Wastewater monitoring is an important tool for administrators, but not without ethical considerations

In this pandemic-marked era, public health officials are looking everywhere for signs that could point to disease spread, including through wastewater monitoring at local sewer systems. Wastewater surveillance is a practice that’s long been used in many countries for various different reasons—Australia, for example, has a program that tracks illicit drugs in sewage—and it’s increasingly been tapped in communities across the nation as a way to better understand the coronavirus. 

Prompted by concerns of COVID-19 spread, the Centers for Disease Control (CDC) launched the National Wastewater Surveillance System in September 2020 as a way to “coordinate and build the nation’s capacity to track the presence of SARS-CoV-2, the virus that causes COVID-19, in wastewater samples collected across the country,” according to the CDC’s website. The practice allows health workers the ability to “capture presence of SARS-CoV-2 shed by people with and without symptoms. This allows wastewater surveillance to serve as an early warning that COVID-19 is spreading in a community.”

But while sludge surveillance has become commonplace because of its effectiveness in helping public health officials identify trends and predict outbreaks, recent studies have shown that most residents might not be aware it’s happening. In a survey of more than 1,500 people published this month in the scientific journal PLOS ONE, a little more than half reported they didn’t know it was happening. Comparatively, 87 percent said they know about restaurant inspections and 76 percent said they’re aware of hotel inspections. In another study published this year in the scientific journal ACS ES&T Water of about 1,700 respondents from Louisville, Ky., only 28% indicated they knew their wastewater was being monitored. Notably, the practice is unregulated for health privacy protection.

The research is relevant because the practice is linked to a few ethical concerns, especially when it comes to monitoring sludge in smaller communities: “Wastewater contains not only a pathogen’s genetic data that allow public health officials to identify the pathogen, but also human genetic data that could potentially be misused. Additionally, communities may be stigmatized if wastewater surveillance data indicate pathogen spread or illicit drug use,” reads a brief from the U.S. Government Accountability Office. 

Given the implications and the fact that there aren’t many regulations around wastewater monitoring because it’s relatively novel widespread, an abstract from the Louisville study stresses the important role local utility administrators play in protecting and educating their constituents. 

“The majority of sewer systems in the United States and other countries are operated by public utilities,” the abstract notes. “In the absence of any regulation, the public perception of wastewater monitoring for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose.”

Meanwhile, the federal government is making investments to research wastewater monitoring ahead of future outbreaks. Earlier this month, for example, the U.S. Environmental Protection Agency (EPA) announced $1,000,000 in grant funding for the University of Illinois Urbana-Champaign to research improving wastewater monitoring to rapidly detect the emergence and spread of infectious disease in the current COVID-19 pandemic, and to detect other pathogens that could cause future pandemics. Beyond COVID-19, researchers are confident wastewater monitoring will be able to detect a slew of pathogens, from the annual flu to more obscure population-level outbreaks like Ebola or the Zika virus.

“As research by EPA and others have demonstrated during the COVID-19 pandemic, wastewater monitoring is an invaluable approach for detecting and tracking infectious disease and ultimately protecting public health,” said Chris Frey, assistant administrator of the EPA’s Office of Research and Development in a statement. “This forward-looking EPA research grant will improve understanding of the presence of disease-causing pathogens in U.S. communities and support public health officials as they make decisions during pandemics.”