Introduction to Wastewater Data Collection

• Sewage contains wealth of health/wellbeing information flowing beneath city streets
• Every toilet use contributes valuable data to city sewers
• Urine/stool contain rich health information doctors analyze regularly
• Waste mixes with hundreds of thousands of other people's waste
• Tiny sample from wastewater treatment plant represents >1 million people
• Can detect: infectious disease viruses, chemical markers for drugs, collective microbiome bacteria

Data Privacy and Aggregation Benefits

• Sewage naturally aggregated and anonymized vs. personal smartphone/smartwatch data
• No way to tie information back to specific person after mixing with thousands
• Described as "perfect data dump"
• Potential to radically improve health outcomes in cities worldwide

Big Data Context in Cities

• Growing field called wastewater epidemiology
• Cities generate massive data: phone calls, package deliveries, miles driven, camera sensors, drones, air quality/water monitoring, healthcare/educational systems
• Digital breadcrumbs tell unique stories about cities and lifestyles
• Data can inform real-time improvements: social policy, environmental management, health equity
• Cities generate hundreds of millions of terabytes daily

Urbanization Statistics and Urgency

• For first time in human history: >50% of people live in cities
• By 2050: nearly 7 in 10 people will live in cities
• Biggest crises (climate change, pandemics, growing inequality) will hit cities first and hardest
• Big data era offers opportunity for new creative solutions

COVID-19 Wastewater Monitoring Success

• Gained popularity during COVID-19 pandemic (2020)
• Research groups worldwide detected SARS-CoV-2 RNA in sewage samples
• Sewage provided accurate representation of COVID activity in communities
• Time series data from March 2020 through present:
  • Blue line: COVID virus concentrations in US sewage samples
  • Yellow line: COVID clinical case data
• First 2 years: datasets tracked very well (people getting PCR tested frequently)
• Past 1.5-2 years: divergence in datasets (people testing less often)
• Sewage doesn't require healthcare access - everyone represented through normal bodily functions

Predictive Capabilities

• Sewage serves as leading indicator of new COVID clinical cases
• Infectious disease viruses incubate before symptoms/testing
• People excrete virus for days during incubation
• COVID sewage data: 1-3 weeks leading indicator for clinical cases

Boston Children's Hospital Case Study

• December 2021 Omicron wave example
• Cases skyrocketed across country end of December, didn't slow until end of January
• Boston Children's Hospital monitored Boston area sewage
• Saw sewage levels rise weeks earlier
• Proactively postponed all non-emergency medical procedures
• Freed up resources to adequately respond to incoming hospitalizations

Drug Epidemic Application

• Pre-pandemic: drug epidemic was biggest US public health crisis
• Drug overdoses growing year-over-year
• Leading cause of accidental death for Americans under 50
• 2018 North Carolina small town case study:
  • Overdoses increasing, needed better data
  • Analyzed sewage samples from several city sites
  • Found prescription opioids most commonly consumed (not injectable opioids)
  • City diverted resources from needle exchange sites to medication takeback programs
  • Held dozens of town halls about prescription painkiller adverse effects
  • Result: 40% reduction in overdoses that year
  • First time community engaged in dialogue around drugs/addiction/overdose

Global Expansion and Future Applications

• Pre-pandemic: tiny field with <12 experts worldwide
• Today: 72 countries use wastewater monitoring for COVID-19
• Future applications:
  • Predict influenza and RSV peaks annually for hospital preparation
  • Map nutrition in cities to identify food deserts and understand social determinants of health
  • Identify superbugs and antibiotic resistant genes as they emerge
  • Prevent next pandemic before it happens

Historical Context and Urban Intelligence

• Cholera prompted London to build modern sewer systems
• Poor health in NYC tenements catalyzed Central Park construction
• Cities can learn from COVID-19 experience
• Foster new intelligent urbanization
• Scientists, policy makers, architects, urban planners harnessing technology/big data to future-proof cities
• Chief Technology Officers appointed in cities worldwide over last decade
• Roles once reserved for Silicon Valley boardrooms now in City Hall

Call to Action

• Consider data contribution when: swiping credit cards, taking taxis, tapping metro cards
• Contributing to city's ever-growing digital infrastructure
• Using toilet = doing civic duty