Back in May, I heard about scientists trying to use wastewater as an early #covid19 warning signal. As I dug into that idea, I learned about their much larger ambition: giving one of the oldest public health tools a major glow-up.
A ~crappy~ thread: 1/x https://qz.com/1923774/covid-19-is-giving-sewage-a-modern-public-health-purpose/

2/x We've got a love/hate relationship with poop. On the one hand, VERY BAD bc it transmits a lot of diseases; hence why we built sewers to keep it out of our drinking water. But on the other, a complete record of everything we've eaten, drank, or otherwise been exposed to...

3/x In the past, wastewater #Epidemiology has shown where there were pockets of polio outbreak or opioid usage—even before cases or overdoses popped up. Turns out, it looks like we can do the same thing with #COVID—it's RNA shows up in poop days before cases do.

4/x This has been useful for college campuses like @SyracuseU + @uarizona which can track wastewater down to the dorm. If there's been a spike in Covid in poop, they can test folks in that specific dorm and isolate accordingly. But what if we could scale that up?

5/x That's what HUNDREDS of cities across the US have been trying to do—but it's hard. First, you have to figure out where you're going to sample from. This involves looking at sewersheds maps to make sure you include poop from EVERYONE, as a health geographer told me:

6/x Then you gotta make sure that things like hospitals or distilleries or even too dang deep sewers aren't messing up your samples. And then you gotta get an autosampler, which like an R2D2 that sits atop the manhole for a couple days scooping up half cups of ever hour.

7/x And THEN you gotta get back to the lab and figure out exactly how you wanna isolate the genetic material and replicate it up so you can detect it.

8/x At the moment, each city is doing this for itself bc there are no federal standards for any of these processes. This means that it's impossible to compare a lot of the data across borders. And as we've seen, viruses ~ don't care about city and state borders ~

9/x But the US wants to come up with a NATIONAL plan to monitor wastewater! Think about that power: It'd be super cheap to see where outbreaks are blossoming, and where to deploy expensive spot testing. We'd know who needs to quarantine + who could safely be out and about.

10/x The problem is the catch-22 of funding. Without initial funding for research, there's no way to set standards needed to make sewers an *actually* useful tool. But without proof that it could be useful, no one wants to fund this work in the long run.

11/x I talked extensively with @Tedsmithphd about some of the work they're doing in Jefferson country/northern Kentucky; they're working off some short-term CARES Act funding + private grants to follow trends of Covid-19 activity in sewage as they learn how it correlates w/ cases

12/x It's working for now, but without a top-down approach (aka a national effort from the government soup of agencies involving @CDCgov, @EPA, @NIST, and even @DHSgov) these efforts may not be sustainable to set up a long-term monitoring system.

13/x This innovative sewage monitoring network wouldn't just be for #COVID—it'd be a brilliant tool to track of all kinds of community-level public health issues, like flu, pollution exposure, or (goddess forbid) another pandemic. But we've got to set standards for it to work.

14/14 Anyway, poop rules. Wastewater monitoring doesn't lie. I believe from my reporting that it's possible to take an old public health tool that had one job to do another—but it's going to take a big push to get the science and best practices in place. https://qz.com/1923774/covid-19-is-giving-sewage-a-modern-public-health-purpose/