Learn how wastewater surveillance can help with managing the current pandemic and with preventing future ones! We need to add capacity, not cut back programs!
Bonus Call to arms for Ontario!
Covid is not over. That’s easy to see from, among many other things, what the wastewater is telling us in California.
Which brings us to the latest issue of the Covid-Is-Not-Over newsletter! This is the penultimate issue before an extended summer break. The main newsletter will be on hiatus starting after the next issue up until the end of July or the beginning of August. I’ll likely be setting up a few “Bonus Catchup” issues for during the break which will have some link lists and very minimal excerpting or commentary or extra features. For example, I’ve gathered a bunch of items on Long Covid over the last few months but haven’t had room for them in the newsletter.
The Ford government’s plan to eliminate all our Covid wastewater monitoring stations is the driving force behind this issue. The theme, however, is a bit more general. And that is the utility of wastewater surveillance in managing and preventing pandemics. The readings are all about some aspect of wastewater surveillance, some about the situation in Ontario, some about wastewater monitoring in general, some about the history of its use for Covid, some about how important it is to deal with the threat of an H5N1 pandemic.
Somehow this all seems like a new idea. Certainly, it’s something that wasn’t on my radar pre-Covid. As it happens, wastewater epidemiology has a history going back into the 1940s when it was pioneered for use in detecting polio outbreaks. A few quick Googles tell me that as early as March 2020, it was becoming obvious that wastewater was going to be useful in the fight against Covid. By April and May and into the summer of 2020, it was widely researched and reported. The fall of 2020 also saw plenty of coverage. The usefulness of this approach is hardly a surprise by now. Where are we today? Google “wastewater H5N1” and you’ll see.
But what about Ontario, you ask? The situation is that the Conservative government has announced that as of the end of July, it will end its wastewater surveillance program, comprising nearly 60 collection and monitoring sites in total. The rationale is that the Federal government is increasing their program in Ontario and there shouldn’t be any duplication. The fact is that the Feds are increasing the number of sites from four to eight or nine. So this ends up being a drastic reduction in the total capacity for infectious disease monitoring.
The reality is that Ontario’s monitoring system was a model for the world, with amazing information, data sharing and public access. It also drove a whole bunch of university research in civil engineering and other fields, spurred on by the people who were actually managing a lot of the infrastructure.
Here’s something from a recent Toronto Star editorial: Doug Ford is again ignoring the lessons of the past:
Cutting the Ontario wastewater surveillance network now is a betrayal of everyone who sacrificed in the fight against COVID-19. It is a mistake on its own. More troubling, it suggests we are already repeating the mistakes we made after SARS. Ford, like his predecessors, is ignoring the lessons of the past and failing the people of the future, setting us up for more fumbling and more deaths when the next pandemic comes.
The previous issue of the newsletter had a list of of media reports on the situation. This issue lists more recent news and commentary (see below). Dig into that if you want a fuller picture of the tragedy.
It's not too late. We can reverse this. Doug Ford and his government are famous for policy flip flops if Ford senses that suddenly people don’t like him anymore. And even if the provincial government doesn’t budge, if we make enough noise maybe the local Medical Officers of Health and their local public health authorities will follow Peterborough’s example and fund the infrastructure themselves.
So, yes, let’s make some noise. Phone, email, make a fuss on social media. Here’s a list of resources to get started!
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Latest News on Ontario Cancelling Wastewater Surveillance
Cancelling Ontario’s waste-water program is an affront to science and common sense | TVO Today
Ending Wastewater Surveillance Initiative a mistake, says local expert - Guelph News
When The Poop Hits The Fan — Ontario wastewater testing needs to be expanded, not stripped back
Province shutting down wastewater surveillance in Waterloo Region | CTV News
Sudbury researcher disappointed Ontario ends COVID-19 wastewater surveillance | CBC News
Region will end its wastewater surveillance next month, alongside other cities
As most have probably noticed, there is no paid subscription option for this newsletter. However, Substack does have an option where subscribers can pledge to subscribe “just in case” and a few kind subscribers have made that pledge. I very much appreciated the vote of confidence in what I’m doing here. What I’ve decided to do on a trial basis is to set up a “tip jar” on the Ko-fi platform. I’m not anticipating a huge surge of income from using Ko-fi but whatever revenue I do end up with, I plan to spend on supporting artists on Bandcamp. Sadly, who knows how long that will seem like a good idea.
U of G Co-Leads $ 15M Initiative to Prepare for Next Pandemic (2024.05.06) / University of Guelph
A University of Guelph researcher will co-direct a research project to prepare Canada for future health emergencies by building the resilience of Canada’s biomanufacturing sector, which uses living cells and organisms to create products such as medicines and foods.
Dr. Lawrence Goodridge, a professor in the Department of Food Science and director of the Canadian Research Institute for Food Safety within the Ontario Agricultural College (OAC), will co-direct Integrated Network for the Surveillance of Pathogens: Increasing Resilience and capacity in Canada’s pandemic response (INSPIRE) with Dr. Robert McKay of the University of Windsor. …
INSPIRE will help the biomanufacturing and health sectors develop proactive strategies to mitigate the impact of infectious diseases and improve information sharing and technologies across borders.
“Dr. Goodridge embodies the expertise, innovation and collaboration that have solidified University of Guelph’s reputation as a research-intensive institution,” says Dr. Rene Van Acker, interim vice-president (research). “His leadership will undoubtedly help prepare Canada’s responsiveness to future health priorities.”
The project will build up Canada’s capacity to produce vaccines and therapeutics by advancing wastewater surveillance and developing technologies that simplify and speed up sampling and pathogen detection.
“As we deal with the increasing emergence of infectious diseases, it’s imperative that we enhance our preparedness for future health crises,” says Goodridge. “This project builds on U of G’s recognized expertise in wastewater surveillance to build resilience into Canada’s biomanufacturing sector. Through collaborative efforts and innovative strategies, INSPIRE aims to equip Canada with the tools and knowledge needed to mitigate risks and bolster our capacity to respond effectively to future pandemics.”
Wastewater surveillance reveals pathogens in Detroit’s population, helping monitor and predict disease outbreaks since 2017 by Irene Xagoraraki (2024.06.12) / The Conversation
Wastewater surveillance hit the big time during the height of the COVID-19 pandemic, when officials started using this technique to monitor local virus levels. But my colleagues and I had been exploring wastewater’s promise as a public health tool years before anyone had heard of SARS-CoV-2.
My environmental virology lab based at Michigan State University has been in a partnership with the city of Detroit and the Great Lakes Water Authority since 2017, when we started testing municipal wastewater from Wayne, Oakland and Macomb counties to survey viral diseases in the Greater Detroit community.
Imagine you want to identify a potential emerging infectious disease in an urban area before it becomes an outbreak. Could you collect clinical samples from everyone in the community on a regular basis and test them all for every possible virus? No, that’s an impossible task.
Instead, we collected municipal wastewater, as a representative composite sample from the community, and tested that with advanced molecular methods to reveal endemic and emerging virus-related diseases circulating in the area. We identified viral genomes related to multiple gastrointestinal, respiratory, blood-borne and vector-borne diseases excreted by the population. We identified herpesviruses, including rare species, and we identified hepatitis A outbreak peaks via wastewater analysis that appeared before peaks in clinical samples.
We Risk a Pandemic if We Don't Do More to Monitor Spread of H5N1 Avian Flu by Henry I. Miller (2024.06.04) / American Council on Science and Health
There is an urgent need to develop the capacity to monitor for and rapidly detect additional spillover of H5N1 into humans, especially any indication of sustained human-to-human transmission. This would rely primarily on traditional public health surveillance approaches such as testing people with symptoms.
But that won’t be enough. Cattle and people working on dairy farms should be tested both for the presence of viral RNA, which would indicate an active infection, and also for antibodies against H5N1, which circulate in the body for longer following an infection. That could help public health officials determine how many people and cattle have been exposed to the virus and had infections that went unnoticed, possibly because they did not exhibit symptoms or were not tested.
Wastewater surveillance will also be important. It showed great potential during the COVID-19 pandemic for monitoring and early detection of surges of the SARS-CoV-2 virus, the etiologic agent.
The CDC revealed that it had found bird flu in sewage samples collected before the virus was identified in U.S. cows. They’re also detecting it in sewage in cities that are far from infected cattle herds. The significance of this is uncertain, however, because of the nature of wastewater. In many areas of the U.S., human waste flows from toilets through sewers into central municipal wastewater-treatment facilities where it can be sampled and tested for the presence and levels of pathogens. However, pathogens excreted by animals are also present in residential sewers because of runoff and other inflows; the presence of animals such as rats in sewers; or disposal into the sewer system of large volumes of contaminated milk from H5N1-infected dairy cows.
Scientists watching wastewater for signs of H5N1 as U.S. bird flu outbreak in dairy cattle grows by Lauren Pelley (2024.05.10) / CBC News
In Canada, though wastewater monitoring is still being used to track COVID-19, it's not part of expanded federal H5N1 surveillance efforts, which now include milk testing and restrictions on imported cattle. (There are no reports yet of the virus infecting Canadian dairy cows, though it has been reported in more than 10 million wild and farmed birds.)
Some Canadian researchers are taking matters into their own hands.
Lawrence Goodridge, director of the Canadian Research Institute for Food Safety and a professor at the University of Guelph, said his team started tracking influenza in Ontario wastewater a few months ago to study trends in human infections, and are now pivoting to see if any H5N1 shows up.
Canada detects poliovirus in wastewater samples by Lisa Schnirring (2023.01.05) / CIDRAP
Two days before Christmas, Canada reported vaccine-derived poliovirus type 2 (VDPV2) from two wastewater samples to the World Health Organization (WHO), the WHO's Pan American Health Organization (PAHO) said in a Dec 30 epidemiologic update.
The Canadian samples that tested positive for the virus were collected in August as part of sampling targeted to areas with close connections to communities in New York where similar wastewater positive samples were found earlier. A third positive environmental sample from Canada, also collected in August, is pending confirmation by virus isolation.
PAHO said the US Centers for Disease Control and Prevention (CDC) is testing the Canadian samples to see if they are genetically related to VDPV2 samples from New York.
SARS-CoV-2 detection in pediatric dental clinic wastewater reflects the number of local COVID-19 cases in children under 10 years old by Dai Kanamori, Jun Sakai, et al. (2024.05.28) / Scientific Reports
The number of COVID-19 cases among individuals < 10 years of age was associated with the SARS-CoV-2 RNA positivity in wastewater from a pediatric dental clinic. Since wastewater from pediatric dental clinics originates from the oral cavities of asymptomatic children, such testing can provide important information regarding asymptomatic COVID-19 in children, complementing clinical pediatric data.
Why scientists say wastewater surveillance needs to continue, despite low COVID-19 levels by Jennifer La Grassa (2023.07.09) / CBC News
Despite a majority of wastewater sites across the country reporting some of the lowest levels of COVID-19 since analysis began, some researchers say this type of surveillance should continue so Canada can be prepared for the next pandemic.
Wastewater surveillance gained prominence in recent years by providing health officials with a summary of the degree of disease among Canadians during peaks in the pandemic. But its value beyond the coronavirus was quickly realized as a crucial public health tool that could help protect people from future harmful infections.
Of the 39 sites tracked by Canada's COVID-19 wastewater surveillance dashboard, recent data shows that about 60 per cent are reporting decreasing levels of the virus. The rest of the sites are stable or slightly lower than their previous readings.
"In the past, I would say, several weeks, we've seen a relatively consistent downward trend," said Dr. Guillaume Poliquin, vice-president of the National Microbiology Laboratory, part of the Public Health Agency of Canada (PHAC).
Something in the Sewage: What watching our wastewater can tell us about infectious diseases by Ya’el Courtney (2023.03.09) / Harvard Kenneth C. Griffin Graduate School of Arts and Sciences
Wastewater surveillance has the potential to help local officials overcome access and affordability issues associated with diagnostic testing, and provide action-oriented information about where to focus public health resources. However, it is important to consider the shortcomings of wastewater surveillance, especially when these shortcomings apply to how this technique can benefit communities in an equitable way. Black, Hispanic, and American Indian or Alaska Native populations have experienced disproportionate negative health outcomes during the COVID-19 pandemic relative to their White counterparts. Likewise, rural Americans have died from COVID-19 at twice the rate of urban Americans. In these underserved communities, the impact of COVID-19 has been exacerbated by limited health care access, a higher prevalence of underlying conditions associated with severe COVID-19, and inequitable access to reliable and convenient COVID-19 testing. So far, wastewater surveillance has almost exclusively been implemented in regions with well-maintained sewage systems. This is problematic, as 20 percent of households in the United States—including many tribal and rural communities—are not connected to a sewer line. These households, along with poorer communities with failing sewer infrastructure, have been largely overlooked by state and national wastewater monitoring efforts.
Further, even after sampling infrastructure may be in place, it is critical that researchers partner with disadvantaged communities to effect positive change. This applies to communities with a strong sense of self-determination and systems of governance, like indigenous and tribal communities, but also to underrepresented or poorer communities around the country. Ultimately, it is up to the governing body of any given community to decide how they can use wastewater surveillance data to push for change—whether that be more resources for diagnostic testing, messaging, or vaccination. Community leaders and public health experts will need to have active conversations about how to interpret wastewater surveillance data and what it means about local risk.
Wastewater surveillance has recently gained significant momentum in the United States in terms of federal funding, expansion into new diseases, and public health implementation. It has the exciting potential to allow us to monitor a variety of public health threats. As progress continues, it will be important to pay special attention to the following considerations to ensure that this technique brings the greatest benefit possible to communities across the nation in an equitable way:
Development and funding of state laboratories with the capacity to process wastewater samples in rural communities
Increasing partnership with American tribal communities, of whom only 100 out of 574 are currently represented in wastewater surveillance data
Intentional education and outreach by researchers to community leaders about how to interpret data and implement protective strategies
More thorough mapping of the 20% of Americans not connected to a sewage system and efforts to implement alternative testing methods that can estimate the scope of outbreaks in these regions
Wastewater sampling in Canada suggests COVID case rate 19 times higher than reported by Mary Van Beusekom (2023.06.29) / CIDRAP
At the peak of the SARS-CoV-2 Omicron variant wave in Ontario, Canada, wastewater sampling conducted before the surge suggested that COVID-19 cases were 19 times higher than reported because of changes in clinical testing, according to a study published yesterday in Emerging Infectious Diseases.
Researchers at the Regional Municipality of Peel, Ontario, led the study, which involved determining the relationship between the SARS-CoV-2 load in wastewater and COVID-19 cases and hospitalizations before the emergence of Omicron (September 2020 to November 2021) at two treatment plants in Peel.
The team used these pre-Omicron correlations to estimate the incidence of COVID-19 cases amid the Omicron surge (November 2021 to June 2022). They collected wastewater samples from the treatment plants 3 to 5 days a week, for a total of 715 samples.
In December 2021, during the Omicron BA.1 variant surge in Ontario, the province restricted clinical polymerase chain reaction (PCR) testing to high-risk people, including hospitalized patients, healthcare workers providing direct patient care, and residents and staff in hospitals and congregate living settings. …
"The monitoring of wastewater in Peel has provided critical information about community transmission of COVID-19 that is independent of clinical testing availability and uptake," the authors wrote.
Wastewater Surveillance for SARS-CoV-2 RNA in Canada by Steve E. Hrudey, Heather N. Bischel, et al. (2022.12.15) / FACETS
Canadians and their governments (Provincial and Federal) should understand that the rapid pace of the achievements documented in this report were not accomplished because of any centralized oversight or prior, high level, pandemic response plan. Most of what was achieved in the first six to nine months of the pandemic (i.e., in 2020) relied on Canadian researchers who were able to apply their prior knowledge, analytical capacity and international collaboration to initiate pilot, proof-of-concept studies to demonstrate what could be done. In most cases, these initiatives had to be funded by creatively diverting resources from other sources and employing a high level of volunteer time and effort to initiate these pilot programs. An unprecedented level of national and international collaboration among researchers allowed them to share experiences and fine tune procedures in their own laboratories to be able to generate useful results. In many cases, these researchers had not previously collaborated. While committing personal time towards establishing capability, most researchers faced a challenge with convincing public health decision-makers and governments that wastewater surveillance for SARS-CoV-2 was worthy of investigation, let alone commitment of longer-term funding.
Tracking Community Health Through Wastewater Surveillance by Charlene Lancaster (2024.02.01) / The Scientist Magazine
Detecting infectious diseases
In 1939, scientists detected live poliovirus within wastewater during a polio (also known as poliomyelitis) epidemic However, they were unable to detect these viral particles after the epidemic ended They hypothesized that researchers could use wastewater testing to track infection levels within a population. At first, scientists cultured the live infectious agents or used the samples to infect animal models to measure infectious diseases. Researchers now assess the levels of emerging and re-emerging viral, bacterial, protozoan, and fungal pathogens by detecting their nucleic acids.
Wastewater surveillance rapidly increased in popularity during the covid pandemic, as researchers detect SARS-CoV-2 in the feces and urine of infected patients before the onset of symptoms.The Centers for Disease Control and Prevention (CDC) started the National Wastewater Surveillance System (NWSS) to assess SARS-CoV-2 levels in wastewater collected across the United States. Through wastewater-based epidemiology, scientists estimate the prevalence of covid in communities and identify new variants. Additionally, wastewater analysis provides public health officials with information about potentially unreported cases. Besides polio and covid, researchers have also used wastewater-based surveillance to track the transmission of influenza, norovirus, mpox, respiratory syncytial virus (RSV), campylobacteriosis, Candida auris, and cryptosporidiosis.
I could just do the Tedeschi Trucks Band every week! This time around it’s a cover of Led Zeppelin’s What Is and What Should Never Be.