D.C. is using your poop to squash the next COVID-19 surge

Months after more than a dozen states adopted the practice, D.C. is finally about to begin analyzing sewage to track COVID-19 in hopes of curbing the next surge.

Starting next month, we could know how many people are infected before they test positive or show symptoms.

Why it matters: Wastewater surveillance—the literal analysis of feces—has proven a powerful tool in other parts of the country, helping officials and individuals assess risk and make decisions. It can warn of a potential spike in COVID-19 cases because it can spot the virus days before individual testing can. It can also identify specific variants.

• Plus, wastewater surveillance can pick up on other illnesses—such as stomach viruses—lurking among the public.

Yes, but: D.C. is behind Maryland and Virginia in getting its sewage surveillance underway.

• In late 2020, the CDC started nudging various jurisdictions—including D.C.—to signal their interest in analyzing poop.
• The city soon agreed to take part, but didn’t receive $420,000 in funding from the agency until November 2021.

Four months later, the city is still waiting on critical equipment.

• Anil Mangla, D.C.’s state epidemiologist, says that if the equipment arrives soon, the city could begin making its data public in April.

The big picture: Wastewater from participating jurisdictions illustrates important trends.

• In the past 15 days, a third of collection sites nationwide have seen an uptick in COVID-19 cases.
• In Missouri last year, signs of Delta were present in wastewater as far back as May before the variant overtook the state, according to the COVID-19 Data Dispatch newsletter.

Between the lines: Amid loosening restrictions, individuals and businesses have been left to enforce their own rules. Meanwhile, D.C. is no longer reporting daily case counts. But there’s still a threat of new variants. See: BA.2, a subvariant of Omicron. Having access to a public poop dashboard would help many of us make smarter decisions — so long as the District reports its data in a timely fashion.

How the poop scoop works

The District will be able to see what’s in most residents’ feces because it is collecting samples from four sources:

• Blue Plains Wastewater Treatment Plant, which processes the bulk of the city’s wastewater.
• A site in Oxon Hill, which gives insight into wards 7 and 8, the areas hardest-hit by coronavirus.
• The Department of Corrections and St. Elizabeths Hospital, whose populations are particularly vulnerable to surges because of the group settings.

You, in turn, will be privy to how much COVID is circulating thanks to a CDC dashboard that aggregates the data.

• And you’ll be able to see how much the percentage of COVID-19 detected in waste has changed over the past two weeks.

Mangla will be eyeing the data closely and reporting trends to city officials.

• Sewage study is a “perfect surveillance system,” he tells Axios.

Context: The program could have a real impact on group settings in particular.

• 17 patients and one staff member at St. Elizabeths have died of COVID-19 since the start of the pandemic, which a report by advocates blamed on the hospital’s slow response.
• 1 person in the Department of Corrections has died and more than 700 sickened, per DC Health data.

What’s next: Officials plan to use the new infrastructure to identify other illnesses and public health concerns, including antibody resistance, fungus outbreaks, and even food poisoning, according to D.C.'s Department of Forensic Sciences interim public health lab director Jocelyn Hauser.

• “It’s kind of like the gateway to more testing,” Hauser says.

Maryland and Virginia: Pioneers in poop

Maryland and Virginia are ahead of D.C. when it comes to gathering COVID intel from sewage, but the scope of their programs differs.

The commonwealth is collecting samples from 25 treatment plants. At least four are in northern Virginia.

• Not every household is accounted for.
• The CDC’s dashboard shows that the NoVa sites cover more than 826,000 residents across Alexandria, Fairfax City, and Fairfax, Loudoun, and Prince William counties.

Of note: Rekha Singh, who manages the program for the Virginia Department of Health, says the agency sends a weekly report to the state’s COVID-19 task force to help guide their thinking and decision-making.

Meanwhile, Maryland has focused its attention on vulnerable populations, analyzing wastewater from public housing and other group settings.

• The state is now working to expand the program with 10 new treatment plants.

What they’re saying: Maryland’s targeted program has worked.

• When the state saw upticks of COVID-19, it increased testing and education around masking and social distancing, Maryland Department of the Environment assistant secretary Suzanne Dorsey tells Axios.
• Dorsey is now watching a national conversation about how to use such surveillance without stigmatizing the most vulnerable.

The bottom line: While wastewater surveillance isn’t new—it’s been used overseas for decades to monitor polio and diarrheal disease—building a robust system now means that future illness outbreaks might be controlled.