Environmental Surveillance: How underground information highways can assist Lesotho with the COVID-19 pandemic

Underground sewerage is fast becoming a gold mine for data analysis and big data when it comes to understanding behavioural patterns of humans. This big data is obtained from environmental surveillance. 

Environmental surveillance consists of testing sewerage and municipal waste water from communities, towns and cities through centralised sewerage networks or municipal waste water collection points in order to obtain data about that population or community. This effective data gathering approach has been tried and tested over the past decade with uses including assisting in the attempt to eradicate the Polio virus globally, as well as tackling the Opioid pandemic in the United States in the early 2000s.

The process is divided into four stages: Sewerage sampling, data accumulation, data analysis and judgement/action. The objective of these stages is to obtain rich spatial data produced by sewage epidemiological research. In the case of COVID-19 applications, this could assist and alert government and policy makers to be able to accurately, effectively and easily identify areas within population groups that are affected by COVID-19 in order for urgent and immediate action to be taken. This could mean early detection of new incidences in areas where there were previously no cases of COVID-19 through municipal waste water analysis before any hospital cases have been reported. It also might be the best way to determine whether the spread and number of infections have entered an accelerated state. Once hotspot areas have been identified and narrowed down, government can then focus on targeted case by case testing in order to find infected individuals within that community/area.

According to Daughton (2020), “Environmental surveillance can be a powerful tool in near-real-time community-wide monitoring and could greatly increase community connectedness and sense of purpose, thereby improving willingness to comply with government recommendations for distancing and self-isolation”.

Currently COVID-19 RNA within sewerage is used as the main marker/signal to identify the presence of the virus in municipal waste water. While further research is required in order to improve sampling techniques, and to understand the storage behaviour of samples with temperature and time, environmental surveillance currently provides a powerful qualitative way to understand, identify and monitor the spread and increase of COVID-19 within population groups. 

Australia, the United States of America and most recently South Africa are among the countries which have started national environmental surveillance initiatives in an attempt to better understand and tackle the Corona virus pandemic.

Developing countries such as Lesotho, which are characterised by higher general mortality rates, fewer hospitals and testing kits, few laboratories for analysis, fewer healthcare professionals, and a higher percentage of vulnerable groups within the population such as textile workers and miners, could stand to benefit greatly from adopting environmental surveillance as a tool in tackling the Corona virus pandemic.

The adoption of environmental surveillance for Lesotho could mean less financial resources being utilised in randomised case by case testing and laboratory analysis, less time delays as fewer test kits would need to be taken to South Africa and early identification of rising COVID-19 cases as well as hotspots could be achieved.

South Africa’s total COVID-19 cases have doubled from 50,000 to 106,108 cases (as at 23 June 2020) in approximately two weeks while Lesotho has reported 17 cases (from approximately 3000 tests conducted). Lesotho is landlocked by South Africa and receives the bulk of its food, petroleum, industrial and manufacturing imports from it. This means that with time there is a high probability that COVID-19 could creep in unnoticed into the mountain kingdom. This likelihood is further exacerbated by the illegal crossing of people through rivers between the two countries even as their national boarders remain closed .

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Keshaviah. A. et al., “The potential of wastewater testing for rapid assessment of Opioid abuse”. Mathematica policy research New Jersey, August 2016

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