To understand more about the initiative and how it is being implemented, Financial Express Online’s Bulbul Dhawan spoke to Health vertical lead of the COVIDActionCollab Dr Angela Chaudhuri.
Coronavirus second wave in India: India has been witnessing a severe second wave of Covid-19 in the country, and amid a sudden influx of cases in April, the queues for getting tests done had extended to a week at some places. Such a delay, if it happens, can cause further spreading of the virus. However, for over a year now, the tests that are being conducted require close contact of trained personnel with potentially infected persons. Therefore, a proactive testing technique that would minimise the exposure of these personnel to infected individuals was felt necessary. Now, the Karnataka government has partnered with COVIDActionCollab, which was set up during the pandemic to support various stakeholders, and together, they are hoping to identify and track the spread of COVID-19 with the help of sewage water testing and surveillance, something similar to what the UK is also doing presently.
To understand more about the initiative and how it is being implemented, Financial Express Online’s Bulbul Dhawan spoke to Health vertical lead of the COVIDActionCollab Dr Angela Chaudhuri. “Platforms such as these can support monitor the presence of various elements and not just viruses, but elements like pathogens, opioids, antimicrobial resistance, gut biome, and others of public health significance for actionable insights and can open up different research opportunities in diet pattern, pathogens, other developing diseases in a community, without the community direct participation in the research study. Data sets from sewage that can support evidence-based programming, research, product development, and other actionable insights. It has long-term and multiple public health implications and we are excited to discover them together with our partners as we move ahead,” they said.
Edited excerpts from the interaction with Shiv Kumar and Dr Angela Chaudhuri:
Where did the idea of testing sewage water for this purpose come from?
The origin of this idea lies in a Sunday cross-country conversation that I (Angela) had with my cousin in April 2020 after reading a publication from the KWR Water Research Institute. It showed how they isolated the SARS-CoV-2 virus from the sewers and concluded that people will start excreting the virus in their feces and urine before showing symptoms of COVID-19. So the idea is to use wastewater measurements as an early warning sign for a potential COVID-19 outbreak in the community. This method brings in the possibility that the SARS-CoV-2 virus can be detected in the community without engaging with any individual within that community
How will this help in tracking and identifying the spread of COVID-19?
The system acts as an early warning signal, so we can know about the presence of the virus several days before reported cases within the community. This can help the system identify and predict the key hotspots. The results cannot tell us the number of individuals currently infected with COVID-19 but it helps to track the progression of the virus in communities and inform public health strategy. Wastewater surveillance has the potential to complement population surveillance methods especially in countries and regions where there is limited capacity to test and trace.
What are the details of the collaboration between COVIDActionCollab and Govt of Karnataka?
Bruhat Bengaluru Mahanagara Palike (BBMP) partnered with Swasti to test wastewater for the presence of COVID-19 RNA in June 2020. Swasti, along with other COVIDActionCollab partners, Molecular Solutions Care Health LLP, a NABL accredited, ICMR approved COVID-19 RT-PCR laboratory; Neshaju Enterprises, and several other independent experts started testing wastewater at several sites and times. This segued into setting up a platform for the city of Bengaluru in collaboration with BBMP and the Government of Karnataka. This will be an intelligent wastewater surveillance system that can accurately predict clusters of new infections of COVID-19 that would signal hotspots, guide strategic testing, trace & prioritize vaccine demand generation, and roll-out through Wastewater-Based Epidemiology.
What is the technique that will be used for testing and surveillance?
At present, we are working on gathering samples twice a week from 45 wards in the city, after which these samples are taken to the laboratory and tested. The technology we use is the same as that is used in an RT-PCR test. We collect, transport, and process the sample before RT-PCR. However, there’s no benchmark, and innovation is involved in the process. Hence, this can not only work in cities but can also work in closed setting environments like residential university campuses, hospitality industry, hospitals, among others.
Once the testing is done, what will be the next steps to control the spread of infection?
The information from the test results needs to be matched with other clinical and population information that would then signal some insights that will help local agencies to plan the covid response appropriately. For example, if it signals the emergence of a cluster of infections then vaccination drives may be prioritized or surge capacity built for local hospitals, or testing and tracing campaigns might begin.
What all wastewater bodies would be studied under this?
Wastewater surveillance is not new, in fact, various countries have initiated and have been running surveillance on various diseases. However, most of these contexts were situated in places where more than 80% of households were covered by the municipal sewerage system. We wanted to see if wastewater surveillance was indeed possible in a country like India with high-density urban settings and in areas that had open drains post rainfall.
The Precision Health Platform in Bengaluru will be testing sewage from sewered as well as non-sewered wastewater so that clusters of new infections can be identified. If these clusters are identified early, the policymakers would be able to use this information to allocate the limited resources in a better manner to guide the COVID-19 response. This type of surveillance works best in dense urban settlements where sewers and overground canals are interlinked so both sewage treatment plants and open canals are suitable.
Are there any plans yet to take this testing to other states or at the national level?
Recognizing the gap in evidence and lack of an early warning system, and the fact the gross containment during the state-sponsored lockdown created enormous financial distress and food insecurity, the COVID Action Collaborative developed a protocol to utilize sewage water testing for COVID19 as an Early Warning System in India. This city-wide surveillance system is being implemented for the first time in Bengaluru. We are hopeful that other cities will also take this system up and accordingly, we’re in talks with some other cities currently. We believe that this system could work in cities, and maybe peri-urban cities as well.
What other steps has COVIDActionCollab taken during the pandemic?
The COVIDActionCollab (CAC) is an all-India collaborative, united to provide relief, recovery, and build resilience among the most vulnerable communities. We envision a world where vulnerable communities are empowered to survive and thrive during a humanitarian crisis. This requires that institutions, ecosystems, and individuals are adequately equipped to effectively respond to disasters. Our collaborative consists of organizations and networks working together to build community, institutional, and ecosystem capacities during this period of crisis to enable them to secure the future.
To date, our 320-partner strong collaborative has mobilized over 2,000 volunteers and mobilized $25 million in the hands of communities through social protection. Partnership is the foundation of CAC, enabling us to achieve the scale required to address the adverse impact of the pandemic. The second wave of the pandemic has taken India by storm, and by surprise. We are employing our one year’s experience at CAC and engagement with our large constituency of partners and are supporting ground-level initiatives, aimed specifically to support vulnerable communities to tide over the pandemic impacts – to their health and livelihoods.
These initiatives can be categorized into:
- Prevention and protection (packages that cater towards critical, short, and medium-term impact)
- Testing and epidemiology (Wastewater testing for early outage warning)
- Treatment and care (COVID Care centers. A support system for those with long-lasting COVID symptoms)
- Impact mitigation (Building Economic Resilience of Vulnerable Populations, Tackling COVID plastic waste crisis through a mix of value addition and advocacy solutions) among many others.
These are being addressed in a collaborative way through our partner network. We aim to achieve synergy among our partners at multiple levels to accelerate impact, in keeping with the needs of the vulnerable communities.