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COVID-19 wastewater efforts confront long-term questions

Funding, data challenges inhibit use of wastewater monitoring for public health purposes

An aerial view of the East Bay Municipal Utility District Wastewater Treatment Plant  in Oakland, California. Public health experts hope monitoring wastewater will help not just detect COVID-19 outbreaks but other public health threats such as opioids and the flu.
An aerial view of the East Bay Municipal Utility District Wastewater Treatment Plant in Oakland, California. Public health experts hope monitoring wastewater will help not just detect COVID-19 outbreaks but other public health threats such as opioids and the flu. (Justin Sullivan/Getty Images)

In February 2020, environmental engineers Aaron Bivins and Kyle Bibby launched an informal collaborative with a few fellow researchers, hoping to share tips and strategies on monitoring wastewater for signs of the burgeoning COVID-19 pandemic.

By April 2022, that group ballooned to more than 1,300 analysts and professionals worldwide, with a Slack account promoting new research and making introductions — all part of an effort to facilitate early information-sharing that didn’t exist at the federal level.

“I’ve been on calls with teams all over the country, just kind of kicking ideas around and brainstorming and troubleshooting,” said Bivins, an assistant professor at Louisiana State University.

The informal conversations underscore how national wastewater surveillance efforts are struggling with questions around sustained funding, geographical limitations and just what states should do with the data.

Public health experts hope the technology will help monitor threats beyond COVID-19, like opioids and the flu, but the strategy requires resources and political buy-in. And while Congress has enacted billions in pandemic funding for states, only a handful have used the money to establish wastewater surveillance.

Most states have instead turned to a Centers for Disease Control and Prevention grant program that has doled out $35.8 million since September 2020 through its Epidemiology and Laboratory Capacity Cooperative Agreement. 

The administration is also working with utility organizations. In April, the CDC awarded a $10.2 million, 11-month contract to Massachusetts-based Biobot Analytics, transferring 226 sites that fellow wastewater firm LuminUltra Technologies established under an earlier agreement.

But health officials will have to play the long game. LuminUltra recruited fewer than half of the 500 contracted utilities, and the technology does not reach many rural areas that lack communal sewage systems.

Biobot founder Newsha Ghaeli is confident the company can meet expectations. Biobot previously won a 300-site, three-month contract to help launch the CDC’s program last May, which Ghaeli pointed to as evidence of Biobot’s ability to deliver.

And while it won’t be a “walk in the park,” the company has worked with all 50 states in addition to territories and tribes, Ghaeli said. Biobot will focus on streamlining the process, particularly for plants participating in duplicative programs. 

“We want to try and reduce as much as possible the operational burden that this presents,” she said. 

Traditionally, there has been little collaboration between wastewater and health departments, said Emily Remmel, director of regulatory affairs at the National Association of Clean Water Agencies, so there were plenty of uncertainties around the program in the early days. But now the barriers center on resources.

“It’s just staffing and whether or not they have the ability to go out once a week, take a grab sample, turn around, ship it,” she said. “It’s a lot of logistics. What happens if FedEx doesn’t come pick it up? Things like that.”  

The prospect of broader monitoring initiatives is also sparking concerns about more regulation in an uncertain environment, Remmel said. If the EPA decides to implement additional monitoring requirements on sites to track antimicrobial resistance, for example, how do they broach problems like distinguishing between livestock and human waste?

Turning data into action 

The Government Accountability Office highlighted many of these problems in a recent report, citing the need to promote the use of cost-benefit analyses and ways states can use the data. The calculation is higher for rural areas.

“The vast majority of treatment plants are quite small,” said Bibby, an associate department chair at the Notre Dame University College of Engineering. “And they treat small amounts of wastewater, and those may not even have a single, full-time personnel there.” 

But Julianne Nassif, director of environmental health at America’s Public Health Laboratories, projects that the recent CDC funding will kickstart a sea change in wastewater monitoring for COVID-19 and beyond.

“We expect that it will be pretty widely used across the country in the coming years,” she said.

Health officials will then have to figure out how to use the data. Differences in sewer contents can vary widely, depending on factors like what industrial plants are in the area or whether the city recently held a major public event. 

Researchers are also unable to determine how much virus infected people shed in their waste. Those differences aren’t reflected in the CDC’s public wastewater dashboard, making it difficult to draw comparisons.

“If I measure something here in D.C., how can I compare that to something being measured elsewhere?” said Jeseth Delgado Vela, an assistant professor in the College of Engineering and Architecture at Howard University. “Or is that comparison even important?”

Establishing a standardized, comprehensive system will take time. Otakuye Conroy-Ben, an assistant engineering professor at Arizona State University, spent the pandemic recruiting tribal organizations to implement wastewater monitoring. Her team is working with five tribes, and another three are pending. 

Infrastructure, geographic and relationship-building issues make the work slow-going. Conroy-Ben, a member of the Oglala Lakota Nation, has worked to get approval from one tribe for more than a year. 

“I was hoping to have a lot more tribes in on this project, but it’s just a lot of groundwork and a lot of administrative work to get a project like this going,” she said.

Potential upsides

For major cities, the benefits are clear. Houston has installed 177 sampling sites since May 2020 across wastewater treatment plants, lift stations and manholes, and is already using the system to track flu cases. 

Loren Hopkins, chief environmental science officer at the Houston Health Department, said the city surges resources and launches awareness campaigns whenever they see a jump in a given area. The data are broken down by zip code, and the manhole sites target individual schools, congregate living facilities and jails. 

Community organizations use the data to establish vaccine pop-ups and launch door-knock campaigns. Epidemiologists monitor the numbers to identify where they might need to surge nurse staffing. Schools use it to launch testing initiatives. And the health department reassigns staffers to COVID-19 work when the numbers spike. 

The system didn’t come cheap. The city has spent nearly $10 million since March 2020, with roughly $8.2 million coming from a federal COVID-19 aid law. And the reliability of the data only came through extensive analysis to gauge its shortcomings and how it compares to individual test results.  

“Now that the positivity rate isn’t there, we can rely on the wastewater more,” Hopkins said. “We feel like it is representative.”

But using the data doesn’t need to be an expensive, complex endeavor, Bivins added. If nothing else, it could simply be used as a type of pandemic weather forecast. 

“When the numbers start to go up,” he said, “maybe you wear a mask.”   

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