In addition to the new crown, sewage plants in various places have also begun to test for influenza

Calgary, Canada's fourth-largest city, is located in
southern Alberta.
To the south of the city, there is a sewage treatment plant
called Pine Creek.
Recently, researchers at the University of Calgary's Environmental Lab have been busy going to sewage plants to take samples and collect sewage samples
from communities across the province.

In fact, since the beginning of 2020, the lab has been working with a team at the University of Alberta to track changes in the novel coronavirus (SARS-CoV-2) in wastewater and provide Alberta's health services with infection trends
in various communities.

Now, the joint team wants to expand the program's tracking audience beyond the coronavirus, as well as influenza A and B, as well as respiratory syncytial virus (RSV),
which plagues the province's health system.

Sewage plant flu tracking system

Back in July 2020, the University of Calgary and the City of Calgary, as well as the Alberta Health Services, began posting daily coronavirus information
in the region on their Health Information Center webpage.

The system divides the map into 3 areas
based on the distribution of three wastewater treatment plants in the City of Calgary.
The system samples each data point every 15 minutes at a 100mL sample, resulting in a sample volume
of 10L over 24 hours.
The collected sample is concentrated and sent to another local laboratory for analysis and infection levels
.

Now, in addition to the coronavirus load, they publish the concentration of influenza A and B in sewage and respiratory syncytial virus (RSV) on this website
.
As shown in the figure below, the public can get a very visual picture of the trend of the concentration of these viruses in sewage over the past two years
.

As far as the current data is concerned, the amount of new coronavirus in sewage in 2022 is not the same as in 2021, and the fluctuation range in 2022 is greater, and interestingly, the interval between each wave peak seems to be relatively consistent, and there are new small peaks after each return, which may also provide some reference
for our epidemic prevention.

A testing ground in a sewage plant

In 2015, the City of Calgary and the University of Calgary partnered to establish a wastewater research base called Advancing Canadian Water Assets (ACWA) at the Pine Creek wastewater treatment plant, which aims to conduct various innovative research
with actual sewage.

They have been testing wastewater for COVID-19 for
the past three years.
As winter progressed and flu and respiratory viruses began to ravage, they decided to add additional surveillance
.
Mr.
Kevin Frankowski, current Managing Director of ACWA, said: "Once samples are collected, it is not difficult
to add additional monitoring content.
Adding more pathogens to future surveillance lists may provide us with important data
.
It's important that all Albertans have transparent access to information so that people can make risk decisions
based on that information.
”

Data from the past month and a half shows that wastewater testing in Calgary shows a decline in flu and COVID-19 cases compared to previous weeks, but RSV is still increasing
.

But Dr Alika Lafontaine, president of the Canadian Medical Association, who is also an Albertan, said: "While I know it's important to build predictive models to help us understand what's going to happen in the future, I think the focus now has to be on the present
.
" What he meant was that while sewage data showed a downward trend, hospital emergency room pressures remained high — the respiratory viral infection season is particularly tough
for young people and children's hospitals in the province.
Alberta's health department has also had to make overall dispatches to help hospitals that are already overstretched
.
Dr.
Lafontaine also called for more effective public health measures, encouraging people to get vaccinated and stay home
as much as possible when sick.
"The pressure on the health care system is like a boulder rolling down a mountain, rolling down the shoulders of the caregivers who provide care and the patients who need to be cared for
," he said.
"It seems that many places abroad are still being tested
by the new crown.

While tracking monitoring may not yet have an "immediate" effect in the eyes of doctors like Dr.
Lafontaine, it is still an excellent investment for Mr.
Frankowski, who sees monitoring wastewater for flow diseases as a very low-cost monitoring program, estimated to cost less than $
1 per person per year.
He leads the ACWA team that has grown in its work since the pandemic began, with a corresponding increase in headcount and expertise in a variety of fields, from analytical chemistry to microbiology
.
In Xiaobian's view, this further shows that the functions of sewage treatment plants will become richer
after the epidemic.

Sentinel of Public Health

Calgary isn't the only city
that has thought of using sewage to monitor respiratory diseases other than coronavirus.
The HRSD Health Department in Virginia also provides a summary web page
for sewage virus information in more than a dozen cities under its jurisdiction.

The design concept of the web page is different from Calgary, in addition to the time change map of the corresponding viral load, there is also a spatial distribution heat map of the virus, which provides the viewer with one more dimension of information
.
However, the homepage also states on the front page that these monitoring data and analysis results are still to be confirmed and should not be considered final
.
The biggest purpose of publicly available data today is to supplement
other public health information.

In addition to HRSD, a joint team from the University of Michigan and Stanford University published an article in the journal ACS in July this year, sharing that they used sewage monitoring to identify two influenza outbreaks
on campus.

Illustration of the University of Michigan/Stanford Joint Research Paper | Source: ACS

On April 3, 2020, Nature published an article
titled "How sewage could reveal true scale of coronavirus outbreak.
" The article interviewed scholars from the Netherlands, the United States, Australia and other countries, all of whom said that sewage plants can play a more important role
in public management.
In the past few years, I have repeatedly reported on the potential value of wastewater monitoring, and one of its biggest advantages is that it can provide near real-time dynamic data
for public health departments.
But why has this vision been delayed in realizing it at scale? This is a question
that makes the editor puzzled.

Hopefully, in 2023, we will hear more good news
from the sewage plant that the virus has subsided.