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The ongoing COVID-19 pandemic caused by SARs-CoV-2 was considered to be transmitted person to person via droplet infections and fecal-oral transmission. To determine this, we used the existing polio environment surveillance network in Pakistan to investigate presence of SARs-CoV-2 using three commercially available kits and E-Gene detection published assay for surety and confirmatory of positivity. A Two-phase separation method is used for sample clarification and concentration. Before proceeding directly for RNA extraction, an additional high-speed centrifugation (14000Xg for 30 min) step was introduced to increase viral RNA yield resulting decrease in Cq value. A total of 78 wastewater samples collected from 38 districts across Pakistan, 74 wastewater samples from existing polio environment surveillance sites, 3 from drains of COVID-19 infected areas and 1 from COVID 19 quarantine center drainage, were tested for presence of SARs-CoV-2. 21 wastewater samples (27%) from 13 districts turned to be positive on RT-qPCR. SARs-COV-2 RNA positive samples from areas with COVID patients and COVID 19 patient quarantine center drainage strengthen the findings and use of wastewater surveillance in future. Furthermore, sequence data of partial ORF 1a generated from COVID 19 patient quarantine center drainage sample also reinforce our findings that SARs-CoV-2 can be detected in wastewater. This study finding indicates that SARs-CoV-2 detection through wastewater surveillance has an epidemiologic potential that can be used as early warning system to monitor viral tracking and circulation in cities with lower COVID-19 disease burden or heavily populated areas where door-to-door tracing may not be possible. However, attention needed on virus concentration and detection assay to increase the sensitivity. Development of highly sensitive assay will be an indicator for virus monitoring and to provide early warning signs.

The ongoing COVID-19 pandemic is caused by SARs-CoV-2. The virus is transmitted from person to person through droplet infections i.e. when infected person is in close contact with another person. In January 2020, first report of detection of SARS-CoV-2 in faeces, has made it clear that human wastewater might contain this virus. This may illustrate the probability of environmentally facilitated transmission, mainly the sewage, however, environmental conditions that could facilitate faecal oral transmission is not yet clear. We used existing Pakistan polio environment surveillance network to investigate presence of SARs-CoV-2 using three commercially available kits and E-Gene detection published assay for surety and confirmatory of positivity. A Two-phase separation method is used for sample clarification and concentration. An additional high-speed centrifugation (14000Xg for 30 min) step was introduced, prior RNA extraction, to increase viral RNA yield resulting a decrease in Cq value. A total of 78 wastewater samples collected from 38 districts across Pakistan, 74 wastewater samples from existing polio environment surveillance sites, 3 from drains of COVID-19 infected areas and 1 from COVID 19 quarantine center drainage, were tested for presence of SARs-CoV-2. 21 wastewater samples (27%) from 13 districts turned to be positive on RT-qPCR. SARs-COV-2 RNA positive samples from areas with COVID 19 patients and quarantine center strengthen the findings and use of wastewater surveillance in future. Furthermore, sequence data of partial ORF 1a generated from COVID 19 patient quarantine center drainage sample also reinforce our findings that SARs-CoV-2 can be detected in wastewater. This study finding indicates that SARs-CoV-2 detection through wastewater surveillance has an epidemiologic potential that can be used as supplementary system to monitor viral tracking and circulation in cities with lower COVID-19 testing capacity or heavily populated areas where door-to-door tracing may not be possible. However, attention is needed on virus concentration and detection assay to increase the sensitivity. Development of highly sensitive assay will be an indicator for virus monitoring and to provide early warning signs.

Coronavirus disease 2019 (COVID-19) named by the WHO as a result of the global public health emergency. COVID-19 is caused by a new coronavirus named as novel coronavirus (2019-nCOV). From the first case reported in December 2019 it is now a pandemic situation and a major public health emergency. The COVID-19 transmission rate is very high, infecting two to three persons on average with contact to an already infected person. There is a need for the health system, specially in developing countries such as in Pakistan, to combat such a novel disease by rapid, accurate, and high quality diagnostic testing in order to screen suspected cases and also surveillance of the disease. A rapid, accurate and low-cost diagnostic point-of-care device is needed for timely diagnosis of COVID-19 and is essential to combat such outbreaks for compelling preventive measures against the disease spread. This review is to highlight the importance of point-of-care diagnostics device for robust and accurate diagnosis of COVID-19 in physician offices and other urgent healthcare-type settings and encourage academics and stake holders towards advancement in order to control outbreaks and develop the public health surveillance system.

Health insurance and health systems literacy needs are evolving with changes to the U.S. healthcare system. Following the implementation of the Affordable Care Act, many residents in West Louisville, Kentucky, a predominantly African American community, gained health insurance coverage for the first time. A qualitative study was conducted to assess residents' health insurance and health systems needs and to identify ways of assisting residents with navigating the healthcare system and utilizing their health insurance coverage. Twelve focus groups were conducted with a total of eighty-seven residents. Round one explored participants' experiences with health insurance, and round two examined their health information delivery preferences. An inductive thematic analysis was performed. Participants revealed the complexity of the health insurance system, many citing difficulty understanding health insurance concepts and finding suitable healthcare providers. High costs, mistrust in the healthcare system, and perceived public-private disparities were barriers to effective health insurance utilization. Health insurance materials in their current form have limited value in translating health insurance and health systems information to the West Louisville population. Alternative forms of information delivery, such as locally accessible and culturally competent community health workers may be better received and more successfully utilized by the community.

Residents' experiences provide rich insight into the factors that drive widening social and health disparities, and those experiences are not homogeneous. Only through attending to people's lived experiences will society begin to see these as issues of the entire community, and only by engaging residents in the process of community change can the kinds of change that are needed ever be achieved. Photovoice is a participatory qualitative research method that gives voice to participants' experiences and perspectives while simultaneously facilitating critical consciousness-raising for social action and social change. This study employed a Photovoice process to explore experiences and perspectives of residents and people working in organizations that serve West Louisville, and to facilitate dialogue and action leading to social change. Forty-three individuals across eight groups completed the Photovoice project, representing youth, older adults, LGBTQ people, faith leaders, educators, activists, and two groups of Black men. Analysis of photos and group dialogue within and across the eight groups identified several common themes that pointed at the historical and present structural racism in the community, the city's lack of concern for the Black community, the importance of Black history, and the need for collective community action. The public Photovoice exhibit helped inform the subsequent agenda for the city's Center for Health Equity.