Gershteyn Mikhail L., Gershteyn Arkady*, Gershteyn Iosif M., Ezrokhi Michael : другие произведения.

Regular residential wastewater monitoring to locate emerging disease hotspots prior to onset of clinical symptoms during pandemics including Covid-19

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    In order to more effectively combat the coronavirus pandemic the authors propose a system for daily analysis of residential wastewater at points of discharge from buildings. Results of testing should be used for the implementation of local quarantines as well as informed administration of tests for individuals.
  Regular residential wastewater monitoring to locate emerging disease hotspots prior to onset of
  clinical symptoms during pandemics including COVID-19
  
  Mikhail L. Gershteyn, Arkady Gershteyn*, Iosif M. Gershteyn, Michael Ezrokhi, Ph.D.
  
  
  Abstract
  
  In order to more effectively combat the coronavirus pandemic the authors propose a system for daily
  analysis of residential wastewater at points of discharge from buildings. Results of testing should be
  used for the implementation of local quarantines as well as informed administration of tests for
  individuals.
  
  
  Background
  
  Large-scale quarantines are considered by many to be an effective tool in the arsenal of interventions
  combating the Coronavirus, however, such measures come at great cost both financially and
  psychologically to the affected populations. Moreover, as the duration of large-scale quarantine efforts
  increase so do the costs, often exponentially, as well as the second order effects thereof (including access
  to routine and emergency healthcare).
  
  Administratively, the challenge of large-scale quarantines is also great. Without enforcement
  mechanisms, human movement restrictions may often be violated, which compounds the problem of
  coordinating enforcement resources (police and military personnel) at a time when resources are often
  thinly allocated as is. Absent enforcement the efficacy of quarantines can be severely impaired.
  
  Local quarantines, however, simplify the administration of such measures by directing enforcement to
  areas where there is high prevalence, and can be specified on a house-by-house basis and would allow for
  individuals to adjust their behavior based on informed local risk. Furthermore, local quarantines do not
  harm the economy nearly to the same extent and allow for mostly undisturbed continuation of vital
  systems and infrastructure within a nation. The combination thereof could be both better at containing
  the spread and mitigating the impact.
  
  Moreover, infected individuals shed the viral particles before the onset of clinical symptoms
  (https://www.nature.com/articles/s41591-020-0869-5) thus unknowingly infecting healthy individuals
  around them. COVID-19 particles were detected in feces and sputum of infected individuals
  (https://jamanetwork.com/journals/jama/fullarticle/2762997). Monitoring sewer effluent makes it
  possible to detect the infection before the manifestation of clinical symptoms, making it possible to alert,
  proactively arrange for medical care and quarantine the infected individuals.
  
  
  Proposal
  
  The mechanism of informing the affected households, neighborhoods, towns or cities as well as making
  decisions about localized quarantine measures requires a fast and effective early detection system,
  preferably capable of detecting the infection before the manifestation of clinical symptoms. The early
  detection system should have the following components:
  A) Daily (ideally) collection of wastewater samples at points of discharge from residential buildings.
  B) Testing of wastewater samples to identify presence/absence of virus in the sewer effluent from
  individual buildings or a cluster of buildings (1).
  C) Individual testing of residents of building(s) that test positive.
  
  Such a system would detect the appearance of pathogens in a locale earlier than the onset of symptoms
  in the case of COVID-19, which has a median incubation time of between two and fourteen days.
  Moreover, given the large proportion of asymptomatic carriers of Coronavirus (notably children), this
  system could provide the tools to prevent waves of infection via early quarantine of asymptomatic
  carriers.
  
  Given that present tests can detect the evidence of viral presence in saliva and feces, we can safely assert
  that if such a system was implemented it could lead to testing of individuals that otherwise would not be
  captured via conventional approaches. There is indirect confirmation from the Netherlands (2) where
  wastewater analysis confirmed introduction of the virus to the locale prior to clinically diagnosed cases.
  Wastewater analysis has now been recognized as a valuable indicator of population prevalence of
   infections by groups in the Netherlands, UK and US (2,3,4,5).
  
  Developing an inexpensive and scalable system of wastewater analysis is crucial both to intelligently
  designing the next quarantine effort and in bolstering long term national security via public health
  infrastructure. The automation of sample collection, delivery, and analysis can take advantage of
  presently built sewage infrastructure via piggybacking pneumatic mail routes or other means. The
  legislative ramifications regarding privacy rights are not lost on the authors, however they might be
  overcome with digital anonymization and potential opt-out procedures.
  
   References
  
  (1) Robert Dorfman (December 1943), "The Detection of Defective Members of Large Populations",
   The Annals of Mathematical Statistics, 14 (4): 436-440, doi:10.1214/aoms/1177731363, JSTOR 2235930
  
  (2) Gertjan Medema, Leo Heijnen, Goffe Elsinga, Ronald Italiaander, Anke Brouwer
  'Presence of SARS-Coronavirus-2 in sewage'; doi:
  ://doi.org/10.1101/2020.03.29.20045880
  ://news.umich.edu/a-sewage-surveillance-effort-to-track-covid-19/
  
  (3) Kang Mao, Hua Zhang*, Zhugen Yang*
  'Can a Paper-Based Device Trace COVID-19 Sources with Wastewater-Based Epidemiology?'
  . Sci.Technol. 2020, 54, 7, 3733-3735; Publication Date: March 23, 2020
  ://doi.org/10.1021/acs.est.0c01174
  
  (4) Krista Rule Wigginton, Alexandria Boehm 'A sewage surveillance effort to track COVID-19'.
  ://news.umich.edu/a-sewage-surveillance-effort-to-track-covid-19/
  
  (5) Fuqing Wu, Amy Xiao, Jianbo Zhang, Xiaoqiong Gu, Wei Lin Lee, Kathryn Kauffman, William Hanage,
  Mariana Matus, Newsha Ghaeli, Noriko Endo, Claire Duvallet, Katya Moniz, Timothy Erickson, Peter Chai,
  Janelle Thompson, Eric Alm 'SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases.';
   doi: https://doi.org/10.1101/2020.04.05.20051540
  ://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1
  
  *Corresponding author, e-mail: ArkadyGer@gmail.com
  Link to PDF on RESEARCHES.ONE :
  ://www.researchers.one/media/documents/295-m-MGAGIMGME-April2020.pdf
   Cite as:
  Mikhail Gershteyn and Arkady Gershteyn and Iosif Gershteyn and Michael Ezrokhi (2020).
  Regular residential wastewater monitoring to locate emerging disease hotspots prior to onset of clinical symptoms during pandemics including COVID-19.
  RESEARCHERS.ONE, https://www.researchers.one/article/2020-04-13.
  
  
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