CanCOVID Speaker Series: Canadian Wastewater Surveillance – Where are We Now?

Introduction hello and welcome beyond the new people are hooking up their audio and joining us it's great to have you here today this afternoon for our can coveted speaker series uh we are joined by dr steve frutti and uh we he will give his presentation and then we will have time for questions at the end as per usual um if you want to keep your monitor on or off that is fine um you will have a chance to ask questions yourself you can also put them in the chat box uh and so now without further ado i'll turn it over to steve steve take it away thank you kimberly good afternoon everyone so uh okay just went to start my there we go okay so uh i'd like to bring uh everyone's Where are we now attention to if you're interested in this subject there is a previous presentation by dominic frigon from mcgill who gave a presentation on june 9th that's in the archive i won't be covering all the ground that dominic did be doing an update on uh where we are now so uh i'm going to talk about the cova 19 wastewater coalition created by the canadian water network tell you a bit about our expert advisory groups uh talk briefly about wastewater surveillance but not the full background that the dominic provided uh we've been running an interlab methods validation that's uh we'll be reporting on very s shortly i'm going to show you some uh wastewater monitoring results that we've got in canada i'm going to talk about uh ethics and communications guidance that i think we're leading the world in and having put these out and then provide you with a summary so uh the covet 19 wastewater coalition was created by cane water network What is CanCOVID um full credit to uh the ceo of canadian water network bernard de comp for for uh bringing this up um the idea was to have something to knit researchers and and users and the public health sector together about what's needed and how we might explore wastewater based epidemiology that could be used to inform public health decision making during the pandemic the first step in launching this was to set up an option for researchers and water utilities and public health authority members to sign on to a set of principles so the map here just shows uh coalition signatories at this point we have 127 who have signed on basically uh to sign on all they had to do is adopt the framework that we spelled out um adopt that the research and activities needed to be framed in terms of end user needs and decision making um commit to open sharing of ideas and ultimately opening sharing of results uh subject of course to the ethics guidance that i'm going to talk about at the end National Research Advisory Group so i burned it stood up a national research advisory group that's representing members from across canada from bc all the way to halifax and uh they provided uh inputs that allowed us to put up uh a lot of the framework and and uh to launch uh things like our our interlab testing we also saw a need to have a public health advisory group and in this case uh this took us a bit longer to stand up because public health folks tended to be up to their eyeballs with with the pandemic itself so we took advantage of a few uh retired individuals and we started the idea here to try and determine what it is that public health decision makers most wanted to learn from from wastewater epidemiology but then we recognized the ethics element and brought a couple of ephesus on board and i'll talk about that at the end of the session so this pretty much got off the ground uh thanks to uh gertrude medema and his colleagues in the netherlands um they were the first to report um success with wastewater monitoring and this came about largely because they were already doing uh monitoring for infectious viruses in wastewater for long-term program and so they had the program in place they just simply needed to adapt it to detecting the cyrus cov2 uh at least rna fragments from the cyrus cov2 virus so this is uh one of their earlier sets of results from amsterdam uh the orange line here is uh the genetic signal that they picked up in in amsterdam inlet sewage the blue line is a indicator of lab confirmed covet cases and the gray line was coveted hospitalizations as i say this is for for amsterdam so this looks pretty promising they indicated that there's a lot of promise here in that the the virus could be detectable uh it allowed tracking uh the coveted cases um in this case appears to provide up to a week of advanced warning uh so with that offer of considerable potential um a lot of people have hopped on board uh and you know part of the presentation here today is to point out that there are still a lot of technical questions that remain unanswered that will need to be dealt with Technical Questions just as a indication of that this is uh another uh paper from madima's group just shows you'll notice this is a log log scale sort of correlation between the gene copies of the virus and cumulative cases in in their sampling and while there's clearly a correlation here that's uh obviously going to be statistically significant but the scatter should should grab some attention as well so this is kind of an interesting uh depiction and uh show you the website in the bottom uh right corner uh some folks in california have been tracking um the users of wastewater monitoring for sars cole v2 and uh little blue uh indicators here are all the places in the world who have uh informed that website uh of their interaction so you can see that uh the technique really has polarified in my research career i've never seen anything quite like it where that much has happened that quickly um which is great in terms of uh you know getting a variety of people looking at it but uh there's also some cautions that uh that we'd like to bring out Early detection so um clearly where all this comes from is that sars kobe 2 uh early on we discovered that it was shed in feces by both asymptomatic and symptomatic people and it's the asymptomatic uh people who apparently can cause infections uh but being asymptomatic they're unlikely to have been clinically tested so uh this opens the possibility of the early warning uh sewage provides a a potentially efficient pooled sample of a community or an institution that provides that uh that sewage so uh you know rather than having only individual clinical samples there's the opportunity for a larger sample body there is evidence initially from the dutch group and and in some evidence we collected as well that as few as a few cases per 100 000 can be detected so the sensitivity is is possible um the idea then is to be able to support epidemiology and surveillance and provide potential early warning um the ultimate focus is on trends analysis and and uh perhaps providing early warning for high-risk institutions so the the The Coalition coalition itself was established to try and uh validate a consensus sampling and analysis method identify the capacity and opportunity for doing this in canada uh inform how waste water epidemiology and surveillance programs could ultimately inform public health decisions but we've stressed with our uh participants that bad data is worse than no data and we encourage our our investigators to undersell and over deliver ultimately we're seeking to foster collaboration and exchange knowledge and uh ultimately we want to be able to identify and encourage promising new approaches rather than just uh repeating existing activities so there's Emerging Science still a lot of emerging science and practice here uh the application is not just as simple as applying pcr so lots of researchers at universities are doing pcr on the health side for clinical sampling but on the environmental side for environmental sampling the sewage sampling is much more difficult there's a processing step that needs to be done and raises questions about where the virus is best going to be detected in the water versus solids and to maximize the potential that we see for it rather than just getting a presence absence like you were infected or not i we're looking to try and be quantitative so that you could detect trends the point is that the wastewater matrix is very challenging and it makes having effective quality assurance quality control essential so uh we put together a uh inter-lab Interlab Study study and uh our participants in that bc centers for disease control in vancouver the university of alberta and provincial public health lab here in edmonton alberta the university of saskatchewan the national microbiology lab has acted as the center for this and prepared the despite samples at the university of waterloo university of windsor university of ottawa and called polytechnique in quebec Characterization of Laboratory Variance what we were trying to do was characterize the inter and intra laboratory variability uh in using this techniques um we recognize that the biases between protocols are likely to be tied more to how the samples were prepared uh rather than differences in the qpcr amplification but i you know with the diversity of protocols we were trying to leverage the existing experience and capacity in doing this study Funding Issues it was clear from the beginning in part because of availability of equipment and and not everybody was funded in fact most groups that have been uh helping here haven't been funded i it's simply not feasible to have a national standard their supply chain issues and other complications we chose to engage a cross-section of public health and research laboratories we determined that most the variability is likely to be attributable to the sample preparation step rather than the pcr quantification steps uh most of the approaches currently used in canada rely on either chemical precipitation or ultra centrifugation processing ultimately we wanted to answer you know can these various methods reliably detect and quantify sars cov2 in wastewater to support establishing trends the constant what we found in terms of results and is the concentration estimates for known spikes were generally consistent spike surrogates are detected in both solids and liquid phases but phase partitioning is an issue that needs to be addressed we need to clarify if and how pcr handles inhibition because it is subject to inhibition from the sewage matrix we need to clarify how individual labs are doing standard curves when they're interpreting results the final study report is under review right at this as we speak and uh that report will be forthcoming shortly so we encourage you to watch the canadian wealth network website i promise to show some preliminary results uh from what's happening in canada this is uh uh for the region of peel uh these results are courtesy of uh mark servos at the university of waterloo who has been doing the analyses for peel region and they've included these results um in their uh epidemiology update uh so the gray mountain in the background are the cases and uh the two lines represent uh monitoring of two different wastewater treatment plants within peel region and you can see that there there is tracking there the other result i'll show here is uh Ottawa from ottawa public health and [Music] they've shown this on a dashboard that they're maintaining for the city of ottawa these results are being provided by a group at the university of ottawa and you can see that there's some early warning back here in july and august but it's not totally consistent i University of Ottawa also mentioned that we're uh investigating uh through the coalition and various investigators in the coalition um other uh novel approaches in this case the the group at the university of ottawa has been exploring the potential for using um protein markers of the sars virus rather than relying on pcr alone uh so the purple line here is the protein marker that they've been evaluating and it shows some promise um they did have this preprint uh article that's available for anyone who's more interested in following up Ethics so i i mentioned at the outset that uh you know we've shown leadership uh in with all of those groups who are doing this around the world the odd one has talked about ethics but nothing explicit was put out we recognized that wastewater monitoring for sars kobe 2 is really an application of public health surveillance and therefore requires appropriate ethical guidance um we recognize that with our very first uh principles we put out uh in in may and june but um uh we brought together that public health group i showed you earlier to actually produce a document so the purpose we recognize if we're out to inform public health uh decision making to protect public health ultimately for that to be effective and we're seeing lots of signals of uh challenges to that uh in canada and around the world requires public trust and so a failure to follow ethical guidance can easily lose that trust there's clearly needs to be a collaboration between investigators and public health decision makers and uh a lot of the academic investigators who are pursuing these techniques since uh this came online i haven't necessarily had previous dealings with the public health community and probably are not aware of the ethical obligations that public health decision makers face Public Health Surveillance um wastewater monitoring clearly has the potential to identify groups of individuals uh that that makes this a sensitive human health related information gathering um public health surveillance involves balancing individual rights and freedoms with population interests and therefore re requires difficult choices we sought to articulate what to consider in way when making decisions planning and implementing using the data from wastewater surveillance and ultimately communicating those findings to the public WHO Guidelines so a major uh breakthrough for us was one of our members on the public health advisory group um had worked uh in producing a systematic review for the world health organization on um public health surveillance uh in general and so we were able to recruit them to our group which led us to uh consulting these who guidelines on the ethical issues involved in public health surveillance which which clearly the wastewater sampling has to be considered public health surveillance we found that 12 out of the 17 guidelines that were in the whole document applied directly to wastewater surveillance so our report on this which is available on our website simply elaborates uh the aspects of uh how uh our uh uh how this activity uh reflects on uh the uh the guidance that who has provided so um we found that uh uh explaining that is the way to to make this real and as i mentioned uh this guidance is available on the clean water network website so it's that web link i just showed so with that all uh Summary i'll summarize um the wastewater surveillance for cyrus copy 2 offers clear promise of providing additional insight for informing public health decisions there needs to be an emphasis on data quality if we're going to underpin any reliance in wastewater surveillance data so recall my comment that bad data is worse than no data many aspects of wastewater surveillance [Music] the quantitative data need to be clarified and better understood we're going to be reflecting on that with our interlab study report which will be available shortly and ultimately the ability of wastewater surveillance to provide effective early warning is a key question that we're attempting to explain to uh potential users as we gain experience with it so with that i'm uh basically Questions through the talk and we can um entertain questions that's excellent thank you so much dr rudy um just to summarize some of the conversation that's happening in the chat already uh colleen naughton from um arc gis online dashboard has shared a link in the chat box there um they also run the twitter account coveted 19 poops if you want to follow them there uh and um they're making sure that they're that ever all this information is getting getting shared uh and there's gonna be a report at the end of october that they're gonna that they're gonna put on cwn rce.ca um vincent moiser asks is there any plan to detect other viruses which may be particularly relevant when uh you know flu and influenza are coming uh no plans right now for for flu and influenza but um the reason as i mentioned with the dutch group was was uh able to get up so quickly is that people have been using this technique uh for uh more than a decade um there's been programs for who Polio Vaccine to determine the effectiveness of the inoculation vaccination programs for polio so i mean i guess an idea that comes to mind is that uh you know hopefully we'll have a vaccine at some point uh for for covet and uh there may be value in this technique for uh monitoring how that plays out in terms of the population so others have done a variety of uh of viruses but uh we're we're pretty much filled up our bandwidth right now dealing with the issues around colburn great thank you so much uh and funmi Chinas Stool Test asks uh the university of china in hong kong has developed a successful stool test for sarsko cov2 has there been any communication with them as to what methods they use which might help in detecting stool in wastewater uh i'm not we haven't had any direct contact i can't speak for all of the 127 people in our group that there may well have been i know some of my colleagues at the university of alberta uh have been working with chinese researchers on a number of fronts um so i think the real challenge of course is you're just so much stuff coming out for everybody to try and keep up with it is a challenge i think the key question that uh needs to be answered there's been limited studies showing whether infectious sars cov2 survives in stool and ultimately into sewage the early indications are that it does not uh so that the the risk to wastewater workers from sampling wastewater appears to be limited uh but verification of that is going to be important uh there was a report out of china just last week of uh where sewage was implicated as as having spread um the uh uh cloven in a dense neighborhood uh but looking closer at the report they were relying primarily on on pcr detection of the rna signals and that doesn't detect infective virus it just detects rna from the virus which is a very different thing great so colleen asks how do you balance ethics guidelines making this information available as a public good and then privacy and data quality concerns a lot of private companies in the us are sampling wastewater and not making this information available that could be useful for researchers to analyze well it is a real challenge and that's why we took it on and and put the guidance out there and we feel pretty comfortable that uh who is a publication source for that guidance is is good what inevitably you find is that all of these guidance uh or individual guidelines tend to work against each other there's no black or white uh do things one way and not another um basically what the ethical guidance tells you is you need to look at these various factors and take them into account and not knowingly blunder into [Music] doing bad things i guess our motivation was we were concerned with the number of people who were starting up to do this kind of work that there's always a uh a pressure on academics to get their results out and tell the world and uh sometimes that can involve uh reporting it to the media before it's even been reviewed um for this kind of work uh we regard that as a bad idea uh it's it's likely to undermine trust and uh we recognize that there's enough challenges with data quality that uh premature release of data without having some consistency um is going to be an issue i should mention in terms of the data quality that um not only are we coming out with our report soon but the water research foundation in denver [Music] funded a major study in the u.s um retained a contractor and dealt with a large number of labs uh to do checking on their ability to produce reliable results from from sewage and that report should be coming out shortly as well um we strongly encourage anybody who wants to work in this area to uh to look at those reports great um the uh peter has a question what is the status regarding the use of wbe data for pandemic management on a day-to-day basis in canada and elsewhere i would have to say it's not being used to manage the pandemic at this point because we're still validating that we believe the results from the monitoring so the number of public health agencies are obviously interested in what this can do for them and they're working with the investigators to collect and review data but i think we're a ways away from having the sewage data uh be a primary determinant for uh public health decisions the exception there may be that there's a focus we're in involved with of looking at institutions um there's been experience out of the u.s where universities have monitored on campus dormitories and picked up early signs of infection and use that as a basis to come in and do clinical testing throughout the the population that kind of approach is being considered now for high risk institutions like uh long-term care facilities that's great um juliette thank you for a great presentation and says uh what do you think some of the practical uses of sewage surveillance data for stars of what do you think some of the practical uses of sewage surveillance data for star score v2 how do you anticipate decision makers could use the data in comparison to the traditional surveillance tools well it's never going to replace clinical testing i think we you know we've tried to be clear about this that it's not a magic bullet it's not an alternative to uh clinical testing in terms of making decisions about individual uh uh infectivity but um it's it's something to expand uh our ability to understand what's going on i think uh retroactively uh the the kind of data that our various participants are collecting is going to help us understand this pandemic a lot better than would have otherwise been the case and and frankly a lot of the the data that's being reported in the literature right now is a little bit more retroactive very short-term retroactive but it's still looking at what's happened rather than necessarily uh providing this uh evidence for decision makers to say let's do something tomorrow i guess we're getting a strong enough signal about you know a second or third wave depending on where you are that um we don't actually need the wastewater evidence to convince us that we're heading into a bad space well on that note we um we're at 4 30 so um i want to thank everyone for your questions and thank you bernadette for uh the clarifications and and posting additional links in the channel um yeah and fun me also had a follow up about the um the hong kong the hong kong paper that we don't quite have time for but uh i want to thank you all for joining us um thank you dr c frutti and uh we can if you are interested in furthering the conversation we do have a wastewater channel and on our karen covid's black where um dominic and others are very good about posting a lot of these articles because as you mentioned there's a lot of stuff that comes up and there's a lot of stuff to track so that's one way you can go for this specifically thank you so much everyone thank you have a good afternoon