Tracking SARS-CoV-2 in Wastewater, Rolf Halden of ASU

Introduction wonderful all right well it's a great pleasure to be here and present again so the last time i presented at this conference it's three years ago we had kind of the same weather but very different circumstances in the meantime we all have acquired brand new jobs all driven by not one but two epidemics um and obviously the the last one that changed your job description is uh the stars kobe 2 covet 19 pandemic um three years ago i actually spoke about wastewater and the prospects of potentially some time in the very far away future to use this tool possibly around the world uh to measure human health and inform public health decision making and uh little did i know that so many things would change and so what i'd like to do today is to uh spend maybe a few you know 30 40 40 minutes um making a little sewage safari that will take us nationally and internationally through space and time to observe what has happened to this nation's nascent discipline and how we are using it today what its history is and also where the pressure points are the difficulties of implementing it and questions that have arisen in its more widespread use since i was presented um so for the in uninitiated What is a WBE this is how i started my talk like three years ago you might be wearing a white coat and be a medical doctor if you are then you like urine sputum stool saliva blood as diagnostic matrix matrices right to analyze and understand a patient and you can glean information even without knowing having a conversation with the patient you can just learn a lot from just analyzing those individual bio fluids and specimens from an individual patient now in a wastewater based epidemiology or wbe as we call it now we do the same so but think of an engineer who puts on a white coat and pretends to be a doctor not a pretty side but uh that is actually what was ahead has happened in um in the very recent time and so the engineer has access to the urine stool and other biofluids and excreta from hundreds of thousands of people because in the developed world we collect our sewage and we treat it centrally typically in wastewater treatment plants which is shown here so we in in principle have access to a diagnostic matrix that gives us a real-time information on the behavior consumption exposure and public health status of entire populations the big difference is that we don't know the individuals we can estimate how many there are contributing to a sample but we do not know their identity which on the one side is a down is a downside because we cannot go back and help an individual on the upside on the flip side we get information very quickly it is inexpensive it is rapid almost near real time we don't have to get any special approvals because the waste as it exits the households as soon as it arrives on the curb on you know on the ground is considered just an anonymous um fluid that can be sampled and interpreted so here's an example of how things that Example of a WBE we're interested in uh get into waste water let's think of drugs maybe prescription drugs so in the upper right corner here um we have various drugs some of them are now illegal after the election other ones might not be and then there are unknown people in a large population that consume it the chemical passes through these people and they excrete um in part the unmetabolized chemical so the what we call the parent compound let's uh let's say it's heroin or fentanyl and and they also metabolize their body as metabolizing the chemical leading to a unique ratio between the thing that they got exposed to and then what they excrete the urinary metabolite and these things arrive at a wastewater treatment plant and there we can measure them so how does this look in in reality here's a here's a few How does it work pictures of how we can get to the sample and what we do to this so on the left hand side here's an image taken in tempe i believe where sampling is taking place and people are actually sampling a what's known as a maintenance hole or manhole of the sewerage system of a city this is now happening across the united states and around the world to measure the covet 19 pandemic um the other opportunity would be to go to the wastewater treatment plant and take a sample there in the next picture we have a more sophisticated sampling strategy where we have an automatic sampler equipped with an electro electric pump that also has is connected to a tube reaching down into a sewer pipe but the sampler can take periodic samples and composite them over time for example it can flip on every 15 minutes and deposit a few milliliters of liquid into a jug and at the end of the day after 24 hours it creates what we call a 24-hour composite sample note that it's not really a true 24-hour representation of the chemistry because the sampler only switches on every about 15 minutes so it grabs you know maybe four or five minutes out of the hour but that's the sample that typically gets collected this one then comes into the laboratory ideally it's rushed if the sample is sensitive and arrives for processing so we extract the chemicals or biological agents of interest and then we feed them into sophisticated machinery for opioid analysis we use tender mass spectrometry with a liquid chromatography front end to first separate the chemicals and then identify them unambiguously in the triple quadrupole mass spectrometer for detection of viruses we target the specific rna so these are genes of the virus that are known to occur at a certain copy number so for sarskov2 the causative agent of covet 19 it's just one copy per um per genome of a virus particle and so we can extract that and feed that into a pcr polymerase chain reaction reverse transcriptive taste pcr system and count essentially count genes in the sample that we have and if we make these detections we get to a concentration of either a virus or a chemical per liter of wastewater in some situations we would like to normalize that immediately if we have a combined sewer where storm water is mixed with a domestic sewage the concentration will vary vastly during a rain event between a vein a rain event and a dry weather event and so we absolutely have to normalize for flow if we have a separate sewer system like in the you know in a lot of western um cities of the us where we have newer infrastructure then uh the need for that is not as big and we'll see trends and that's true for example for 10p but we can also measure other chemicals that we know are being consumed by people for example caffeine and uh so i got my cup here um and uh as we all consume caffeine at a certain quantity we can then normalize and estimate how much caffeine a given person is or one individual in a population is consuming we can measure the caffeine and then adjust our measurement for the number of people we estimate to be there and that then gives us a mass per capita and that's really a dose so this is the dosage of whether it's caffeine or whether it's opioids or thc from cannabis use um or even if we look at virus particles you know a certain number of virus particles per people in the in the community although we understand that not all people take drugs so we make a very simple um normalization here in terms of uh equating it to a thousand people or ten thousand per ten thousand people so this work is uh not really new so people have measured particularly illicit drugs for over 20 years um it uh started in europe and uh whoever started it never stopped i think that's a good sign so um the europeans are still measuring and they started in a few major european cities doing this once a year for about four chemicals and they're still at it they increased it to over 60 cities uh in europe and that allowed them to take a look at what types of illicit drugs are being consumed in any given metropolis across europe and so we know it worked but it didn't see a lot of other uses and my my background is in in public health so i always thought of it not just as a tool to track drug use but also as a real-time tool to get a better sense of how population health is and and whether anything that we do in terms of improving population health how we can measure those impacts of the interventions that we implement and with that we went off and Measuring sewage we found one really forward-looking city and it happened to be tempe the home of arizona state university where the biodesign institute is located where we did all our measurements all of this started in 2015 actually we laid the groundwork of doing sewage measurements back in 2015 by inviting stakeholders sitting down having conversations figuring out what is it that we want to measure who would con who will see the data and so forth and and then the opioid epidemic forced us to focus to train our mass spectrometry on opioids and that's what we did and the city of tempe became not only the first city in america to implement a strategic wastewater based epidemiology long-term monitoring program but it was also the first city and that is quite remarkable to take data from the sewer and immediately post it on a public website to share the data with everyone with all the constituents all the stakeholders so this is immediate public health information going to out to everyone and it came for something that is i think is quite um sensitive that is drug consumption and um and so what we what we learned is that this actually could be done and so we we formed a strategic partnership between asu and the city of tempe we got some funding to do this through the innovation program and off we went and started measuring and maybe i showed this here if you look at the on the left you see that there's different areas of tempe so this is millions of gallons per day this is a sewage flow and uh what you see is that we didn't just measure a wastewater treatment plant or the biggest pipe coming out of the city and then declaring that we measure an average health or consumption of behavior profile for that entire city we thought there are probably different populations in the city that are worthwhile monitoring separately and so early on we divided the city into different areas and began to measure things like um Measuring drug consumption heroin and its metabolite six acetyl morphine or fentanyl and its characteristic metabolite nor fentanyl and we did this since 2018 and immediately shared the data um this was in the middle of what we thought was kind of the worst thing that could happen to america a u.s you know opioid um epidemic that has affected many families and has robbed over 70 000 lives per year um at its peak and uh and so we were measuring this and our goal was to immediately share this type of information so again you can go on this website right now i share the links here and you feel free to contact me if you um if you would like to receive them separately um so you can go there and look at real-time information of drug consumption by city area we started with three areas and expanded it and we are now at seven tempe areas plus the town of guadalupe for the area of greater tempe alone The ultimate goal now the we have to remember the ultimate goal of this is not to find out whether drugs are in the city the key thing is to inform the stakeholders which drugs are in the city which new drugs are arriving which drugs might decline in in consumption which ones might go up and then share that information and translate it into public health interventions that improve health and limit uh substance abuse and um and that's what we did so we we met on a regular basis first in um in city hall um and then we also had off-site meetings at different locations to look at laboratories for example there's a picture taken from one of these outings and and communicated the opioid data to the decision makers that were managing opioid and substance abuse in the city of tempe while we were doing that we already thought of what is the next thing on the horizon and obviously for every year in the united states and in other places around the world there are infectious diseases that are coming um seasonally and affecting large populations taking many lives the influenza virus so the flu is one example and so we developed an interest having now developed a system for accessing wastewater strategically throughout the city and also across cities around the world and we hypothesize that we might be able to measure the flu in wastewater and inform people of how we are doing with respect to an infectious disease that is difficult to track because not everyone seeks medical health but it is known to kill tens of thousands of people every year and we started this work so we were we wanted to find some resources to do this uh the city of tempe had helped us with the opioid program but in order to convince ourselves and others that this works we thought why don't we make a cocktail and again just take my cup of coffee here and pour in sewage and biosolids so sewage sludge from across the nation to get a sense of all the different viruses that exist in the united states in wastewater in the wastewater environment so we did that we extracted rna in the dna and then we just sequenced the dna at the time and uh and looked at the information and by doing so we discovered over 3 000 new viruses that had never been observed before we of course also found many viruses that we knew existed so we knew we had something of value this was covered in nature medicine back in 2018 we wrote an application to the nih and then we got some funding NIH funding and by may of 2019 we started to build a um a nationwide prototype of infectious monitoring network and guess what in late december january we heard the first news a new virus respiratory virus being coming from asia asia and so we retrained our network and started to look at samples that we acquired from around the world and that are deposited in the human health observatory SARS coronavirus at arizona state university and so in in these samples we have the chemical and biological footprint of over a quarter billion people worldwide and so we we begin to use our uh monitoring network to focus on covet 19 and particularly cyrus cov2 which is the causative agent so how does this work we had applied it once for the opioid epidemic and it How does this work worked it is ongoing work we still appreciate this we actually built out the dashboard but uh i'd say i think it's fair to say that few people beyond tempe and maybe arizona took note of what was happening there um and so when we applied it to the pandemic obviously there was a much greater interest and and so we followed the same playbook we already had the monitoring network we already had gained the trust of the community we already had coordinated between the city and the analytical lab and we already had sliced the city if you will into different um areas and we actually increased the number of areas and started measuring the virus initially it was unclear whether the virus is even detectable because rna viruses are rather labile so they fall apart quickly and the rna decays beyond recognition and can then not be detected identified and quantified but we set this up the the information here is again available online and so the web link is shown in the upper right the city of tempe has been separated into seven different areas plus the town of guadalupe and we began monitoring in the large area right here area one which is about a hundred thousand people this is where we kind of uh um tested our technologies to see whether it's even possible to measure the virus this happened in um in early april and then by may we understood hey we can measure the virus it works and then we started to increase the areas where we monitored and we were just at the you know at a peak at the first wave of the virus hitting our state of arizona and with it the city of tempe we saw very high levels so the the axis here is a is a log plot so semi-log plot where you see concentrations rising from the detection limit of 5 000 copies of the of the gene of stars cov2 per liter of wastewater and you see that the valleys were in the millions per per liter so virus particles or gene genes per per liter of wastewater then came the lockdown a drastic measure that immediately showed impact so in essence our hypothesis of having a tool that allows us to see the impact of public health interventions seem to work right away because we saw the suppression of the levels of course what we also experienced was a great frustration a great despair depression about the inability to carry on with their normal lives and so the burden psychologically as well as economically obviously was very harsh and so while this was successful we had to open up again for the sake of the economy which becomes a political question and it's not a scientific one and so when we presented these data we knew that the data if we succeeded in this would be very powerful and potentially could be criticized for what we did with them so we took a very conservative approach i mentioned before that since we have we are in an arid area where it barely rains and since we have a separate sewer system we were able to just work with the concentration and use the concentration because we don't have to normalize it for weather events and we look at this as these data similar to uh you know the sea levels of so how high are the seas or how hot is it outside it's the physical measurement so we take a physical measurement here of the number of genes that pass through a monitoring location in the city there's little to argue about okay what you do with that information becomes a political decision but these are you know this is this is it i mean you can you know you can have discussions about whether it's hot in in in arizona but you can measure the temperature i think we have to agree on that it does get hot here and we have many 100 you know plus degrees fahrenheit days so after the lockdown was lifted we immediately saw even before cases were reported by the health agencies an increase in the virus levels again by june 19 the city of tempe ordered mandatory masks in in a lot of places and that helped to bring those levels down again and so we experienced then a period where in in a number of areas of tempe we did not detect the virus in wastewater but as soon as the fall semester started we see an uptick and we went back to concentrations that were equal to that wave that we experienced it back in the in the summer and then again we had various measures and all of these measures are tracked on the website so you can take a look and look at what has happened and then what the response is in the sewage and so eventually the levels came down again only to now spike again so we are in yet another wave i don't know uh counting waves is difficult here but i think it's fair to say it's the third time that uh you know maybe the fourth time after the initial event that things are picking up again and that's the situation we're in right now so what did we do with this data how you know who is using this so again we are still meeting with the city now remotely and uh and discussing the data and its implications let me give you one example of Example how this worked for one area the town of guadalupe in guadalupe there was very little information guadalupe is a is a township that is made up mostly of latin latino and um pascua yaki uh tribe native americans and and so the uh the household income is is lower than in other areas of of tempe and uh there's there's a limited amount of public health resources and support and a lot of these people also don't have health care so it's difficult to assess their health status when we went in and measured wastewater from guadeloupe we found very high levels of the virus in wastewater this was new information it was not known that this area was affected that harshly by by the virus and so immediately we communicated that information to the What should have happened key decision makers of the town of guadalupe and what happened what do you think what do you do if you get really bad news about your place and i think what happened here is an example of what should have happened when you are acting in the interest of public health you get that information out you share it with as many people as possible so that we can make informed decisions that's exactly what the town of guadalupe folks did they said uh oh this you know we need to help our citizens let's make these data public please post them on your website because we don't have one yet and that's the fastest way to go so they did and um and we had targeted interventions money was raised resources were redirected to the town of guadalupe and that resulted in local interventions that brought the virus level down to less than 5 000 copies of the gene per liter of wastewater from millions so a huge success indeed maybe the first example of how wastewater can be used in order to manage small clusters of infections of A huge success sars kov2 and it led to headlines locally here arizona republic uh wrote that guadalupe is slashing its covet 19 case rate by uh using by looking to wastewater and working with the data that were collected by asu and um and the town of tempe so um a great success it's still a rare success um and we get to the reason why it is still rare i think there actually is a lot of useful data around but it is difficult to share this Whats next so now we just heard about a success story what's happening next well in a way you know uh we can't take anything for granted with uh covet 19. it is a constantly evolving story where we learn more and more and uh where we also see that areas that initially had done a fantastic job of recovering think of early on it was new zealand europe italy after a very hard outbreak you know uh came back and essentially looked like it says a normal you know society again where you can do most of the things that he used to be able to do but lo and behold in europe it flared up once in new zealand they're still good i think right now but here in guadalupe we see similarly that the levels have risen again but we are keep our eye on it and so initially when we immediately when we see this we can react to it so um that's where we stand right now maybe let's discuss Key issues a few key issues that uh come with looking at wastewater um i i mentioned in the beginning that uh the type of sample you get is important so you can get a grab sample by just opening a manhole and taking out some sewage what does that mean if you're in the city of uh of tempe in area one and a giant pipe comes by and you take a little bit of water out there and measure it it gives you information on hundreds of thousands of people so if if a person is not using the restroom if only one in a hundred or a thousand people is going to the restroom at that very time when you take your sample or you know offset by the travel time then you still get a reasonable amount of people reflected in that sample however as you reduce the scale of the population you measure the chance of catching stool which contains the virus and which is the major source of this health signal becomes an unlikely event because we are not spending ideally the whole day you know on the on the toilet um and so it is it is uh important to think about the sample and i mentioned the limitation of that the automatic samplers that are deployed across the united states right now only draw a sample every once in 15 minutes maybe 10 minutes um so they get an imperfect signal and the chemistry is not necessarily in the job that is a key issue and i'd like you to think of that as you determine maybe you would want to measure a population in a building like in a school or at the university you know so it's an important issue if you detect it yes then you got lucky if you don't detect it it doesn't really mean that the virus isn't there it means that given this type of sampling whether it's grab sampling or an imperfect sampler that periodically takes grab samples that you might miss out on a lot of information so here's the next issue then the key issue and that is your observational reach if you if you Observational reach can imagine that you can reach down to the subsurface and you can pull out the sewer papaya and then you look down the sewer pipe and that's illustrated here in this in this image and and what we've known all along you have someone excreting very big signal from those from maybe just a few individuals let's say the three individuals that are shown here in red but if you look down a pipe that is connected to hundreds of thousands of people then um the the signal potentially from people that are far down the line uh might be degraded if the if the signal you're looking for is lay by if it degrades over time and that's exactly what the coronavirus does so if we had a dirty bomb attempt and somebody was mixing a plutonium in an in a household and draining it into a pipe that plutonium protectable no matter where it is released whether it is comes from 50 miles away or whether it's a building next door where it enters into the pipe but with the virus it's very different and that's also the reason why we had to go on the on the city area level in order to see this cluster of infections in the town of guadalupe when you combine all that sewage as you combine more and more a lot of the single gets lost and so we published a paper in early 2020 showing that the the amount of people that you can see is a function of two things of the ability of your um of your signal so if it degrades quickly then you know you can only see a certain amount of population before the signal disappears no matter how much is dumped into the pipe upstream and the second thing is temperature now lo and behold here in tempe we have tremendous fluctuations in temperature so that also means that there could be a modulation of a signal over time over seasons and one at the same level of virus particles detectable in one and the same location might actually mean very different things depending on what season you're in and so we explored this computationally for over 3 000 wastewater treatment plants so i think actually 13 000 across the united states and did all this modeling and we showed that that when you look through that pipe in the winter you can see a lot of people a lot of populations in the summer your vision is is impaired and a lot of the signal disappears and you can see only a little bit down the road and what this means is if we look at the population demographics we actually look at different people depending on how far we can look down the sewer pipe in other in other words our populations are not homogenously distributed and as you know that as you look into the suburbs the the demographics you know race and a lot of demographic characteristics change as you venture out from the city center and the same is true as you look at a sewage sample it is you know partially degraded it reflects um different populations at different times over the year and the third key issue and i think that's a really important one for the audience right now for for you and me and others who want to Data access influence public health decision making this one is linked to data access who can see the data who can share the data how quickly is it released and to whom is it released this is about the ownership of information that potentially can save lives or costs lives depending on how you manage it and this is this is a really important ethical question of where do we measure who gets that information in what way delivered and you know who's also who's paying for this um and uh to put everyone into a position to use public health information so it worked for guadalupe but guadalupe was an exception if you look how many places now measure viruses in or suscov2 in wastewater across the united states here's another example so this comes from an unidentified campus Campus measurements in the united states these types of campus measurements are now going on everywhere and so we had a long history of measuring campuses as well as city areas and cities across the united states so here's an example of a community that sees an increase in virus levels immediately How to use the data at the start of the semester that's you know these are very high levels so this is not on a logarithmic plot and so the you see these are very high numbers and they're going up how do you use this type of information who should have access to it and what should we do about this information important ethical questions um and there are no simple solutions obviously because the decision you make here has humongous implications economically socially on the populations you manage however i think what needs to happen in our society is that we go back and we draw kind of the distinguishing line between science and the use of scientific data and that's important particularly as we're still counting votes and you know we're in an election process we should all agree on the scientific foundation of issues there is an infectious virus the infectious virus has arrived if the numbers of the infectious virus go up that's bad let's share that information that's scientific information it's just like temperature right but what you do as you see levels rising that becomes a politician and it's fine to develop different strategies and to value things differently whether it's the economy or whether you want to maximize public health so do you want a public health expert make a recommendation of what should be done yes but it you know we have to interpret the information in the context of politics and i think what has happened in our nation unfortunately is that we now disagree about the science but there's no reason to do that because if the politician had some backbone they could just say well we understand this is the science this is where we're at what needs to happen now is that we interpret that that information and make uh political decisions on it and they those will weigh economy you know economic as well as public health outcomes and so it's not as simple as just doing the best thing that public health can do because it might completely kill your economy and might have impacts that are actually worse than um what is happening um if you um if you open up and you um accept that there are more cases but finding that that balance that's a political decision and uh luckily i have nothing to do with it we just produce the information but we surely would appreciate if we would look at the scientific data just like you do and interpret it as a reality like if you measure blood pressure you don't want to fight about that that's the reality that's the blood pressure what is causing it what should be done is a different decision the ethics of sharing data is implement is shown here so or the the issue so here you have some information on the virus counts in a community and then it is shown juxtaposed here with death cases of covet 19 deaths and so three weeks before the spike of deaths is seen you have a signal in wastewater now clearly this is very information and very important information to have and i think a case could be made that people should have access to this information because should inform their individual decision making beyond larger you know societal and political decisions but individually we also can make decisions to um to avoid becoming infected and then there's other issues also where do we measure not every community in the united states has a wastewater treatment system a centralized one so do we just ignore communities that don't have one or that don't have the money to measure it these are difficult questions these they apply around the world One Water One Health so in order to address some of these issues we have formed one water one health a non-profit entity coming out of the arizona state university foundation and its purpose is to bring wastewater-based epidemiology to communities in need that don't have the resources to pay for it maybe also don't have the educational resources to fully interpret this so we are working with these communities we're not parachuting in and dropping data we work with the communities to develop a strategy of finding out what it is that they want to measure and obviously we already mentioned the opioid epidemic we got the covet 19 epidemic but there's many other things that destabilize communities and take a great toll on public health and so these uh all these activities we do are free of charge and so all we need to know is whether the community that in the united states here or abroad is eligible to receive our services here's a map of and also a link so if you know of a community that might be in need of doing these measurements and could profit from it please let us contact us and here's and all of you the green states are the ones where we are have ongoing activities and have measured in the past as well one example is also i'd like to bring up Native Americans the native americans we already talked about one tribe that is um residing in the mostly in the town of guadalupe but the navajo nation uh also is heavily impacted by covet 19 obviously infrastructure wise it's a very different story of what we have in large cities and so we have thus far Funding raised over half a million dollars and are supporting our strategic monitoring measurements uh monitoring in for the navajo nation and other um communities so please contact us and we are very grateful for the funders that include the flynn foundation and uh kaplan and uh and others um with respect to uh getting the right sample um Getting the right sample imagine if you go to a movie theater and you there's a technical issue and you see only five to ten minutes of the feature film you could say well it was a good film you could might know it's a it's maybe it's a murder mystery or maybe it's a love story you could figure that out but depends really on what scene you see and so the samples that are being taken right now are only that they are a snapshot in time even when you use what's called a continuous sampler they don't sample continuously they just take multiple graph samples over the hour so we had way back in 2016 we have had explored this and had uh published papers and developed a device that is now being commercialized by an asu spin-off company which with which i'm also associated for full disclosure it's called aquavitas so but getting a characteristic a representative sample is very important What else is happening what else is happening now we talked about implications and applications of wastewater based epidemiology here in tempe and we measure also the city of phoenix and other communities um so um what's happening nationwide so the national science foundation is getting behind this and is funding it and so they are funding four researchers here we included coming from notre dame stanford and howard university as well as asu where we try to coordinate all these ongoing efforts that are happening now across the nation with respect to wastewater monitoring from very small scales maybe a dorm maybe a building to entire large cities like chicago or new york city and the goal here is to collect that information share it very quickly and and learn as quickly as we can if Where are we you have an interest in finding out where we're at so these sessions get recorded uh here's a link of uh how to look at the kickoff meeting where a lot of good information came actually from international collaborators all around um and the the last seminar was webinar was just today this morning and uh we have future ones coming up here's a map just and this is old now showing you how many places really have adapted wastewater based epidemiology uh i didn't know that my job description would change and you didn't know it either but i would have not for you know foretold that we would see such an explosion of wastewater-based epidemiology in such a short period of time but that's where we are and so the next webinar for the research collaboration network is november 18 so feel free to Next webinar dial in for the very latest data and uh to summarize the talk here are the milestones of what we have Milestones accomplished so far personally my group started this work in 2004 where we began to strategically acquire samples we created the human health observatory we archived everything so we can go back in time and look at how things were back in the day and how they are today we discovered an antimicrobial which i spoke about three years ago at this conference and um and so we discovered it in wastewater we showed that it exposes people we showed exposure in vulnerable populations we showed that is contaminating water around the united states and it was bad based in part on the data that we collected from waste water uh systems treatment systems and so the fda banned triple sand tried carbon and uh 17 other risky antimicrobials in addition to those two we created the world's first opioid dashboard again you know look at the link it will it gets constantly upgraded updated we created the first wastewater based monitoring network for infectious diseases and that is now being replicated around the world and we created the first dashboard for public sharing of data not just making these first measurements but actually getting that information out to as many people as possible as quickly as possible we have now a nationally coordinated network the rcn is funded by the national science foundation and the cdc has a strategic office that they now created a national wastewater surveillance system where they collect data from around the united states to understand uh where we are with respect to the science of measuring things in wastewater and with this i'd like to thank uh the many many individuals that have contributed to this uh it's it's really um it's mind-boggling how many people it takes and how many people have stepped up and worked tirelessly to make this happen and how many entities have thrown their support and dollars into this in order to make this work uh possible and to allow us to do this first which hopefully have changed and continue to change the course of the pandemic we are all immersed in and with this i'd like to stop and would be happy to answer any questions maybe while we are waiting here for the results to come in with respect to food safety it's another potential application Other questions of looking at wastewater as we know not everyone who has a food poisoning presents at the doctor's office and gets then diagnosed for whatever specifically is happening wastewater offers a very nice opportunity to uh to determine what types of food safety issues are present in the city and whether they go up or down so exactly for example we demonstrated years back that we can measure the norovirus um in in wastewater and so create a system for looking at norovirus infections are very not as deadly but very common infection i see another question coming in here regarding the sampling the sampler so um the question is whether the sampler is refrigerated the answer is it can be it doesn't need to be some samplers don't have a refrigeration unit built in so there's just ice being added either into the sampler at the bottom or around the sampler as an ice pack but you can also refrigerate it it's a really good idea to keep that sample as cool as possible particularly if you're measuring something as labile as sara's kobe 2. rolf we also have another question any plans for the tracking marijuana use after past legislation in arizona all this is already happening we are measuring so many things so we are developing methods constantly we measure over 300 different agents the issue is not right now one of resources for us so we have been applying to the nih for a long period of time to do these measurements and in the in the past they've said it's impossible well now it's possible now our priorities are not necessarily uh thc right a lot of resources right now go to kovit 19 rightly so and uh without a budget for the future years it's difficult to allocate so we're a little bit in limbo right now i i hope that we can do these measurements we have in the past you know um proposed to do that and there actually was also a pilot study conducted by by colleagues in washington state that already have demonstrated that you can measure thc metabolites and and use of cannabis in a community and personally from a public health perspective i'm very interested in learning how the legalization impacts use of course the decriminalization is good particularly if it's uh systematically you know uh targeting uh certain people in law you know by law enforcement and puts a lot of people behind bars for for something that it really is a public health issue but uh so i mean it's worrisome if you drive into a city and all you see is advertisements for drugs and you wonder well doesn't this increase the drug use and is this really a good idea that we all medicated all the time um probably not that's my opinion so uh yeah this is a good question it's feasible i encourage you to contact me particularly if you if you think you have resources either study that we can design together or if you have resources and we can do these measurements for you they can be done by the university or they can be done by a commercial laboratory for you all these options are are there i see the food borne diseases i already mentioned that we can measure uh the relative abundance of food-borne disease agents in wastewater and this is i saw in the program we have folks from the armed forces the us army we always felt that the army is a perfect place to look at populations that are under extreme stress stress hormones we also measure and that are interested in excellence performance and have to have people that are performing all the time and that are also in an envelope that puts them in into a very different risk category and there's a lot of things that we can see earlier before people present get sick and make other people sick so we have been income you know talking to folks from from different branches of the armed forces thus far uh i think we we still like to identify kind of a home run uh study like we did with with the opioids and later on with kobit 19 uh with the armed forces but just with viruses and knowing you know if you have a vessel on the oceans going to remote places there are lots of threat agents that are difficult to diagnose but we know we can do the job and we could potentially help people that could be equipment that is installed in the facility or it could be at a base well while we're waiting i mean one final comment um the the field the discipline of wastewater based epidemiology is uh doesn't have a home it doesn't have an institute of the nih nobody really owns it for engineers we are kind of tapping with it because we have to know something about epidemiology and about infectious diseases so there's multiple disciplines coming together in order for this technology to have the greatest benefit it really requires us to come together to define what we hear when certain words are being used right from ecological to others they have different meanings in the different fields of engineering of computer science of uh you know public health and and so we have to learn to find a common language and and work with our expectations too i think a lot of medical people are really turned off and if they can make a observation link observation to an individual but you know it is still useful information and even if your signal is so much fluctuating that you can't get much out of it you can't tell a trend you still have qualitative information wouldn't you want to know whether a given drug is in your city or not particularly if it's very deadly like carfentanil so we're looking for that and we find it it's an issue that we identify if we don't look for it we will never know and we might not even identify people who overdose on that drug because we don't routinely measure measure for it so it really requires multiple disciplines and an ability to to find a common language and work together to pull this off and help as many people as possible