
Sewage could reveal true scale of coronavirus outbreak - plcancel
https://www.scientificamerican.com/article/how-sewage-could-reveal-true-scale-of-coronavirus-outbreak/
======
jart
Before anyone goes collecting sewage samples, consider deriving your scaling
factors from discrepencies in ICD-10 diagnostic encoding practices.

\- Stacked bar chart:
[https://twitter.com/OccupyWallSt/status/1246478379064295425/...](https://twitter.com/OccupyWallSt/status/1246478379064295425/photo/1)

\- Govt data: [https://data.cdc.gov/NCHS/Provisional-Death-Counts-for-
Coron...](https://data.cdc.gov/NCHS/Provisional-Death-Counts-for-Coronavirus-
Disease-C/hc4f-j6nb)

ICD-10 is really the heart of the matter. Earlier recommendations have asked
doctors to encode corona death information using Pneumonia (J12.89) or
Bronchitis (J20.8, J40) if positive test results are available, suffixed by
B97.29 if authorized by the CDC to do so. We now appear to finally have the
pneumonia encoded info thanks to NCHS. Hopefully govt will open source the
bronchitis encoded reports too.

See also:

\- [https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-
Coding-...](https://www.cdc.gov/nchs/data/icd/ICD-10-CM-Official-Coding-
Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf)

\- [https://www.cdc.gov/nchs/data/icd/ICD-10-CM-
April-1-2020-add...](https://www.cdc.gov/nchs/data/icd/ICD-10-CM-
April-1-2020-addenda.pdf)

\- [https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-
final....](https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf)

~~~
ramraj07
What is the implication here? Is it that the number of pneumonia deaths is the
real indication of covids prevalance?

~~~
jart
We don't know yet. These numbers are still preliminary, but it helps us to
understand better the impact of the workarounds that doctors have needed to
use, to tell the CDC it's COVID, when the software does not yet have a button
for COVID.

The good news from the recent report ([https://data.cdc.gov/NCHS/Provisional-
Death-Counts-for-Coron...](https://data.cdc.gov/NCHS/Provisional-Death-Counts-
for-Coronavirus-Disease-C/hc4f-j6nb)) is that __overall __mortality in America
these past few months, has actually been lower than previous years. The bad
news is that we should prepare for the possibilty that mortality for the new
coronavirus specifically could turn out to be much worse than many non-
official sources online have speculated, and that what 's happening in NYC is
happening in a lot more places too. Correcting for software workarounds and
verifying good accurate data takes time.

~~~
edraferi
I expect 400k COVID-19 deaths in the US. Anything less than that is a major
win. Anything less than the 2.2M is progress.

~~~
abstractbarista
This is likely a gross overestimation. We're at 70k _worldwide_ deaths; turns
out it's just not as bad as we were initially told.

------
fludlight
Actual paper:

Presence of SARS-Coronavirus-2 in sewage / Medema, et al.

[https://www.medrxiv.org/content/10.1101/2020.03.29.20045880v...](https://www.medrxiv.org/content/10.1101/2020.03.29.20045880v1.full.pdf)

Check out Table 4.

~~~
viraptor
Seeing papers like that, I really appreciate what tex did for scientific
publishing. (Yes, I understand formatting was not their top concern right now)

~~~
aaron695
Maybe, equally we have every idiot going to the useless John Hopkins site
because it looks pretty.

I guess it's an arms game in part.

~~~
pupdogg
Thank you! At least someone understand my frustration. When I try to compare
countries, it somehow manages to insert New York along with a few other US
states as countries. He/She/They might be a good React/GraphQL ninja(s), but
definitely skipped out on the ETL course.

~~~
mhandley
Is this any more useful as a comparison?
[http://nrg.cs.ucl.ac.uk/mjh/covid19/](http://nrg.cs.ucl.ac.uk/mjh/covid19/)

------
mirimir
Interesting. That's also been done for recreational drugs. And artificial
vanilla flavoring.

I wonder whether sampling from sewage pumping units could be done. That might
produce higher resolution data. But getting representative samples would be
harder. You'd probably need to take large samples, mix, and subsample.

~~~
nradov
Here's a recent wastewater analysis study showing the prevalence of several
illegal drugs in Europe.

[http://www.emcdda.europa.eu/topics/pods/waste-water-
analysis...](http://www.emcdda.europa.eu/topics/pods/waste-water-analysis_en)

~~~
ddrt
> This report is focused on illicit stimulants. No results for cannabis are
> reported because cannabis use is estimated by measuring its main metabolite
> (THC-COOH), which is the only suitable biomarker found so far, but is
> excreted in a low percentage. More research is needed to understand the
> excretion percentage of THC-COOH or find alternative biomarkers (Causanilles
> et al., 2017a).

this is the second sewage testing paper I’ve read today. Why are these so
incredibly interesting and fun to read when compared to the other testing
documents I’ve read haha.

~~~
kijin
It's a kind of hack on modern sanitation systems. It makes you realize that
everyone is (literally!) leaking all sorts of information about what's in
their bodies. You just need to know where to pick up that treasure trove of
information. It tickles the hacker fantasies!

~~~
Mirioron
Here's a horrifying thought:

"Smart" toilet/sink/pipe + sewage testing = data

~~~
DownGoat
Reminds me of an old "Bastard Operator From Hell" story.
[https://www.theregister.co.uk/2004/03/09/bofh_protecting_bod...](https://www.theregister.co.uk/2004/03/09/bofh_protecting_bodily_waste/)

------
dontbenebby
Ah yes, the quantified toilets joke from SIGCHI 2014 has come to unironic
fruition:

[https://www.theatlantic.com/technology/archive/2014/04/what-...](https://www.theatlantic.com/technology/archive/2014/04/what-
a-toilet-hoax-can-tell-us-about-the-future-of-surveillance/361408/)

It was meant as a prank, not an instruction manual.

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jerzyt
What a wonderful symmetry to the cholera outbreak in 1854 in London, where
John Snow traced the sources to drinking water wells:
[https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outb...](https://en.wikipedia.org/wiki/1854_Broad_Street_cholera_outbreak)

~~~
8bitsrule
Interesting that while Snow blamed germs, 'authorities' later blamed 'miasma'
instead and ignored Snow. Once again, we learn from history that...

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cameldrv
I’ve been wondering about this. It would be especially interesting if, after
we come out of lockdown, we could sample sewage at many points as the sewer
comes together. You might be able for example to identify an infected block
and then go around to give individual swabs to each resident if the block came
up positive.

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jerzyt
This should also allow to monitor for mutations of the Covid 19, whereas it
would be impractical to do at an individual level. It would give an early
warning signal.

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dhash
There’s a YC company [0] already doing this.

[0] [https://www.biobot.io/covid19](https://www.biobot.io/covid19)

~~~
sb057
STFC19aaS (Sewage Testing for COVID-19 as a Service)

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thdrdt
Serious question: are there 'pandemics' we don't hear about because the virus
doesn't hurt us? Are those outbreaks also studied?

~~~
tobylane
If you mean animal flus that didn’t cross over to humans then certainly. Some
of them are in wild animals where we might not casually notice a drop
unrelated to our activity, or in farm animals where the heavy use of
antibiotics reduces the spread within some farms.

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darkerside
I'm sure there are great reasons, but why is it that we can't detect the virus
in wastewater at a personal level? Could this be a less invasive way to test
for covid19?

~~~
vichu
There's an Adult Swim short about that:
[https://www.youtube.com/watch?v=DJklHwoYgBQ](https://www.youtube.com/watch?v=DJklHwoYgBQ)
:)

~~~
Waterluvian
They just never took the Smartpipe bit to its conclusion. No punchline
happened. Broomshakalaka, however, is masterclass.

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DoingIsLearning
Public statement from the Dutch CDC (RIVM) on this method:

[https://www.rivm.nl/node/153991](https://www.rivm.nl/node/153991)

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awaythrower
Maybe. Similar to drug testing an entire city using sewage.

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yalogin
That is interesting. Do we now what the rate at which the virus dies in water?

~~~
cblades
You don't need live viruses, just their RNA.

~~~
kardos
... so do we know how fast the RNA degrades in sewer conditions?

~~~
marcosdumay
Slowly enough to not matter. Unless something is degrading it, RNA can last
years.

~~~
ddrt
I’m pretty sure ribonucleases are found everywhere (even in sewage) so if
enough are present it would break down all RNA fast. RNases come from skin and
dust, for example.

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hkai
Incidentally, we can also test sewage for drugs and then swat places where
people consume drugs. How very helpful. It's just because we need to fight the
virus! ️

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potiuper
Except in areas without sewer

