An innovative program born out of the COVID-19 pandemic gives new meaning to the old proverb, “waste not, want not.”
Wastewater surveillance, which involves analyzing human feces for indications that people have been infected with SARS-CoV-2, better known as COVID-19, has become world-shattering in a quieter way than the germ.
After nearly three years, the practice is now a vitally important means of tracking the highly infectious disease, experts say.
The science of identifying emerging bodily contamination days before people realize they’re sick is a silver lining amid the detrimental effects of the 21st-century pandemic, said Rick Johnson, laboratory manager for Colorado Springs Utilities.
“Because you produce antibodies even before you start showing symptoms, those antibodies are processed through your body, your poop, and we can pick that up through testing techniques to give us an early indication of the virus,” he said.
“The pandemic gave us an opportunity to evaluate this technique, which could help us with other illnesses and challenges we have in the community.”
The idea seems like it’s here to stay.
Federal funding is available for states to conduct COVID wastewater surveillance through 2025, said Allison Wheeler, waterborne disease unit manager in the Disease Control and Environmental Epidemiology Division of the Colorado Department of Public Health and Environment.
The agency has received $9.4 million in federal funds from January 2021 through July 2023, with extensions expected, she said.
The money covers the costs of personnel, supplies, equipment and other expenses of the surveillance program.
While other countries have routinely tested wastewater for disease for years, it’s a fledgling practice in the United States.
Colorado was one of the early adopters of the technique, Wheeler said, and among the first to launch statewide monitoring after the pandemic began.
City-owned Colorado Springs Utilities was one of 17 initial utilities’ companies along Colorado's Front Range to band together in April 2020, following the onset of COVID the prior month, with the intent of determining trends in the population of how the virus was spreading.
With supply chain shortages, it was difficult to get materials and supplies at first, Johnson remembers, but that's no longer the case.
Even with COVID waning, the virus remains actively infectious, and samples continue to be extracted two times a week from Colorado Springs’ two wastewater treatment plants, one on East Las Vegas Street and one on North Nevada Avenue.
“It’s been pretty awesome to see all these communities and utilities come together and continue to work through this,” Johnson said.
The program is voluntary, Wheeler said, and excludes septic-system users and utilities with fewer than 3,000 customers. The Centers for Disease Control and Prevention does not recommend monitoring areas with fewer than 3,000 people, to avoid possible identification of individuals, she said.
Colorado State University initially did the testing, but now state-sponsored laboratories test the majority of the samples of excrement — about the size of a roll of quarters.
The Colorado Department of Public Health and Environment, the lead authoritative agency throughout the pandemic, got involved in August 2020, as testing began to become cost prohibitive for individual utilities, and they needed assistance with funding, Wheeler said.
Each viral detection sample costs $60, she said, which does not include personnel and maintenance costs.
Over the years, the program has grown from the original 17 participant utilities to 64 of the state’s 523 permitted domestic wastewater facilities.
Higher-education campuses began testing excrement from specific dorms but some, including Colorado College, have since discontinued their involvement.
Collectively, participating utilities’ providers serve 70% of the state’s population, Wheeler said, which provides a healthy measure of what’s going on in Colorado with COVID.
The benefit has been significant to state and local public health officials, and communities overall, she said.
“The cool thing about this is that this is a community sample, so we’re able to capture data on asymptomatic and symptomatic (presence of COVID) — so we don’t have to rely on clinic testing, which people aren’t really seeking anymore,” Wheeler said.
Since many residents now use at-home COVID testing, the number of cases tracked by public health agencies no longer provides an accurate representation of the prevalence of the disease, Johnson agreed.
Thus, “the health agencies are finding the data a lot more valuable, even now,” he said.
The state public health department continues to compile surveillance results at https://www.arcgis.com/apps/dashboards/d79cf93c3938470ca4bcc4823328946b.
Researchers also are examining how utilities’ companies can watch for the presence of influenza, respiratory syncytial virus, or RSV, and other respiratory pathogens.
Experts are developing and validating testing panels, Wheeler said, with a goal of launching additional testing in the fall, as the respiratory illness season begins.
Colorado and other states reported a trifecta of respiratory illnesses beginning last fall and extending into this winter season, with the flu, RSV and COVID-19 simultaneously hitting the population, which pushed many hospitals to capacity.
Knowing what’s happening with different pathogens around the state “enables communities to prepare and take precautions,” Wheeler said.
Local health departments can alert the public and issue recommendations about social distancing, masking and vaccinations, which can be particularly important and helpful for people who are more at risk for illness, she said. The information also is helpful in determining which communities need more resources to help stop the spread, Wheeler said.
Said Johnson: “This really does have value for the future; hopefully none of us have to go through this (a pandemic) again, but at least it’s another tool we’ll have at our disposal that we didn’t have before.”
Colorado Springs Utilities plans to continue its involvement in the process, possibly even after federal funding expires, he said.
“We’ve all become virologists over the last few years, and it’s really an interesting science,” Johnson said.
