The national lock down to control the spread of COVID 19 highlights a critical weakness in our public health system: it is reactive and slow in rolling out diagnostic testing for COVID-19. This leaves everyone (i.e. public officials, pundits, experts, media, citizens) wondering how big the outbreak is, the curve, the peak and where it is going next. There are confusing signals coming from the White House, NIH, CDC, health departments, local hospitals, and public officials on who to prioritize, where, when, and how often people need to be tested. There are questions about the accuracy of the tests, particularly the antibody test.
The data we have now is post symptomatic and probably misses vast numbers of people who have contracted the disease. The lack of comprehensive, real time proactive data has made opening up the economy a challenge by state, region and community. A mistake could mean reinfection and another cycle of lock-down and a devastated economy. We need more real time and validated data. We need to know the intensity of the virus; how many people are likely to have the disease; the direction of the trend; and, related measures to determine consequences of the spread in human behavior and health.
A Potential Solution. Sewage contains viruses, bacteria, and chemical metabolites that are excreted in urine and stool. It is likely that people excrete the COVID 19 virus before they are symptomatic. The technical discipline is called Wastewater-Based Epidemiology (WBE). Sewage attributes could be an early "collective" signal of disease spread and helpful in real-time surveillance as we begin the process of opening the economy. Instead of everybody being tested individually, we can monitor the status of COVID by analyzing a community's wastewater before treatment (influent). The first confirmed detection of SARS-CoV-2 in untreated wastewater in Australia gives proof- of- concept for the wastewater surveillance of COVID-19 in the community.
BioBot Analytics is a US company developing this solution. As noted on the website: "The goal is creating a health database that is independent from hospital reporting systems, free from biases affecting who can and cannot seek care, and rapidly adaptable to new and emerging public health threats. There is an incredible opportunity to use this technology to get ahead of and monitor the COVID-19 epidemic. A wastewater epidemiology system that aggregates samples from wastewater treatment plants across the US would provide a real-time map of COVID-19 as it spreads to new places. Without the need for individual testing. Government officials, school administrators, and employers would no longer need to rely on confirmed cases or hospital reporting to make tough decisions like enforcing work from home policies. "