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Wastewater monitoring took off during the COVID-19 pandemic – and here’s how it could help head off future outbreaks

Over 800 sites across the US report coronavirus data from sewage to the CDC. Here’s how this kind of surveillance system works and what it can and can’t…

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Sampling wastewater can be time-intensive. John Eisele/Colorado State University

A community’s sewage holds clues about its COVID-19 burden. Over the course of the pandemic, wastewater surveillance has become an increasingly popular way to try to understand local infection trends.

Microbiologists Susan De Long and Carol Wilusz met and became wastewater aficionados in April 2020 when a grassroots group of wastewater treatment plant operators asked them to develop and deploy a test to detect SARS-CoV-2 in samples from the sewers of Colorado. De Long is an environmental engineer who studies useful bacteria. Wilusz’s expertise is in RNA biology. Here they describe how wastewater surveillance works and what it could do in a post-pandemic future.

How is wastewater monitored for SARS-CoV-2?

Wastewater surveillance takes advantage of the fact that many human pathogens and products of human drug metabolism end up in urine, feces or both. The SARS-CoV-2 virus that causes COVID-19 shows up in surprisingly large quantities in feces of infected people, even though this is not a major route of disease transmission.

To figure out whether any pathogens are present, we first need to collect a representative sample of wastewater, either directly from the sewer or at the point where what engineers call “influent” enters a treatment plant. We can also use solids that have settled out of the wastewater.

Technicians then need to remove large particles of fecal matter and concentrate any microbes or viruses. The next step is extracting their nucleic acids – the DNA or RNA that holds the pathogens’ genetic information.

The sequences contained in the DNA or RNA act as unique bar codes for the pathogens present. For instance, if we detect genes that are unique to SARS-CoV-2, we know that the coronavirus is in our sample. We use PCR-based approaches, similar to those used in clinical diagnostic tests, to detect and quantify SARS-CoV-2 sequences.

masked lab worker with glassware and lab equipment
A lab technician prepares to process wastewater samples for SARS-CoV-2 detection at Colorado State University. John Eisele/Colorado State University

Characterizing the nucleic acid sequence in more detail can provide information about viral strains – for instance, it can identify variants like omicron BA.2.

Currently, the vast majority of wastewater surveillance efforts are focused on SARS-CoV-2, but the same techniques work with other pathogens, including poliovirus, influenza and noroviruses.

Before the pandemic, one application was monitoring for rare poliovirus outbreaks in areas where polio vaccination is ongoing. Wastewater can also be monitored for signs of various drugs to give insights into the level and type of drug use in a population.

Where does the data go?

During the pandemic, the U.S. Centers for Disease Control and Prevention developed the National Wastewater Surveillance System specifically to track SARS-CoV-2 across the country. Over 800 sites report data to this NWSS system, but not all states and counties are currently represented.

Map of U.S. with dots for sites that report to NWSS
More than 800 sites that cover populations of various sizes report COVID-19 wastewater numbers to the CDC. CDC COVID Data Tracker, CC BY

Many state agencies, like the Colorado Department of Public Health and Environment, and cities, like Tempe, Arizona, have their own dashboards for reporting data. Some companies performing wastewater analysis report data on their own dashboards, too.

In our opinion, the NWSS represents an exciting first step in monitoring population health through wastewater. Similar systems are being established in other countries, including Australia and New Zealand.

What does wastewater data really show?

SARS-CoV-2 levels in wastewater from large populations are an excellent indicator of the infection level in a community. The system automatically monitors everyone who lives in the sewershed, so it’s anonymous, unbiased and equitable. Importantly, it is also impossible to track the infection back to a particular person, household or neighborhood without taking additional samples.

Wastewater surveillance doesn’t rely on the availability of clinical tests or people reporting their test results. It also picks up asymptomatic and pre-symptomatic cases of COVID-19; this is critical because people who are infected but don’t feel sick can still spread COVID-19.

In our opinion, wastewater testing is increasingly important as more COVID-19 tests are done at home. And because vaccination has also led to more mild and asymptomatic cases of COVID-19, people may be infected without getting tested at all. These factors mean that clinical case data are less informative than earlier in the pandemic, while wastewater data remains a consistent indicator of community infection level.

COVID-19 rapid tests for home use on a pharmacy shelf
Wastewater surveillance doesn’t rely on people reporting a positive home test or even being aware of their infections. Spencer Platt/Getty Images News

So far, you can’t accurately predict the number of infected individuals in a community based on the level of virus in its wastewater. The stage of someone’s infection, how their body responds to the virus, the viral variant, how far a person was from where the wastewater sample was taken, even the weather can all affect the amounts of SARS-CoV-2 measured in sewage.

But scientists can infer relative changes in infection rates. Watching viral levels go up and down in sewage provides a glimpse of whether cases are rising or falling in the community as a whole.

Because SARS-CoV-2 can be detected in wastewater days or even weeks before outbreaks occur, wastewater monitoring can provide an early warning that public health measures may be warranted. And trends in the signal are important – if you know levels are rising, it may be a good time to reinstitute a mask mandate or recommend working from home. At present, public health officials use wastewater monitoring data along with other information like test positivity rates and the number of clinical cases and hospitalizations in the community to make these kinds of decisions.

Data from sequencing can also help detect new variants and monitor their levels, allowing health responses to take into account the characteristics of the variant present.

In smaller populations, such as in college dormitories and nursing homes, wastewater monitoring can detect a small number of infected people. That can sound the alarm that targeted clinical testing is in order to identify infected people for isolation. Early detection, targeted testing and quarantining are effective at preventing outbreaks. Rather than using clinical testing for routine monitoring, administrators can reserve disruptive clinical tests for times when SARS-CoV-2 is detected in the wastewater.

What will monitoring look like in the future?

Widespread and routine use of wastewater monitoring would give public health officials access to information about the levels of a range of potential infections in U.S. communities. This data could guide decisions about where to provide additional resources to communities, like holding testing or vaccination clinics in places where infection is on the rise. It could also help determine when interventions like masking or school closures are necessary.

In the best case, wastewater monitoring might catch a new virus when it first arrives in a new area; an early shutdown in the very localized area could potentially prevent a future pandemic. Interestingly, researchers have detected SARS-CoV-2 in archived wastewater samples collected before anyone had been diagnosed with COVID-19. If wastewater monitoring had been part of the established public health infrastructure back in late 2019, it could have provided an earlier warning that SARS-CoV-2 was becoming a global threat.

For now, though, establishing and operating a national wastewater surveillance system, particularly one that includes building-level monitoring at key locations, is still too costly and labor-intensive.

Ongoing research and development efforts are trying to simplify and automate wastewater sampling. On the analysis side, adaptation of PCR and sequencing technologies to detect other pathogens, including novel ones, will be vital to take full advantage of such a system. Ultimately, wastewater surveillance could help support a future in which pandemics are far less deadly and have less social and economic impact.

[Research into coronavirus and other news from science Subscribe to The Conversation’s new science newsletter.]

Susan De Long receives funding from Colorado Department of Public Health and Environment, the Anschutz Foundation, the National Science Foundation, and the Department of Energy.

Carol Wilusz receives funding from Colorado Department of Public Health & Environment and the Anschutz Foundation.

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Science

Long COVID: female sex, older age and existing health problems increase risk – new research

A new study has analysed UK data from long-term health surveys and electronic health records to understand how common long COVID is, and who might be at…

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shurkin_son/Shutterstock

About 2 million people in the UK currently have long COVID, according to the latest data from the Office for National Statistics.

In the UK, long COVID is defined as “signs and symptoms that continue or develop after acute COVID-19”. This definition is further split into people who have symptoms between four to 12 weeks after infection (ongoing symptomatic COVID-19) and for 12 weeks or more (post-COVID syndrome).

Symptoms can include fatigue, breathlessness, difficulty concentrating and many more – but the precise nature of the symptoms is not well understood. There are also gaps in our knowledge when it comes to the frequency of long COVID, and whether there are particular factors that put people at higher risk of developing the condition.

All of this is partly because the symptoms used to define long COVID often vary between studies, and these studies tend to be based on relatively few people. So the results may not apply to the wider population.

In a new study published in the journal Nature Communications, my colleagues and I looked at data from ten UK-based long-term studies, alongside 1.1 million anonymised electronic health records from English general practices. Based on this data, we investigated whether the burden of long COVID (how common it is) differs by demographic and health characteristics, such as age, sex and existing medical conditions.

The studies were established before the pandemic, and have tracked participants over many years. From these surveys, we used data from 6,907 people who self-reported they’d had COVID-19. Comparing this with the data from the electronic health records of people diagnosed with COVID allowed us to examine the frequency of long COVID in those who have seen their GP about it and those who haven’t.


Read more: Long COVID: a public health expert’s campaign to understand the disease


We found that of the people who self-reported having COVID in the studies, the proportion who reported symptoms for longer than 12 weeks ranged between 7.8% and 17%, while 1.2% to 4.8% reported “debilitating” symptoms.

In the electronic health records, we found that only 0.4% of people with a COVID diagnosis were subsequently recorded as having long COVID. This low proportion of diagnoses by GPs may be partly because formal logging of long COVID was only introduced for doctors in November 2020.

COVID-19 National Core Study, Author provided

The proportion of people who reported symptoms for more than 12 weeks varied by age. There was also a lot of variation depending on which definition each study used to capture long COVID. But overall, we found evidence to suggest an increased risk of long COVID was associated with increasing age up to age 70.

The studies include participants across a range of ages, from an average age of 20 to 63. Using a strict definition of symptoms affecting day-to-day function, we found that the proportion of people with symptoms for 12 or more weeks generally rose with increasing age, ranging from 1.2% for 20-year-olds to 4.8% for those aged 63.

We also found that a range of other factors is associated with a heightened risk of developing long COVID. For instance, being female, poorer pre-pandemic mental health and overall health, obesity and having asthma were also identified as risk factors in both the long-term studies and electronic health records.

These findings are broadly consistent with other emerging evidence on long COVID. For example, a recent international review study concluded that women are 22% more likely than men to experience long COVID.


Read more: COVID: long-lasting symptoms rarer in children than in adults – new research


It will be important to understand why these links exist, which is beyond the scope of our research. But identifying who may be at higher risk of long COVID is important, and as we continue to learn more, this could inform public health prevention and treatment strategies.

Ellen Thompson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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International

Redundancy: what to know about your rights when an employer lets you go

Redundancies are an unfortunate fact of life for businesses, but companies can try to make the process of job cuts less painful for workers.

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Companies making redundancies should treat both dismissed employees and those that remain with compassion. Syda Productions/Shutterstock

One of the biggest rail strikes in 30 years has been playing out in recent weeks as 40,000 workers protest the threat of job cuts. Their employer, Network Rail, wants to lay off up to 1,800 people as it prepares to introduce new technologies in an attempt to save more than £100 million annually following a post-pandemic drop in passenger numbers.

Transport secretary Grant Shapps has claimed this industrial action will cost around £150 million in lost revenue, in addition to a £450 million hit to the wider UK economy. With such significant costs expected, not to mention the ongoing impact on individual travellers, the government has called on the parties involved – the rail operators and the unions representing the workers – to agree a deal via negotiations.

We already saw the impact of a company taking such matters into its own hands earlier this year when P&O Ferries dismissed 800 employees without notice as it tried to make savings. In the current situation, Network Rail’s management is following a process of consultation with affected employees. It has offered voluntary redundancy in an attempt to limit the impact of its plans for modernisation that will lead to the redundancies, with more than 5,000 workers applying so far, according to news reports.

Unfortunately, redundancies are a fact of life for businesses, particularly in difficult times like the current economic environment. In such circumstances, businesses often choose to make redundancies to create a more sustainable future for the company as a whole. And while making employees redundant tends to be an unpleasant experience for all parties involved, the impact is, of course, most significant for the employees that are losing their jobs. Companies must therefore find a way to implement redundancies with compassion, providing clear communication for all employees during the process, as well as offering ongoing tools and support to the employees that lose their jobs and those that remain.

Setting expectations

So what should you expect? Employees at risk of redundancy are entitled to a fair redundancy process underpinned by the Employee Rights Act 1996, which includes the right to meaningful consultation. According to the UK Advisory, Conciliation and Arbitration Service (ACAS) this should provide the opportunity to discuss the changes and why certain employees are at risk of redundancy. If employees meet specific criteria, such as being employed for a certain amount of time (usually a minimum of two years), they are also entitled to statutory redundancy payments. It is important to check specific employment contracts and the company’s policy on redundancy pay as well, however.

Going beyond basic rights, redundancy programmes can be implemented more smoothly when employees understand the business rationale for the situation, according to my research. Business leaders must provide a clear understanding of why redundancies are being made. Network rail, for example, has discussed its plan to make savings by implementing technology such as drones for site inspections and to drive automation of ticket sales.

To ensure consultations are useful and beneficial, employers should also be able to clearly demonstrate to unions and their members how they have attempted to save costs through means other than redundancies. This could involve reducing or selling unused assets or saving on procurement costs, for example. All reasonable alternatives to redundancies should be considered, such as potential redeployment of employees at risk of redundancy.

Once it has been decided that redundancies are to be made, however, a company should be ready and able to explain how employees were selected and why certain parts of the business were impacted. Overall, employees and unions should be given a clear plan for individual and collective consultation with anticipated timelines and effective communication channels. This will show all impacted employees that careful consideration was given to all decisions around the redundancy programme.

For those employees at risk of redundancy, additional services should be provided to help with the adjustment to life after redundancy. This can include support from the company itself, as well as services from external providers for up to three months after redundancy. Examples include:

  • Retraining: redundancies can be avoided where possible through redeployment by retraining employees to fulfil alternative, available and suitable roles. This depends on the role requirements and reasonable ability to transfer skills.

  • Counselling: loss of income is extremely stressful, causing anxiety and financial worries. Organisations should have the necessary help in place to support employee’s mental health by providing access to free counselling and one-to-one support.

  • Transition: employers can also offer alternative support such as workshops on financial planning and guidance, or on how to start a business.

Two women talking, counselling.
Companies should provide additional support following redundancies. wavebreakmedia/Shutterstock

Supporting other employees

A more compassionate redundancy process should also consider the employees that remain with the organisation. During my research, I found that the way organisations treat the employees who lose their jobs can have a significant impact on the employees who remain in the organisation. They may feel guilty or angry about colleagues losing their jobs, as well as experiencing continued fear of job insecurity if more job losses are expected.

Treating all employees with compassion, fairness and respect during redundancies also benefits the management staff that must implement the process of redundancies. Again, widespread communication – not just with the union, but with employees themselves – helps companies conduct the process with compassion. Remaining employees should understand the future vision and mission of the organisation. Other ways to lift employee morale include investing in training and development, as well as recognising job-related progress or achievements.

Redundancies cannot always be avoided, but the negative impact can certainly be limited for those who lose their jobs, as well as for those who remain. And when unions work with management to ease the pain of redundancies, employees can at least leave the organisation more equipped for the future.

Madeleine Stevens does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.

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Spread & Containment

U.S. FDA will decide on redesigned COVID vaccines by early July

U.S. regulators plan to decide by early July on whether to change the design of COVID-19 vaccines this fall in order to combat more recent variants of…

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U.S. FDA will decide on redesigned COVID vaccines by early July

By Michael Erman

“The better the match of the vaccines to the circulating strain we believe may correspond to improve vaccine effectiveness, and potentially to a better durability of protection,” Dr. Peter Marks, director of the FDA’s Center for Biologics Evaluation and Research, said at a meeting of outside advisers to the regulator.

Vials with Pfizer-BioNTech and Moderna coronavirus disease (COVID-19) vaccine labels are seen in this illustration picture taken March 19, 2021. REUTERS/Dado Ruvic/Illustration

The committee is scheduled to vote on a recommendation on whether to make the change later on Tuesday.

The updated shots are likely to be redesigned to fight the Omicron variant of the coronavirus, experts say. read more The exact composition of the retooled shots and whether they also will include some of the original vaccine alongside new components will be considered at the meeting.

Pfizer Inc (PFE.N), Moderna Inc (MRNA.O) and Novavax Inc. (NVAX.O) are scheduled to present data at the meeting. All three companies have been testing versions of their vaccines updated to combat the BA.1 Omicron variant that was circulating and led to a massive surge in infections last winter.

Both Moderna and Pfizer with partner BioNTech (22UAy.DE) have said that their respective redesigned vaccines generate a better immune response against BA.1 than their current shots that were designed for the original virus that emerged from China.

They have said that their new vaccines also appear to work against the more recently circulating BA.4 and BA.5 Omicron subvariants, even though that protection is not as strong as against BA.1.

Experts also want to know if the new shots will boost protection against severe disease and death for younger, healthier people or merely offer a few months’ additional safeguard against mild infection.

Scientists who have questioned the value of booster shots for young and healthy people have said a broad campaign is not needed with an updated shot either.

Other experts have championed any additional protection new vaccines may offer.

Reporting by Michael Erman Editing by Bill Berkrot and Bernadette Baum

Our Standards: The Thomson Reuters Trust Principles.

Source: Reuters

 

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