Should I Stop Ordering Packages? (And Other Covid-19 FAQs)
Plus: What it means to “flatten the curve,” and everything else you need to know about the coronavirus.Back at Stanford, the samples are filed away in the lab freezer of Alexandria Boehm, an engineering professor who studies microbes in the environment. Soon, their team will begin analyzing those samples for traces of genetic material from SARS-CoV-2, the virus that causes Covid-19. That freezer is becoming a library of what the Bay Area’s bowels have revealed as the pandemic has progressed, and if all goes according to plan, it will become a blueprint for how studying sewage might provide a way for cities to detect flare-ups of Covid-19.
Right now, health experts are focusing on efforts to flatten the curve, urging people to shelter in place and keep their distance to get the spiraling rate of infection under control. But what comes next? As safety measures relax, life won’t go back to normal, exactly. Without a vaccine, which is a year off (at least) , and without herd immunity to stymie the virus’s spread, public health officials will next face a long game of whack-a-mole, requiring constant vigilance to contain infection hot spots. Part of that will involve large-scale testing—likely a mix of blood tests and swab tests—to identify individual cases, plus getting those people into quarantine and tracing who they’ve had contact with. But Boehm’s team wants to know whether passive forms of disease surveillance, like monitoring our sewers, could get us that information sooner.
The release of genetic data has also spurred a flurry of new research findings in recent days, including one paper published by a team of Chinese researchers last night in the Journal of Medical Virology that claims to have used the viral sequence to find the most likely source of the emerging outbreak.
The approach holds promise because a number of studies have shown high levels of viral shedding in fecal samples from Covid-19 patients. Since that shedding happens early in the disease’s progression, well before patients show any symptoms, there’s reason to suspect evidence of the virus might show up in a city’s wastewater, even before the residents of that city have been tested. (By the way, don’t worry about catching the virus from sewer water; contaminated water is an unlikely route of infection. Plus, in the US, at least, wastewater treatment should destroy the virus just fine.)A number of groups are racing to figure out how to make such monitoring work. Last week, researchers at the KWR Water Research Institute in the Netherlands were the first to publicly report they had detected SARS-CoV-2 in wastewater samples. The group started testing in early February in cities across the country, before the Netherlands had identified any Covid-19 cases. As the first cases emerged and then spread in early March, the researchers found the viral concentration in sewer water went up in tandem. Other groups, including researchers at the University of Arizona and an MIT startup called Biobot, have begun collecting samples from towns and cities across the US, but neither has released data yet.
At Stanford, the retooling began in early February, when Boehm and her colleagues applied for an emergency grant from the National Science Foundation. The US, at the time, had just two cases. (“My program manager thought I was crazy,” Boehm says.)Coronaviruses like SARS-CoV-2, however, are not Boehm’s specialty. She studies different pathogens, mostly those that infect via the fecal-oral route, usually when someone ingests contaminated water. Some of those diseases have been subject to sewage surveillance efforts in the past—to eradicate polio in Israel, for example, and to track salmonella outbreaks in Hawaii.She says the Dutch results offered validation, even though that data has not yet been peer-reviewed. “It’s encouraging as a proof of concept,” Boehm says. Demonstrating that the virus’s RNA is actually detectable in sewage samples is an important first step. But the bigger challenge is making that value predictive—to correlate RNA concentrations in a sewage sample to the actual number of cases in a community.
To uncover those “ potentially infectious materials ,” the Global Polio Eradication Initiative hosts a big table that lists the dates and locations of wild poliovirus outbreaks, and the times each country did live-virus vaccinations, so labs around the world can scan the database and see whether their samples might have originated in a polio-prone area.
“The ability to back calculate from the sewer to the number of people could be difficult,” says says Dan Burgard, a professor of chemistry at the University of Puget Sound who specializes in wastewater epidemiology. “We don’t have a Star Trek tricorder where you hold up a device and it tells you exactly how much material is present.”