan Africa and Oceania lacked access to effective handwashing.

"Handwashing is one of the key measures to prevent COVID transmission, yet it is distressing that access is unavailable in many countries that also have limited health care capacity," said Michael Brauer, a professor at IHME.

The study found that in 46 countries, more than half of people lacked access to soap and clean water.

In India, Pakistan, China, Bangladesh, Nigeria, Ethiopia, Democratic Republic of the Congo, and Indonesia, more than 50 million persons in each country were estimated to be without handwashing access, according to the study.

"Temporary fixes, such as hand sanitizer or water trucks, are just that -- temporary fixes," Brauer said.

"But implementing long-term solutions is needed to protect against COVID and the more than 700,000 deaths each year due to poor handwashing access," Brauer said.

He noted that even with 25 per cent of the world's population lacking access to effective handwashing facilities, there have been "substantial improvements in many countries" between 1990 and 2019.

Those countries include Saudi Arabia, Morocco, Nepal, and Tanzania, which have improved their nations' sanitation, the researchers said.

The study does not estimate access to handwashing facilities in non-household settings such as schools, workplaces, health care facilities, and other public locations such as markets.

Earlier this month, the World Health Organization predicted 190,000 people in Africa could die of COVID-19 in the first year of the pandemic, and that upward of 44 million of the continent's 1.3 billion people could be infected with the coronavirus, the researchers said. 

Paris, May 10: The number of coronavirus cases worldwide topped four million as some of the hardest-hit countries readied Sunday to lift lockdown restrictions despite concern about a second wave of infections.

Governments around the world are trying to stop the spread of the deadly disease while scrambling for ways to relieve pressure on their economies, which are facing a historic downturn with millions pushed into unemployment.

Despite the intense political pressure to reopen, nations are also keen to avoid second waves of infections that could overwhelm healthcare systems, with reminders over the weekend of the threat posed by the virus.

In the United States, media reported Saturday that the nation's top infectious disease expert, Anthony Fauci, was among three members of the White House coronavirus task force who will self-isolate after potential exposure.

And in South Korea, the capital Seoul shut all bars and clubs on Saturday as more than 50 cases were linked to a man who tested positive after spending time in one of the city's busiest nightlife districts.

Despite the risks, some governments in hard-hit Europe have said are signs of progress that justify cautious steps towards normality.

Officials in France on Saturday said the day's death toll of 80 was the lowest since early April, while nursing home fatalities also fell sharply as the nation prepared to relax curbs on public movement imposed eight weeks ago.

The easing, to begin Monday, has brought mixed reactions.

"I've been scared to death" about the reopening, said Maya Flandin, a bookshop manager from Lyon. "It's a big responsibility to have to protect my staff and my customers."

French health officials have warned that social distancing must be kept up even as restrictions are eased.

In Spain, about half the population will be allowed out on Monday for limited socialisation, and restaurants will be able to offer some outdoor service as the country begins a phased transition set to last through June.

With lingering fears of a resurgence, authorities excluded Madrid and Barcelona -- two COVID-19 hotspots -- from the first phase.

Belgium is also easing some restrictions on Monday, and in some parts of Germany, bars and restaurants reopened on Saturday with further easing set for Monday.

In Britain, Prime Minister Boris Johnson is expected Sunday to lay out a plan for the nation to emerge out of its current lockdown.

Media reports have suggested that Britain may introduce a mandatory 14-day quarantine for international arrivals to stop the spread of the virus.

Global economic figures are pointing to the most acute downturn in nearly a century, with businesses forced to shut and supply lines badly disrupted, and pressure is growing on leaders around the world to find a way out as the worldwide death toll topped 277,000 and infections crossed four million.

In the United States, the country with the highest death toll and where more than 20 million people have lost their jobs, President Donald Trump has insisted that next year would be "phenomenal" for the economy, urging reopening despite the virus still claiming well over 1,000 lives daily in the country.

The scale of the challenge was brought in sharp focus over the weekend as US media reported that top disease expert Anthony Fauci, who has become the trusted face of the government response to the pandemic, is going to self-isolate after possible exposure to an infected White House staffer.

Fauci told CNN that he will undergo a "modified quarantine" as he had not been in close proximity to the staffer, the network reported. He will remain at home teleworking, and will wear a mask for two weeks.

Robert Redfield, the director of the Centers for Disease Control and Prevention, and Stephen Hahn, the commissioner of the Food and Drug Administration, will also self-isolate, CNN added.

All three will still testify at Tuesday's Senate coronavirus hearing, with Redfield and Hahn participating via video link, according to Senator Lamar Alexander, chairman of the chamber's health committee.

It is believed Fauci will attend wearing a mask, CNN reported.

President Trump has faced sharp criticism from his predecessor Barack Obama, who said on a leaked tape that Trump's handling of the crisis was an "absolute chaotic disaster".

With people wearying of being indoors and under economic pressure, anti-lockdown protests have been held in a number of countries in recent weeks, with some demonstrators arguing that such restrictions violate their rights and others promoting conspiracy theories about the pandemic.

Ten people were arrested and a police officer injured in Melbourne, Australia, on Sunday in the latest such protest, where around 150 people gathered to demand an end to the shutdown.

Participants were promoting a number of conspiracy theories, such as linking 5G cellular communications to the disease.

Australian chief medical officer Brendan Murphy said there was "a lot of very silly misinformation out there", including the 5G allegation.

"I have unfortunately received a lot of communication from these conspiracy theorists myself," he said.

"It is complete nonsense. 5G has got nothing at all to do with coronavirus."

Thiruvananthapuram, Apr 26: Kerala Chief Minister Pinarayi Vijayan on Saturday urged media houses not to resort to layoffs and pay cuts while the whole community is facing the COVID-19 pandemic.

The Chief Minister said the state government will also take necessary steps to test the media personnel in the state to ensure they have not contracted the deadly virus.

He also pointed out that the pandemic has severely impacted the media sector with many newspapers even reducing the number of pages.

"Journalists are among those who have been affected the most. Journalists on the field are also in danger. We have come to know about the reporters affected with coronavirus in other states. The government will take necessary precautions including testing to ensure that journalists don't contract the disease," Vijayan said.

He said the newspapers were not receiving advertisements these days because there are no social or public events resulting in less commercial activities in the society.

"I would like to urge the media houses not to engage in layoffs or salary cuts during this pandemic. Journalists are working shoulder to shoulder with health workers. During this pandemic, scribes are out in the field collecting news, despite the threat of disease and it was admirable," Vijayan said.

The chief minister said the government has asked the PRD to release the dues to various media houses.