Two quick updates about the CDC’s surveillance efforts for COVID-19 and other diseases:
The CDC has provided a short-term wastewater surveillance contract to Verily, the biotech company that’s affiliated with Google, so that data collection can continue at about 400 sewage testing sites while a longer-term contract is in dispute. This temporary measure will help keep up surveillance during the winter respiratory virus season, though Verily still has a lot of logistical work ahead to actually start testing at sites where another company, Biobot Analytics, was previously in charge. (Verily will need to contact the sites, send them equipment, set up sample collection procedures, etc.) The CDC’s National Wastewater Surveillance System is also working on an updated COVID-19 dashboard, according to POLITICO’s story about the short-term contract. For more context, see my coverage of the contract switch and POLITICO’s previous reporting.
The CDC is expanding its testing program for international travelers arriving at U.S. airports, in a three-month pilot program for the winter virus season. This program, called the Traveler-Based Genomic Surveillance program, has screened travelers for coronavirus variants over the last two years, primarily using PCR tests among travelers who volunteer for a nasal swab. This winter’s pilot program expands surveillance in two ways: adding about 30 testing targets (including flu, RSV, other common diseases, and markers of antimicrobial resistance), and adding wastewater testing at three airports. One airport, San Francisco’s international airport, was already providing samples from plane sewage. See my article in Science News for more details.
Two weeks ago I wrote an article explaining that the CDC has a new wastewater contract, essentially transferring responsibility for COVID-19 testing at hundreds of wastewater treatment plants across the country from Biobot Analytics to a company called Verily, which is affiliated with Google. In the time since that post, I have seen some other articles and social media posts alleging that, thanks to the contract change, Biobot will no longer be posting any COVID-19 data on their dashboard. This is inaccurate!
It is true that Biobot no longer has access to data from about 400 sites that were part of the CDC contract. But Biobot still has its own testing network separate from the CDC’s—which actually predated its contract with the agency—and which includes hundreds of other sites across the country that either have individual contracts with Biobot or are receiving free testing in exchange for sharing data.
Copying from my post two weeks ago: on Biobot’s dashboard, “County-level data won’t change. National and regional data will still be available, but are likely to be less comprehensive pictures of wastewater trends across the U.S., if I’m right about Biobot no longer including CDC contract sites in those visualizations.” In fact, Biobot updated its dashboard this past Friday and will resume weekly updates soon, after making some changes to its data processing systems, according to social media posts from the company.
Meanwhile, it is currently unclear how the new contract will impact data on the CDC’s wastewater dashboard as well as on Verily’s own dashboard. On the CDC dashboard, you can see that contract sites are not reporting wastewater data while they switch testing providers. Verily has a dashboard that currently shows data from WastewaterSCAN, a separate program that already uses Verily to test its samples; this dashboard hasn’t added CDC sites yet as far as I know.
I’m not sharing the inaccurate posts I mentioned to avoid giving them extra attention, but I wanted to provide this extra update in case any readers had seen those posts and were confused. Once again: Biobot is still sharing data, it’s just less comprehensive, and I would still recommend going to their dashboard for COVID-19 trends. In this era of fragmented surveillance, it’s always good to rely on multiple dashboards (eg. CDC, Biobot, WastewaterSCAN) rather than just one.
Editor’s note, October 15: This article has been updated with comments from Verily.
This week, the CDC and life sciences company Verily announced that the agency awarded a five-year wastewater surveillance contract to Verily. The announcement marks a shift in the U.S. sewage monitoring landscape and will impact our public COVID-19 data, with short-term gaps and changing coverage in a couple of sources—but ultimate improvements in the long term.
First, some background:
In fall 2020, the CDC launched the National Wastewater Surveillance System (NWSS), a network of sewage testing sites around the country all reporting data to a central location. While some state and local health agencies quickly developed in-house systems for testing wastewater and reporting their data to NWSS, others lacked the resources (staff, lab capacity, data infrastructure, etc.) to start doing this new type of health surveillance.
As a result, the CDC began working with private testing companies to fill gaps in the NWSS network and expand surveillance more quickly across the country. The first contactor was a diagnostic company headquartered in Canada called LuminUltra. Then, last spring, the CDC awarded a contract to Biobot Analytics, a startup focused on wastewater surveillance. Biobot did a lot of work to extend the NWSS, helping bring the total CDC network up to nearly 1,400 sites; but the contractor switch initially led to a few weeks of missing data for about 150 sites covered by the CDC contract, as they transitioned from one set of testing protocols to another. (See my coverage at the time for more details.)
One advantage of Biobot working with the NWSS, if you’re someone who cares about public wastewater data, is that the company added data from many CDC contract sites to its COVID-19 wastewater dashboard, making that dashboard more comprehensive in its view of national COVID-19 patterns. You couldn’t view the CDC sites in Biobot’s county-level visualizations; those present data from other sites that have individual contracts with the company or are participating in the free Biobot Network program. But Biobot added CDC sites that opted into data-sharing to its national and regional visualizations, a company spokesperson told me last year.
What’s changing with the new contract:
Biobot’s contract with the CDC ended last month. The CDC’s new contract with Verily replaces it. Verily’s contract covers five years (as opposed to shorter periods for prior CDC wastewater testing contracts), and includes additions of more pathogens that may be tested through NWSS, in addition to SARS-CoV-2. These are both great improvements, adding to the surveillance system’s longevity and expanding its capacity beyond COVID-19—though additional federal funds will likely be needed past this contract.
However, in the short term, we will see data gaps on NWSS as contracted sites change over to Verily from Biobot. These testing sites may have to adjust how they collect samples, how they package and ship samples, and other logistical changes. The CDC NWSS dashboard already indicates a reporting dip in the last couple of weeks, coinciding with the contract change.
Meanwhile, Biobot will no longer have the same direct access to the CDC contract testing sites. While all the sites’ data will still be published publicly by the CDC, the Biobot-Verily switch will likely lead to changes in sample processing and analysis that make data from those sites no longer directly comparable with the hundreds of other sites covered by Biobot. My guess here is that Biobot may no longer be able to include the CDC contract sites in its national and regional visualizations.
I reached out to Biobot for comment about this shift, and haven’t heard back from them yet. I’ve also reached out to Verily asking about the contract changeover and any data-sharing plans they may have, and haven’t heard back there yet either. I will update this post with more details from the companies as I receive them.
How this new contract may impact major data sources:
CDC NWSS: Data from all sites participating in NWSS will continue to be available on the CDC’s dashboard, though the sites covered by the CDC’s national testing contract (previously with Biobot, now with Verily) may have missing data for a couple of weeks. NWSS continues to be the most comprehensive place to find wastewater data in the U.S., but unfortunately doesn’t share national or regional trends because it is compiling from many different testing programs with different methodologies.
Biobot Analytics: County-level data won’t change. National and regional data will still be available, but are likely to be less comprehensive pictures of wastewater trends across the U.S., if I’m right about Biobot no longer including CDC contract sites in those visualizations. Also worth noting, Biobot shifted its update schedule recently to once a week on Mondays (with a longer delay in data, but likely less retroactive updating).
WastewaterSCAN: No changes due to this contract switch, though WastewaterSCAN has been working with Verily for a while to test sewage samples from its network. This project also recently announced that it’s adding six more disease targets to its program: parainfluenza, rotavirus, adenovirus group F, enterovirus D68, Candida auris, and hepatitis A. See the statement from WastewaterSCAN below for more details.
In the long-term: The CDC’s new five-year contract will enable continued expansion of the NWSS, potentially with both more sites and more disease targets. I also expect public data offerings will continue to improve as scientists and public health officials learn more about how to interpret wastewater surveillance data.
Statement from WastewaterSCAN about the new contract
WastewaterSCAN was pleased to learn that the CDC selected Verily to support the National Wastewater Surveillance System (NWSS). As our lab partner, Verily has an important role managing sample collection logistics from wastewater treatment plants participating in the WastewaterSCAN network, processing samples, and supporting our research to advance the science of wastewater-based epidemiology.
WastewaterSCAN continues to demonstrate that wastewater monitoring can provide comprehensive, efficient, community-wide tracking of seasonal and emerging diseases. We recently added six disease targets to our program and are helping many communities prepare for the respiratory virus season with a public data dashboard to communicate what wastewater is telling us about the diseases circulating in our communities.
At this time, only data from our program will appear on WastewaterSCAN’s data dashboard. WastewaterSCAN will continue to make our methods public and to collaborate and share data with NWSS and contribute to its important, mission-critical work.
Statement from Verily, responding to COVID-19 Data Dispatch questions
CDD: Will the WastewaterSCAN dashboard start including data from wastewater testing sites included in the CDC contract, as they come online? Or is Verily planning to launch its own dashboard that will share data from those sites (perhaps in aggregate, national trends, similar to the current Biobot dashboard)?
Verily: WastewaterSCAN representatives have responded. On the question of sharing aggregated, national trends data from these sites: This is a CDC decision for the NWSS testing program.
CDD: Besides public dashboards, will there be alignment between WastewaterSCAN and Verily in how wastewater data are processed, analyzed, and interpreted?
Verily: There are many methods for analyzing the concentration of pathogens in wastewater. Verily offers several methods for wastewater analysis to its customers and ones chosen by the CDC NWSS and WastewaterSCAN programs differ primarily in what part of the wastewater is analyzed and how the pathogens are concentrated and extracted before measurement of pathogen concentrations. Beyond these initial steps, Verily’s lab processes all samples similarly.
The liquid fraction (of influent samples) will be concentrated and tested for the CDC NWSS program, similar to the approach previously used for NWSS contract testing.
The solid fraction of samples (from the primary clarifier or influent) has been shown to concentrate many pathogens and is tested for the WastewaterSCAN program.
Results from methods have shown agreement with case data in the literature. However, differences between the methods make them complementary to each other.
CDD: When the CDC previously switched contractors in spring 2022, some testing sites covered by the contract didn’t report to NWSS for several weeks while they transferred to a new process. What is Verily doing to help transition sites during the current switch?
Verily: Verily has an established system and team dedicated to onboarding new sites with the ability to rapidly initiate testing. This is informed by our previous experience providing logistics and lab services to over 200 sites in wastewater monitoring programs.
As we receive information from the CDC NWSS program about which sites will transition, we will get sites up and running as soon as possible. Our goal is to have up to 200 sites testing within the first four weeks of the contract.
I have a new story up this week at Science News, describing how the field of wastewater surveillance exploded during the COVID-19 pandemic and is now looking toward other public health threats.
As long-time readers know, wastewater surveillance has been one of my favorite topics to cover over the last couple of years. I’m fascinated by the potential to better understand our collective health through tracking our collective poop—and by all the challenges that this area of research faces, from navigating interdisciplinary collaborations to interpreting a very new type of data to obtaining funding for continued testing.
My story for Science News builds on other reporting I’ve done on this topic and provides a comprehensive overview of the growing wastewater surveillance field, with a particular focus on how research is now going beyond COVID-19. There’s so much potential here that, as I point out in the story, many researchers are asking not, “What can we test for?” but “What should we test for?”
The future of disease tracking is going down the drain — literally. Flushed with success over detecting coronavirus in wastewater, and even specific variants of SARS-CoV-2, the virus that causes COVID-19, researchers are now eyeing our collective poop to monitor a wide variety of health threats.
Before the pandemic, wastewater surveillance was a smaller field, primarily focused on testing for drugs or mapping microbial ecosystems. But these researchers were tracking specific health threats in specific places — opioids in parts of Arizona, polio in Israel — and hadn’t quite realized the potential for national or global public health.
Then COVID-19 hit.
The pandemic triggered an “incredible acceleration” of wastewater science, says Adam Gushgari, an environmental engineer who before 2020 worked on testing wastewater for opioids. He now develops a range of wastewater surveillance projects for Eurofins Scientific, a global laboratory testing and research company headquartered in Luxembourg.
A subfield that was once a few handfuls of specialists has grown into more than enough scientists to pack a stadium, he says. And they come from a wide variety of fields — environmental science, analytical chemistry, microbiology, epidemiology and more — all collaborating to track the coronavirus, interpret the data and communicate results to the public. With other methods of monitoring COVID-19 on the decline, wastewater surveillance has become one of health experts’ primary sources for spotting new surges.
Hundreds of wastewater treatment plants across the United States are now part of COVID-19 testing programs, sending their data to the National Wastewater Surveillance System, or NWSS, a monitoring program launched in fall 2020 by the U.S. Centers for Disease Control and Prevention. Hundreds more such testing programs have launched globally, as tracked by the COVIDPoops19 dashboard run by researchers at the University of California, Merced.
In the last year, wastewater scientists have started to consider what else could be tracked through this new infrastructure. They’re looking at seasonal diseases like the flu, recently emerging diseases like bird flu and mpox, formerly called monkeypox, as well as drug-resistant pathogens like the fungus Candida auris. The scientists are even considering how to identify entirely new threats.
Wastewater surveillance will have health impacts “far broader than COVID,” predicts Amy Kirby, a health scientist at the CDC who leads NWSS.
But there are challenges getting from promise to possible. So far, such sewage surveillance has been mostly a proof of concept, confirming data from other tracking systems. Experts are still determining how data from our poop can actually inform policy; that’s true even for COVID-19, now the poster child for this monitoring. And they face public officials wary of its value and questions over whether, now that COVID-19 health emergencies have ended, the pipeline of funding will be cut off.
This monitoring will hopefully become “one of the technologies that really evolves post-pandemic to be here to stay,” says Mariana Matus, cofounder of Biobot Analytics, a company based in Cambridge, Mass., that has tested sewage for the CDC and many other health agencies. But for that to happen, the technology needs continued buy-in from governments, research institutions and the public, Matus and other scientists say.
New York Times COVID-19 tracker is back: After shutting down ahead of the ending federal public health emergency, the New York Times COVID-19 tracker has now resumed updates. Since the tracker is based on CDC data, case numbers and other major metrics are no longer available; but readers can find hospital admissions, deaths, and vaccinations nationally and by state, along with some local data based on hospital service areas. The NYT website doesn’t give much information about why they resumed updates—if anyone reading this can share what happened, please let me know! (And thank you to reader Robin Lloyd who flagged the renewed updates.)
CDC Director calls for more data authority: CDC Director Rochelle Walensky appeared in front of Congress this week, speaking to Republican lawmakers for a hearing about her time leading the agency before she steps down at the end of June. One notable trend from the hearing, according to reporting by Rachel Cohrs at STAT News: Walensky acknowledged that the CDC wasn’t able to collect some key COVID-19 data points, such as vaccination rates for COVID-19 patients in hospitals. Walensky called for Congress to give the CDC more authority in collecting data from state and local health departments.
CDC expanding its wastewater testing targets: Another CDC update for this week: the agency’s National Wastewater Surveillance System is expanding the pathogens that it will look for in sewage, Genome Web reports. NWSS plans to test for several respiratory viruses (COVID-19, flu, RSV), foodborne infections such as E. coli and norovirus, antimicrobial resistance genes, mpox, and other pathogens that may warrant concern. CDC scientists are working with the company GT Molecular to develop and test new assays. Other wastewater research groups are similarly developing tests to expand the health data that we get from sewage, I’ve learned in reporting for an upcoming story (which will be out later this summer).
Genomic surveillance to keep tabs on Omicron’s evolution: CDC researchers invovled with tracking coronavirus variants shared some updates in a study published this week by the agency’s Morbidity and Mortality Weekly Report. As fewer people are getting PCR tests across the U.S., the CDC has access to fewer samples for sequencing than it did at prior points in the pandemic. As a result, scientists have had to update their analytical procedures for using available data to estimate how much different variants are spreading. According to the CDC, Omicron has dominated the U.S. since early 2022, with earlier BA lineages giving way to XBB.
Fungal infections increased during the pandemic: In recent years, hospital patients have become increasingly at risk of infection with fungi, which can spread widely in healthcare settings. A new paper from the CDC adds evidence to this trend: fungal infections in hospitals have increased steadily from 2019 through 2021, the researchers found. The researchers also found that patients hospitalized with COVID-19 and a fungal infection had high mortality rates, with almost half of these patients dying in 2020-2021. COVID-19 can disrupt patients’ immune systems and make them more vulnerable to fungi, the researchers suggested. This is a major threat that’s likely to continue in coming years.
My attempt to explain the wastewater surveillance funding ecosystem in one diagram. (Credit: Betsy Ladyzhets)
This week, I have a new story out in Scientific American about why the wastewater surveillance infrastructure built during the pandemic may not last in the long term. While current monitoring projects aren’t likely to go anywhere right now, issues with funding, uneven commitments at state and local levels, and the overall novelty of this field may lead those programs to shut down in the coming years.
Here’s the story’s opening paragraphs:
During the past three years of the pandemic, testing sewage water for the virus that causes COVID has become a valuable tool: it has spotted surging infections and new variants weeks before they showed up in medical clinics, for instance. The technology has also warned of other health threats such as seasonal viruses and increased opioid use.
But now its long-term ability to protect public health is in jeopardy. Funding uncertainty from the federal government and uneven commitments from state health departments have raised the specter that wastewater monitoring programs may shut down in the future.
The U.S. Centers for Disease Control and Prevention’s National Wastewater Surveillance System (NWSS), which includes the majority of wastewater testing sites in the U.S., is “fully funded through 2025,” says Amy Kirby, director of the program. But after that, “new sources of sustainable funding” are needed, Kirby says, ideally through the CDC’s regular budget rather than resources tied to COVID. Uncertainty about money—along with logistical challenges and questions about how to interpret data from this relatively novel source—has made some state governments hesitant to invest in the technology, leading to an uneven national system.
My reporting for this piece involved interviews with the CDC, state and local public health agencies, and other major wastewater organizations (Biobot, WastewaterSCAN). I learned a lot about the overall ecosystem for funding wastewater surveillance, including a lot of somewhat-technical details that didn’t make it into the SciAm story. So, I’m sharing some of those details here.
Where wastewater surveillance funding comes from:
The primary funder for wastewater monitoring programs across the U.S. is CDC NWSS. The CDC itself received funding through the American Rescue Plan in 2021, sufficient to fully fund NWSS through 2025.
That CDC funding has gone in two main directions. First, the CDC has funded state and local public health agencies to set up (and maintain) their own wastewater testing projects. This is how most of the states with robust programs (places like New York, Utah, Virginia, Ohio) have funded their efforts. State and local health agencies may also receive funding from their own local governments, though most of the agencies I talked to for my story said they were primarily relying on the CDC. New York State is one major example of a state government funding wastewater surveillance right now.
And second, the CDC has set up national contracts with wastewater testing companies to supplement NWSS in places where monitoring otherwise might not be happening. The agency first contracted with LuminUltra in early 2022, then switched to Biobot Analytics last spring. Earlier this year, Biobot’s contract with the CDC was extended for six months, through July. After that, the agency plans to enter a new, five-year contract with a wastewater testing company that will cover COVID-19 as well as other emerging diseases, like mpox. This contract could go to Biobot or another company; the CDC is currently going through an application process.
Biobot and other private companies like it are also receiving funding from private sources, such as venture capital firms. In addition, individual water treatment facilities, local governments, and even businesses might set up contracts with private companies to help them test the wastewater in their jurisdiction. For example, Toronto’s Pearson Airport has contracted with LuminUltra to test wastewater from the airport terminals. In these cases, funding is coming from the specific organization that wants testing, rather than a larger program. Biobot also tests at hundreds of sites for free through its Biobot Network, in exchange for sharing the data publicly.
Finally, there’s a whole separate ecosystem of academic wastewater surveillance efforts, mostly run by university labs or research centers. WastewaterSCAN is the biggest example of this right now; the project was founded at Stanford and Emory Universities, but has since expanded through grants and philanthropic funding to cover about 150 sites across the country. Most academic projects either partner with specific treatment facilities in their areas or test the sewage on their campuses—SCAN is an exception with its broader scale.
Concerns for wastewater surveillance’s long-term future:
As you can probably tell by this description of the funding landscape, wastewater surveillance in the U.S. is pretty complicated. When scientists started testing wastewater for SARS-CoV-2 in spring 2020, this was basically a grassroots effort with different research projects across the country trying out different things. CDC NWSS has worked hard to compile data into one national system and develop standards, but the system is still far from unified.
For the CDC program to continue its efforts, the agency needs more long-term funding—and this funding shouldn’t be tied to COVID-19. The potential for wastewater surveillance to inform public health decisions goes far beyond this pandemic, and funding should reflect that potential; also, no COVID-specific funding packages have passed Congress since the American Rescue Plan, in 2021.
One way Congress could do this would be by expanding a funding system called “Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases,” or ELC. Most wastewater grants to state and local health agencies over the last couple of years have gone through ELC, though the funding came from the American Rescue Plan. Many of the health officials I talked to for my story like ELC, know how to fill out the annual applications, and would want to keep using it to receive wastewater funding.
Before the pandemic, the ELC program was drastically underfunded, I learned from experts at the Association of Public Health Laboratories (APHL). States’ applications historically “vastly exceed the money that CDC is given to put out for them,” APHL policy officer Peter Kyriacopoulos told me. APHL recommends that Congress should expand the program’s funding from $300 million per year (its pre-pandemic benchmark) to $800 million per year, or more. The ELC program is up for renewal this year, which could be an opportunity for Congress to add more permanent funding for wastewater surveillance and other epidemiological efforts.
More permanent funding could go a long way in convincing more state health agencies to invest in wastewater surveillance programs, rather than relying on outside assistance from companies like Biobot or academic partners. More data and guidance on how to actually use wastewater data to inform public health decisions would help, too, since many agencies are still figuring this out. Such investment at the state level would help make the country’s wastewater infrastructure more comprehensive, and more capable of responding to new health threats.
Instead, right now, we have an uneven system. Some places are regularly monitoring for COVID-19 and easily able to expand to new testing targets, while others might lose this valuable data source in the next year or two. For any local reporters reading this, I highly recommend digging into your community’s wastewater surveillance system, and figuring out whether it’s set up for the long term.
Biobot provides wastewater testing and analysis for more than 400 sites in the NWSS network, accounting for about one-third of the system’s total 1,200 sites. The CDC/Biobot arrangement basically makes it easy for these wastewater treatment plants to participate in COVID-19 and mpox testing, since sites can send in samples without spending the time and resources needed to build up their own testing programs.
I was glad to see this news, as the continued contract will mean no interruptions in CDC NWSS data for at least another six months. Long-time readers might remember that there were major wastewater data gaps last spring, when the CDC switched contractors from LuminUltra to Biobot.
Of course, six months is far from the long-term investment that the U.S. should be making in wastewater surveillance… but that’s a topic for another week.
Nearly a year after the CDC’s National Wastewater Surveillance System began reporting public data, the system still has very unequal representation across the U.S.
This week, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a major report about the state of wastewater surveillance for infectious diseases in the U.S. The report, written by a committee of top experts (and peer-reviewed before its release), is an extensive description of the promise and the challenges of wastewater testing.
Its authors describe how a grassroots network of researchers, public officials, and wastewater treatment plant staff developed strategies for sewage testing, analysis, and communicating results. Now, as committee chair Guy Hughes Palmer writes in the report’s introduction, broader collaboration and resources are needed to “solidify this emergency response to the COVID-19 pandemic into a national system” that continues to monitor COVID-19 as well as other public health threats. To this end, the report includes specific recommendations for the CDC’s National Wastewater Surveillance System.
Here are some key findings from the report, taken from its summary section and a NASEM webinar presentation last Thursday:
Overall, the report finds that wastewater surveillance data “are useful for informing public health action and that wastewater surveillance is worthy of further development and continued investment.” The authors recommend that public agencies at all levels keep funding and promoting this monitoring tool.
Wastewater surveillance is not a new technology; it’s been used for decades to monitor the spread of polio. But COVID-19 led to widespread adoption of this technology and innovation into how it could be used, driven by some municipalities and universities that were early to embrace wastewater.
As a population-level tool, wastewater surveillance provides data on how diseases spread through a community without relying on access to clinical testing. This surveillance is becoming more important for COVID-19 as people opt for at-home tests over PCR tests, and should be used specifically to track new variants.
Community sewersheds that may be tested range in size from serving hundreds of people to serving millions; they also differ based on geography, demographics, and many other factors. As a result, early researchers in this space developed testing and analysis methods that were specific to their communities.
Now, however, the CDC faces a challenge: “to unify sampling design, analytical methods, and data interpretation to create a truly representative national system while maintaining continued innovation.” In other words, standardize the system while allowing local communities to keep doing what works best for them.
Sites in the CDC’s National Wastewater Surveillance System (NWSS) are currently not representative of the U.S. as a whole, as the system is based on wastewater utilities and public health agencies choosing to participate.
The CDC needs to expand this system to be more equitable across the country, with targeted outreach, offering resources to sites not currently participating, and other similar tactics. This expansion process should be open and transparent, the report’s authors write.
As NWSS expands, the CDC should select and prioritize “sentinel sites” that can help detect new coronavirus variants and other new emerging health threats early on. These sites might include international airports as well as zoos and livestock farms, where potential animal-to-human transmission may be monitored.
Better public communication is needed: the CDC (and other agencies) should improve its public outreach about wastewater data, including addressing any privacy concerns that people may have. The report specifically recommends that the CDC “convene an ethics advisory committee” to assist with privacy concerns and data-sharing concerns.
In assessing potential new targets for wastewater surveillance, the report recommends three criteria: “(1) public health significance of the threat, (2) analytical feasibility for wastewater surveillance, and (3) usefulness of community-level wastewater surveillance data to inform public health action.”
NWSS needs more funding from the federal government to expand its sites, continue its COVID-19 tracking efforts, fund projects at state and local levels, and pivot to new public health threats as needed. This funding needs to be “predictable and sustained,” the report’s authors write.
As we head into the holidays with limited COVID-19 testing and undercounted case numbers, wastewater surveillance is the best way to evaluate how much the virus is spreading in your region. And it’s now available in more places than ever, thanks to the many research groups and public health agencies setting up sewage testing.
Let’s review the options. First, there are now three national dashboards with U.S. wastewater data, each covering a different set of locations.
The CDC’s National Wastewater Surveillance System is the biggest, including more than 1,000 sites from almost every state, though some states have far better coverage than others. Click on an individual site to see coronavirus trends for that location.
Biobot Analytics is the biggest private company doing wastewater surveillance; it provides analysis for hundreds of sites in the CDC NWSS network as well as its own, separate network. Biobot’s national and regional data (which include NWSS sites) are particularly helpful for large-scale trends.
WastewaterSCAN is a project that started from an academic partnership between Stanford University, Emory University, the University of Michigan, and communities in California. It’s since expanded to include sites in about 20 states, and participating sewersheds are tested for monkeypox, flu, and RSV in addition to the coronavirus.
Second, 21 states currently have their own wastewater dashboards or reporting systems. If this is available in your area, I highly recommend looking at your local dashboard in addition to the national options. State and local dashboards tend to include more detailed and/or more frequently updated data, and are often tailored to their community’s needs more closely.
These are the states with wastewater dashboards; see the resource page for links and more info:
California, Colorado, Georgia, Hawaii, Idaho, Indiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Nebraska, New York State, North Carolina, Ohio, Oklahoma, Oregon, Utah, West Virginia, Wisconsin.
Wastewater trends do not correspond directly to infection trends, because people sick with COVID-19 might shed the virus at different rates (based on where they are in their infection, variants, and other factors). Some researchers are working to better understand the correlation between wastewater trends and cases, but for now, the sewage data are best understood as a broad indicator of risk—not a precise estimate of how many people in your community are sick.
CDC adds new chart to wastewater dashboard: This week, the CDC updated its National Wastewater Surveillance System (NWSS) dashboard with a new chart that aims to summarize the overall picture of coronavirus trends in the country’s sewers. The chart shows the percentage of NWSS sites that have reported their coronavirus concentrations decreasing, staying stable, and increasing over two-week periods; it also shows the overall number of sites with recent data. (This number dropped when NWSS switched contractors, though it has ticked back up in recent weeks as Biobot onboards sites.) Of course, the sites included in NWSS represent a small fraction of the U.S. population, and different locations are using different analysis methods which may be difficult to summarize. But the new chart is still a helpful way to see national trends from the surveillance network.
Preprint suggests 30x scale of case underreporting: Last week, researchers from the City University of New York (CUNY) shared striking results from a study in which they’d surveyed about 1,000 New York City residents about their COVID-19 status during two weeks of the BA.2/BA.2.12.1 surge. The sample was designed to represent the broader city population, and residents could self-report positive test results on both PCR and at-home rapid tests as well as possible symptoms and contact with infected people. About 22% of the survey respondents had a coronavirus infection during the study period (April 23 to May 8), the researchers found. The study hasn’t been peer-reviewed and should be interpreted with caution, but still: it could indicate that one in five New Yorkers got COVID-19 within two weeks. Official case counts were 30 times lower, the researchers found, reflecting massive underreporting; and NYC has more access to PCR testing than many other places.
1. In our new (not yet peer reviewed) pre-print on NYC's BA.2/BA.2.12.1 surge, in a population-representative sample, we estimated SARS-CoV-2 prevalence to be 22.1% during April 23-May 8 (about 1.8M adults). About 31 times the official case count. https://t.co/Vr7PUWsWd7
CDC study demonstrates disproportionate COVID-19 impact on Native Americans: One study from the CDC’s Morbidity and Mortality Weekly Report (MMWR) that caught my attention this week: researchers in Alaska (at the state’s health agency and tribal health institutions) examined COVID-19 rates for the state’s indigenous population. They found that the age-adjusted COVID-19 case rate among Native Americans/Alaska Natives was about twice as high as the rate among white people living in Alaska, and the death rate was about three times higher. Many indigenous people in Alaska live in rural, remote areas, some inaccessible by car, which heightens the challenges of accessing healthcare.
Native American life expectancy fell during the pandemic: Another related preprint: researchers at Virginia Commonwealth University, the University of Colorado Boulder, and the Urban Institute have produced multiple studies examining how life expectancy changed during the pandemic. In general, COVID-19 led to massive decreases in life expectancy across the board; but the latest update from this group showed that Native Americans were particularly hard-hit. Native American life expectancy dropped by 4.7 years, compared to a 2.1 drop for the white American population. Steven Woolf, corresponding author, discussed the study in a Q&A with Virginia Commonwealth University. (H/t Andrew Stokes.)
Higher burden of COVID-19 in developing countries: And one more notable new study, published this week in BMJ Global Health: a group of researchers at institutions in the U.S., Australia, Brazil, and other countries conducted an in-depth review of global COVID-19 serology data to estimate the disease’s true infection and fatality rates across the world. The researchers found that infection fatality rates (i.e. the share of infected people who die of COVID-19) were much higher in developing/low-income countries than in developed/high-income countries, in some cases up to three times higher. “The results are, in a word, depressing,” lead author Gideon Meyerowitz-Katz wrote in a Twitter thread discussing the study.
New job posting at CDC forecasting center: The CDC’s new Center for Forecasting and Outbreak Analytics, formally launched in April, has posted a job opening for (at least one?) data scientist. Considering that the center plans to hire 100 scientists and science communicators, this singular posting is likely just one of many more opportunities to come.
COVID-19 Data Dispatch 