Ethics Guidance for Environmental Scientists Engaged in Surveillance of Wastewater for SARS-CoV-2

Abstract

The COVID-19 pandemic has given rise to rapid and widespread international pursuit of wastewater surveillance for genetic signals of SARS-CoV-2, the virus causing the pandemic. Environmental scientists and engineers familiar with the techniques required for this endeavor have responded. Many of the environmental scientists engaged in these investigations have not necessarily had experience with the ethical obligations associated with generating and handling human health data. The Canadian Water Network facilitated adoption of these surveillance methods by creating a national coalition, which included a public health advisory group that recognized a need for ethics guidance for the wastewater approach to public health surveillance. This Policy Analysis addresses that need and is based on a review of relevant ethics literature tightly focused on ethics applicable to public health surveillance. That review revealed that classical health bioethics governing clinical practice and general public health ethics guidance did not adequately address key issues in wastewater surveillance. The 2017 World Health Organization guidelines, directly based on a systematic literature review, specifically addressed ethical issues in public health surveillance. The application of relevant ethical guidance to wastewater surveillance is analyzed and summarized for environmental scientists.

The devil is in the details: emerging insights on the relevance of wastewater surveillance for SARS-CoV-2 to public health

“…Although there is general agreement about the desirability of having standardized sampling and analytical protocols, it has not been possible to implement such standardization while simultaneously performing WBS during the course of the pandemic. Chik et al (2021) reported on an interlaboratory study among eight laboratories organized by the CWN. Wastewater from the City of Winnipeg, at a time when it had only 85 known cases in a total population of 700,000 (1.2 cases per 10,000), was provided as a blank.…”

“…In lieu of the development of a single standardized method for WBS for SARS-CoV-2, there is a clear need for the development of standardized quality assurance and quality control (QA/QC) requirements that can streamline the approach to the evaluation of the various methods, improving confidence in the reliability of the analytical results from the different methods and making more useful and reliable any comparisons between different sites or laboratories. Gawlik et al (2021) have called for developing a QA/QC framework, noted that the EU is committed to implementing a proficiency test and called for more interlaboratory testing such as reported by Chik et al (2021). The establishment of standardized QA/QC requirements should significantly improve the basis for greater confidence in the use of the analytical data for public health applications going forward.…”

“…The sewer monitoring applications mentioned above provide clear illustrations of the need for appropriate ethics guidance over WBS that was suggested for CWN by Hrudey et al (2021). Gawlik et al (2021) noted that the European Commission has adopted this ethics guidance for its proposed sentinel sewage surveillance system for Europe.…”

“…In making the case that WBS should be ethically governed as public health surveillance, Hrudey et al (2021) note that the first guideline offered by the WHO (2017) guidance for public health surveillance included the statement that: 'Surveillance systems should have a clear purpose and a plan for data collection, analysis, use and dissemination based on relevant public health priorities.' Although this implied connection between WBS and public health decision-making may be self-evident to many, it is not clear to us from the WBS literature that all investigators do recognize that WBS should be first and foremost about informing public health decision-making.…”

COVID-19 Pandemic: Public Health Risk Assessment and Risk Mitigation Strategies

“…Despite these factors limiting wastewater surveillance, it holds tremendous potential as an inexpensive type of widespread monitoring that can detect hotspots before they turn into outbreaks, inform recovery guidance and avoid the emergence or resurgence of the SARS-CoV-2 [95]. Further efforts are required in the field, including policy reforms, ethical practices, sophisticated protocols useful for measuring virus concentrations in wastewater, and accurate estimation of disease prevalence and community surveillance [94,96].…”