Although COVID-19 is still with us, it is not too early to prepare for the next pandemic. The virus, which arrived in the United States in early 2020 and has contributed to more than 1 million American deaths, can provide important lessons about identifying and addressing new threats to public health.
That is the thinking behind programs that analyze a community’s wastewater. As a supervisor for Washington’s wastewater-based epidemiology system said: “Wastewater can be used for a lot of things. It’s really exciting when you start digging into it.”
Most of us likely would not consider analyzing wastewater to be exciting; then again, we aren’t epidemiologists. But the science behind the program is interesting and can be instructive.
Before, um, digging into it, something should be pointed out – no, the government is not analyzing what flushes out of your household. An examination of wastewater cannot determine if somebody in your family has COVID or has a taste for gin or is using illicit drugs; it cannot identify specific households.
But what that analysis can do is provide a snapshot of the community. If the COVID rate is increasing or if a new variant is taking hold, wastewater studies can provide an early warning signal. Equally important, they can identify an uptick in flu viruses, other bacteria or new pathogens.
As David Hirschberg, founder of a Tacoma laboratory, told The Seattle Times: “Now we’re finding different (coronavirus) strains, but you can measure other pathogens and really look at the health of a system without invading people’s lives. Once you flush, people are like, ‘I don’t really care about that anymore.’ ”
Some scientists, however, do care. A report last month from the National Academies of Sciences, Engineering and Medicine determined that wastewater analysis in the early days of the COVID pandemic provided valuable public health information and warrants further development.
In Washington, such analyses are being conducted at 28 sites in 16 counties. For Clark County, that includes the Marine Park, Salmon Creek and Westside Sewage Treatment facilities.
“Wastewater can look for so many things — polio, respiratory infections that have an intestinal component,” Hirschberg said. “COVID is a respiratory disease, but obviously it’s in the digestive tract. We’re learning a lot about COVID, but COVID is really the poster child for a lot of other diseases that are coming our way or are already circulating.”
The state program is supported by $6.6 million in grants from the Centers for Disease Control and Prevention. Most important, it serves as a reminder of the need for investment in public health.
As research from Health Affairs found in 2021: “State spending levels on public health were not restored after cuts experienced during the Great Recession, leaving states ill equipped to respond to COVID-19 and other emerging health needs.” And as a 2016 study published by the National Library of Medicine presciently found: “Despite widespread rhetorical endorsement of prevention, public health programs have received less attention and far less funding than personal medical services.”
As individual health care spending has skyrocketed in recent decades, investment in public health has declined. When health departments are effective, they are largely invisible to the public as crises are avoided.
The COVID pandemic altered that dynamic, and it should alter how Americans think about the possibility of the next pandemic. Even if it means digging into wastewater.
