Many states are not yet on board with the Biden administration's plan to monitor the nation's sewage.
California, Florida, Texas and Pennsylvania only have clusters of collection sites in major population centers. Minnesota and New Jersey don't know how large their programs will be. Neither North Dakota nor Wyoming plan to participate.
Public health officials can use poop to identify and respond to clusters of Covid cases. The country is vulnerable to the next Covid-19 variant or public health crisis due to the lack of participation in a comprehensive early warning system for infectious diseases.
Ted Smith is the director of the Center for Healthy Air, Water and Soil at the University of Louisville.
State health officials and wastewater experts told POLITICO that sewage surveillance operations in some areas have grappled with privacy concerns and logistical challenges, such as figuring out how to coordinate dozens of treatment plants routinely sending in sewage samples to a handful of labs and standardizing processing protocols.
The federal government paid a private lab more than $6 million to help states monitor sewage on their own, but the company struggled to build trust with local operators who weren't always aware of what the federal government was trying to do.
The CDC would have gotten more for its money if it had relied on local labs instead of a large, national company, according to the vice president of applied services at LuminUltra.
There is a fundamental flaw in this particular strategy and it is not sustainable.
State and local health officials demonstrated how they could detect the coronaviruses in their community's sewage systems before residents developed symptoms. The efforts caught the attention of federal health officials at the CDC, who launched the National Wastewater Surveillance System in late 2020.
The goal was to build a system that could detect Covid case surge and new variant. It could pick out other public health threats, such as the appearance of a virus that could cause the next Pandemic, as well as growing resistance to popular antibiotics.
Only a dozen states have submitted data to the NWSS since the effort began 18 months ago. The information from some of the states is thin. Most of the 23 collection sites in California are in the Bay Area. The CDC doesn't have at least two data points from the last 15 days to calculate a percentage change in viral concentration because more than half of New York's sampling sites have no recent data on the dashboard.
Smith said that the danger for public health decision makers is assuming that a national wastewater monitoring system is fully prepared and ready, when in fact it is still a patchwork system that risks falling apart without sustained funding and participation.
He said that if everybody thought we were done, that would be a misunderstanding.
Even if all states don't participate, the CDC believes the system can work because it's designed to supplement other public health efforts.
One of the biggest advantages of NWSS is that it gives local health officials specific, actionable information about what's happening in their community so that they can take action.
For states that weren't interested in building their own surveillance infrastructure, the CDC worked with a private company that would process samples for local wastewater plants free of charge, believing the data collected would demonstrate to state officials.
Efforts have yet to convince all states to join. The CDC has been told by some states that they don't have the time to devote to the effort.
They were busy trying to respond to the Covid epidemic, and they didn't have enough bandwidth to stand up a new system, according to Amy Kirby, a senior service fellow in the Waterborne Disease Prevention Branch at the CDC.
37 states have been awarded nearly $36 million by the CDC. There are two dozen that aren't reporting to the CDC.
One community refused to join the project because they didn't want local wastewater treatment plants on board. The project team had to figure out how to get 30 facilities across the state to send in samples three times a week to five Idaho Bureau of Laboratories. The labs had to standardize their equipment.
The professor of environmental engineering at the University of Idaho said that people get frustrated at the pace at which things are happening.
Other states have decided not to monitor their residents. In North Dakota, the state health department is in the process of redirecting current federal grant funding for sewage surveillance after residents voiced concerns about the data being reported. A health department spokesman said that not participating in the federal program would best meet the needs of our citizens.
The wastewater monitoring program in Wyoming ended in December. Even though additional funding is available to the state, a spokesman for the department of health said there has been no decision on future wastewater monitoring plans.
The backup plan to entice these states to build long-term wastewater infrastructure by proving the value of the data is struggling. Some treatment plants didn't want to work with the company because they didn't have a relationship with it. Wastewater treatment plants are regulated by the EPA and are sensitive to additional activity.
The CDC is working with the Water Environment Federation and the EPA, which have relationships with wastewater facilities, and offering guidance to facilities on how to participate.
Several wastewater scientists interviewed by POLITICO said they see the value of a national wastewater system that standardizes and makes permanent their piecemeal efforts over the last two years. They say that a tool like this would help protect public health.
They say it can be done without widespread buy-in. If the program continues, there won't be enough momentum to get a robust version of NWSS up and running, according to an associate professor of public health at Syracuse University. The program needs at least $100 million a year from the federal government to give it a chance at long-term success.
Wastewater scientists worry that the opportunity to establish a national wastewater system will be lost if there is no permanent funding.
We have built up these capacities, so let's not waste what we've done. Let's not let this slide away.
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