Full Transcript

Bernadette Conant:
Everybody’s focus, understandably, has been on the early warning potential. In my personal view, the biggest potential value of this technique is the insight it’s going to give us into how this happened, how it happens, how things spread.

Stacey Dumanski:
Hello, everyone, and welcome back to Let’s Talk About Water. My name is Stacey Dumanski and I work with the amazing team here behind the scenes. We bring you another bonus episode, and this one is on poop. No, literally poop. Our guests chat about how wastewater’s being used to help detect COVID-19 outbreaks. I’ve personally taken a strong interest to this topic as I go on my maternity leave. Knowing that researchers are watching for these early signs of COVID-19 outbreaks in our community brings just a small sense of preparedness to our family. Now, this episode is a condensed version of one of our live public forums. So the sound quality may be a bit off, but sit back, relax, and enjoy.

Jay Famiglietti:
Many of you will have seen or heard about this in the news that COVID could be found in our poop and that scientists can therefore track COVID in wastewater to predict future outbreaks. Today, I’m joined by two remarkable individuals working on using wastewater and wastewater data in our ongoing battle with COVID-19, Bernadette Conant and Markus Brinkmann. Bernadette Conant is the CEO of the Canadian Water Network. She’s been instrumental in bringing people together to collaborate on national initiatives, such as the Canadian Municipal Water Consortium and The COVID-19 Wastewater Coalition. She holds an MSC in hydrogeology from the University of Waterloo. Markus Brinkmann is an assistant professor in exposure and risk assessment modeling in the school of environment and sustainability at the University of Saskatchewan. He’s also a member of USASK’s Toxicology Center and the Global Institute for Water Security. Thank you for joining us. Hello to you both. And we’ll start with Marcus because he has some history with Let’s Talk About Water. He was on the COVID-19 episode that we did, which was the first episode of season two. So, Marcus, why don’t you take it away?

Markus Brinkmann:
For sure, yeah, thanks so much. As you mentioned, I’m a toxicologist. So usually, I’m focused on chemical contaminants in the water cycle. We look at surface water, storm water, and oftentimes also wastewater. And when the pandemic hit in Canada, our research programs were shuttered, labs were closed, and myself, along with many others, were looking for ways in which we can bring our expertise to the table and help public health decision-makers and the general public be better prepared. So this is why myself, along with a number of other researchers, tried to find ways in which we can contribute. And we got interested in this topic of wastewater-based epidemiology and wastewater-based monitoring for COVID-19. And we started doing this back in July, collecting samples, analyzing them for traces of the virus. And our program is online since July 2020 in monitoring traces of COVID-19 or SARS-COVID-2, the virus causing COVID-19 in the wastewater here in Saskatoon. We were able to expand beyond that to smaller communities, first nations in Saskatchewan, and we are quite excited about that research as well. So yeah, I’m very glad to be here, and thanks again for the invitation.

Jay Famiglietti:
Well, thanks. It’s great to have you. Bernadette, over to you.

Bernadette Conant:
Thank you. And thank you also for the invitation, wonderful to share the virtual stage with Dr. Brinkmann and yourself. I think Matt Damon or Water Org is credited with the statement that “Water is PPE when it comes to COVID.” What was the first thing we were told? About washing your hands, about hygiene, and sanitation. And it became really clear to us that this was an opportunity for those working, whether it was research or government or in municipalities and communities themselves on the wastewater side to really become support for the public health community. So Canadian Water Network’s niche in that support is improving the curation of the so what of the science. What does it mean? What’s this implication not to steer it and not with the purpose of promoting the technique but to be able to always ask the question, does it help public health decision-making, not just the science?

Jay Famiglietti:
So how did all the wastewater testing and the national monitoring network come about?

Bernadette Conant:
So KWR in the Netherlands and in [inaudible 00:04:28], whose name you’ll see a lot, they were already doing wastewater surveillance. And one of the amazing science things that happen is the speed, the rapidity with which this genetic sequencing of the initial SARS virus actually happened. That opened the door across the board, not just here. So that group that was already doing wastewater testing said, “I wonder if we could see the SARS-COV-2 virus?” So the virus that causes COVID, they took a crack at it like, “Can we see it?” And the early indication of their work was, “Yes, it could be seen.” And there were some indications from that early work that not only could it be seen, but it could be seen in wastewater samples. And this is important, but it could be seen in wastewater samples that were collected before the disease was recognized by clinical samples. So it didn’t answer any questions, but by pivoting, it really raised the question of like, “Could we use this approach?” And it suggested strong potential that yes, maybe it could. So this really kicked off an explosion of work.

Jay Famiglietti:
Very cool. So, Marcus, is there anything you want to add, or maybe you could tell us where things are at today?

Markus Brinkmann:
Sure. Yeah. I think for us it started, like Bernadette said, basically, “Hey, can we see this virus in our wastewater?” And we turned this into something useful for public health decision-makers. So it started out of curiosity, for us at least. As people became more interested in the topic, it really showed that yes, there is a potential for early warning because an infected person starts shedding the virus relatively rapidly after being infected, but might not show up for testing until days later. But it goes far beyond that. Right now, one of the biggest interests in the topic is detecting the presence of new variants of concern in a community. So for example, in Saskatoons, we are screening for the UK variant, for the Brazilian variant, and the South African variant to try and inform public health decision-makers, on the one hand, has a variant arrived in the community, but also how rapid does it spread? What is the relative proportion of the variant in a community, et cetera? So right now, we are basically dealing with trying to understand the spread of variants of concern in a partially-vaccinated population. And that’s something that really hasn’t been done in that level of detail before.

Jay Famiglietti:
So are there other benefits to the wastewater testing in addition to those that we’ve just mentioned? And, Bernadette, let’s go to you.

Bernadette Conant:
Everybody’s focus, understandably, has been on the early warning potential and that’s important, but I guess, in my personal view, the biggest potential value of this technique is the insight it’s going to give us into how this happened, how it happens, how things spread. So if I can jump forward to maybe one of your questions that might be is, what do we learn from this? For me, it’s kind of like the 2005 flood in Calgary. The learning from that made their ability to deal with a 2013 flood much better.

Jay Famiglietti:
Marcus, anything you wanted to add to that?

Markus Brinkmann:
Yeah, I fully agree with what Bernadette said earlier. Understandably, everyone focused a lot on the early warning aspect of this, trying to forecast how many active cases you might see in a community. But I think one of the big advantages of wastewater is that it does not depend on who shows up for testing. So for example, last year, we had a big snowstorm in Saskatoon, and Saskatchewan as a whole people did not really make it to the drive through testing centers. So a lot of samples were delayed, a lot of people were showing up delayed for testing, and that’s really where this ability to forecast falls apart. Or if you see that the behavior of people changes… For example, people might be vaccinated and get the sniffles and don’t find it necessary to show up for testing. So I really think the value here of wastewater testing is that it can also detect those latent infections. So it really generates this extra layer of information for our public health decision-makers to really see what’s going on in the community without relying only on one source of information.

Jay Famiglietti:
Thanks, Marcus. So things are happening so fast. COVID, everything we know about transmission and testing and tracing and the vaccines, it’s all evolved so quickly. Sometimes there’s new information, sometimes conflicting information in the same day. How does that impact the work that you do, the research, and the monitoring? And let’s start with you on this one, Marcus.

Markus Brinkmann:
So our group is represented on a number of different national panels and basically trying to get the most current signs in what everyone else in Canada is doing. And there’s a number of weekly calls, basically. The speed at which things are happening is just mind boggling and sometimes quite intimidating for a scientist. As scientists, we oftentimes try and look at all the different complexities and to really think deeply about things as they happen, but with the public eye and really with a magnifying glass looking at what we are doing and adapting as we go, it’s really tricky sometimes. And folks are not usually happy with an answer that we, as scientists, often give saying, “It depends.” And so it’s really difficult to do that.

Jay Famiglietti:
Yeah, I mean, it’s crazy, just as a private citizen, when it comes to this kind of work, it’s tough for me to keep up. So, Bernadette, let me just add onto this question. How do they do it all safely? How do you maintain the integrity of the process so we don’t lose confidence?

Bernadette Conant:
So Dr. Michael Ryan of the WHO have talked early on in the pandemic, and I wish I could do it with a good Irish accent. And he said, “If you need to be right before you move, you will never win. The virus will get you every time.” This pandemic lays bare the difference between pursuing regulations and science and everything in the systems that we’ve built around them versus the world of emergency response. My learning from the past is those two worlds have to meld, and I don’t ever think we’re going back. So the reality going forward is the rapid evolution of science, the rapid exchange of science, the need to rapidly inform decisions really challenges the whole set of systems that we have. So that’s a very long answer to your short question is, the what do we do, and with a coalition, is say the most important thing for us to do is improve and accelerate the conversation that connects those who have an interest in hearing the facts and really structure that well and always structure it and push so that it becomes less of a competition and more of a sharing process.

Jay Famiglietti:
Marcus, in your own lab, how do you keep up with these changes? On an individual lab basis, what are you doing to maintain the integrity of the process and your results?

Markus Brinkmann:
We certainly try to stay up with the information that’s flying at us faster than we can really take it in. Another aspect of this, and I think the leadership that the Canadian Water Network and the coalition with Bernadette and others has been bringing upon this field is that there is a very rigorous QA/QC process in place so that when you put a value out there on a public-facing dashboard, for example, or we submit weekly reports to the Saskatchewan Health Authority, that there is confidence in the results we are producing. And then it’s always a trade-off between the really new things that are happening and trying to incorporate that in our reporting. So for example, the topic of new variants of concern, we are using an assay for the UK variant, which is pretty well established by our colleagues, and that can really help us predict the fraction of that variant in the wastewater and potentially in the community. But now with other variants showing up P1, the variant first identified in Brazil, these comparisons of fractions really become more difficult. And we always try to be very transparent about those realities of the lab process.

Jay Famiglietti:
So what’s the uptake looking like?

Markus Brinkmann:
As with any new technique or method that might potentially be useful for public health decision-making, there’s always a little bit of a lag time until it’s really taken up and seen as valuable and used in making decisions. There needs to be this period, basically, of where decision-makers can gain confidence in a technology and that took a while across the country, I would say, certainly for us here in Saskatchewan, but right now what we do is we provide weekly reports to the health authority, to the emergency management office here in Saskatoon, the wastewater treatment plant, the Public Health Agency of Canada. So we really try to bring our information to all the players as quickly as we can. And how then this information is used in the particular decision-making process, that’s certainly out of our hands. We are not public health decision-makers, but we are certainly glad to hear that our information is valuable. And we get weekly thank-you messages back basically for doing this, which is really rewarding.

Jay Famiglietti:
Well, you get a thank-you message probably from everyone that’s on this call with us today. So, Bernadette, what sort of uptake are you seeing?

Bernadette Conant:
So I think it’s been slow because it’s been push rather than pull. The analogy I would use, you’re standing somewhere and there’s a huge forest fire going on, like there was in the early pandemic, and you go up to the fire chief, who’s holding this huge hose with massive flames, and you’re pulling on her sleeve and you’re telling that chief, “Look, I got this really neat, new technique that you could use along with your other techniques that might help.” It’s like, “That’s great, but I don’t have time to listen.” That’s essentially what was happening in the early months when we were doing this. But if you go back to that chief and she’s wiping her brow of sweat and you look around you and there are 500 smoldering piles of embers, anyone that could go up at any time and say, “I think I have a way that will help us decide which of these piles of embers are most likely to burst into flames,” all of a sudden, there’s more of an interest. And I think now, there’s almost a more of an uptake when people see that it can be the tool that just having their fire hose won’t help them.

Jay Famiglietti:
Anyone who wants to try to influence policy or practice, it’s really a challenge. Marcus, I want to turn to you and ask about wastewater treatment plants. Can we be looking at how to design them better if we’re going to use them in monitoring?

Markus Brinkmann:
So there are a number of lessons learned from this whole effort, and that is that not all wastewater treatment plants are the same, not all wastewater is the same. Wastewater is not like your coffee that you get at your favorite coffee shop that is the same across every different city. It differs in composition. It differs in the dilution. It differs in how many people are contributing and shedding virus into this wastewater collection system. So the methods for detecting the virus need to be very much adapted to the specific circumstance. And I really think that this is one of the lessons learned from all of this, that if we want to use this for future users for potential future pandemics, for other purposes in monitoring public health, then I really think that this increase in our understanding is going to be super useful. So a term that has been coined quite recently is that of syndemics.

Markus Brinkmann:
So this is not only COVID-19 pandemic. There is a number of other epidemics that are happening at the same time. You’ve heard about fentanyl-laced crack cocaine and the rise of that causing drug overdose deaths, the increase in potential alcohol and other substance abuse, obesity, lack of physical activity during the pandemic. And all of those are things that you can observe in the wastewater, at least try to do that. And yeah, I think the lessons learned from all of this are really going to be putting us into a much better position to, A, understand the impacts of those syndemics and, B, to be better prepared for potential future outbreaks with pandemic potential.

Jay Famiglietti:
I thought I heard you comparing wastewater to coffee from a coffee shop. Did I hear that, or did I get that wrong?

Markus Brinkmann:
No, you got that right. In one of my earlier interviews, I mentioned the actual company and brand name, which I think was not appreciated, but yeah, I mean, just think about all the different ways that coffee could look like. You can put milk and sugar in there. It can be pretty dark, could roast black. It could be a very thin brew. So wastewater is very different. Also, it depends on time of day sometimes. It depends on seasonal impacts in some municipalities, at least. So here in Saskatoon, for example, the wastewater, both in terms of the volume that we get per day, but also in the constituents is relatively stable. Temperature pH, how many solids are in there, all of that is pretty stable in Saskatoon, but when you have combined sewer systems, for example, when the snow melts in the spring, then you get a lot of that snow melt going into the same collection system and that dilutes the whole thing and you really run into problems. I think that’s important to address and realize.

Jay Famiglietti:
Yeah, well, I just wanted some clarification there because I don’t think I want to go to the coffee shops that you go to. I think it’s time for us to now start to take questions from the audience. Can you detect COVID in raw/natural water, raw sewage, et cetera? Any takers?

Bernadette Conant:
Sure, that’s a common question. First, I have to acknowledge I’m a proud generalist, but I can tell you from generalist, following this science, that people who have been looking for detections of infective, so live infective virus in sewage systems, they’ve not been seeing it at all where their treatment systems, but also in raw sewage systems, it’s possible that it’s there, but it’s really hard to culture and hard to see it. So we won’t say that it’s not possible, but all the science I’m aware of to date suggests that it’s very improbable and low-risk SARS, as a virus, is a wimpy virus as an envelope virus compared to many of the others. So there are other pathogens that are regularly present in wastewater that are probably a bigger threat to you in terms of coming in contact with untreated water. So bad news is we never want to take a risk, so we have to look at these things. The good news is all the research I see to date suggests that it’s not an added or larger risk than things that are already in untreated waters. There are other things that should worry you more.

Jay Famiglietti:
Thanks, Bernadette. How about another question? Can we use this technology for other constituents or general water quality changes, such as oil spills, toxic chemical release, et cetera? Marcus, do you want to give it a try?

Markus Brinkmann:
Sure. Yeah, that’s an excellent question. There’s a huge potential to use this technology to monitor other molecules, so you can, for example, monitor the use of pharmaceuticals across the population. You can monitor the use of illicit drugs across the population. You can also monitor and detect molecules that we are excreting on a regular basis and that our transformation products that would, for example, preferentially show up in people with diabetes and things like that. So there’s this potential to really use this for public health but to monitor other and different things. So yeah, we can use the same or very similar tools for very different purposes. It’s basically a pocket knife of different applications there.

Jay Famiglietti:
Can we take another question, please? Okay, how do we advocate for more interaction between academia and government? Bernadette, you want to give that one a try?

Bernadette Conant:
Sure. In my space, it’s actually dropping the advocating, and that fundamentally changes the conversation because if you come into the room advocating for money for the academic sector, you immediately position that conversation for resistance. So I often say we’re not in the business of solution delivery. We’re in the business of solution enabling, but I will say it’s much harder to get funded because people want to use the systems they have, and they want to buy a solution, not pay you to help them collectively get there together faster.

Jay Famiglietti:
Yeah, I understand the challenge. Let’s take another question. What does research academia transparency look like, sharing data, frequent media releases? What would make the general public comfortable? Marcus, you want to take a stab at that?

Markus Brinkmann:
That’s an excellent question. So initially when we started this whole process, a media release was really the way of getting the information out there. What other recent trends, if we saw dramatic changes in the wastewater signal, we were informing the general public about that. That’s certainly a difficult position to be in because with a heated political environment, where lots of folks like to point fingers, that’s a really difficult spot to be in.

Jay Famiglietti:
So we’re getting towards the end of our time. I’d like to ask what gives you hope? What are you looking forward to here? What are the bright spots on the horizon? And Bernadette, let’s start with you.

Bernadette Conant:
If you think back, the turn of the last century, turn of the century, 1800s to 1900s, wastewater management emerged because of the need for sanitary engineering. It really was a public piece. And over the 20th century, it divided into pieces, and there’s been a lot of focus on environmental protection and end-of-pipe cleanliness and all those things are important, but what I’ve found with the people that we’re working with and that coalition of the willing of moving this forward is how much they have formed those relationships and understanding of how wastewater can be a more integrated part of public health. And I think that’s a lasting lesson that’ll hopefully pivot again to the next challenge because there’ll be one.

Jay Famiglietti:
Thanks for that great perspective, Marcus, how about you?

Markus Brinkmann:
Sure, I fully agree. Those connections that have been formed, those contacts that have been made, they are going to be invaluable going into the future. So going forward, what gives me hope is that I think we are in a much, much better position now to use different sources of information, including wastewater, to be prepared for the next pandemic. And yeah, as Bernadette says, there will be one. It’s not a question of if. It’s a question of when.

Jay Famiglietti:
Bernadette, Marcus, always a pleasure to speak with you. Thanks again, everyone, for joining us today.

Stacey Dumanski:
This episode of Let’s Talk About Water was produced and edited in-house at the Global Institute for Water Security at the University of Saskatchewan. Thanks to everyone who helped put the show together, including Mark Ferguson, Laura McFarlan, Jesse Witow, Shawn Ahmed, Amy Hergott, Fred Reibin, and Erin Stephens. And a special thanks to Linda Lilienfeld. And remember, we’re an Apple Podcast, Spotify, Stitcher, and many other quality podcasting platforms. You can also stream us on Facebook at Let’s Talk About Water podcast or follow us on Twitter @LTAWpodcast. Thanks for listening. Be sure to stay tuned for season three of Let’s Talk About Water.