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In the Tales Told by Sewage, Public Health and Privacy Collide

  • 27 April 2021
  • ckearns

Sewage epidemiology has been embraced in other countries for decades, but not in the U.S. Will Covid change that?
Visual: Tim Robinson for Undark

IN EARLY MARCH 2020, as Covid-19 cases were accelerating across the globe, the American aircraft carrier U.S.S. Theodore Roosevelt made its way to Da Nang, Vietnam for a scheduled stop to celebrate the 25th anniversary of diplomatic relations between the nations. Nearly 100,000 cases of Covid-19 had been confirmed worldwide, and more than 3,000 people had died from it, when thousands of sailors poured off the ship for five days to mingle with locals, posing shoulder to shoulder for photos, overnighting in local hotels, and shooting hoops with Vietnamese kids.

Less than two weeks after pulling anchor, three crew members tested positive for SARS-CoV-2, the virus that causes Covid-19. In the ensuing weeks, the illness zipped through the vessel, eventually infecting 1,271 of the nearly 5,000 sailors, along with the ship’s captain. Twenty-three sailors were hospitalized, with four admitted into intensive care. One died. The acting secretary of the Navy fired the captain for skirting the chain of command when he begged for help with the crisis, before the acting secretary himself resigned.

Thousands of miles away, landlocked in a suburb of curving roads and sunbaked backyard pools, Christian Daughton, a retired environmental scientist from the Environmental Protection Agency, followed the unfolding disaster online from an office nook in his kitchen. The former branch chief at what had been one of the EPA’s foremost environmental chemistry labs in the country knew that something could have been done — that there was a tool out there to help. Through an EPA colleague, Daughton contacted the office of the chief of naval operations to inform the Navy about the tool, which could decisively detect the virus onboard ships before sailors felt sick — and, crucially, before the virus exploded among the rest of the crew.

But it was as if Daughton had rowed up in a dinghy to the ship’s towering bow and tapped on its hull. He got no response. Daughton, 72, was frustrated but not surprised. For years, government officials had overlooked his work.

The tool Daughton was eager to share with the Navy begins at the toilet. He first proposed it 20 years ago: analyzing sewage to see what it says about public health. The field, called wastewater-based epidemiology, began in the early 2000s with researchers isolating the residues of illegal drugs to understand community-wide use. But over the last two decades, wastewater-based epidemiology expanded to look at the remains of other substances, such as pharmaceuticals and alcohol; pathogens, to identify existing and emerging infectious diseases; and substances made in the body that illuminate the overall health of a given population. The research can happen at a single wastewater treatment plant, or scale up to capture information from an estimated three-quarters of the U.S. population and roughly 25 percent of people worldwide.

Daughton and other experts believe wastewater-based epidemiology — which is fast, inexpensive, and adaptable — could help transform public health in the United States, where, according to a 2013 report by some of the leading health researchers in the country, residents have shorter life expectancy, higher rates of obesity and chronic disease, and the worst birth outcomes compared to peer countries. Sewage monitoring could help address these challenges by providing unbiased health snapshots of entire communities — regardless of access to health care or participation in testing or surveys.

In the 20 years since Daughton first published the idea, countries all over the world have made wastewater analysis a standard public health measure — and they’ve been able to use this existing infrastructure during the Covid-19 crisis. But Daughton and others feel that the U.S., which produces 34 billion gallons of wastewater daily, has yet to adequately leverage this health information to fight Covid-19 and other health challenges.

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