“If you enjoyed the way this pandemic worked, you can expect to have that again,” said Ted Smith, the director of the Center for Healthy Air, Water and Soil at the University of Louisville’s Environment Institute. “That’s what’s at stake here.”
State health officials and wastewater experts told POLITICO that sewage surveillance operations in some areas have grappled with privacy concerns and logistical challenges, such as figuring out how to coordinate dozens of treatment plants routinely sending in sewage samples to a handful of labs and standardizing processing protocols.
The federal government paid LuminUltra, a private commercial lab, more than $6 million to assist states that couldn’t monitor sewage on their own, but the company struggled to build trust with local operators who weren’t always aware of what the federal government was trying to accomplish.
Mark McIntosh, the vice president of applied services at LuminUltra, said the CDC would have gotten more for its money if it had relied on local labs instead of a large, national company.
“There’s a fundamental flaw in this particular strategy, and [it’s] just not sustainable,” he said.
Wastewater surveillance gained popularity during the pandemic as state and local health officials demonstrated how they could detect the coronavirus in their community’s sewage systems before residents developed symptoms. These efforts caught the attention of federal health officials at the CDC, who launched the National Wastewater Surveillance System — NWSS, pronounced “news” — in late 2020.
The hope was to build a system that could identify coming Covid case surges and detect new variants. And moving forward, it could pick out other public health threats, such as growing resistance to popular antibiotics, upticks in opioid use or the appearance of a virus that could cause the next pandemic.
But 18 months since the effort began, only a dozen states — California, Colorado, Illinois, Missouri, North Carolina, New York, Ohio, Rhode Island, Texas, Utah, Virginia and Wisconsin — are routinely submitting data to NWSS, according to the CDC. Even then, the information from some of those states is thin. California, which has 39 million people, has 23 collection sites on the CDC’s NWSS dashboard, most of them clustered in the Bay Area. More than half of New York’s nearly 60 sampling sites have no recent data on the dashboard, meaning the CDC doesn’t have at least two data points from the last 15 days to calculate a percentage change in viral concentration.
The danger for public health decision makers is assuming that a national wastewater monitoring system is fully prepped and ready — when in fact, it’s still a patchwork system that risks falling apart without sustained funding and participation, Smith said.
“If everybody imagines we’re done, that would be a misunderstanding of the situation,” he added.
CDC officials believe a wastewater surveillance system can work even if all states do not participate, noting that it is designed to supplement other public health surveillance efforts — not act as a singular watchdog.
“Having more sites sampling wastewater allows for a more robust national surveillance system, but we know that one of the biggest advantages of NWSS is that it gives local health officials specific, actionable information about what’s happening in their community so that they can take steps to protect the public’s health, if needed,” a CDC spokesperson said.
For states that weren’t interested in building their own surveillance infrastructure — or where efforts were slow — the CDC worked with a private company that would process samples for local wastewater plants free of charge, believing the data collected would demonstrate to state officials the value of monitoring their residents’ feces.
But those efforts haven’t yet persuaded all states to get on board. Some states have told the CDC they just don’t have the time or manpower to devote to the effort.
“They were busy trying to respond to the Covid pandemic, and they did not have enough bandwidth to also stand up a brand new surveillance system,” said Amy Kirby, a senior service fellow in the Waterborne Disease Prevention Branch at the CDC. “We know we’re asking a lot of them.”
The CDC, looking to entice more participation and bolster existing efforts, has awarded 37 states nearly $36 million. But of those, two dozen aren’t yet regularly reporting to the CDC.
In Idaho, the wastewater surveillance project first had to get local wastewater treatment plants on board — one community outright refused. Those working on the project then had to figure out how to get the 30 or so facilities across the state to send in samples three times a week to five labs across the Idaho Bureau of Laboratories. Those labs finally had to standardize their protocols and equipment to ensure consistency.
“I think people get frustrated at the pace at which things are happening,” said Erik Coats, professor of environmental engineering at the University of Idaho. “But it just takes some time.”
Other states have flushed plans to monitor their residents’ poop. Take, for instance, North Dakota, where the state health department is in the process of redirecting current federal grant funding for sewage surveillance after lawmakers and residents expressed concerns during the recent legislative session about wastewater data being federally reported. A health department spokesperson said not participating in the federal program would “best meet the needs of our citizens and alleviate those concerns.”
In Wyoming, a wastewater monitoring program ended when federal funding dried up in December. Even though additional funding is available to the state, a spokesperson for the state’s department of health said there has been no “firm decision” on future wastewater monitoring plans.
The backup plan — to entice these states to build long-term wastewater infrastructure by proving the value of the data — is struggling, too. Some treatment plants were wary of working with LuminUltra because they had no prior relationship with the company. Wastewater treatment plants are regulated by the Environmental Protection Agency and are “fairly sensitive to additional activity,” McIntosh said.
A CDC spokesperson said the agency is working with the Water Environment Federation and the EPA, which have relationships with wastewater facilities, and offering guidance to facilities on how to participate.
Several wastewater scientists interviewed by POLITICO said they see the value of a national wastewater system that both standardizes and makes permanent their piecemeal efforts over the last two years. Such a tool, they say, would be instrumental to protecting public health.
Yet they say it can’t be done without widespread buy-in. David Larsen, an associate professor of public health at Syracuse University who has been involved with setting up New York state’s sewage surveillance systems, said he worries there won’t be enough momentum to get a robust version of NWSS up and running if the program continues to operate on a voluntary basis. He estimated federal lawmakers need to earmark at least $100 million per year for sewage monitoring at the largest wastewater treatment sites across the country to give the program a chance at long-term success.
Without permanent funding, some wastewater scientists worry the opportunity to establish a national wastewater system will wash away.
“Let’s not waste what we’ve done,” Coats said. “We’ve built up these capacities, we’ve connected people, we’ve prioritized wastewater as an excellent indicator. Let’s not let this slide away.”