Our poop is a scientific goldmine: Wastewater testing is a vital early warning system for Covid-19 outbreaks
With bonus “What are we even doing?”
In a world where Covid data collection sucks…
How do we know what the situation is out there? How much community spread is there? How many cases per day are getting infected? Without data, we are flying blind. And in a “you do you” “evaluate your own risk” pandemic, how are we supposed to make those decisions without any good information?
The answer is that we can’t. At least not without something that approximates that detailed case reporting we got through the first two years or so of the pandemic. And that something is wastewater monitoring. The good news is that our poop is full of Covid.
Welcome to the most recent issue of the Covid-Is-Not-Over Newsletter. Today’s coping strategy is looking at the usefulness of wastewater monitoring as a way of understanding the state of the pandemic at any given time. If your location tests and releases that data, you can have a pretty decent idea of what’s going on and can make your risk evaluations accordingly.
I hope that today’s reading will help us all understand how wastewater monitoring works, how useful it is, what it really tells us and, interestingly, how applicable it is for disease tracking beyond Covid-19!
I have included some samples of wastewater monitoring projects, mostly close to home in Ontario, Canada. Along with the normal 10 or so references I’ve highlighted, there’s another bunch of links at the end with more information.
And as a special bonus, along with our musical interlude and some Ko-fi buying opportunities, I’ve also added what I hope will be a semi-regular feature. And that’s “What are we even doing?” where I pick out some Xeets and articles and whatnot with some very bad takes.
A Few Resources
Ontarians’ poop is a scientific goldmine. We need to exploit it by Matt Gurney /TVO Today
Let’s not belabour this: wastewater surveillance is a fascinating new technology that should be properly funded. It is the most anonymized data possible: it’s sludge that no one would ever want to keep or claim, and it’s a scientific gold mine that we must exploit. I don’t care who takes the lead here. Feds, provinces, municipalities, universities — I don’t care. Just figure this out, yesterday, and get the funding arranged. And expanded! Let’s get this set up and running across the country.
Let’s also figure out some standards that can be applied broadly and get the data shared freely and centrally. All these things may seem like foreign concepts to Canadians, but none of this is hard. It won’t even cost much money. It’ll be a boon to public-health agencies and researchers of all kinds and may prove a vital early warning indicator in future pandemics (God forbid, but hey). Early warning was a major missing piece of our COVID-19 response, and we aren’t actually legallyobligated to make the same mistakes over and over, even though it sometimes seems that we must be.
So let’s get this done. Now. Again, I don’t care how or by whom. But this is an easy, quick win that would actually provide some lasting value and help make, in a tiny way, some of what we all had to go through, well, not worth it, but at least meaningful. Study the poop for the betterment of all Canadians. That’s the pitch. Who’s going to run with it?
Wastewater Surveillance: Vital for an Outbreak Early Warning System / The Rockefeller Foundation
Wastewater surveillance is a powerful public health tool that is:
Timely – wastewater surveillance can provide early indications of community transmission of diseases and variants. It often foreshadows clinical data, picking up signal in mild cases, before people would present in a healthcare system.
Cost-effective – wastewater sampling can often be done at a fraction of the cost of clinical testing. One sample at the population level versus a single clinical sample is a more efficient view into community health.
Inclusive – traditional health surveillance tools often overlook populations that lack access to health services, despite being at the highest risk for poor health outcomes. Leveraging wastewater, public health officials can better understand disease burden in these vulnerable communities.
Adaptable – when it comes to diseases surveillance, there is no ‘one size fits all’ approach. Wastewater sampling is highly flexible – location and frequency can change based on need – and it can be used in treatment plants to pit latrines, using a high tech autosampler to tampon.
Wastewater surveillance may be best marker of community COVID-19 prevalence by Mary Van Beusekom / CIDRAP
Wastewater surveillance may be the most accurate way to track SARS-CoV-2 community prevalence and identify variants of concern amid increased home COVID-19 testing, decreased public health reporting, and fewer healthcare visits due to asymptomatic cases and the wide availability of vaccines and treatments, Stanford University researchers report today in JAMA Network Open.
Wastewater sampling in Canada suggests COVID case rate 19 times higher than reported by Mary Van Beusekom / 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.
A global wastewater surveillance program could have stopped the spread of COVID-19, Northeastern researcher says by Cynthia McCormick Hibbert / Northeastern Global News
Maintaining and enhancing wastewater surveillance programs that sprung up around the globe in response to COVID-19 will be key to halting the next pandemic, a Northeastern researcher says.
“If we’d had the kind of wastewater surveillance systems that now exist in most places, I think we would have stopped” COVID-19 from spreading, says Samuel V. Scarpino, director of AI and Life Sciences at the Institute for Experiential AI at Northeastern. …
“We want to make sure that the infrastructure and the knowledge that was built during the pandemic around wastewater surveillance can be leveraged for routine infectious disease surveillance, and we’ll be ready the next time we have to respond to an international infectious disease threat,” Scarpino says.
Using wastewater monitoring to assess patterns in community transmission of COVID-19 by Hugo Francisco de Souza / News Medical
Comparisons between wastewater and clinical data indicated that wastewater data is a leading indicator of COVID-19 surges. The lag period varied from WWTP to WWTP, with an average of seven days to a maximum of 12 days across sites. When restricting the analyses to data obtained during Delta and Omicron surges, correlations between wastewater viral load and case data were observed at a rate of 84% and 85% across sites, respectively.
The effect of sample size was an important predictor of correlation strength, with large WWTPs servicing a larger population size depicting higher correlations than their smaller counterparts.
Comparing wastewater metrics with clinical data during Delta and Omicron surges showed that viral concentrations in wastewater rapidly increased during the viral surge. This correlation was more robust during the Omicron surge than the Delta surge; however, both were susceptible to small sites being lower than the limit of detection (LOD).
Why scientists say wastewater surveillance needs to continue, despite low COVID-19 levels by / CBC News
Although the COVID-19 pandemic was recently downgraded from global emergency status, continued wastewater surveillance is still very important, said Eric Arts, Canada Research Chair in viral pathogenesis and control at Western University in London, Ont.
"It's too easy for the general public to see it and say, 'Well, [COVID-19] is no longer here, so why are we bothering with this?' And it's getting the information out that says ... 'You don't listen to the weatherman most of the time, but when you see a storm rolling in, you really wish you would have listened,'" Arts said in an interview with CBC News.
"It's preparing our health-care system for an impending wave."
Whether that's a new subvariant of COVID-19 or a range of other infectious diseases, Arts said advance warning could help the health-care system get ahead by rolling out protections and preventative measures.
Wastewater-based epidemiology predicts COVID-19-induced weekly new hospital admissions in over 150 USA counties by Xuan Li, Huan Liu, et al. / Nature Communications
The COVID-19 pandemic has profoundly impacted the healthcare system with additional burdens to hospitalization demands. Using wastewater surveillance data from the past 20 months from 99 counties, our studies revealed the feasibility of using WBE to predict the county-level weekly new hospitalizations with a leading time of 1–4 weeks. The early warning capability of WBE for predicting the weekly new hospital admission in the healthcare system is likely related to viral RNA shedding from COVID-19 patients to sewers and the transmission of COVID-19 within the population.
Wastewater could be used to track more viruses than COVID-19 by Vidya Nagalwade / Tech Explorist
Alexandria Boehm, professor of civil and environmental engineering at Stanford Engineering and the Stanford Doerr School of Sustainability, said, “We are gathering evidence that wastewater can be useful for many infectious disease targets beyond COVID-19 and that it’s a really valuable resource for understanding community health. We found that concentrations of RNA, the building block of virus genomes, from influenza A and B, RSV, rhinovirus, parainfluenza, metapneumovirus, and seasonal coronaviruses in wastewater follow the trends also observed in the clinical data from sentinel laboratories. The possibilities seem very endless at this point.”
Boehm envisions a future in which communities could continuously test wastewater for viruses of all kinds. Calculating our risk of flu that day would be as simple as checking the local weather forecast for rain.
Study shows value of wastewater surveillance for early detection of flu, RSV by Stephanie Soucheray / CIDRAP
Today in Morbidity and Mortality Weekly Report, researchers in Wisconsin show how during the 2022-23 respiratory diseases season, high concentrations of influenza A virus and respiratory syncytial virus (RSV) in wastewater samples in three Wisconsin cities preceded virus-associated emergency department (ED) visits.
The authors say the study provides more evidence that wastewater surveillance can detect viral signals earlier than other surveillance methods.
COVID-19 wastewater surveillance in Canada by Qiaochu Liang / Borealis Blog
The procedures for regular SARS-CoV-2 screening in wastewater are based on work done to monitor other pathogens. Prior to the emergence of COVID-19, wastewater-based epidemiology was used to identify and quantify pathogens such as norovirus and hepatitis A.
The process of wastewater surveillance includes collecting samples at wastewater treatment plants, isolating the virus, detecting the genetic material of SARS-CoV-2 (RNA), and quantifying the viral load. A nationwide wastewater surveillance network that covers over two thirds of the population of Canada was established (see the Map of Pan-Canadian Wastewater Network). Wastewater is collected three times a week from the wastewater catchment that flows into a treatment plant. Samples are transported to public health laboratories where the virus fragments in each sample are concentrated by filtration for molecular analyses. The viral RNA is extracted and quantified with PCR-based approaches. The highly sensitive sequencing technology identifies all of the circulating variants in the wastewater. This information reveals which variants are dominant and can provide valuable insights into emerging virus mutations.
Major hurdles for this process are transportation delays and population coverage. The Government of Canada is working to overcome these barriers by increasing the reach of monitoring through enhanced local testing and more wastewater sampling sites. To make the data as reliable as possible in different settings, scientists are constantly refining techniques for sample collection and analysis.
More Info on Wastewater Monitoring
A look inside Waterloo Region's wastewater surveillance program
Wastewater can predict COVID-19 surges, but NYC’s data remains hard to find - Gothamist
Sewage is the new gold for the public health scientists who track viruses | CBC News
A Valuable Early-Warning System for Disease Outbreaks Could Be Shut Down - Scientific American
Government of Canada continues to monitor and invest in COVID-19 wastewater monitoring
Wastewater monitoring can anchor global disease surveillance systems - The Lancet Global Health
Inside the lab that looks for viruses in wastewater from US homes | New Scientist
What are we even doing?
B.C. Health Minister Adrian Dix: "We felt it was important during this period when COVID cases were relatively lower that we have a period where doctors and nurses and healthcare workers could see...each other's faces. Which has its value, right?" I'm sorry what?! / Tom Jackman (@frozen) / X
Hospitals are killing patients because they don't feel like doing infection control
DeSantis backs Florida surgeon general in urging residents against new Covid vaccines
'We've been constantly sick': Why we can't kick the 'yo-yo flu'
U.S. cancels program aimed at identifying potential pandemic viruses | Science
Opinion | Covid is here to stay. That means long covid is, too. - The Washington Post
Huntington Beach City Council approves banning mask and vaccine mandates - CBS Los Angeles
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