Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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  • Malini
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Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

The COVID-19 pandemic has once again exposed India’s inadequate waste management abilities. While the guidelines and standard operating practices for handling solid waste (municipal, bio-medical, COVID contaminated domestic waste) are developed by the Central Pollution Control Board and Health Ministry and operationalized at the state and municipal level, liquid waste and the associated problems during this period of pandemic are hardly being addressed.

The potential spread of COVID 19 in India via wastewater simply cannot be ignored. In line with the global trends, media coverage highlighting the need for conducting studies on the presence of the virus in wastewater has been increasing. Sampling protocols suitable for the complex non-sewered contexts in India are under development and pilot studies are being undertaken. Results of initial studies undertaken by scientific community in collaboration with city water boards are also being reported. A potential fallout of this increasing reporting on the presence of COVID-19 in wastewater could be unnecessary public panic and the undesirable reactions towards pandemic response activities by the local governments.

Communication during the time of pandemic and emergency response is therefore a major challenge particularly in todays times of information overload and conflicting recommendations. The principles of good risk communication require it to be quick, transparent, credible and consistent. Balancing this in the context of changing information and high chances of misunderstanding of research findings is difficult.Further, this can be particularly damaging in the context of “at-risk populations” who are those residing at localities considered to be at highest risk of health-related, economic, and societal consequences of the pandemic. 

Effective communication with “at-risk” populations is integral to minimizing panic, illness, and potential fatality. Local governments and others therefore need to identify and plan the approach as well as the channels of communication in advance.

·      What communication challenges can the potential COVID-wastewater connection create/aggravate?
·      What are the SOPs for establishing a robust communication infrastructure that delivers coordinated and consistent  communication across multiple channels? 
·      What are some best practice communication engagement models for communication that we can learn from? 
·      What special measures are required for communication with “at risk” populations/ communities?
 
Malini
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  • paresh
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

Thank you Malini for initiating the discussion.

I don't think we are in a situation where local governments are communicating at all; they are simply following the orders of the state government which is also following guidelines issued by the Union. This mechanism can be very useful if the messaging from the top is scientific and right.  Unfortunately that has not been the case. The lockdown for example was sold as a solution rather than a mechanism to buy time to prepare for the peak. We have now been shut for more than 2 months with no exit strategy. Now that Covid-19 is reaching villages with migrant labours, the only option panchayats know of is shutting down. 

On the communication front, I think local WhatsApp groups are playing an important role. However, they are also used to spread fake news and rumours which can spread panic.  Kerala's strategy of communication, that is a daily press conference at a fixed hour, which has been applauded all around could be easily remodelled. Local leadership can use Facebook live (Media may not always be available) to update about the situation and spread the message. Local TV channels can also be used if available. 

Regards
paresh


 
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

Dear Dr. Malini

There is no evidence of "infective virus" prevailing in waste-water (sewage). Presence of RNA strands points to faecal excretion of Covid-19. Direct faecal sample analysis to establish "infectivity" is a precursor to further work on WBE. 

While we continue to pursue ideas to use emerging research on sparse (highly non-correlated, and not infective) Covid-19 traces in Waste-Water, Please consider the following:
  1. Request to quote the original science publication or organizational report
  2. Refrain from using news-paper science articles as the onus of reading entire paper is shifted to unknown reporter
  3. Where possible, highlight the constraints or limitations the original authors have raised (so, we know the boundaries)
Some of us may have expertise in Endemics or Epidemics, yet they may be facing life's first Pandemic. Many are from disciplines outside epidemiology (like myself) and need to read original science reports to grasp the tip of complexity.
 
Kindly encourage formal positioning of all suggestions and opinions. Clear referencing, pointers to case-studies and logical positioning are needed to make the effort a reasonable science. 
 
Mr. Nitya Jacob is considering taking these viewpoints and making a recommendation report to the recipient agency. This necessitates every position taken in this forum to be responsible and carefully reviewed.
 
Thanks!


 
Certifying Oil & Gas Reserves helped in realizing the fallibility of lot of Science and Technology. I believe that reliable and sustainable science needs integrity and commitment. Disbelief in science is originating from - i) Pseudo-Science; ii) Inconsistency and conflict in scientific doctrine; and iii) Weak Evidence: Data, Process, Review and Results.
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  • alabasterg
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

Dear All,
I think this is a very interesting topic and we (UNHabitat) would like to support the group to develop this further. Maybe we can contribute to the protocol development and in particularly how we determine the contributing population. We can also help to shape this tool so it can be readily applied in local settings, where local authorities and water and sanitation utilities hold ultimate responsibility.

Kind regards
Graham Alabaster 
Dr Graham Alabaster
Chief Waste Management & Sanitation
Urban Basic Services Branch
United Nations Human Settlements Programme
Geneva Office

Phone +41 (0) 22 7913555
Mobile +41 763584929
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  • paresh
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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
Certifying Oil & Gas Reserves helped in realizing the fallibility of lot of Science and Technology. I believe that reliable and sustainable science needs integrity and commitment. Disbelief in science is originating from - i) Pseudo-Science; ii) Inconsistency and conflict in scientific doctrine; and iii) Weak Evidence: Data, Process, Review and Results.
Data Intensive Scientific Discovery (DISD) is the new paradigm for growth.

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  • nityajacob
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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
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  • Malini
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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
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  • Malini
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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   
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  • Malini
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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 
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  • sunetralala
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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  [/font]
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  • Thakur
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Re: Topic 2 What can be standard operating procedures for community outreach based on evidence of Covid-19 in wastewater

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.  
Thakur
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