Unflushable or missing toilet paper, the dilemma for developing communities during the COVID-19 episode.

Unlike in developed countries, most public toilets in China do not provide toilet paper onsite and users must bring their toilet paper. Moreover, an open waste bin is placed in each user's cubicle to collect used toilet paper and tissues. Such practices, which are common in East Asia and central America, have induced a dilemma of toilet paper disposal because some municipalities have removed waste bins from public toilets to prevent virus transmission by fecal matter. As a consequence, users were forced to flush down their used toilet paper and tissues. Yet, it is unknown whether standard toilet paper can be flushed easily without causing issues in sewer operations. Here, we surveyed the conditions of toilets in university campus and other public facilities in different regions across China. We also evaluated the disintegration characteristics of toilet paper products both by conducting online surveys and by physical disintegration experiments. We found that only 15% of toilets provided toilet paper, while open waste bins occurred at nearly all sites. Further, our survey indicated that 82% of toilet paper products sold in China did not give any indication on their flushability, whereas 77% of US products did. Disintegration results showed that none of the five popular, best-selling toilet paper products passed the flushability standard. We propose strategies to solve the current toilet paper dilemma in developing communities.