Wastewater-based epidemiology for pandemic surveillance

Wastewater Epidemiology involves the analysis of wastewater to provide an indication of the presence of infection in human populations. It involves sampling and analysis of wastewater to look for chemical or biomarkers emanating from human excrement. The importance of this relatively nascent area of science has been accentuated exponentially since the beginning of the Covid-19 pandemic.
Let us rewind back to February 2020, and the media channels were abuzz with the news of a pandemic spreading globally. The fog of uncertainty lay thick as there were no established or deployed mechanisms to understand how fast the virus was spreading to which communities, cities, and countries.

With the benefit of hindsight, a robust proactive pandemic monitoring and control system based on wastewater epidemiology could have been an efficient tool to better understand this spread.

The efficacy of wastewater epidemiology and its global roll out depends on a few factors that are intertwined between technology developers, service providers, decision makers and enforcement agencies:

1. Development of exceptionally reliable and accurate technology platforms and analysis equipment that can detect the virus or other biomarkers at low concentrations repeatedly, reliably, rapidly and cost effectively.
2. Sample collection, management, analysis, and timely reporting and leveraging smart, digital and artificial intelligence solutions.
3. Effective strategies to manage highly localized quarantining.

In theory, the opportunities for wastewater epidemiology are endless as it has the potential to detect numerous viral or bacterial pandemics ranging from SARS-CoV2 to Norovirus as well as drug abuse in populations. It is a non-invasive technique and does not rely on individual action and test results. It provides a centralized monitoring and control opportunity to municipalities, governments as well as key industrial manufacturing units and the travel / leisure industry.

In a manufacturing or industrial setting, early warnings can help manage operations more successfully and safely, effectively enabling facilities to actively implement a phased strategy to limit and mitigate spread of future pandemics by pinpointing areas, shifts or locations of concern.
The next step in the process is to analyse and determine the concentration of these fingerprints in the wastewater, to determine the extent of the affected population.

Since the method is typically based on the detection of RNA – genetic fingerprints of the virus, it provides insight into specific variants of the virus. As we have learnt with the latest pandemic, this can be a crucial piece of information from a control, contain and remediation perspective.

Both the understanding and technology to enable effective wastewater epidemiology has developed rapidly over the last 12 months, but to fully harness its enormous potential in proactive pandemic management, and better anticipate the next pandemic or viral mutation, concrete regulatory, infrastructure and deployment strategies need to be put in place as quickly as possible. As a start:

1. Legislation and regulatory compliance needs to be enacted to accelerate and support the deployment of sewer sampling and wastewater surveillance across each country. Starting with major cities and then gradually increasing granularity down to communities.
2. Funds to initiate and deploy a central nationwide network that is actively carrying out surveillance.
3. Setup strategic working groups across government bodies, sewage companies, technology and service providers to work out the deployment strategy for a robust and scalable wastewater surveillance network. The work also needs to focus on some of the current technological challenges such as complexity of wastewater matrix, quantification and estimation of affected population size and a fast validated analysis time. Another area for development is predictive modelling platforms, employing artificial intelligence algorithms.
4. Extend the development and deployment to a range of pathogens, drugs, and chemicals of concern. This goes beyond pandemic issues, but aids public health officials manage their resources. For example:
  • Viruses: influenza A/B, norovirus, rotavirus, respiratory syncytial virus, enterovirus D68
  • Chemicals: pharmaceuticals, chemical exposure, hormones and population biomarkers.

The European Commission has taken the lead and published latest recommendations in March 2021 and is associated with a biodefense preparedness plan.

Collectively, and as part of building truly resilient smart cities we need to start putting in place the infrastructure to deploy WBE (Wastewater Based Epidemiology), to better anticipate the management of future pandemics.

SUEZ and its partners have been at the forefront of developing and deploying solutions for WBE, providing support to a number of regional WBE programmes across the EU (European Union) and the UK. There has been a lot of innovation and insights with regards to WBE over the last two years and we need to consolidate these knowledge gains and leverage them for maximum benefit and impact by implementing smart infrastructure for public health monitoring for truly smart cities. Indeed, human excrement never lies!