COVID in Wastewater: How Data from Sewer Assets Enhanced the UK's Response to the Pandemic Threat and Enables Completely New Public Health Services

This abstract gives a brief insight on how the concept of Wastewater Based Epidemiology (WBE) is being made a reality in the UK as part of the HMG response to the COVID19 pandemic. It describes Atkins role in projects coordinated by the UK government and focusses particularly on the role of data and digital twins within operating models for the delivery of entirely new public health services in future. Early in the pandemic it was established that RNA fragments of SARS-COV2 virus can be detected in wastewater and are present roughly in proportion to the prevalence of Covid in the connected population. They are faecally shed and may be detected several days ahead of Covid symptoms emerging and so can give advance warning before people report sickness or present for testing. This opened a potential additional layer of surveillance to support the clinical tests used in tracking and tracing of the infection and in planning social measures for pandemic control. The UK Government Joint Biosecurity Centre initiated a programme of piloting WBE across 80% of the UK population and in early 2021 set up an agile programme to accelerate the development of the science, technology, services and operational models required to establish a robust national WBE capability for management of Covid and then in the longer term for other health, security and environmental threats, this will be an important tool in the transition from pandemic to living with endemic Covid and beyond. Problems and Objectives The threat posed by the COVID19 Epidemic is critical and the measures to address it are extremely costly, intrusive and disruptive to the normal functioning of society. Huge effort has been invested in finding ways of managing the threat through the 4 pillars of: medical services and therapies; testing and surveillance of the spread of infection; public health and social control measures; and vaccination. Successful policies and measures in each of these have been based on nurturing and following the rapidly advancing science, developing new technologies and enacting public information strategies. Successes have followed where confidence and trust has been built in the data, the science, the technologies and the decisions that followed those and been implemented in a systematic and organised manner. When there is doubt, uncertainty and unclear strategies then societies do not heed advice or take action and the virus can find opportunities to spread further and cause greater death and injury. The problem is that there never is full and complete data, technologies are always works-in-progress and public information messages are hard to make comprehensible to all and protected from disinformation. WBE is a potential tool for the management of the Covid epidemic and can also provide information on other health, security and environmental threats such as antibiotic resistant bacteria, other viral and microbiological diseases, use of pharmaceuticals in the population, presence of traces of explosives and environmentally hazardous chemicals. Genomic analysis of DNA in the wastewater can also potentially provide information about the population and vulnerabilities to specific health threats. The urgency of the Covid pandemic is driving the development of the technology for this now, but in the longer term WBE can emerge as a much wider field. To realise its full potential, WBE needs to be deployed in a credible, reliable, and workable manner; whereby the appropriate activities, assets, organisational structures, and incentives are in place. Approach A WBE capability needs to be built from the ground up. Though there are technologies and organisations in place that can be built on, the requirements are different and all need to be adapted and developed to become fit for purpose to meeting the service need. WBE can be broadly divided into: - Strategic monitoring at WWTW and selected points in the network to cover the general population. - Tactical monitoring to monitor specific sites such as Universities, schools, prisons, critical infrastructure facilities, commercial offices or production facilities. - Reactive, to trace an outbreak upstream in response to an alert. The WBE service needs to be built in stages from collecting a suitable sample from the right spot to analysing it and providing credible data to inform decision makers through appropriate digital systems and organisational structures. In more detail these stages: - Planning of sampling — need to identify suitable locations for sampling, with the right flow conditions, accessibility and coverage of a population accounting for the rate at which the RNA fragments decay in sewers. - Collection of samples — requires advances on simple grab samples or periodic autosampler composites to develop equipment and a sampling regime to collect representative RNA for a high proportion of the faecal shedding events that occurred upstream. Equipment must be suited to harsh sewer environment and the WBE service requirement — 'the right tool for the right stool'. - Analysis of samples — need to rapidly prepare the sample for the analysis process and complete in a laboratory or in the field in an automated sample handling and analysis system. - Reporting of results — need effective data management and visualisation to control quality and normalise the data in order to extract and present the maximum useful information to decisionmakers and to the public through dashboarding systems. - Target Operating Model — need the arrangements of government departments with the wastewater asset owners, private sector contractors and WBE service users to be set out agreed with stakeholders and implemented. A coordinated effort between scientists, asset managers, data managers and service providers is required to develop and deliver WBE services. Those WBE services can support other public health measures — in few cases would they replace them. All public health measures have limits to their efficacy and the design of the service offerings need to understand the level of confidence and resolution that is achievable for a given level of effort and investment. For example: monitoring the wastewater from a university campus can alert the facilities managers of the level of presence of Covid on site and support decisions to relax or increase clinical swab testing of students and staff and restrictions on movements. Designing the WBE system requires the plotting of user stories for each stage that needs to be developed, then engaging industry to further develop those user stories and develop the equipment, digital tools and service offerings to meet those needs. In parallel research in universities needs to be supported to address some of the basic unknowns about viral behaviour in sewer systems, sample collection, handling, and analysis methods. Particularly challenging is getting the universities undertake and deliver results in the 3 month time frames of agile development sprints. Outcomes and Benefits Atkins, along with others in supply consortia, have been engaged in the UK Government next generation COVID in wastewater programme to help develop and deliver advanced WBE capability. Specifically, we undertook the discovery on how to engage with the water companies that own the sewer assets and data. We went on to develop a Minimal Viable Product (MVP) of the 'SewerSafe' application that supports strategic WBE with planning where to sample to cover the population, based on understanding of viral behaviour in the sewers and the suitability of the site for different samplers and to provide the information necessary to normalise the results of analysis based on flow and population. We partnered with equipment manufacturers and researchers to develop specifications and prototypes for samplers suited to WBE requirements and to review their performance in test rigs. We have helped in the development of sampling strategies for the different WBE requirements and have designed trails in Universities to demonstrate and refine tactical WBE service offers and assess the benefits of hybrid WBE and clinical testing. As the project enters phase 3 and from October 1st 2021 will be an active government service, we are engaged to continue our advisory role and are working on proposals for the Target Operating Model. We expect to further develop the SewerSafe application and are looking at integration with digital twinning principles in the development of regional WBE services for local government. Ultimately WBE services will form a public health and security component within the system of systems that comprise smart city and digital government operating models. The urgent nature of the Covid challenge can help to push through barriers that have long hampered aspects of integrated digital solutions deployment in the water sector.