Research Highlights

“If our prediction models are showing early warning signals of a problem, we could sound the alarm for state and federal authorities to prepare for an outbreak,” Irene Xagoraraki, associate professor in environmental engineering at MSU who is leading the study, said in a news release. “The medical community needs to be armed with resources to help these communities and early action might be one of the answers.” The study builds upon Xagoraraki’s, Kaneene, Cunningham Initial work in Uganda (USAUGANDACenter for Viral Disease Surveillance” NSF, Grant approved: 02/11/2020). Most recently Dr. Xagoraraki is researching viruses among Detroit’s population by analyzing past research tracking viruses among Detroit’s population by analyzing the city’s wastewater in 2017 and 2018. During that study, researchers detected a spike in hepatitis A infections seven to nine days before health care facilities noticed the change. Anil Gosine, a program manager with Detroit Water & Sewerage Department, said the COVID-19 wastewater project has the potential to function as a similar early warning system. When a patient contracts COVID-19, it can take as long as two weeks for them to start feeling sick. But infected people begin shedding virus in their saliva, mucus and waste much earlier. “Lots of people have the virus and don’t know they’re spreading it,” Gosine said. “The idea would be, this would give us an indication of where there’s an invisible uptick.” Armed with that information, local public health officials could take measures to prevent further spread, such as advising area residents to limit their face-to-face interaction and ramping up local testing and contact tracing efforts. Hospitals, meanwhile, could brace for a coming surge in patients. If Detroit could have received such a warning before the first Michiganders tested positive for COVID-19, “hundreds if not thousands of lives could have been saved,” said William Cunningham, Associate Dean for global health in the MSU College of Osteopathic Medicine.

Although the effort to apply the MSU team’s research method to the COVID- 19 pandemic is still in its infancy, researchers say it will soon be ready for public health officials. They are collecting samples weekly and working to establish a baseline level of COVID-19 in wastewater, Cunningham said, which will enable them to spot any spikes that indicate a new outbreak. That early detection capability is particularly useful given that Michigan’s COVID-19 testing capabilities remain low. Tracking the virus through widespread testing requires not only the cooperation of residents willing to get tested, but also access to reagents,
swabs and other medical equipment that is in short supply after the pandemic fueled a global spike in demand. The MSU team’s viral forecasting system requires only access to a community’s wastewater and the ability to analyze the samples.

“Say you have 5,000 people in a square mile,” Cunningham said. “Think of the resources it would take to test every one of those 5,000 people and wait for results to come back, versus those 5,000 people are discarding waste into the same sewer, so you analyze aggregate data by running one sample.” Researchers around the globe are using similar methods to track COVID-19, with promising results. Preliminary findings from a study in Massachusetts, for example, showed that COVID-19 volumes in a metropolitan area’s wastewater indicated a far higher infection rate than had been officially reported
in that area at the time. In addition to assisting with Michigan’s COVID- 19 response, Xagoraraki and her team hope their methodology can help detect and contain other infectious disease outbreaks around the globe.

In 2022, Dr. Xagoraraki’s team expanded the project to South America, Peru. Peru was one of the worst-hit countries during the pandemic. In Peru, from January 2020 to December 2022, there have been 4,330,521 confirmed cases of COVID-19 with 217,566 deaths, reported by the World Health Organization (WHO). Moreover, multiple other viral diseases (enteric, respiratory, bloodborne, and vector-borne) are endemic and arising. Arboviruses, such as Dengue virus, have been on a rise in South American countries including Peru1. Other arboviruses like Chikungunya and Zika have also been reported in the region2. According to the Peru Ministry of Health, the COVID-19 pandemic reverted the current health facilities of the country leading to reduced action to curb other diseases like arboviruses. Furthermore, many viral diseases in the area are under-reported and not recognized. Identification, early detection, and prediction of emerging viruses and upcoming viral outbreaks is a key for successful management and containment.

Traditional disease detection systems are based on diagnostic analysis of clinical samples. This approach, however, assumes that patients are examined at a clinical setting after symptoms have developed and after the outbreak has been established and recognized. Recent research efforts in developing optimized detection systems and sensors focus on rapid methods for analyzing blood or saliva samples, but this approach assumes that patients are examined on an individual basis. Testing every individual for active infections or immunity, especially in under served communities, is practically impossible for effective treatment. Traditional systems alone fail to detect early warnings of public health threats at a population level and fail to predict outbreaks in a timely manner.

Environmental based surveillance provides a means of obtaining and analyzing community composite samples (CCS) that can lead to early warnings of potential upcoming viral outbreaks as well as predictions of fluctuations of established outbreaks for specific geographical areas. Wastewater surveillance has been proven effective in predicting viral outbreaks such as COVID-19. The methodology of wastewater-based-epidemiology has been described by our group at Michigan State University. In recent studies in Detroit MI, Dr. Xagoraraki’ s team has been successful in identifying multiple endemic respiratory, enteric, bloodborne and vector-borne diseases extracted by the population. Moreover, we were able to predict surges of COVID-19.

Progress reports of the samples taken in Trujillo, Peru between October 22 and October 24, 2022, reveal the presence of virus and a variety of them depending on the collection site. More results are still to come. If local partners in Trujillo collaborate in the funding of the full-scale project; it is expected to lead to a joint publication with co-authors from UCV and Michigan State University. The journal publication will demonstrate technical capability of the group, evidence of established collaboration, and potential of laboratory training for technology transfer. These aspects are critical for a subsequent large research grant to be requested from other institutions.