Sewage monitoring for COVID-19 a is a promising tool, but critical challenges remain

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Surveillance of COVID-19 is at a crossroads in the United States. As the number of tests at home now exceeds the number conducted in laboratories, official case estimates are less complete than ever, as the nation and the world face increasingly advanced variants of the coronavirus. Sewage monitoring is ready to fill in the gaps and help avoid the threats that an invisible wave of the virus could bring. This observation can help identify transmission trends a week or two earlier than a clinical trial, giving public health executives the opportunity to focus on messages and resources. It can also be used as a tool to sequence a virus and quickly find new options. But the desire to use this tool is stifled by uncertainty about exactly how to do it, as well as a lack of resources and support for learning. Viral particles can give early signals of increased transmission in society, capturing even those who have asymptomatic infections or fail testing. Since the U.S. Centers for Disease Control and Prevention launched the National Wastewater Surveillance System in September 2020, hundreds of sites have appeared online, with the potential for even greater expansion. The CDC is funding the program until 2025, and the National Association of County and City Health Officials says its members ’interest has grown significantly over the past two years. But few communities have been able to translate this interest into sustainable pandemic action or specific action. Although 38% of local health facilities at some point in the pandemic monitored wastewater, only 21% plan to continue after the pandemic weakens, according to a recent report. Health agencies estimate sewage control as the least influential factor in the fight against a pandemic, and only about half have used it for decision-making. The report presents the results of a survey of more than 200 health officials across the country, which was conducted between November and January. is that it is inherently dirty, “said Megan Diamond, who manages wastewater treatment for the Rockefeller Foundation to combat COVID-19. and the recovery team. The Rockefeller Foundation conducted a survey with the Institute for Pandemic Prevention and Mathematica A government observer’s April report said sewage monitoring has “enormous potential” to become a key tool in U.S. public health, but noted that some aspects of science needed “further development.” Sewage samples can be diluted with rainwater. or industrial discharges and can be contaminated with things like animal waste, for example. ”As a result, you get a lot of uncertainty, and uncertainty is not the word you want to introduce to an epidemiologist. It’s scary. That means you have to make a lot of assumptions, or you have to research new science during a pandemic, “Diamond said. To COVID-19. But about a quarter said there was no clear organization to run the work, and about half said they did not have the resources or ability to do it on their own. ” , the people who actually run this job say, “Yeah, it’s not sustainable for us,” Diamond said. The launch of the CDC’s national wastewater program has helped some, the survey found. But it didn’t happen without his own problems. It took the CDC about a year and a half to work on how best to standardize and present the data it collected in the national dashboard, indicating how complex the data can be. In February, the agency installed a national dashboard for the first time, presenting only one point of data on the relative change in virus levels on each site over the past 15 days. He recently updated the dashboard to include another point of data on how the current level of virus detection compares to other points of the pandemic. But a government report last month said there was still work to be done. The lack of national coordination and standardized methods “challenge the dissemination and complicate efforts to interpret data and use them for health interventions. It is also unclear how cost-effective wastewater monitoring is,” the report said. says that sewage monitoring may be “especially useful if clinical testing is limited in resources,” but otherwise the question arises as to when it makes sense to use it. Clinical testing may or may not be limited in the United States, but it is underused In favor of -home tests that remain unregistered or not conducted at all.Current trends in the data are clear: the level of viruses is growing on most surveillance sites in the US for several weeks.At the end of last week more than a third of surveillance objects found levels that were higher than most historical levels, pavo for CDC data. Despite the challenges that remain, the benefits of sewage monitoring cannot be ignored, Diamond said. “I don’t think we shouldn’t be deterred by the lack of consensus around standardization in data because it may never come,” she said.

Surveillance of COVID-19 is at a crossroads in the United States. As the number of tests at home now exceeds the number conducted in laboratories, official estimates of cases are less complete than ever, as the nation – and the world – are facing increasingly advanced variants of the coronavirus.

Sewage monitoring is ready to fill in the gaps and help avoid the threats that an invisible wave of the virus can bring. This observation can help identify transmission trends a week or two earlier than a clinical trial, giving public health executives the opportunity to focus on messages and resources. It can be used as a tool for virus sequencing and faster search for new options.

But the desire to use this tool is stifled by uncertainty about exactly how to do it, as well as a lack of resources and support for learning.

Testing wastewater for the presence of viral particles can provide early warning signs of increased transmission in society, covering even those who have asymptomatic infections or are not tested.

Since the U.S. Centers for Disease Control and Prevention launched the National Wastewater Surveillance System in September 2020, hundreds of sites have appeared online, with the potential for even greater expansion. The CDC is funding the program until 2025, and the National Association of County and City Health Officials says its members’ interest has grown significantly over the past two years.

But few communities have been able to translate this interest into sustainable practice or concrete action to combat the pandemic.

Although 38% of local health facilities monitored wastewater at some point during the pandemic, only 21% plan to continue after the pandemic weakens. according to a recent report.

The Health Agency noted sewage monitoring as the least influential factor in the fight against the pandemic, and only about half used it to make decisions.

The report presents the findings of a survey of more than 200 health officials across the country, which was conducted between November and January.

“The point with wastewater data is that they are inherently messy,” said Megan Diamond, who manages wastewater treatment work on the Rockefeller Foundation’s COVID-19 response and recovery team. The Rockefeller Foundation conducted the survey along with the Pandemic Prevention Institute and Mathematica.

Government oversight report In April, it was stated that wastewater monitoring has “huge potential” to become a key public health tool in the U.S., but noted that some aspects of science require “further development”.

Sewage samples can be diluted with rainwater or industrial discharges and can be contaminated with things like animal waste, for example.

“As a result, you get a lot of uncertainty, and uncertainty is not the word you want to introduce to epidemiologists. It’s scary. It means you have to make a lot of assumptions, or you have to research a new science pandemic,” Diamond said.

Sewage monitoring is not a new public health tool, but prior to COVID-19 it was far from basic.

According to a survey of public health executives, health agencies were more likely to implement sewage surveillance programs if they had the support of experts. But about a quarter said there was no clear agency to manage the work, and about half said they did not have the resources or ability to do it themselves.

“Here the whole rally is in sight around the sewage monitoring, and then the guys on the ground, the people who actually do the work, say, ‘Yeah, it’s indecent for us,'” Diamond said.

The launch of the CDC national sewage program has helped some, a poll found.

But not without their own problems. It took the CDC about a year and a half to work out how best to standardize and present the data it collected in national dashboardevidence of how complex the data can be.

In February, the agency raised its national dashboard for the first time, presenting just one point of data on the relative change in virus levels on each site over the past 15 days. He recently updated the dashboard to include another point of data on how the current level of virus detection compared to other points of the pandemic.

But a report from the State Department of Accountability over the past month noted what more needs to be done.

The Monitoring Agency called the “lack of national coordination and standardized methods” challenging the wider application and complicating efforts to interpret and use the data to conduct health interventions.

It is also unclear how cost-effective wastewater monitoring is, the report said. GAO says sewage monitoring can be “especially useful when clinical trials are limited in resources,” but otherwise the question arises as to when it makes sense to use it.

Clinical testing may not be limited in the U.S. now, but it is underutilized in favor of home tests that remain unregistered or not conducted at all.

Current trends in the data are clear: the level of viruses is rising in most surveillance sites in the US within a few weeks. And late last week, more than a third of surveillance sites found levels that were above most historical levels, according to the CDC.

Despite the challenges that remain, the benefits of sewage control cannot be ignored, Diamond said.

“I don’t think we should be held back by the lack of consensus around standardization in data because it may never come,” she said.

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