During the COVID-19 pandemic, wastewater monitoring and analysis became a key tool for monitoring and measuring the amount of virus in communities.
But some experts warn that data collected from these studies can also lead to privacy concerns, especially because samples are often collected from public sources without individual consent.
“Bioethics, which is at the heart of what health care providers do, has historically been based on ‘no harm’ – and the idea of informed consent,” said Steve Hrudy, an honorary professor in the Department of Laboratory Medicine at the University of Alberta and Pathology. . “Well, informed consent is really not possible for this type of technique.”
Hrudei is chair of the COVID-19 National Wastewater Coalition Research Advisory Group, a non-profit group founded in the spring of 2020 that helps coordinate and share information on wastewater surveillance efforts across the country.
Document from 2021, co-author of Hrudei and six other researchers recommended that the COVID-19 wastewater monitoring programs follow a list of 17 guidelines provided by the World Health Organization for ethical oversight of public health.
These guidelines suggest that monitoring programs should pursue four main objectives: working for the common good, justice, respect for people and good governance.
“The case for maximizing the potential of this approach is compelling, but the benefits of wastewater surveillance must clearly outweigh the ethical risks to the community,” the document said.
Poop doesn’t lie
Humans can secrete genetic material from the SARS-CoV-2 virus in the form of RNA. Sometimes the virus can be detected in human wastewater samples before anyone shows symptoms of the disease.
“If you excrete it immediately, within days of infection, this information is already flushed down the toilet. [and] a trip to your wastewater treatment plant, where it is collected and analyzed by, you know, us or someone like us, ”said Nyusha Gaeli, co-founder of the epidemiological company for wastewater Biobot Analytics.
Newsha Ghaeli is the co-founder of Biobot Analytics, an American company that tests wastewater for COVID-19. (Biobot Analytics)
Ghaeli, who studied in Waterloo, Ontario and Montreal before founding Biobot in the United States, said the technology used by her company could now find a positive case in a sample of 6,500 people.
These data are becoming increasingly important as provinces and territories reduced access to PCR tests in the second half of 2021, especially after the Delta and later Omicron waves saw significant jumps in reported and suspected positive cases.
Experts like Ghaeli say that while the data may be very accurate, there is no way to identify a person, even if they find a single positive case.
Your stools do not have identifying information such as a fingerprint, so to speak.
“When we get a positive test, there is no way to know who it came from. “You know, it’s like saying, ‘Oh, we have so many 401 cars today.’
Pellets derived from wastewater material are seen in the Gilbride Laboratory at the University of Toronto Metropolitan. (Peter Mitton / CBC)
Sludge life, stool pellets
Gilbride’s lab analyzes sewage samples delivered from the entire Toronto area: some from hospitals, long-term care homes, while others come from the Humber treatment plant.
These bottles are mostly filled with cloudy water, but some of them are more opaque and labeled “sludge”.
“When you open one of them – yes, you have to hide behind cover,” said Babnit Chana, a research assistant who helps with sample processing.
Nora Dana is a postdoctoral researcher working at the Gilbride Laboratory for Wastewater Monitoring at the University of Toronto Metropolitan. (Peter Mitton / CBC)
Chana and another assistant, Matthew Santili, work mostly with equipment that comes with a hood to release these odors. They place the samples in centrifuge tubes – turning the pellet into a relatively inert pea-sized pellet for analysis.
“It’s anonymous. “We don’t really go after people and say, ‘This is you, you know,’ or ‘This is your house,'” said Nora Dana, a postdoctoral fellow who also works in the lab.
Data can help or harm people in neighborhoods: Hrudei
This is not enough to allay Hruday’s fears, who say “you can concentrate on very small areas” if samples are identified and collected from specific sewerage networks in a city.
With enough data, public health officials could be stationed in a neighborhood to prevent further outbreaks. But it could also be abusive to stigmatize the people who live there – or worse, Hrudi warned.
This is also not purely theoretical, he said.
There was cases in Hong Kong and Singapore where sewage monitoring was used in residential buildings and authorities then monitored positive samples from individual apartments, Hrudei said.
“The authorities showed up and said, ‘Well, you know, you have a case here and you need to be tested,'” he said.
“Now you can say that there is a justification for public health for this. But you can see that a slippery slope is possible.”
Babneet Channa, a research assistant, processes bottles of wastewater samples at the Gilbride Laboratory at the University of Toronto. It works mainly under a fireplace, which removes odors. (Peter Mitton / CBC)
Hrudi also said he had seen a draft research proposal that suggested it might be possible to plot levels of infection in the neighborhood with COVID or other traceable diseases next to the block.
“It was detailed enough to almost identify street addresses,” he said.
However, he stressed that the proposal is theoretical – presenting only what is possible – and does not know that anyone in Canada has tried this or gained access to private citizens’ data to use.
“Health authorities are bound, at least in Alberta, and I suspect that in most provinces, by very strict privacy laws regarding individually identified health records,” he wrote in a subsequent email to The Sunday Magazine.
He is not the only one who raises these concerns.
An article from 2021 in the European Journal of Law and Technology, by Dutch scientist Bart van der Sloat, outlines potential future uses that are almost readable as science fiction: wastewater monitoring robots that can crawl through residential pipes, taking samples from a street or even a lonely home.
Ghaeli agrees that a clearer ethical basis needs to be set for how wastewater monitoring is used – rather than later. But we are not there yet, she said.
“I think we will be in a different place in about a year, because I think it is absolutely necessary to discuss and resolve these difficult issues,” she said.
With files from Peter Mitton. Radio segment produced by Peter Mitton.
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