How does a multiday mass gathering affect the local concentration of diseases like COVID-19? And, by monitoring the wastewater, what insights could be gained and acted upon?
These are questions that Verily, an Alphabet life sciences company, set out to answer during HLTH 2024.
“We just started having some conversations about the importance of understanding what happens when you have large groups of people descend on a geography. And Vegas is a place where this happens all the time,” Amy Lockwood, Ph.D., Verily public health partnerships lead, told Fierce Healthcare in an interview during the conference. “Let's do an experiment and see if we change our testing cadence … Can we see the impact of having this group of people descend on a place?”
Verily, which works with the Centers for Disease Control and Prevention on wastewater testing, began pushing into wastewater surveillance during COVID-19. It tests for pathogens in wastewater treatment facilities nationwide with the goal of helping communities prepare for and prevent infectious diseases. Today, it tests samples from hundreds of sites across the U.S. in partnership with academic institutions like Stanford University and state and local public health departments.
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“We were responding to the pandemic,” Vindell Washington, M.D., chief clinical officer and head of the Health Equity Center of Excellence at Verily, told Fierce Healthcare in an interview on the sidelines at HLTH last month. “We had already had a biobank, we already had a testing lab … it was not on some grand business planning strategy and structure to jump in, save for the pandemic and that response.”
Having already done prior work with Las Vegas’ Clark County Water Reclamation District, a treatment agency, Verily pitched the idea of a new pilot project. They could monitor the local wastewater on a daily basis from one week before the conference to one week after to see whether there were any notable infectious disease spikes. They would test for eight different pathogens. It would work like this: The treatment agency would take representative samples of incoming sewage. It would then distribute those samples to Verily’s lab. Verily would run its analysis and report back to the Southern Nevada water authority and health department.
As part of the experimental project, Verily set up a microsite with daily sampling results and displayed QR codes in some bathrooms of the Venetian, where HLTH took place. The QR codes led to the site and helped inform the public about the project. The Verily team had not noticed anything out of the ordinary as of Oct. 21, about one day into the conference. A final report on the findings will be available in the coming weeks.
“We’re excited to have Verily at HLTH, conducting vital wastewater testing to support public health in Clark County. Their monitoring of pathogens like SARS-CoV-2 and Influenza provides real-time data that benefits both local health officials and our attendees,” Rich Scarfo, president of HLTH, told Fierce Healthcare in a statement. “This collaboration highlights how innovation can enhance community health and safety, both during HLTH and beyond."
Wastewater surveillance is not necessarily new. It has many benefits: It can capture the presence of COVID, for example, regardless of a person’s symptoms. It can be an early indicator that community infection levels are rising or falling. It does not rely on people accessing the healthcare system and can be implemented anywhere with municipal wastewater collection systems. What is newer, according to Verily executives, is it being done at scale nationally—something academia is not able to do.
For its part, the Clark County Water Reclamation District was on board to start surveillance in the early days of COVID, Deputy General Manager of Operations Dan Fisher explained. The agency’s job is to treat the local sewage and turn it back into drinking water.
“We have a connection to public health, we protect public health and the environment by reclaiming wastewater and safely discharging it back into the environment,” Fisher said. “We felt that we are kind of obligated, I would say, to go a little bit out of our way by participating. It’s not horribly difficult or onerous.”
The agency has participated in several programs over the past four and a half years, collecting more than 1,000 samples for wastewater surveillance. Going forward, Fisher expects there to be more interest in localized, targeted sampling of specific areas like airports or a sporting event like the Super Bowl. That, however, depends on specific plumbing access that varies widely. More than 2,200 miles of pipeline deliver wastewater to the treatment agency, so sampling could get tricky.
“I expect that as this evolves, there’ll be more of that reaching out into the system,” Fisher said. “It requires expertise of knowing the pipes … sometimes, we say we can’t do it, because of the way the pipes are laid out.”
But why even monitor wastewater when we can test for many common viruses today? It’s all in the timing, Washington says.
When a healthcare facility has a positive test to report, it slowly makes its way through a “maze of public health agencies.” By the time it gets there, it is long past a potential disease outbreak. That’s assuming that every sick person even goes to the doctor and gets tested. “If I could change that from a month to two days, then agencies have lots of levers to pull … Those early signals can lead to actions that can help people live better lives,” Washington said.
Wastewater surveillance is also “population equitable,” Lockwood added, given 80% of the U.S. population contributes to sewers. “As long as you are contributing to a sewer shed, you are counted.”
Editor's Note: A previous version of this story erroneously stated that Verily has a contract with the military; it does not.