What if nasal swabs only show us part of the picture of COVID-19?
What if nasal swabs only show us part of the picture of COVID-19?
13:43

What if nasal swabs only show us part of the picture of COVID-19?

Wellness
For over six months into COVID-19 and still know surprisingly little about how it spreads through our population, how it affects population wellness. Now why? [MUSIC] Ted Smith is gonna have some ideas about this. He is the director of the Center for healthy air, water and soil at the University of Louisville's environment Institute. We're gonna dig into that word in just a moment. Ted's got an interesting background. He's the hardest guy to find on LinkedIn because you're always sure you have found the wrong Ted Smith. Before this. He was the head of smart city innovation for the city of Louisville, which is a very smart and ambitious city on that front. Before that he was head of b2b and enterprise coverage here at CNET. That's where I first met him. Before that many years ago, he was developing VR at Accenture so you know, you don't let a lot of moss grow around you there Ted, do you know? No, it's gotta be busy. So let's get to your current project. You're dealing with something called the enviro Rome. I think most of us, Do not know what that is explaining.>> It certainly makes sense that most of us don't know what it is because we didn't make up the word. So what we like to tell people is if you if you know the genome, you're going to love the environment because it is the other side of the coin. You know, we know an awful lot about sources of disease that have come from sequencing the human genome. new kinds of therapies that have come from that a lot of really great biotech development that's happened over the past couple decades. And now we're turning ourselves outward and beyond the sack of chemicals that we are and we're looking at the role the environment plays either in keeping us well or making us sick. And so our institute is fully focused on those environmental determinants of our well being. Dr. Eric Topol over at Scripps, he talks about a lot of ohms microbiome meta biome transcriptome environment fits in that stack, right? Yeah, it's really once we leave the skin and we go out that that's those are the ohms that we're very focused on. Now let's bring it down to how it actually is. Is essayed and sampled and figured out you're going into sewers. In the last, you know, 10 years or so there's been a real interest in emphasis on what we can learn from say that gut microbiome and all of these, you know, sort of biomarkers that you know, people like Dr. Topol have been helping us discover So, this this is a great leap forward in some ways to essentially leave the individual gut and all the wonderful things we can learn about your health and well being at the individual level, and then look at the collective gut of a community, which is essentially what the sanitary sewer system is. And so we're, among a bunch of researchers right now that are focused on this new field called wastewater based epidemiology. How do you get into something that is so mixed? That is so huge and the number of contributors and mixing the number of substances they're each excluding and then pull out something meaningful. You can ask the same question about pooled sampling of any sort. So it's a it's a well known idea in. Public health in infectious disease surveillance that we can sometimes get economies of scale by pulling samples. You know, it's the same basic technology. We're still hunting for very specific markers of things and we can find very specific markers and count them up in in something as messy and complex as sewage. So let's take an example of that. How does this intersect with COVID? It's a really wonderful kind of development. And I love the way you open the segment here. I mean, we've been in this pandemic for quite a while, and yet we still seem to not have a grasp on how to trap infection and spread of infection. And the big surprise was published a few months ago right out of Yale University. Were they looking at Central Wastewater treatment in New Haven, Connecticut, they were able to show that a copies of SARS Coby to the virus that causes COVID 19. They were able to count copies of the virus Corresponded to the number of infections the community would see clinically seven days later, and they were able to follow the first surge up and follow it back down. And so many in the world took note that there was finally potentially some Tool that we could use to see where there could be the risk of increasing infection. And if we had lead time over when people got sick, there might be more we could do from a public health targeted intervention perspective, and that's very much the way that we're approaching. This is it's a surveillance early warning system. In partnership with communities, public health organizations, we really have the potential to sort of get into a much more focused war on this virus>>Sounds almost like a vast passive COVID testing. System without any of us having to opt in or get tested, we just keep going to the bathroom. That's exactly right. It is a passive monitoring system and it's extremely cost effective. The cost for running one of these tests is the same as one nasal swab test. So, if we're leveraging that across a neighborhood or a couple of neighborhoods, you know, that really is remarkable. So we're, we're excited about that. That because friction has been so Such a persistent component of this pandemic. I mean, how do we get people tested and how you know, nobody wants to get tested because it hurts or whatever. And so, you know, here we have this passive and then the other thing that's important to know is it's also another Anonymous. So, we don't know who is contributing. So, for those that are very concerned about privacy matters. This is anonymous public, essentially public information. We're really trying to just estimate trends and infection in places we're not trying to find individuals. Okay? So that's an important point is this serves a different purpose than contact tracing. It's different than contact tracing and it's different than say small scale like facilities based testing, which by the way is important and different. So I don't know if you read the news out of University of Arizona, but They had been surveilling dorm wastewater and because there are a manageable number of people inside a dormitory, when they saw a signal, they went in and tested everybody and they found two asymptomatic people. That's a great story right and they stopped what could have Bit bigger spread by the time you move to sort of city levels, neighbourhoods together hundreds of thousands of people, you know, we're really now looking at transmission dynamics. So is there increasing infection activity in an area and then do we want to try to focus on Targeted interventions in those areas not looking for the one person because the scale isn't your best friend in that particular case.>> Without getting too medically dense and over our heads. What is it we're shedding that allows this particular application with COVID to work what do you look for?>> So we are we are shedding copies of the virus in the same way that we are shedding them when we sneeze or cough. So it turns out more than half, the heart estimate isn't really there. But in the sort of 68% of people who've been affected that have essentially been researched have shown fecal shedding As part of the course of infection.>> Our discharges into the sewer system are relatively broad in terms of being able to reveal a lot of things kind of like a blood test it sounds like kind of. Like a blood test. I mean, one of the things that I'm personally excited about is you get simultaneously Not only biomarkers of the status of a person, right, we can look at how much caffeine is in the sewer system and how many prescription drugs and we can get a picture of the chemistry that's going into people and the chemistry of Of people and then we can look at some of these environmental factors like pathogens and all of these or bioterrorism or any other things that are in the environment. So it's both an assessment of the environmental conditions and an assessment of the health of the population. Now you're a smart cities guy, as I mentioned with your work with the city of Louisville. As this expands, do you think this is going to lead us down a path to smart sewer systems that are not just being passive as they are now, but perhaps have some technology built into turbocharge this process? I have no doubt that that's, that's the road that we're on right now. And I know you've all done some great coverage in the past on things like smart toilets and, you know as part of the whole Smart Home franchise, there already are Parts of the tech industry that are thinking like this, and it's certainly at the level of the individual or the household. Now here we have this sanitary sewer infrastructure. Most people in the world live in cities. And so we have this opportunity to now connect that piece. But the system wasn't designed to do this kind of work. And so we're doing all sorts of hacks out there in the field. Field in trying to get equipment that does the right kind of sampling. But, if we really want to cash the dividend cheque on this, then we really need to think about investing. Differently in the way the sewer systems work to really provide all sorts of benefits not just for this pandemic, but for future exposures to toxins or future pathogens or any number of things that you can find in the collective gut.>> Now, we mentioned a couple times investment in this technology investment in perhaps a smarter sewer system years down the road. Investment by either private or municipal parties comes with proven established sort of bank technology. Where does this whole science stand in terms of being peer reviewed and agreed upon, or are you seen as fringe still I mean, three months ago still pretty fringe. Now, not so fringe so you know the you know in the United States the Department of Health and Human Services the Centers for Disease Control EPA the Department of Homeland Security FEMA There are many, many, many parts of the federal government that are now activated working on this. So, you know, I think this is becoming more mainstream every day. The science itself as it relates to COVID. Still too early it's not part of our current public health response. But we have many different pioneering activities all around the United States and around the world, where we're really looking aggressively to try to get these dividends. Now And, you know, I think, you know, stay tuned is the shorthand on this. But, you know, i think it looks extremely promising and I think we should expect great things. What do you target is your next two low hanging fruit areas maybe?. Well, you know, believe it or not, we started doing this work before the COVID pandemic and so we are working actually in a collection of neighborhoods in livable Looking at urinary metabolites of air pollution, so that you know there's there are many neighborhoods in all cities that there are these environmental justice asymmetries and there are people who are subject to breathing more air pollution than others. We can actually detect that. The wastewater and then that can help us understand the chronic disease burden that may exist in some parts of some communities. So, if you look at even the number one killer is heart disease globally, and once we're past this pandemic, we will probably shift back to being very concerned about diabetes, obesity, cardiovascular disease, I mean These things that are just a really big part of cost in all the developed world's healthcare systems. Here, we now might have another tool to keep track of where those asymmetries are, where there might be an opportunity for targeted action. And, you know, I think we've got a bright future unfortunately in chronic disease right now. It's interesting. This really is a completely different take on a smart city turns it on its head where we always think Smart Cities are embedding our cities with sensors and applying great data techniques to the wash of data that comes back. But here it's smart city in the sense of a smart look at what's already in a city. Yeah, and I like to think of it after spending a lot of time looking at sort of the the last version of smart cities and IoT, sensors everywhere and there was a sort of a maybe a hammer looking for a nail and all of that right like just because I can make a cheap sensor and put it on a phone call, should I right? And so This to me is refreshing because we're really turning in, sort of inside out. We're saying, How can I live in an optimally healthy way? And so in some ways, I'm the sensor, right? And so how do I best figure out What my sensor is picking up and processing. And so then that leads us to a completely different part of the city to go figure out what were all are the experiences of us all and I think given the the great challenges of society right now There isn't a better time to really focus on the different lived experiences of all kinds of people in this country. And how do we build a technology that, you know, restores equity where there's inequity? How do we, you know, look for what's a meaningful problem versus what's missing. Measurable problem and I think this is a great next chapter. Ken Smith is director of the Centre for healthy air, water and soil at the University of Louisville's in Virome Institute. [MUSIC].

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