A new way to use wastewater surveillance to monitor the possibility of bird flu in humans

Monitoring the wastewater from hospitals and health systems could provide an early warning of bird flu in humans

May 5, 2024 Check out STAT+

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By Pat Skerrett First Opinion Editor

Ever since I first encountered a wastewater treatment plant in a civil engineering class in college nearly 50 years ago, I've been interested in these odoriferous marvels that meld biology, chemistry, and engineering. As a high school science teacher in Denton, Texas, I'd take my biology classes to the local sewage treatment plant. Every student proclaimed to be grossed out, but some were quietly keen to see how bacteria, amoeba, ciliates, tardigrades, and other critters combine to break down human waste and turn sewage into relatively clean water. In Boston Harbor, the huge digesters that are part of the Deer Island Wastewater Treatment Plant are hard to miss. Working quietly and behind the scenes, wastewater treatment plants were vaulted into the spotlight with the emergence of Covid-19. Just a few months into the pandemic, they were being eyed as an efficient way to detect the community spread of SARS-CoV-2, the virus that causes Covid-19. I had the pleasure of working on a First Opinion essay with Christian Daughton, a research scientist for the Environmental Protection Agency who first proposed, in the late 1990s, using sewage treatment plants to track emerging classes of pollutants, as well as for monitoring community-wide health or disease. Wastewater treatment plants are back in the news as public health officials watch what is happening with the H5N1 bird flu outbreak affecting dairy cows in several states. The worry here is that this adaptable virus could jump from animals to humans. Municipal wastewater treatment plants wouldn't be helpful — at least not yet — for tracking H5N1 in humans because the number of people infected at the start of an outbreak would be low, and the virus is carried by other animals, whose waste gets into sewage systems. In a First Opinion this week, a team of researchers in New York City propose monitoring wastewater from hospitals and health systems. Why there? That's where sick people show up first, and wastewater from these facilities doesn't contain any animal waste. So any H5N1 detected would be coming from people. You can read their essay here, along with those by other authors on topics ranging from the worrisome increase in cancer among young people to why medical students feel the need to publish or perish, the confusing zigzagging recommendations on whether women in their 40s should get mammograms, and more. The First Opinion Podcast is back. Click here for this season's first episode. I'm always keen to read submissions for First Opinion. Please send yours to first.opinion@statnews.com.

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