Public health officials are looking for an indication of how long this surge might last as the Omicron variant pushes national coronaviruses case numbers to record highs.
The clues are coming from sewage.
The coronaviruses can be shed in the stool of people who contract them, and the levels of the virus in the local wastewater can be a strong indicator of how much is circulating in a community.
The sewage data shows a wave cresting in different places.
The coronaviruses in wastewater in 183 communities across 25 states have begun to decline in many big cities but are still rising in smaller communities.
In the Boston area, the wastewater viral load has been falling since early January, consistent with other data suggesting that the virus may have peaked there. According to data shared by scientists in the region, the virus appears to be waning in New York City wastewater.
In Denver, San Diego, Saint Paul, Minn., and other places, there has been a decline in the number of viral loads.
There are lags between when wastewater samples are collected and when they are publicly available, but the most recent data shows that the virus may not have peaked yet in parts of Ohio, Utah, Florida and rural Missouri.
Amy Kirby is the program lead for the National Wastewater Surveillance System, which the Centers for Disease Control and Prevention established in the fall of 2020. It is helpful to monitor the full trajectory of a surge, as it is an early warning sign.
Scientists, health officials and companies have been building systems that they hoped would spot new strains, track the spread of the virus and give advance notice of coming surge during the Pandemic.
When we use the restroom, we are all creating a type of data that is naturally created.
Dr. Kirby said that the C.D.C. will add wastewater data to its online tracker within the next few weeks. The agency is adding about 500 testing sites across the country.
The local response to the swine flu is already being informed by wastewater surveillance. Hospitals are using it to make life-or-death decisions about which treatments to use, and city officials are using it to funnel resources into neighborhoods where the virus is surging.
These efforts are limited to places where good data is easy to find and local officials are interested in using it. The United States needs to do more to coordinate and make more data available.
There is no centralized public dashboard where all of the nation's wastewater data is collected and displayed. The Netherlands has a national wastewater system that covers nearly all of the country's residents, while the public-facing dashboard is updated daily.
The U.S. is behind, according to Dr. Matus.
An engineering student analyzed wastewater samples at Colorado Mesa University.
Houston has had a wastewater program since the summer of 2020 and is reaping the benefits.
The chief environmental science officer for the city's health department is running the program. Every Tuesday, it samples 39 wastewater treatment plants, as well as nursing homes, jails and other communal spaces, to measure the viral load across the city.
Dr.Hopkins consults with wastewater screeners weekly to determine where the city should put its resources. The Houston program noticed that the sewage in one ZIP code, a largely Hispanic neighborhood, had high levels of the virus week after week, so they distributed testing and cleaning supplies and multilingual educational materials about the virus and vaccines. The Holy Ghost Catholic Church was the site of regular coronaviruses testing. The area's wastewater dropped out of the priority list.
Houston is an example of how powerful this is.
Wastewater samples are being analyzed to determine the proportion of Omicron, Delta and other variations. That is important information for doctors when they decide how to allocate the monoclonal antibodies, which can prevent people at high risk for Covid-19 from being hospitalized.
Two of the three authorized treatments don't seem to work against Omicron, and the other one is in short supply.
The Omicron wave arrived in the region and clinicians were trying to save their sotrovimab. They switched from the other treatments to sotrovimab after local wastewater data suggested that Omicron was responsible for most of the infections.
Jessica Gilmore, who directs the hospital's pharmacy department, said that they don't have the ability to do gene sequencing in real time. The sewershed data is the best we have.
It can be useful to know when the peak has passed. Boston Children's Hospital has been limiting or postponing some procedures recently, according to the hospital's chief medical officer. Now that Omicron appears to be in retreat, the staff are pondering when they might be able to reassign these procedures.
He said that coming to the hospital with your child is already stressed out. Coming and having to have a date canceled is worse.
The crush is likely to continue because Covid hospitalizations lag behind cases. Boston Children's Hospital may schedule more procedures for the second half of February if the wastewater data is good.
He said that no one before the Covid pandemic had said that they loved looking at the wastewater data. We are here.
Workers in Monaco took sewage water samples to detect coronaviruses.
Wastewater monitoring is becoming more common, but strategic public health responses like the one that unfolded in Houston are rare.
There are no other cities in Texas that are doing it. I would think they would try, because it has been such a success.
The C.D.C. is funding to collect wastewater data in 43 of them, but only 13 of them have fully implemented their systems.
It's hard to track a fast- moving variant in real time when there is a lag of at least several days before the results are available.
Dr. Kirby acknowledged that the time it takes to turn around is never quick enough.
Scientists have been monitoring New York City's wastewater since June 2020, but the city has not made it public.
The data from the wastewater was consistent with the city's testing data, according to a spokesman for New York City's Department of Health and Mental Hygiene.
Wastewater surveillance data lacks the precision of, and generally lags behind, data provided through our primary surveillance systems and is useful in confirmation of what we are seeing around the city.
The officials have to figure out how to act on the data. The Rockefeller Foundation, which funds wastewater surveillance projects around the world and coordinates the U.S. Wastewater Action, discovered that the variant was present in multiple cities, but it did not appear to be widespread.
The federal government should have focused on public health measures that might have helped flatten the curve instead of banning travel from South Africa.
He said that the U.S. federal government didn't move fast enough. We could have had at least two more weeks to get the testing capacities up.
In the meantime, public officials and exhausted health care workers who live in localities where the peak seems to have passed can take some solace in the wastewater data.
The data shows that there is a light at the end of the tunnel.
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