Monday, 11 May 2020

Can Coronavirus/Covid19 be spread via human waste?

This is my 11th May Paper/Report requested by Mark Fletcher, Member of Parliament for Bolsover, who also wants an answer to my simple question: 

Can Coronavirus/Covid19 be spread via human waste?

Dear Mark,

As requested I am detailing my research and commentary. I have edited the original material I sent and updated my initial question because, as I learned more, the issue became clearer and potentially more serious than I had first imagined.

I hope that the paper is helpful and above all I hope my fears are unfounded. I suppose I was being alert before it became fashionable!

Thank you for your genuine interest and willingness to take this up.

John



Can Coronavirus/Covid19 be spread via human waste?

· In public toilets, especially via urinals
· In our watercourses, rivers, lakes and seas, when sewage is discharged







BACKGROUND:

I first raised this issue, with local Councillors, Severn Trent, and Environmental Health at the end of March 2020. My initial concern began a couple of years ago, whilst walking my dogs, by the side of Normanton Brook between Hilcote and Huthwaite and Westhouses, in Derbyshire.


As a walker and sometimes wild swimmer, I already knew that there were issues about disease spread through sewage discharge into watercourses, lakes, and seas. See links to Surfers Against Sewage and Channel 4 below. So, I asked a technician, testing the water, about sewage discharge and regular testing by Severn Trent Water. He told me that there were high levels of raw sewage discharged into the brook, from two sewage treatment plants, after heavy rain and advised me not to let dogs, or children, play in the brook, at such times.


The Covid19 outbreak raised further concerns when I noticed far more families than usual walking along the brook footpath in Lockdown. So, at the end of March I tried to find an answer to the question, “Could sewage discharge into watercourses spread Covid19?”

(Jumping ahead, you'll see that my concern peaked on reading that research was starting on testing for Covid19 spread through sewage. If it can be detected in sewage - can it contaminate, as other pathogens clearly can?)


I emailed and telephoned Severn Trent, Environmental Health and Public Health England and, as Mark Fletcher MP did later, received unhelpfully standard, or no replies, from all. Two District Councillors passed on my email and one advised me not to let my dogs in the water. So, I did some more rudimentary research and it became obvious, as a layman, that this could be a potential national and international issue around the spread of Covid19, on top of the, well established, serious concern about Water Companies, legally, discharging sewage into watercourses. I wrote to friends, I knew had knowledge, or interest, in the issue and floated the issue on twitter (all puns intended) The best of the information I have found, so far, is in the Research section and the main tweets are in The Appendix.






RESEARCH: (NB my underlining for key phrases)


1. A good initial source of information about the dangers of sewage discharge generally and Covid19 specifically, was from Surfers Against Sewage. They state here https://www.sas.org.uk/news/campaigns/what-is-the-risks-of-covid-19-transmission-from-sewage-discharge/


“Given the new status of COVID-19, the transmission risk from an infected person’s faeces and through sewage systems is not yet known, but a better understanding can be achieved looking at other coronaviruses such as severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)[2].


Can I catch COVID-19 if I enter the sea?
COVID-19 has been detected in the faeces of infected patients. However, the amount that is shed, how long it is shed, and whether it is infectious in the stool itself is not yet known. However, given COVID-19 is likely to behave like other coronaviruses such as SARS and MERS, our understanding of these viruses suggests that the risk is low. So far, there have been no reports of faecal-oral transmission of COVID-19[3].


Sources


[1] Heymann, D. L & Shindo, N 2020, COVID-19: What is next for public health?, The Lancet, viewed 19 March 2020, .
[2] Centers for Disease Control and Prevention 2020, Water Transmission and COVID-19, Centers for Disease Control and Prevention, viewed 19 March 2020, < https://www.cdc.gov/coronavirus/2019-ncov/php/water.html>.[3] Centers for Disease Control and Prevention 2020, Water Transmission and COVID-19, Centers for Disease Control and Prevention, viewed 19 March 2020, < https://www.cdc.gov/coronavirus/2019-ncov/php/water.html>.
[4] World Health Organization & UNICEF 2020, Water, sanitation, hygiene, and waste management for the COVID-19 virus, viewed 19 March 2020, <https://apps.who.int/iris/rest/bitstreams/1272446/retrieve>.
[5] Centers for Disease Control and Prevention 2020, Water Transmission and COVID-19, Centers for Disease Control and Prevention, viewed 19 March 2020, < https://www.cdc.gov/coronavirus/2019-ncov/php/water.html>.
[6] World Health Organization & UNICEF 2020, Water, sanitation, hygiene, and waste management for the COVID-19 virus, viewed 19 March 2020, <https://apps.who.int/iris/rest/bitstreams/1272446/retrieve>.


2. I saw that Channel 4 News had covered sewage discharge earlier. https://www.youtube.com/watch?v=x1AmHDByodI&feature=youtu.be Whilst there was an agreement that sewage is a health risk, it seemed that politically and systemically, despite warnings, as a nation, we are far too accepting of this dangerous and filthy practice. There are many proven high risks from sewage in our rivers lakes and seas. It was clear to me that the Coronavirus Pandemic raised, potentially, another, possibly more serious risk. As Channel 4 stated this is, “The Water Boards ‘ dirty little secret”


3. In early April I began to read that several countries were beginning to test sewage in order to trace the spread of Covid19. That led me to hypothesise, “if it can be traced can it not be spread too?” (See the Dutch example and note there are emerging examples in UK at Newcastle and Bangor Universities) https://amp.dw.com/en/coronavirus-in-sewage-foreshadowed-outbreak-in-dutch-city/a-52972980


For example a BBC News report on 5th May focussed on Bangor University: https://www.bbc.co.uk/news/amp/uk-wales-52544247


4. I made contact with David Graham, Professor of Ecosytems Engineering at Newcastle University, who is also investigating testing foir Covid19 spread in sewage. He replied,


“Coronavirus are highly unstable in water, including sewage. There has never been detection of infective virus in wastewater, although virus debris can be detected on occasion. That debris is what one can detect, although it is not intact virus. Therefore, your concern is not warranted. We are doing background monitoring, but this is for completeness……. Exposure is NOT the same as risk. Virus in sewage is fragmented and dead. Droplets can contain virus fragments, but the combination of events that could cause transmission is so rare that it (is) not a practical concern.”


5. The World Health Organisation seems, similarly, unworried:


“Safely managing wastewater and faecal waste
There is no evidence that the COVID-19 virus has been transmitted via sewerage systems with or without wastewater treatment. Further, there is no evidence that sewage or wastewater treatment workers contracted the severe acute respiratory syndrome (SARS), which is caused by another type of coronavirus that caused a large outbreak of acute respiratory illness in 2003”


https://www.who.int/publications-detail/water-sanitation-hygiene-and-waste-management-for-covid-19

The same paper does outline detailed procedures for dealing with the high risk of "fresh human waste" in hospitals etc.


6. I was somewhat reassured, about the sewage discharge concern but kept remembering two lessons from history:


· Beware of the negative hypothesis: “there is no evidence, therefore, there can be no problem”.
· Don’t underestimate ignorance, plus a determination to minimise reputational damage… it often leads to suppression of critical information and censorship. The chilling, apposite, example was when our intelligent antecedents dug wells next to sewers unaware that it caused cholera. When Florence Nightingale uncovered this and wrote a damning, self-critical, report it was embargoed by the Government of the day.






7. Then, on 6th May, Richard Quilliam Professor of Environment and Health, at Sterling University, alongside Professor Manfred Weidmann, Dr Vanessa Moresco, Heather Purshouse, Dr Zoe O'Hara, and Dr David Oliver, was reported in the Scotsman and Independent Paper as publishing serious concerns about the lack research into Covid19 being transmitted via sewage, stating:


"there is a significant risk of “widespread” distribution of the coronavirus through sewers because most patients are either asymptomatic or experience only mild symptoms and remain at home.”


News Report here: https://www.independent.co.uk/news/health/coronavirus-sewage-spread-research-professor-richard-quilliam-wastewater-sewers-a9501386.html?utm_medium=Social&utm_source=Twitter&fbclid=IwAR3dmSImlYkXvHEXlBk4lVGSpncq4GSkPOgD30NzHjxMVk8F3SmFZ2N6MS0#Echobox=1588775214


Richard Quilliam’s paper, makes very interesting reading. It has a strong and powerful bibliography. here: https://www.sciencedirect.com/science/article/pii/S0160412020312873


8. At the time of writing, reports are beginning to appear, about the need to find out more and questions are being raised in the press and more publicly, by myself and others. I am indebted to (you) Mark Fletcher MP, for progressing this issue with Ministers. In your reply to my email, you wrote,


“The Covid19 virus being spread through sewage was not a risk that I had personally considered, and I thank you for bringing this to my attention. I would be grateful if you could send me a document of your research and tweets… for me to pass over to the relevant minister for their response.”


CONCLUSIONS & RECOMMENDATIONS:


To be blunt: If Covid19 can be spread by droplets from a cough, and we know it is, it is reasonable to explore whether it can also be spread in droplets from urine and faeces.

I wrote to those I expected to know and was disturbed to receive no answers, or worse, be fobbed off. It became clear and obvious to me, as layman, there is growing concern that Covid19 spread via sewage must be investigated.


There are good examples of best practice in mitigating the risk of Covid19 spread from “fresh human waste” including the use of PPE by those dealing with it in hospitals and, sadly less so, in Care Homes. There is however no agreement on any practice regarding the discharge of sewage waste, with respect to its potential risk to spread the disease. Indeed, it remains legal, and seemingly acceptable, to discharge waste into UK watercourses and seas, as a matter of course. Like many others, I believe this is unacceptable at any time but particularly so during the Covid19 pandemic, when the implications are demonstrably unknown.


Whilst some scientists state the risk is low, they also state, presumably in support of that conclusion, that there is little evidence. I am wary, even suspicious, when not having evidence is cited as a reason for there not being a problem. History shows us this is not a sensible conclusion. I am no conspiracy theorist, but I do sense a stubborn reluctance to face up scrutiny by almost all I have contacted.


We are in the midst of a deadly World Health Pandemic and the UK’s statistics are not good. We have been told to be alert. I am alert and being so, encourages me to recommend the following URGENT actions:


1. That URGENT research be scheduled, along the lines suggested by Professor Richard Quilliam, to ascertain any level of risk of Covid19 spread through human waste, together with any recommendations for mitigating action by all, but particularly those living and working where human waste is prevalent. This to include:
- a study of “fresh waste” risk in hospitals, care homes and especially urinals in Public Toilets where there is an obvious and considerable splash back of urine.
- a study of ‘sewage waste” risk at treatment plants, discharge points and beyond in our watercourses and sea
- Consideration and recommendations are proposed for any necessary mitigating measures for workers in settings where fresh human waste, or sewage is dealt with and for members of the public exercising in, or nearby, watercourses, lakes and seas.






2. If the risk levels merit it (I accept this will be a balanced decision) that actions are taken to both warn those likely to be exposed to it and to advise them of actions they must take to stay safe and save lives.


3. In the meantime, whilst urgent further work is underway it seems sensible to alert and advise the Public to a potential risk from human waste by:


a. Providing more detailed “wash hands regularly” advice to include cleaning in and around toilets
b. Providing sewage workers with both advice and PPE
c. Holding Water Authorities legally responsible for alerting the public if and when a sewage discharge is being made into a watercourse (NB there are already established risks form several pathogens in our rivers, streams, lakes and seas


4. Monitoring, more effectively, than hitherto, how the Water Companies, Environmental Health, Public Health England (etc?) work together in an open and transparent way to identify, clarify and respond to risks inherent in their practices.


John Pearce



APPENDIX. See initial Twitter thread on @JohnPearce_JP

Text only:


(1st tweet) 11:58 am · 25 Apr 2020·Twitter for iPhone


Serious ‪#Covid19 question:


Can ‪#Coronavirus be transmitted via ‪#Sewage outflow?
https://www.sas.org.uk/news/campaigns/what-is-the-risks-of-covid-19-transmission-from-sewage-discharge/




This thread charts my failure - so far - to get an answer from ‪#EnvironmentalHealth, ‪#SevernTrent and others. NB If there is a risk it should be publicised (see thread)


(2nd tweet) 12:09 pm · 25 Apr 2020·Twitter for iPhone
My first tweet suggests there is a risk of ‪#Covid19 being spread through ‪#Sewage discharge. We know there are rivers and watercourses where animals and humans swim which have known discharges.
https://www.sas.org.uk/news/campaigns/what-is-the-risks-of-covid-19-transmission-from-sewage-discharge/


See ‪#channel4news. https://youtu.be/x1AmHDByodI


Should this risk be publicised wider?


900,000 hours of human sewage and rainwater flow into UK rivers in...
Untreated sewage is being released into rivers across England and Wales - perfectly legally - and campaigners are calling it a 'dirty little secret'. (Subscr...
youtube.com


(3rd tweet) 12:18 pm · 25 Apr 2020·Twitter for iPhone


Further evidence that ‪#sewage outflow might be a spread risk for ‪#Covid19 is that several countries, including ‪#Australia, ‪#Netherlands and ‪#UK, are tracing ‪#Coronavirus spread by analysing sewage discharges. One example from many:


‪https://amp.dw.com/en/coronavirus-in-sewage-foreshadowed-outbreak-in-dutch-city/a-52972980…


(4th tweet) 12:29 pm · 25 Apr 2020·Twitter for iPhone


‪#WHO states “While there is no evidence to date about survival of the ‪#COVID-19 virus in water or ‪#sewage, the virus is likely to become inactivated significantly faster than non-enveloped human enteric viruses with known waterborne transmission” but WHO fails to say there is no risk.


Water, sanitation, hygiene and waste management for COVID-19
who.int


(5th tweet) 12:37 pm · 25 Apr 2020·Twitter for iPhone


I await more detailed responses about the risk of ‪#COVID19 spreading in ‪#sewage discharge in watercourses from: ‪#SevernTrent ‪#EnvironmentAgency and have alerted ‪#Guardian Investigations and
@sandralaville


I hope my concern proves to be misplaced. Meanwhile stay dry!



(6 tweet) 12:52 pm · 25 Apr 2020·Twitter for iPhone


6th tweet exploring risk of ‪#COVID19 being spread through those known watercourses subject to ‪#sewage discharge. There is some evidence
Walkers, dog owners, parents and wild swimmers need to be informed of any risk, as we exercise outdoors in ‪#lockdown