Fighting Coronavirus/COVID-19 with Public Health Data

 covid19.tempe.gov 

Tempe is in a unique position for an innovative response to the coronavirus/COVID-19 pandemic due to the Wastewater Data Analytics - Opioids program supported by the Tempe City Council’s Innovation Fund in 2018 and the community trust cultivated by our compassion, science and services approach in using public health data.  

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the virus SARS-CoV-2 that can spread from person to person. SARS-CoV-2 is a novel (new) coronavirus first identified during an investigation into an outbreak in Wuhan, China. 

Patients with COVID-19 have had mild to severe respiratory illness with symptoms including fever, cough, shortness of breath or difficulty breathing, chills, muscle pain, sore throat and new loss of taste or smell. Severe complications from this virus include pneumonia, multi-organ failure, and, in some cases, death. The virus is thought to spread mainly between people who are in close contact with one another (within about 6 feet) through respiratory droplets produced when an infected person coughs or sneezes. It also may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly, their eyes.  

When it comes to fighting the spread of COVID-19, community leaders and first responders need relevant and up-to-date information to make strategic and operational decisions about this public health crisis.

In an innovative partnership to prevent and reduce the spread of COVID-19, the City of Tempe is working with scientists from Arizona State University's Biodesign Institute to study the city's wastewater. Wastewater-based epidemiology (WBE) is the science of studying community sewage for public health information.  

This data can inform the city's strategic efforts in the community and measure progress to stop the spread of the virus. 

This strategic program advances the  City Council Strategic Priorities  and aligns with the following strategic priorities and performance measures:

 Safe and Secure Communities 

•  Feeling Safe in City Facilities (1.11) 
•  Feeling of Safety in Parks (1.23) 
•  Feeling of Safety in Your Neighborhood (1.05) 

 Strong Community Connections 

•  Satisfaction with Availability of City Information (2.21) 

 Quality of Life 

•  Community Health and Well-Being (3.34) 
•  Mental Health & Wellness (3.37) 

There are many benefits to using data-driven evidence through wastewater analysis.  The main benefit is ensuring a healthy community. When used alongside information on diagnosed cases and deaths, state and national data, the study of wastewater for COVID-19 also provides:

• Evidence of the virus’ presence in the community, for both diagnosed and undiscovered cases;
• Potential leverage for mobile testing and additional public services; 
• Data to inform policy makers for continued social distancing, business/school closures;
• Opportunity for data-informed decisions to re-open businesses and schools; 
• Forecasts for public health conditions and threats;
• Scientific partnerships and research with Arizona State University; and,
• Innovative use of wastewater epidemiology to set the standards for the region, state and nation for advancing community health and wellness.

Studying sewage for public health information is known as Wastewater-based epidemiology (WBE).  

Similar to visiting your doctor for your health tests, wastewater has biomarkers that indicate the health of the entire community. Biomarker is short for biological marker, and is used to identify when a biological process has happened in the body. Analyzing wastewater provides a way to understand community health in a manner that provides rapid and sensitive analysis of an entire community without conveying any personally identifiable information.

If you use a restroom in Tempe, whether you live, work, study, visit, or just drive through, you might contribute to a sample. Locations that are served by septic tanks are not included in the wastewater study since they are not connected to the city's wastewater system.

The presence of COVID-19 in the wastewater accounts for a collective of individual samples, that include both diagnosed and undiagnosed cases in the community. This community-level viral biomarker is important in analyzing the presence of the SARS-CoV-2 virus in the City of Tempe and represents part of a set of tools to address important public health questions.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. People infected with SARS-CoV-2 excrete the virus in their feces in a process known as “shedding”. The municipal wastewater treatment system (sewage system) collects and aggregates these bathroom contributions across communities. 

Tempe wastewater samples are collected downstream of a community and the samples are brought to the ASU lab to analyze for the virus. Analysis is based on the genetic material inside the virus.

In the lab, wastewater samples are filtered, concentrated, and viral genetic material is recovered. After obtaining this material, ASU scientists are ready to analyze the sample using molecular tools. 

ASU scientists detect the virus through an amplification method that uses specific probes to quantify the viral genetic material in a sample. When scientists have the virus’ genetic material, they run an assay commonly referred to RT-qPCR to detect and determine the relative abundance of the virus’ characteristic gene(s) in the sample. The signal strength is similar to softness or loudness of sound. The stronger the signal, the more prevalent the virus. 

The unit of measurement is the abundance (copy number) of genes of the virus per liter of wastewater sampled. This is a conservative metric of reporting. Other metrics of reporting include an estimation of the number of infected people in the wastewater capture zone. Tempe does not report the number of infected cases because these estimates carry large uncertainties and the formulae used for calculation are subject to dispute and change.

In utilizing public health data, Tempe integrates data and sciences. The following dashboard displays the wastewater collection areas.

Note of Caution:

The influence of this data on community health decisions in the future is unknown. Data collection is being used to depict overall weekly trends and should not be interpreted without a holistic assessment of public health data. The purpose of this weekly data is to support research as well as to identify overall trends of the genome copies in each liter of wastewater per collection area. In the future these trend data could be used alongside other authoritative data, including the number of daily new confirmed cases in Tempe published by the Arizona Department of Health and data documenting the state and local interventions (i.e. social distancing, closures and safe openings). The numeric values of the results should not be viewed as actionable right now; they represent one potentially helpful piece of information among various data sources.

We share this information with the public with the disclaimer that only the future can tell how much “diagnostic value” we can and should attribute to the numeric measurements we obtain from the sewer. However, what we measure, the Covid-related RNA in wastewater, we know is real and we share that info with our community.

In the Tempe COVID -19 Wastewater Results Dashboard, please note:

• These data illustrate a trend of the signal of the weekly average of COVID-19 genome copies per liter of wastewater in Tempe's sewage. The dashboard and collection area map do not depict the number of individuals infected. 
• Each collection area includes at least one sampling location, which collects wastewater from across the collection area. It does not reflect the specific location where the deposit occurs.
• While testing can successfully quantify the results, research has not yet determined the relationship between these genome values and the number of people who are positive for COVID-19 in the community.
• The quantity of RNA detected in sewage is real; the interpretation of that signal and its implication for public health is ongoing research. Currently, there is not a baseline for determining a strong or weak signal.
• The shedding rate and shedding duration for individuals, both symptomatic and asymptomatic, is still unknown.
• Data are shared as the testing results become available. As results may not be released at the same time, testing results for each area may not yet be seen for a given day or week.
• The dashboard presents the weekly averages. Data are collected from 2-7 days per week. 
• The quantifiable level of 5,000 copies per liter is the lowest amount measurable with current testing. Results that are below the quantifiable level of 5,000 copies per liter do not suggest the absence of the virus in the collection area. It is possible to have results below the quantifiable level of 5,000 on one day/week and then have a greater signal on a subsequent day/week.
• For Collection Area 1, Tempe's wastewater co-mingles with wastewater from a regional sewage line. Tempe's sewage makes up the majority of Collection Area 1 samples. After the collection period of April 7-24, 2020, Collection Area 1 samples include only Tempe wastewater.
• For Collection Area 3, Tempe's wastewater co-mingles with wastewater from a regional sewage line. For analysis and reporting, Tempe’s wastewater is separated from regional sewage. 

Over 400 cities, nationally and internationally, receive data about their cities’ wastewater from Arizona State University. However, Tempe is the first city to incorporate wastewater data with other strategies to drive decisions that advance community health outcomes.

Understanding changing trends in the presence and signal strength of COVID-19 in city wastewater over time is one tool to protect, communicate and contain the spread of the virus.

To measure outcomes and identify strategies, the trends in the wastewater results for COVID-19 are used alongside information on diagnosed cases and deaths, state and national data.

Strategies for reducing the spread of COVID-19 are already in progress in Tempe.

Tempe has a vast array of resources at  tempe.gov/coronavirus  where a  sign-up for regular emails  is available.

With public safety and health in mind, the City of Tempe has canceled public special events and project-specific public input meetings temporarily. On March 19, 2020, the Mayor issued a proclamation to order the closure of Tempe bars, in-restaurant dining and recreational and entertainment venues as well as the closure of Tempe gyms and workout studios temporarily.

This is in compliance with state and federal orders and the Centers for Disease Control and Prevention (CDC) guidance about large gatherings and the benefits of social distancing in minimizing community spread of COVID-19.

Like other organizations locally and nationally, Tempe hopes that a temporary pause in public gatherings could have a positive impact on minimizing community spread of the virus and keeping people healthier.

All critical services that Tempe provides – police and fire protection, traffic control, light rail, buses, Orbit, court services, water and wastewater and solid waste pickup – continue to be available. Tempe’s Emergency Operations Center is active with Tempe Fire medical rescue working closely with the Arizona Department of Health Services.

As schools and senior community facilities are closed, the City of Tempe is working with partners to ensure the food services that many people count on continue.  Tempe Elementary School District ,  Kyrene School District  and  Tempe Union High School District  are providing meals for students up to age 18.

Valley Metro and Orbit use a regularly scheduled cleaning process for transit fleet and public spaces, enhancing the cleaning and disinfecting regimens on public transit.

The City has installed seven mobile handwashing stations throughout the city. 

LIMIT YOUR RISK - We urge all to take precautions to limit their personal exposure to COVID-19. It is important to stay calm and informed, while taking precautions to prevent the spread of virus.

The  Maricopa County Department of Public Health  recommends: 

• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer. Visit:  When and How to Wash Your Hands 
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces.

If you are sick, do not go to public spaces. Follow your doctor’s guidance and adhere to  Center for Disease Control  directions.

If you were infected with COVID-19, symptoms may appear 2 to 14 days after exposure and include fever, cough, shortness of breath or difficulty breathing, chills, muscle pain, sore throat, or new loss of taste or smell. In some instances, people infected with COVID-19 have no symptoms or symptoms are so mild they don’t feel sick. That’s why it’s so important for all of us to stay home as much as possible, avoid gatherings of 10 or more, and practice  social distancing  to help slow the spread of the virus.

The  Maricopa County Department of Public Health  recommends, if you feel like your symptoms are worsening, especially if you have difficulty breathing, to call your healthcare provider or seek medical attention.

In adults, emergency warning signs include*:

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest
• New confusion or inability to arouse
• Bluish lips or face

* This list is not all-inclusive. Please consult your medical provider for any other symptoms that are severe or concerning.

If you live in the same home as someone who has tested positive for COVID-19 or someone who has symptoms of a new respiratory infection, such as cough or shortness of breath (not allergies or asthma), you should stay at home and away from others (quarantine) for 14-days after the last time you had close contact with the sick person in your household. Close contact is being within 6 feet of the person for 10 minutes or more.

No. Testing and sampling is conducted on large areas of the City and does not identify individuals.

There is currently no vaccine to protect against COVID-19. The best way to prevent infection is to take everyday preventive actions, like avoiding close contact with people who are sick and washing your hands often. 

There is no specific antiviral treatment for COVID-19. People with COVID-19 can seek medical care to help relieve symptoms.

The City and ASU findings and detection are only about wastewater (sewage). The virus that causes COVID-19 has not been detected in drinking water. Conventional water treatment methods that use filtration and disinfection, such as those in most municipal drinking water systems, should remove or inactivate the virus that causes COVID-19.  

The study of Tempe’s wastewater and the resulting actionable strategies requires a multidisciplinary approach with collaboration among scientists, researchers, water operators, first-responders, policy analysts, program providers and elected officials. Partners include: 

Center for  Environmental Health Engineering at the ASU Biodesign Institute 

Over five City of Tempe Departments and Service Areas:

• Tempe Fire Medical Rescue
• Municipal Utilities Department - Water
• Strategic Management and Diversity Office
• Internal Services - Information Technology
• Human Services- CARE 7, Tempe Community Council, Tempe Coalition
• City Attorney’s Office

Our mission is to advance an inclusive, innovative, transparent, and data driven organization to create a world class city for our community and our region.

We welcome inquiries and invite you to contact us about our program to utilize wastewater analysis and data for decisions that advance community health.

Rosa Inchausti, Director, Strategic Management and Diversity Office 

• 480-350-8999;  rosa_inchausti@tempe.gov 

Wydale K. Holmes, Strategic Management Analyst, Strategic Management and Diversity Office 

• 480-350-5312;  wydale_holmes@tempe.gov 

Rolf Halden, Ph.D., P.E., Director of the Center for Environmental Health Engineering at the Biodesign Institute, Arizona State University

• 480-307-2330;  rolf.halden@asu.edu 
• More info:  https://biodesign.asu.edu/environmental-health-engineering/human-health-observatory 

Stephanie Deitrick, PhD, GISP, Enterprise GIS & Data Analytics Manager

•  Stephanie_Deitrick@tempe.gov