Hi Malini,

Thereare several scientific reports in the literature which talk about SARS-CoV-2 genetic material being detected in untreated wastewater. But there are no reports of the detection or persistence of viable, infectious SARS-CoV-2 virus itself in wastewater.

Here I may like to state the obvious, i.e. the difference between SARS-CoV-2 the full virus molecule that causes the disease called COVID-19 and the genetic material of this virus (RNA), which has been reported present in the sewage. Sewage surveillance for SARS-CoV-2 virus’s genetic material has the potential to become a valuable surveillance tool particularly in areas where individual testing for COVID-19 infections is a big constraint. On the other hand, there are evidences that similar viruses (but no evidence to suggest that SARS-coV-2 too can) can remain infectious for days to weeks in the untreated wastewater. Conventional wastewater treatment processes should therefore reduce risk, if at all any, posed by the SARS-CoV-2 virus in wastewater. Further,there have been no reported cases of COVID-19 due to contact with the faeces of an infected individual.

According to WHO , the risk of faecal-oral transmission of COVID-19 is low. Preventionof transmission from respiratory droplets from person to person and via surfaces remain the priority as of now. Nonetheless, human waste is hazardous contains numerous pathogens (disease causing organisms) so should be safely managed in all settings. Maybe,it is a little too early to seek standard operating procedures for community outreach based on evidence of Covid-19 in wastewater. Let there be enough studies first to quantify the scale of infection in a
population from wastewater samples. Researchers say that they will need to find out how much viral RNA is excreted in faeces
and extrapolate the number of infected people in a population from concentrations  of viral RNA in wastewater samples. Researchers will also need to ensure a representative sample of what is being excreted by the population and not just one snapshot in time, and that their tests can detect the virus at low levels according to the scientists representing the Queensland Alliance for Environmental Health Sciences in Australia. I have taken the liberty of amply quoting from the study reports available through open access. 

Hi Graham.

Very few city and state Governments are willing to undertake these studies. This is due to two reasons: (1) No directive from central government or other regulatory bodies (2) lack of trust on scientific community and media regarding how the results are communicated such that citizens do not panic.

State Government of Telangana has taken the bold step to institute a study. We are their partners and we would greatly appreciate any collaborative effort that comes our way. 

best
Malini   

Dear Graham,

Thank you for the offer.

Can UN HABITAT help with developing the collection and testing, or local government + community outreach sections of the protocol? We would be very interested in picking a city in India to work with the local administration.

The local situation is that city governments, other than one, have not proceeded with a protocol around testing as a means of surveillance. You have expertise in working with them as well, and that would be a major piece of work.

Look forward to hearing from you.

Regards,
Nitya

Dear Nitya,
Please see some broad quick thoughts  on the questions.

1. What communication challenges can the potential COVID-wastewater connection create/aggravate? The real challenge to communication is the issues of data integrity and weak corroborative / statistical evidence the analysis provides. However even the positive relationship provides opportunities for designing early warning signals and responses. The results in conjunction with other evidence could be effectively communicated to local governments, communities and health systems.
   
2. What are the SOPs for establishing a robust communication infrastructure that delivers coordinated and consistent  communication across multiple channels? The SoPs may inter alia include: (i) data integrity and analytical rigour (ii) impartial scientific unbiased observations with qualifying remarks; (iii) evidence based communication not to  create panic  (iv) identify target audience for structured communication (vi) use results as awareness tools for behaviour change and nudging and (vi) make research methodology transparent devoid of judgements and follow research ethics.
   
3. What are some best practice communication engagement models for communication that we can learn from? Awareness creation tools; EWS and Nudging models to prime self-regulatory strength at individual and societal levels, devoid of coercion and threat.   www.ircwash.org/blog/power-‘’self-assemb...ur-change-toilet-use
   
4. What special measures are required for communication with “at risk” populations/ communities?: Communication be backed by effective interventions and supportive  measures like STPs and scientific containment and treatment systems at Municipal level and short and long term measures like spatial planning of urban spaces. Secondly the communication strategy and channels need to consider the specificities including the  behavioural and habitation /migration patterns of the 'at risk ' group. One need to recognise the value of decentralised and empowered local governments and communities as the most effective strategy.  

I think, the following need to be discussed / verified through several means and processes before heading towards developing SOP: 

• Get data from health authorities about new cases at the settlements/catchments of sewer systems and compare/analyze against the data from wastewater samples.
• There will be some preliminary (pilot) assessments/investigations in selected locations/catchments with known population/verified data on COVID 19 cases
• After thorough analysis of the reports and possible correlations, then establish a comprehensive test program for formal assessment which will decide and validate the relationships
• Communicate towards collaboration among health agencies (Epidemiology Dept, COVID 19 focal units), accredited labs and wastewater management agencies
• Explore possibilities to establish, formalize and support technical working groups represented by collborating agencies and competent HR
• Investigate on reliability of representating catchment population by the samples of wastewater. In case, if the sewers are leaking, this will drastically impact on reliability of data and whole analysis.  

Dear all,
 
Malini asks:

 

1. Are social media channels such as WhatsApp, Tik Tok, Facebook, etc. viewed with trust by citizens? Are these getting increasingly viewed as channels spreading misinformation?
2. Can community service officers be considered as "key channel of communication"?
   

I feel the social media channels can be a quick way to reach a large audience. But more than the medium, it’s the messages that are crucial. It should be possible for the leading doctors from hospitals in a town to endorse a message to the citizens that is credible and based on sound evidence. It should be around the reasons and benefits of testing sewage for COVID-19. The messages should clearly state there is no danger of getting COVID-19 from sewage or toilets if regular precautions like handwashing with soap are followed. Testing is being done with the sole purpose of identifying hot spots and taking preventive steps to contain the pandemic. 

Malini's suggestion of community service officers being communication channels is a great one. They can be oriented, provided materials and protective gear, and deployed according to a calendar. For instance, ASHAs who visit Dharavi in Mumbai regularly to identify and counsel COVID-19 people can double as communicators about sewage testing. They must be provided with enough information to communicate clearly and allay any fears people may have about surveillance and chances of infection. 

For SBM, effective communications and monitoring channels were set up inmost district and towns for toilet construction. These can be reactivated. The people trained as swachhata doots can be brought back and incentivised to work as COVID-19 communicators. Suitable modifications can be made in the guidelines for SBM 2 to enable this. 

Regards,
Sunetra Lala
WASH Sector Leader
SNV Cambodia  

There are three points that I would like to place and hope to elicit some experiences:

1. Do outdoor channels such as hoardings and billboards run the risk of causing much embarassment to the "at risk" affected community and lead to extended social stigma and ostracising? Has this channel proved to be effective in communciation during pandemics?

2. Are social media channels such as whatsapp, tictoc, facebook  etc viewed with trust by citizens? Are these getting increasingly viewed as channels speading misinformation?

3. Can community service officers be considered as "key channel of communication"?

The state Government of Andhra Pradesh  has introduced ward volunteers (1 for every 50 households) who are the point of contact with the hosueholds to note grievances, extent support for availing government services and for enhancing awareness and hence demand for government schemes. The volunteers report to Ward Secretariat (1 for every 100- 1500 households) which interacts directly with the municipality for improving the quality fo public services. The same system is implemented in rural areas as well. 

Given that the ward volunteers are members from the communty, there is inherent trust that citizens place in them. This can prove to be an extremely effective channel of communication for sharing the results of the studies in a manner that it provides information and yet assuages fear and provides guidance on measures to be implemented to address the situation at hand. 

Self-Help Groups and ASHA workers are other community support channels which can be trained to effectively communicate.

best 
Malini 

Very few city and state Governments are willing to undertake these studies. This is due to two reasons: (1) No directive from central government or other regulatory bodies (2) lack of trust on scientific community and media regarding how the results are communicated such that citizens do not panic.

State Government of Telangana has taken the bold step to institute a study. We are their partners and we would greatly appreciate any collaborative effort that comes our way. 

best
Malini   

Dear Sir,

Scientific studies conducted globally are yet to establish infectivity of the covid-19 strains detected in wastewater. Studies in India are sparce and yet to conclusively determine presence of the virus, leave alone infectivity. As the evidence develops it will get suitably referenced and cited in academic circles. We are all conscious academics and reserachers.

This topic of discussion here however is about the challenges of communicating with citizens at large who may not be as discerning about news items as you and members in this forum maybe. 

There is a growing interest in media to report about presence of covid-19 in wastewater and this could potentially lead to an unecessary panic. Would greately appreciate if you could share your views on this to benefit this discussion.

thanks and regards D

Dear Malini,

I'll attempt to answer two questions here:

1.  What communication challenges can the potential COVID-wastewater connection create/aggravate?

A lot official and informal communication about COVID has used terms like 'deadly' and 'highly infectious'. This has painted a picture of an unseen 'enemy' that must be defeated at all costs. The warlike hysteria this has whipped up has led to stimatisation of COVID+ people, attacks on health workers, extreme lockdown measures and uninformed decision-making.

A reality check on how the virus is transmitted, chances of contracting an infection, the chances of falling seriously ill or dying need to be clearly stated in communication material. Further, as we are concerned here with transmission from sewage, it needs to be stated clearly that on date, there is no evidence to suggest a person can get COVID-19 from sewage.

1. What are the SOPs for establishing a robust communication infrastructure that delivers
   coordinated and consistent  communication across multiple channels?

Thankfully, many channels exist now. Each lends itself to a certain type of message and audience.
WhatsApp: One of the most popular, used for spreading messages. It is powerful and multilingual. The district health officer can be provided readymade messages in the local language to transmit every day. They can be forwarded onto citizens through the health workers' network. However, it needs compatible phones and some literacy.
TikTok: Another hugely popular medium, this can run on lower-end phones and needs no literacy. Content can be produced and sent out in local languages.
Facebook: This has gained appeal during the lockdown and there is a lot of local language content. Can be used as a more static medium to put out messages by officialsConventional media: Regular advertorials with detailed information can be placed in local papers and TV
Community radio: Can carry the audio content from TikTok to a local audience
A schedule to send out content will need to be established. The district swachhata preraks had developed an IEC strategy for districts with the messages, timings, media and person(s) responsible. This can be adapted for COVID-19.

Regards
Nitya

Good Day Paresh
There are 2 or 3 methods to arrive at a collective guidance.
1. Create Narratives or Scenarios and address them -- Empirical method 
2. Establish a Theoretical basis for the approach
and 
3. Trial-and-Error method. Start with some approach, and refine as one progresses

I have an actual case scene from where I am now locked-in. Since I drafted it, 4 more active Covid-19 positives have emerged and 6 are unwell (Arogya Setu). {Attached}

Q1- What is the communication that the District Collector can/should do?
Q2- How should he/she be doing it?

Once Q1 is clear, Q2 is a choice of tool.  WhatsApp, Hoardings, Personal-Pamphlets, Posters, Newspaper announcements, +++  are more local in nature and have to change from place to place (urban, semi-urban, rural etc).

We need to work on -
i) how we create our guidance; {I am aware of 3 methods identified above for it, more can be added}
ii) how evidence/support to any view is collected and reviewed; and {This is my request to Dr. Malini to subject all ideas to systematic review and evidence}
iii) how variations are collated.  {Nitya Jacob has taken this role. Some previous work at Susana may be available as good guidance}

Hope we give some carefully thought and implementable direction from our efforts.

Thanks

Dear Srikanth,
No denying there is no evidence of faeco-oral transmission of COVID-19. However, there is evidence that Wastewater Based Epidemiology (WBE) can provide early warning.

The questions Malini is posing pertains to a situation where once it is identified that a particular area has infected person/s, how would the local government communicate with people residing in that particular area and  especially 'at risk' population. 

I hope this clarifies.

Regards
paresh