Tool has been deployed in nine cities to date, and the results are being used by local authorities to design and prioritize programming and policy. The SaniPath Tool is a novel approach to support public-health evidence-based decision-making for urban sanitation policies and investments.
Background Beginning in early February 2020, COVID-19 spread across the state of Georgia leading to 258,354 cumulative cases as of August 25, 2020. The time scale of spreading (i.e., serial interval) and magnitude of spreading (i.e., Rt or reproduction number) for COVID-19, were observed to be heterogenous by demographic characteristics, region and time period. In this study, we examined the COVID-19 transmission in the state of Georgia, United States. Methods During February 1-July 13, 2020, we identified 4080 transmission pairs using contact information from reports of COVID-19 cases from the Georgia Department of Public Health. We examined how various transmission characteristics were affected by disease symptoms, demographics (age, gender, and race), and time period (during shelter-in-place and after reopening). In addition, we estimated the time course of reproduction numbers during early February-mid-June for all 159 counties in the state of Georgia, using a total of 118,491 reported COVID-19 cases. Findings Over this period, the serial interval appeared to decrease from 5.97 days in February-April to 4.40 days in June-July. With regard to age, transmission was assortative and patterns of transmission changed over time. COVID-19 mainly spread from adults to all age groups; transmission among and between children and the elderly was found less frequently. Younger adults (20-50 years old) were involved in the majority of transmissions occurring during or after reopening subsequent to the shelter-in-place period. By mid-July, two waves of COVID-19 transmission were apparent, separated by the shelter-in-place period in the state of Georgia. Counties around major cities and along interstate highways had more intense transmission. Interpretation The transmission of COVID-19 in the state of Georgia had been heterogeneous by area and changed over time. The shelter-in-place was not long enough to sufficiently suppress COVID-19 transmission in densely populated urban areas connected by major transportation links. Studying local transmission patterns may help in predicting and guiding states in prevention and control of COVID-19 according to population and region. Funding Emory COVID-19 Response Collaborative.
The serial interval and effective reproduction number for coronavirus disease (COVID-19) are heterogenous, varying by demographic characteristics, region, and period. During February 1–July 13, 2020, we identified 4,080 transmission pairs in Georgia, USA, by using contact tracing information from COVID-19 cases reported to the Georgia Department of Public Health. We examined how various transmission characteristics were affected by symptoms, demographics, and period (during shelter-in-place and after subsequent reopening) and estimated the time course of reproduction numbers for all 159 Georgia counties. Transmission varied by time and place but also by persons’ sex and race. The mean serial interval decreased from 5.97 days in February–April to 4.40 days in June–July. Younger adults (20–50 years of age) were involved in most transmission events occurring during or after reopening. The shelter-in-place period was not long enough to prevent sustained virus transmission in densely populated urban areas connected by major transportation links.
Background During 2014 to 2019, the SaniPath Exposure Assessment Tool, a standardized set of methods to evaluate risk of exposure to fecal contamination in the urban environment through multiple exposure pathways, was deployed in 45 neighborhoods in ten cities, including Accra and Kumasi, Ghana; Vellore, India; Maputo, Mozambique; Siem Reap, Cambodia; Atlanta, United States; Dhaka, Bangladesh; Lusaka, Zambia; Kampala, Uganda; Dakar, Senegal. Objective Assess and compare risk of exposure to fecal contamination via multiple pathways in ten cities. Methods In total, 4053 environmental samples, 4586 household surveys, 128 community surveys, and 124 school surveys were collected. E. coli concentrations were measured in environmental samples as an indicator of fecal contamination magnitude. Bayesian methods were used to estimate the distributions of fecal contamination concentration and contact frequency. Exposure to fecal contamination was estimated by the Monte Carlo method. The contamination levels of ten environmental compartments, frequency of contact with those compartments for adults and children, and estimated exposure to fecal contamination through any of the surveyed environmental pathways were compared across cities and neighborhoods. Results Distribution of fecal contamination in the environment and human contact behavior varied by city. Universally, food pathways were the most common dominant route of exposure to fecal contamination across cities in low-income and lower-middle-income countries. Risks of fecal exposure via water pathways, such as open drains, flood water, and municipal drinking water, were site-specific and often limited to smaller geographic areas (i.e., neighborhoods) instead of larger areas (i.e., cities). Conclusions Knowledge of the relative contribution to fecal exposure from multiple pathways, and the environmental contamination level and frequency of contact for those “dominant pathways” could provide guidance for Water, Sanitation, and Hygiene (WASH) programming and investments and enable local governments and municipalities to improve intervention strategies to reduce the risk of exposure to fecal contamination.
Graphical AbstractPhages infecting Bacteroides fragilis strain GB-124 and non-source specific somatic coliphages (SOMCPH) were deployed for identification of fecal contamination pathways in Kolkata, India. Analyses of environmental samples representative of nine different exposure pathways, pooled sewage from shared community toilets and sewage from pumping stations showed the presence of both SOMCPH and GB-124 phages in all the sample types.
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