A change is brewing in the public health world about wastewater. And there’s a lot of misinformation circulating. Here’s what’s going on. First, setting the playing field. It’s not an understatement to say that wastewater surveillance has transformed public health. (See my
I knew this was coming, but thanks for the additional information. In a perfect world, I’d like to see several systems collecting non-overlapping data, allowing comparison and correlation.
Or they could market to other customers besides the government. An interesting use case would be using wastewater data for what's called parametric insurance, where instead of indemnifying losses, the policyholder simply gets money if an agreed upon index goes over a certain threshold. That money could be used to pay for more boosters, antivirals, masks, air purifiers, additional sick days, whatever - basically any "response" with an associated cost.
I'm quite certain this is already being explored, but it's probably a trade secret. I'm OK with that.
I work at a POTW sending in samples. I only have direct experience with Verily; they send a small stipend per sample in addition to paying for shipping. That allows us to donate the staff time to collect samples. It’s been working well and the WW SCAN website has some helpful data visualization tools.
This is a great post and very informative. Seems sometimes wastewater data is all we have left. I agree the CDC site is a bit tricky, but the link you provide shows a page where users only have to scroll down to find the place to choose their state and county. In my part of NY state the numbers seems to show a rapid and huge spike coinciding with school and college starting up again in person...
Hugely timely and welcome! I do have two questions for you, Dr. Jetelina: it appears that no wastewater samples are being collected in all of NYC. As a result, neither biobot nor CDC (nor NYS or NYC) are displaying any wastewater for NYC. Two questions: Do we know why that is, and when we can expect data to start being collected again? Also, while I have been using Nassau County as a proxy (which is what biobot has been doing all along), I am concerned that it is not altogether reliable as an indicator for NYC, for reasons such as higher density in NYC, generally, and much higher use of public transportation, and that any discrepancies will be exacerbated during the holiday season. As an older person, I had hoped to use wastewater data to help me assess how to handle unmasked holiday gatherings. Any insights you have on this will be much appreciated.
PS, very glad indeed to see CDC is including you on its wastewater team. This gives me profound hope for much more public-friendly wastewater data information!
Personally I feel like there's enough mixing between regions at this point that it probably doesn't matter much where one is, as far as *personal* risk assessment is concerned. I don't really see a role for wastewater determining my own individual actions.
Asking people to test before unmasked gatherings seems like a pretty reasonable stance for the foreseeable future, regardless of ambient conditions; my own personal slogan for discretionary social gatherings is "Mask when asked, test on request" - cheerfully and without hesitation. The only awkward issue with that is "Who pays?", now that these things aren't paid for by governments any more. I think that might vary by context and power dynamic. It's kind of like a game of chicken, where it depends on who wants the gathering to occur, and who's OK with punting it altogether. If I *want* to attend, I'll pay for the test, and if I don't much care to attend, I'll try to get the other person to pay (I'm using the word "pay" in the broad sense; if I have to raid my inventory of rapid tests, that's still incurring an expense)
As for population density in NYC, my understanding is that the risk has less to do with people per square mile, as it does with "people per household". I live in a rent stabilized one bedroom apartment in Brooklyn, and managed to dodge Covid until four weeks ago (all better now thanks to Paxlovid!).
I’m glad you are recovered. After staying Covid free since the beginning of the pandemic, we had a nasty bout last holiday season, from a small gathering of people in their 70s and 80s. It was the very first such gathering we had tried. To our knowledge, everyone had tested, but it turned the person who infected us all had tested before she went to a large unmasked indoor gathering and didn’t test again before our gathering. Oopsy daisy, everyone present got Covid.
If the person who you think infected you went to the “large unmasked indoor gathering” on the same day you saw her, it’s highly unlikely she was contagious when you saw her. Meaning she’s probably not the one who infected everyone.
If her large gathering was 2-4 days earlier than your event, well, she should have tested the day of your event before coming over.
It’s not clear from your post how much time lapsed between the large and small gatherings, but people aren’t likely to be infectious a mere few hours after exposure.
Understood. No, it was not the same day--and I agree with you, on the timing issue. (After all, we are all here students of Dr. Jetelina, so we have far better info than most, for which we are grateful, eh?) Indeed, after this incident, I sent everyone Dr. Jetelina's guidelines for testing, so they'd know what to do going forward. It was actually pretty well received, which I was glad to see. It's always a bit fraught to do that sort of thing.
Yeah, although I do think you need to give people space to have their own narrative truth about how they got it. I have mine, knowing full well that it's utter hogwash (I'm still going to choose to believe Susan's story, as a matter of decency, even if mine is garbage. That's just how it has to be)
As you'll see from the above, I didn't just decide she was the infector. It was based on a number of variables, notably the timing of her event v. that of our gathering, and the sequencing of who got sick when, among other things. Of course, nothing is certain, but our friend recognizes she is the likely culprit, and she's been a champ about testing ever since.
I think the truth, to the extent known, should always take priority over a good story. Indeed, I don't think the story is all that good if it's not based on evidence. We know evidence can be faulty too, but one does the best one can to arrive at the truth, and adjusts when new facts come to light.
Dr. Jetelina, I've been following you since COVID began; thank you for another important post! I would point out, though, that when you say "It’s not an understatement to say that wastewater surveillance has transformed public health", you really mean it's not an OVERSTATEMENT: its importance can't be stressed too much. Thank you!
An assessment of target virion level requires a denominator, such as volume of wastewater, mass of solids, or count of a more ubiquitous and stable virus that itself correlates well with catchment population/volume. Dr Jetelina, would you mind describing how different wastewater labs differ on their denominators, and the merits of each?
I concur. Looking at the downloaded CDC data for my little hole-in-the-wall treatment plant indicates approximately 10e7 copies (of what?) but does not indicate the volume. In the Biobot graphic Dr. Jetelina offered the y-values were in the 10e3 range/mL. Can one assume that the raw data values in the CDC table are per liter? Simply adding a "/L" would clarify this and require minimal effort. Sigh, will it ever happen?
I feel like we're just going to have to be patient and accept that the field is still in its infancy, and not assume that these hiccups are the result of incompetence or malice, just growing pains.
Dr. Jetelina, I respectfully and energetically disagree with your assessment of the relative merits of Biobot and Verily to serve as the CDC’s data source. Verily’s data presentation (data.wastewaterscan.org) is lightyears more useful, up-to-date, fine-grained, and intelligently presented than Biobot’s. I am an ordinary citizen who closely tracks these results every week, in order to advise choral organizations about Covid safety policies (especially antigen testing and masking) according to the current prevalence of disease in the community. Choirs making use of such help have managed to escape the major outbreaks that threatened performances in other organizations, while optimizing their opportunities to safely sing unmasked. Have a look at Verily’s tools and graphic presentation: crystal clear, offering county-specific data that is 48-hours fresh. I do happen to live in the SF Bay Area, which Verily covers comprehensively, but I’ve had occasion to turn to Biobot for information in geographic areas that Verily doesn’t serve: the contrast is dramatic. For one, Biobot’s graphs are presented on a such a tiny scale that it’s very difficult to decipher even month-to-month trends, much less week-to-week. On a national level, the CDC’s Biobot-based wastewater graphics are completely unintelligible. From a more technical perspective, Verily’s and Biobot’s testing protocols differ significantly. It’s not at all clear that Biobot has made the better choices.
Agreed. When I go to Verily's home page the first thing I see is their assessment of the current risk level, at the closest location to me - about 20 miles. There's sufficient mixing within a 20 mile radius, so that's good enough. People poop at home, but travel and breathe all over the place.
Just dropping in to mention that there's nothing nefarious or untoward about the government switching contractors. We WANT competitive bidding, the same way we want free and fair elections and meritocratic civil service. Seeing it happen in real time can be a little jarring and stressful, but on the whole, it's a good thing.
Ok so it looks like the nearest site is Millbury MA. That's not so bad - a two hour drive. There's enough mixing between upstate NY and central/western MA (Alan Chartok commuted from Great Barrington after all), so that should do.
How good are covid tests now anyway? Again and again people say they are sick and don't have covid and then someone in the house tests positive while the others stay negative.
It seems unlikely to me that house after house has ill people with different illnesses.
With new strains, or infections after vaccination, or second or third infections, are people testing negative with OTC tests who have covid? Are tests expiring?
Most of the cases I’ve seen where people fell ill because of household exposure to others with known Covid, and yet tested negative, happened because they hadn’t taken their tests at the right time to get an accurate result. Home antigen tests are only 60-80% sensitive under the best of conditions. Bear in mind that it typically takes about 3- 5 days after exposure before a person begins to have symptoms; and then the test might not turn positive until those symptoms had been present for 5 days. I’d consider it reasonable evidence against Covid only if two tests taken 48 hours apart, no sooner than day 5 of symptoms, are both negative. You can improve the
...continuing my response: you can improve antigen test sensitivity considerably by swabbing the throat AND the nose: swab the throat first, for the duration of time recommended in the package insert for nasal swabbing, and then use the same swab in each nostril, again for the recommended duration. Then proceed as usual.
I’m an internist/intensive care specialist. As a singer, I have an especially keen interest in Covid safety for choirs. And being retired, I’ve had plenty of time to keep up with the scientific literature and take deep dives into related subjects, becoming a volunteer consultant to several choirs in the SF Bay Area along the way.
I'm glad that the difference inaccuracy is minimal. I'm also glad that the very American habit of unfettered, even rough, competition is at work in this.
That said, I'm awed by the short, skinny, bespactacled old man who will stand in line at a hamburger stand in Seattle, is still quietly advancing science in so very many fields. There is hope for my grandkids' world.
I knew this was coming, but thanks for the additional information. In a perfect world, I’d like to see several systems collecting non-overlapping data, allowing comparison and correlation.
Does this mean that Google can now target Paxlovid online ads by geography with even more precision?
Maybe they should be paying the CDC and not the other way around!
Or they could market to other customers besides the government. An interesting use case would be using wastewater data for what's called parametric insurance, where instead of indemnifying losses, the policyholder simply gets money if an agreed upon index goes over a certain threshold. That money could be used to pay for more boosters, antivirals, masks, air purifiers, additional sick days, whatever - basically any "response" with an associated cost.
I'm quite certain this is already being explored, but it's probably a trade secret. I'm OK with that.
I work at a POTW sending in samples. I only have direct experience with Verily; they send a small stipend per sample in addition to paying for shipping. That allows us to donate the staff time to collect samples. It’s been working well and the WW SCAN website has some helpful data visualization tools.
This is a great post and very informative. Seems sometimes wastewater data is all we have left. I agree the CDC site is a bit tricky, but the link you provide shows a page where users only have to scroll down to find the place to choose their state and county. In my part of NY state the numbers seems to show a rapid and huge spike coinciding with school and college starting up again in person...
If you don’t mind saying, where in NYS are you located?
Hugely timely and welcome! I do have two questions for you, Dr. Jetelina: it appears that no wastewater samples are being collected in all of NYC. As a result, neither biobot nor CDC (nor NYS or NYC) are displaying any wastewater for NYC. Two questions: Do we know why that is, and when we can expect data to start being collected again? Also, while I have been using Nassau County as a proxy (which is what biobot has been doing all along), I am concerned that it is not altogether reliable as an indicator for NYC, for reasons such as higher density in NYC, generally, and much higher use of public transportation, and that any discrepancies will be exacerbated during the holiday season. As an older person, I had hoped to use wastewater data to help me assess how to handle unmasked holiday gatherings. Any insights you have on this will be much appreciated.
PS, very glad indeed to see CDC is including you on its wastewater team. This gives me profound hope for much more public-friendly wastewater data information!
It's truly appalling
Personally I feel like there's enough mixing between regions at this point that it probably doesn't matter much where one is, as far as *personal* risk assessment is concerned. I don't really see a role for wastewater determining my own individual actions.
Asking people to test before unmasked gatherings seems like a pretty reasonable stance for the foreseeable future, regardless of ambient conditions; my own personal slogan for discretionary social gatherings is "Mask when asked, test on request" - cheerfully and without hesitation. The only awkward issue with that is "Who pays?", now that these things aren't paid for by governments any more. I think that might vary by context and power dynamic. It's kind of like a game of chicken, where it depends on who wants the gathering to occur, and who's OK with punting it altogether. If I *want* to attend, I'll pay for the test, and if I don't much care to attend, I'll try to get the other person to pay (I'm using the word "pay" in the broad sense; if I have to raid my inventory of rapid tests, that's still incurring an expense)
As for population density in NYC, my understanding is that the risk has less to do with people per square mile, as it does with "people per household". I live in a rent stabilized one bedroom apartment in Brooklyn, and managed to dodge Covid until four weeks ago (all better now thanks to Paxlovid!).
I’m glad you are recovered. After staying Covid free since the beginning of the pandemic, we had a nasty bout last holiday season, from a small gathering of people in their 70s and 80s. It was the very first such gathering we had tried. To our knowledge, everyone had tested, but it turned the person who infected us all had tested before she went to a large unmasked indoor gathering and didn’t test again before our gathering. Oopsy daisy, everyone present got Covid.
If the person who you think infected you went to the “large unmasked indoor gathering” on the same day you saw her, it’s highly unlikely she was contagious when you saw her. Meaning she’s probably not the one who infected everyone.
If her large gathering was 2-4 days earlier than your event, well, she should have tested the day of your event before coming over.
It’s not clear from your post how much time lapsed between the large and small gatherings, but people aren’t likely to be infectious a mere few hours after exposure.
Understood. No, it was not the same day--and I agree with you, on the timing issue. (After all, we are all here students of Dr. Jetelina, so we have far better info than most, for which we are grateful, eh?) Indeed, after this incident, I sent everyone Dr. Jetelina's guidelines for testing, so they'd know what to do going forward. It was actually pretty well received, which I was glad to see. It's always a bit fraught to do that sort of thing.
Yeah, although I do think you need to give people space to have their own narrative truth about how they got it. I have mine, knowing full well that it's utter hogwash (I'm still going to choose to believe Susan's story, as a matter of decency, even if mine is garbage. That's just how it has to be)
As you'll see from the above, I didn't just decide she was the infector. It was based on a number of variables, notably the timing of her event v. that of our gathering, and the sequencing of who got sick when, among other things. Of course, nothing is certain, but our friend recognizes she is the likely culprit, and she's been a champ about testing ever since.
Don’t let the truth get in the way of a good story 😉
I think the truth, to the extent known, should always take priority over a good story. Indeed, I don't think the story is all that good if it's not based on evidence. We know evidence can be faulty too, but one does the best one can to arrive at the truth, and adjusts when new facts come to light.
I feel like for relatively inconsequential personal stories it's pretty much a wash.
Dr. Jetelina, I've been following you since COVID began; thank you for another important post! I would point out, though, that when you say "It’s not an understatement to say that wastewater surveillance has transformed public health", you really mean it's not an OVERSTATEMENT: its importance can't be stressed too much. Thank you!
An assessment of target virion level requires a denominator, such as volume of wastewater, mass of solids, or count of a more ubiquitous and stable virus that itself correlates well with catchment population/volume. Dr Jetelina, would you mind describing how different wastewater labs differ on their denominators, and the merits of each?
Here’s a start — a nice article explaining the importance of “normalization” to get meaningful measurements of viral prevalence:
https://biobot.io/wp-content/uploads/2022/02/2022-01-White-paper-Effective-concentration.pdf
I concur. Looking at the downloaded CDC data for my little hole-in-the-wall treatment plant indicates approximately 10e7 copies (of what?) but does not indicate the volume. In the Biobot graphic Dr. Jetelina offered the y-values were in the 10e3 range/mL. Can one assume that the raw data values in the CDC table are per liter? Simply adding a "/L" would clarify this and require minimal effort. Sigh, will it ever happen?
I feel like we're just going to have to be patient and accept that the field is still in its infancy, and not assume that these hiccups are the result of incompetence or malice, just growing pains.
Dr. Jetelina, I respectfully and energetically disagree with your assessment of the relative merits of Biobot and Verily to serve as the CDC’s data source. Verily’s data presentation (data.wastewaterscan.org) is lightyears more useful, up-to-date, fine-grained, and intelligently presented than Biobot’s. I am an ordinary citizen who closely tracks these results every week, in order to advise choral organizations about Covid safety policies (especially antigen testing and masking) according to the current prevalence of disease in the community. Choirs making use of such help have managed to escape the major outbreaks that threatened performances in other organizations, while optimizing their opportunities to safely sing unmasked. Have a look at Verily’s tools and graphic presentation: crystal clear, offering county-specific data that is 48-hours fresh. I do happen to live in the SF Bay Area, which Verily covers comprehensively, but I’ve had occasion to turn to Biobot for information in geographic areas that Verily doesn’t serve: the contrast is dramatic. For one, Biobot’s graphs are presented on a such a tiny scale that it’s very difficult to decipher even month-to-month trends, much less week-to-week. On a national level, the CDC’s Biobot-based wastewater graphics are completely unintelligible. From a more technical perspective, Verily’s and Biobot’s testing protocols differ significantly. It’s not at all clear that Biobot has made the better choices.
Agreed. When I go to Verily's home page the first thing I see is their assessment of the current risk level, at the closest location to me - about 20 miles. There's sufficient mixing within a 20 mile radius, so that's good enough. People poop at home, but travel and breathe all over the place.
Just dropping in to mention that there's nothing nefarious or untoward about the government switching contractors. We WANT competitive bidding, the same way we want free and fair elections and meritocratic civil service. Seeing it happen in real time can be a little jarring and stressful, but on the whole, it's a good thing.
Rennselaer County
Ok so it looks like the nearest site is Millbury MA. That's not so bad - a two hour drive. There's enough mixing between upstate NY and central/western MA (Alan Chartok commuted from Great Barrington after all), so that should do.
How good are covid tests now anyway? Again and again people say they are sick and don't have covid and then someone in the house tests positive while the others stay negative.
It seems unlikely to me that house after house has ill people with different illnesses.
With new strains, or infections after vaccination, or second or third infections, are people testing negative with OTC tests who have covid? Are tests expiring?
Most of the cases I’ve seen where people fell ill because of household exposure to others with known Covid, and yet tested negative, happened because they hadn’t taken their tests at the right time to get an accurate result. Home antigen tests are only 60-80% sensitive under the best of conditions. Bear in mind that it typically takes about 3- 5 days after exposure before a person begins to have symptoms; and then the test might not turn positive until those symptoms had been present for 5 days. I’d consider it reasonable evidence against Covid only if two tests taken 48 hours apart, no sooner than day 5 of symptoms, are both negative. You can improve the
...continuing my response: you can improve antigen test sensitivity considerably by swabbing the throat AND the nose: swab the throat first, for the duration of time recommended in the package insert for nasal swabbing, and then use the same swab in each nostril, again for the recommended duration. Then proceed as usual.
Thank you - this seems right to me.
And may I ask what your professional context is?
I’m an internist/intensive care specialist. As a singer, I have an especially keen interest in Covid safety for choirs. And being retired, I’ve had plenty of time to keep up with the scientific literature and take deep dives into related subjects, becoming a volunteer consultant to several choirs in the SF Bay Area along the way.
I wish it was easier to find information in those links. :(
I'm glad that the difference inaccuracy is minimal. I'm also glad that the very American habit of unfettered, even rough, competition is at work in this.
That said, I'm awed by the short, skinny, bespactacled old man who will stand in line at a hamburger stand in Seattle, is still quietly advancing science in so very many fields. There is hope for my grandkids' world.