WSU-led report backs nationwide wastewater-disease surveillance

Covid viruses superimposed over an aerial view of a sewage treatment plant.

Experts are taking the nation’s fight against infectious diseases to the sewer. A new report recommends investing in wastewater testing for infectious diseases across the nation, as some cities and organizations have done for COVID-19.

The wastewater-based disease surveillance report released last week represents the consensus of a special National Academies’ committee chaired by Dr. Guy Palmer, Washington State University regents professor of pathology and infectious diseases. While the ad-hoc system used during the pandemic helped, the country needs a more formal, organized system to be able to respond better to COVID-19 and other infectious diseases, Palmer said.

“The volunteer-based system we have now has been made up of municipalities that wanted to participate,” he said. “To be equitable and have good sampling coverage, we need a system with an intentional design.”

Tracking the spread of COVID-19 became difficult when people started using home-test kits and fewer cases were officially reported. Since traces of virus that causes COVID-19 are shed in human feces, testing wastewater allowed public health officials to determine when a spike in infections was occurring and what variants were spreading. This then helped them allocate hospital resources and even determine which monoclonal antibody treatments would be most effective.

Closeup of Guy Palmer
Guy Palmer

WSU conducted its own wastewater surveillance of residence halls during COVID-19 to help determine what was happening in the student community. Palmer said smaller testing like this would not be part a part of a national system, which seeks to inform a country-wide response, but the report does not preclude organizations from undertaking such testing on their own.  

The National Wastewater Surveillance System was launched by the Centers for Disease Control and Prevention in 2020 in response to the COVID-19 pandemic. The report offers recommendations to strengthen nationwide coordination and ensure this national system is flexible, equitable, and sustainable.

The report presents a vision for a national wastewater surveillance system that would be able to track multiple pathogens simultaneously and pivot quickly to detect emerging pathogens. This includes establishing a transparent process for the CDC to prioritize pathogens when evaluating potential targets for future wastewater surveillance. The agency should also consider three criteria: the public health significance of the threat, the analytical feasibility for wastewater surveillance, and the usefulness of community-level data to inform public health action.

In addition to expanding wastewater surveillance to currently underserved areas, the sampling program should be designed based on data analysis for prioritized pathogens. Specific “sentinel” sites should be incorporated, such as large international airports or zoos, to monitor for specific emerging pathogens at their points of entry.

The report also recommends predictable funding for the system, to maintain workforce capacity and continue to advance sampling and analysis methods and tools. Another recommendation is to establish a standing ethics advisory committee to propose guidelines about how data is shared and evaluate future expansions of data collection and access, with a strong firewall to preclude use of data by law enforcement.

The committee will now move into a second phase of the National Academies study to offer a detailed assessment of technical constraints and opportunities.

“Investment in this national system is important for strengthening public health, but sustaining that investment requires clearly communicating how wastewater surveillance benefits our communities while addressing privacy concerns,” said Palmer.  

Visit the National Academies site to read the full report: Wastewater-based Disease Surveillance for Public Health Action

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