How experts are running sewage COVID tests

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Image credit above: KC Water’s Chief Plant Operator Kevin Herman walks around the ‘Sludge House’ and machinery that filters the waste. (Vicky Diaz-Camacho | Flatland)

Tucked behind train tracks along Hawthorne Road in Kansas City, the Blue River Wastewater Treatment Plant doesn’t look like much.

But inside, TV screens hung on the wall follow the flow, locate the waste and filter it.

Inside a large shed, gargantuan machines sift through “sludge,” the preferred euphemism for solid waste. Two minutes away by car, you will find the so-called “mud house”.

“We get everything from Grandview to here,” said Kevin Herman, who is the chief plant operator for KC Water. “Fifty to 60 million gallons.”

Water flows to the facility through a channel and then through an underground pipe. Operators working on site open what looks like a mini plastic shed. The liquid then passes into a larger container where the operators collect the samples.

Every Tuesday, about a quarter cup of sewage is siphoned off into small plastic containers, poured by hand. Timestamped and dated, the health service then sends the bottles to the laboratory.

“Nothing like that,” said Scott Goins, the main plant operator who collected the sample that morning.

Step by Step: Collecting COVID-19 Samples with Scott Goins

Complex issues, confusing narratives

As simple as this process may seem, tracking COVID was complicated at first.

The way the data is collected has confused members of the general public who have said they don’t know what to do with inconsistent messages. The Centers for Disease Control and Prevention admitted his missteps in August.

Pew Research is giving public health officials mixed marks on their response to COVID-19.

In a statement to the media, CDC Director Rochelle Walensky said, “Our performance did not reliably meet expectations.”

If the information is incomplete or misinterpreted, the risks are conflicting headlines and poor public health guidance, writes Raj Dev, a contributing author at TowardDataScience. This happened for much of 2020 and 2021.

In a Pew Research Institute survey, nearly half of respondents said public health authorities were “unprepared for the outbreak.”

Those sentiments resonated across the political spectrum, but were especially prevalent among Republicans, according to Pew. Communication was the biggest thorn.

These questions were the culmination of problems.

Science communicators blame a few things:

  • The inability to track COVID home test results.
  • Poor public health communication efforts.
  • Non-existent or unclear access to PCR testing sites.
  • More relaxed directives from municipal leaders in social contexts.

Other reasons are partly psychological.

The emphasis by health officials on guidelines for safely masking or socializing, some say, is important. Some health communication advocates say there is still a need for consistent and clear messaging from public health officials in the region.

Public-facing reports such as COVID dashboards can also be confusing. Additionally, some are incomplete because many county health departments in the Kansas City metro area have stopped collecting data on the population and cases of COVID-19. On a larger scale, the state of Missouri stopped publishing some county data in its COVID-19 dashboard in early April 2022.

So, scientists have sought to fill the void.

Information as power

About two years ago, a partnership between the Missouri Department of Health and Senior Services (DHSS), the Missouri Department of Natural Resources (DNR), and the University of Missouri (MU) was formed.

Together, they launched a program to fill the information gap. It relied on a more reliable tool: public services.

The idea of ​​tracking COVID down the drain gained traction when they realized how difficult it was to determine accurate case rates with outdated public health reports.

Dominoes started falling at the start of the pandemic outbreak.

“We worked around the clock,” said Dr. Chung Ho-Lin, senior scientist at the University of Missouri-Columbia’s laboratory for the sewer monitoring project. “We have a day shift and a night shift. We were able to (move to) development in almost two weeks.

Dr. Chung Ho-Lin is the lead laboratory scientist at the University of Missouri-Columbia for the Sewer Monitoring Project.  (University of Missouri)
Dr. Chung Ho-Lin is the lead laboratory scientist at the University of Missouri-Columbia for the Sewer Monitoring Project. (Courtesy | University of Missouri)

Jeff Wenzel, the senior epidemiologist, took the helm with Ho-Lin. Wenzel and his team set out to collect sewage samples, which university researchers could study in the lab.

They specifically looked at the viral load of SARS-CoV-2 in wastewater. This method has taken the scientific world by storm. He was able to follow the pandemic with more clarity.

“From the beginning of last year, January, February 2021, we started looking at variants and determining whether or not we could see what variants were present in a community,” Wenzel said.

The sewer monitoring project team would track community transmission and circulation of the variants. The higher the viral load, the more likely it was that cases would rise.

“Anytime we see a viral load increase of 40% or more week over week, it indicates that we will see a significant increase in known human cases of at least 25% – with a probability of 70 %,” Wenzel explained.

Epidemiologists study sewage to detect changes in population or disease case rates and have even been able to detect new variants.

When a sub-variant of Omicron appeared, called BA5, Wenzel saw the rise reflected in the data. As of October 2022, this subvariant accounted for 62% of cases, and this project has seen its importance grow as it has unfolded.

Over the past two years, the sewer monitoring project has grown to include 100 Missouri communities that cover nearly 70% of the population. The sample pool was ideal, capturing a more accurate census.

During March, the CDC’s National Wastewater Surveillance System (NWSS) highlighted the benefits of early detection.

“The virus can then be detected in wastewater, allowing wastewater monitoring to detect the presence of SARS-CoV-2 excreted by people with or without symptoms. This allows wastewater monitoring to serve as an early warning when COVID-19 is spreading in a community,” according to the NWSS.

The sewage data showed numbers that the PCR tests did not show. It was comprehensive and matched the real-world dynamics doctors were seeing in their hospitals.

In Kansas City, the benefits of wastewater monitoring were clear.

The Blue River Wastewater Treatment Plant is the largest in the area and serves nearly 80% of the Kansas City metro area, a city spokesperson said.

COVID-19 Trends in Wastewater

Screenshot of data tracked by the Sewershed Surveillance Project.
An example of data tracked by the Sewershed Surveillance Project, a partnership with the Missouri Department of Health and Senior Services (DHSS), Missouri Department of Natural Resources (DNR), and University of Missouri (MU). (Screenshot)

Sewage provides a more complete picture of what’s circulating in the city than self-administered tests, epidemiologists say. Not all home tests are done correctly and not all results are sent to the health department for follow-up. That leaves gaps in crucial health data that public health officials rely on to make their next call.

Wastewater analysis is more efficient because everyone in the metropolitan area uses toilets. Samples from there can give experts more accurate COVID rates, all in real time. For example, with daily data updates, people can check the map, see if there’s an increase, and delay a trip if necessary, Lin said.

The resulting data derived from human sludge reveals a clearer picture. This work was fast and heavy work for Wenzel, Lin and the group of 10 researchers.

But it takes science from the lab to the real world. For Lin, this is the strength of this partnership.

Although usually tucked away in a small office, stacked to the ceiling with papers, this project gave the Missouri scientist purpose. It’s not every day that a lab study informs what’s going on outside, in the real world.

“I was able to witness this whole project from scratch. It is very rewarding to be a scientist,” he added.

Cracking her lips into a smile, Lin says learning more about COVID day-to-day shouldn’t inspire fear, but rather enable people to live safer and happier lives. And he had one last message.

“Science in higher education can be powerful,” Lin said.

Vicky Diaz-Camacho covers community affairs for Kansas City PBS.

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