Researchers at the Excellence Water-Based Early-Warning Systems for Health Protection will track virus and bacterial DNA in wastewater samples to provide an early-warning system for outbreaks of infectious diseases. 

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The study, published in the journal Nature Water, analysed more than 300 million hospitalisation records from 747 communities in eight countries (Australia, Vietnam, Brazil, Canada, Chile, Thailand, New Zealand and Taiwan) that had experienced major flood events between the period of 2010 and 2019. Regions included the northeast region of New South Wales, Australia, the Amazon River and the southern region of Brazil, the Mekong Basin in Vietnam, and the southern region of Thailand. 

The study found increases in hospitalisation for cardiovascular diseases (35%), respiratory diseases (30%), infectious diseases (26%), digestive diseases (30%), mental health disorders (11%), diabetes (61%), cancer (34%), nervous system disorders (34%), and renal diseases (40%). 

While immediate health impacts of flooding, such as drowning, electrocution and hypothermia, would be expected, this study found long-term impacts on health, including an elevated risk of digestive diseases and the spread of infection through the contamination of water supply systems. 

Additionally, the study highlights that floods can create environments that are conducive to the growth of fungi, bacteria, viruses, and vectors such as mice and insects, which can trigger outbreaks of respiratory, digestive and infectious diseases, and force mass evacuations, causing displacement, with people living in temporary shelters and having access to limited sanitation facilities – resulting in poor hygiene, with conditions raising the likelihood of respiratory, digestive, and infectious diseases. Access and capacity to healthcare services may also be impaired after floods, leading to delays in medical interventions; and psychological stress from property damage and financial losses can worsen or induce adverse health outcomes. 

Adding to this picture, a study by researchers from Columbia University’s Mailman School of Public Health, in partnership with researchers at Arizona State University, Harvard University and the University of Arizona, USA, published in Nature Medicine, analysed the impact of floods on mortality over the past 20 years. 

The researchers used a statistical model to calculate how death rates changed in three-month periods following large floods compared with equivalent periods in normal conditions. 

The researchers found the largest overall increases in injury death rates among older people (24.9%) and females (21.2%) during the month of tropical storm/hurricane-related flooding, with increases in death rates associated with heavy rain-related flooding for infectious diseases (3.2%) and cardiovascular diseases (2.1%). Snowmelt-related floods were also associated with higher death rates for certain diseases. 

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At least 30% of resources raised will be used to finance innovations in non-sewered sanitation to serve low-income communities. Projects will be developed upon City Wide Inclusive Sanitation principles to ensure that the whole community benefits from equitable sanitation; that human waste is managed safely and sustainably; that authorities demonstrate political will and accountability; and technical and managerial leadership drives innovation and fiscal responsibility to ensure services are sustained and inclusive.

The fund aims to accelerate the adoption of new approaches to sterilise human waste and help to end infant deaths and the $233 billion annual cost linked to diarrhoea, cholera and other diseases caused by poor quality water.

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Antimicrobials have been essential in reducing the burden of infectious disease in humans, animals, and plants for decades. However, their effectiveness is now in jeopardy because several antibiotic, antiviral, antiparasitic and antifungal treatments no longer work because of antimicrobial resistance (AMR).

According to the World Health Organization, AMR is among the top 10 global threats to health. The UN report predicts that AMR could result in 10 million additional deaths annually by 2050 – equal to the number of deaths caused globally by cancer in 2020.

AMR can occur naturally or can be acquired. River and lake sediments can be a transient source of AMR. Because sediment can remain in one location for long periods, AMR can slowly accumulate and remobilise en masse into the wider environment during extreme weather events.

Increased use and misuse of antimicrobials and other microbial stressors, such as pollution, create favourable conditions for microorganisms to develop resistance both in humans and the environment.

For more information, see Bracing for Superbugs: Strengthening environmental action in the One Health response to antimicrobial resistance

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The researchers argue that the global spread and persistence of the chemicals, coupled with their risk to health, represents a new planetary boundary, and that the global spread of four assessed chemicals shows the planetary boundary for chemical pollution as being exceeded.

The researchers note that guideline values for PFAS in drinking water, surface water and soils have decreased dramatically, reflecting the greater understanding of the potential effects of the chemicals. At the same time, levels of some harmful PFAS in the atmosphere have not notably declined, despite them being phased out by the main manufacturer, 3M, some two decades ago. This is because PFAS continually cycle back into the atmosphere from the planet surface, for example by transportation of seawater to marine air by aerosols from sea spray.

In their paper, ‘Outside the Safe Operating Space of a New Planetary Boundary for Per- and Polyfluoroalkyl Substances (PFAS)’, the researchers conclude, for example, that levels of PFOA and PFOS in rainwater often greatly exceed US Environmental Protection Agency (EPA) Lifetime Drinking Water Health Advisory levels.

Lead author Professor Ian Cousins, of the Department of Environmental Science, Stockholm University, is quoted in reports as stating: “Based on the latest US guidelines for PFOA in drinking water, rainwater everywhere would be judged unsafe to drink. Although in the industrial world we don’t often drink rainwater, many people around the world expect it to be safe to drink and it supplies many of our drinking water sources.”

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The report investigates policies, institutions, and regulation (PIR) and their implementation by governments. Recognition of the importance of PIR, and water governance generally, is growing with regard to achieving the UN Sustainable Development Goals in the face of increasing shocks and stresses in the water sector. However, mainstreaming and implementation of PIR into concrete reforms and investment programmes has, thus far, been sporadic.

Taking a new approach to water sector reform, the World Bank launched its PIR initiative in 2016. Previously, global initiatives offering technical solutions aimed at expanding water and sanitation infrastructure lacked sufficient understanding of the regulatory framework necessary to improve service delivery and operate infrastructure in a sustainable manner.

This first phase of the PIR initiative was followed by a second phase (2019-2022), which has now been concluded. The aim of this second phase was to put the concept into practice, refine the concept, and inform the development of a tool for operationalising PIR in government and development partner programmes.

This recent report reviews the application of this PIR framework globally and reconfirms its importance along with the alignment of incentives to support more effective service delivery.

It advocates greater action by policy makers, development partners, international financial institutions, and civil society and includes insights from various countries, including Bosnia and Herzegovina, Brazil, Colombia, the city of Chennai in India, Mozambique, and Uzbekistan.

The report is accompanied by the PIR Framework Tool, which provides more detailed guidance on how to undertake policy discussion on PIR and identify reform options, as well as how to apply it in practice.

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The health advisories announced by the EPA were released under President Biden’s action plan for clean water and EPA Administrator Michael Regan’s PFAS Strategic Roadmap, in response to newly available science and in line with the EPA’s responsibility to protect public health. They provide technical information on contaminants in drinking water that can cause adverse effects on human health. This information can be used by federal, state, and local officials to assist development of monitoring plans, treatment solutions and future policy.

The EPA will also be inviting states and territories to apply for $1 billion to counter PFAS and other emerging contaminants in drinking water, especially in small or disadvantaged communities that are on the frontlines of PFAS pollution. This funding package is the first of $5 billion that can be used to address PFAS in drinking water through measures such as technical assistance, water quality testing, contractor training, and installation of centralised treatment technologies and systems.

Both measures build on the EPA’s progress on safeguarding communities from PFAS pollution, while also informing forthcoming efforts, including the EPA’s proposed National Primary Drinking Water Regulation for PFOA and PFOS, which EPA will release in the latter part of 2022.

The EPA will be disseminating information within states and territories advising how they can submit a letter of intent to participate in this new programme, alongside consultations with Tribes and Alaskan Native Villages regarding the Tribal set-aside for the grant programme.

The funding complements $3.4 billion in funding that is available through Drinking Water State Revolving Funds (SRFs) and $3.2 billion through the Clean Water SRFs, which can also be used to counter PFAS in water.

Find out more at: https://www.epa.gov/pfas/epa-actions-address-pfas

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Using examples from various locations across the world, the report also outlines what aspects to consider when creating a national wastewater surveillance programme aimed at controlling the impacts of COVID-19.

Early on in the COVID-19 crisis, SARS-CoV-2 was discovered in human faeces, where it can be detected as soon as people are infected. A highly sensitive test – real-time reverse transcription-polymerase chain reaction (RT-qPCR) assay – can be used to detect the virus at an early stage, including in asymptomatic cases, thereby preventing wider transmission. This test can detect minute traces of the virus, even in faeces diluted by rainwater or industrial effluent.

Some challenges with this method still to be overcome include the need for quality assurance in the various analytical methods involved, particularly because there are various factors that act to influence the amount of measurable viral material in water.

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The latest annual update, ‘Bathing water management in Europe: Successes and challenges’, draws attention to potential impacts around climate change. More frequent and stronger storms, periods of increased flow in rivers, water scarcity, and rising sea levels all have potential consequences for bathing waters.

The EEA used the latest update as an opportunity to reflect on the contribution of the EU’s Bathing Water Directive. According to the EEA, the number of sites monitored increased from around 7500 in 1990 to more than 22,000 in 2019, with the share of sites with sufficient water quality increasing from 74% to more than 95% from 1991 to 2019, and the share of sites with excellent water quality from 53% to 85%.

The report highlights five main groups of issues affecting bathing water quality – microbiological pollution, extreme events, eutrophication, cyanobacterial blooms, and the challenges around the growing interest in wild swimming.

“There will be climatic changes in the future that will substantially affect bathing and bathing water management,” the report states, adding: “A higher demand for bathing will pressurise national authorities to expand their bathing water networks, identify and monitor new bathing waters and ensure that supporting infrastructure is in place.”

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The promising progress with surveillance of the SARS-CoV-2 virus in wastewater and sludge, as a possible tool to complement testing and tracing of COVID-19 in humans and help inform public health measures, has prompted the World Health Organization (WHO) to prepare a scientific brief on this topic. This will complement other WHO guidance on WASH and COVID-19.

Similar methods have been used successfully in polio eradication to complement surveillance in humans. For use on COVID-19, research is needed to clarify methods and use cases, particularly in countries with low coverage of sewers and limited laboratory capacity.

The rapidly increasing research is based on assessing non-infective SARS-CoV-2 RNA. As this research progresses, it is critical to ensure that service providers, their workforces, and the general public are well informed of the very low risk of COVID-19 transmission from wastewater. It is equally important that essential water and sanitation services and hand hygiene are maintained as the primary WASH actions within the COVID-19 operational response.

The WHO brief reflects that several potential use cases for environmental surveillance are emerging. These include use for early warning, particularly of a second wave in countries that have contained outbreaks and are easing public health and social measures. Environmental surveillance may also be used to support decisions on relaxation of control measures, to fill data gaps in locations where human testing is low, to identify and monitor hotspots and vulnerable populations, or purely to advance research on virus shedding dynamics.

Design and application of environmental surveillance should consider representativeness of sampling sites, especially in locations with low sewer coverage; coordination among research institutes, utilities and public health authorities; and cost-effectiveness of developing capacity for environmental surveillance versus the public health and research benefits.

Further reading

WHO information on WASH and COVID: www.who.int/water_sanitation_health/news-events/wash-and-covid-19/en

WHO COVID-19 Strategic Preparedness and Response Plan: www.who.int/docs/default-source/coronaviruse/covid-19-sprp-unct-guidelines.pdf

WHO Scientific Brief on Environmental Surveillance for SARS-CoV-2 virus: https://apps.who.int/iris/bitstream/handle/10665/333670/WHO-2019-nCoV-Sci_Brief-EnvironmentalSampling-2020.1-eng.pdf

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