key: cord-0971591-8k6a7sy0
authors: Chakraborty, Paromita; Vinod, P. G.; Syed, Jabir Hussain; Pokhrel, Balram; Bharat, Girija; Basu, Avanti Roy; Fouzder, Tama; Pasupuleti, Mukesh; Urbaniak, Magdalena; Beskoski, Vladimir P.
title: Water-sanitation-health nexus in the Indus-Ganga-Brahmaputra River Basin: need for wastewater surveillance of SARS-CoV-2 for preparedness during the future waves of pandemic
date: 2021-11-15
journal: Ecohydrology & Hydrobiology
DOI: 10.1016/j.ecohyd.2021.11.001
sha: c3160b46939d795504f2ec148ec576a3270e2feb
doc_id: 971591
cord_uid: 8k6a7sy0

The Indus-Ganga-Brahmaputra River Basin (IGBRB) is a trans-boundary river basin flowing through four major countries in South Asia viz. India, Pakistan, Bangladesh, and Nepal. Contamination of surface water by untreated or inadequately treated wastewater has been a huge problem for pathogenic microorganisms in economies in transition. Recent studies have reported that sewage surveillance can provide prior information of the outbreak data, because faeces can contain the novel coronavirus (SARS-CoV-2) shed by infected humans. Hence, in this study we have geo-spatially mapped the COVID-19 hotspots during the peak time in the first and second wave of pandemic to demonstrate the need and usefulness of wastewater surveillance strategy in IGBRB during ongoing pandemic. Further we discussed the status of sanitation, health and hand-hygiene in the IGBRB along with characterization of the challenges posed by the pandemic in achieving the United Nations Sustainable Development Goals (UN-SDGs). Monthly Geographical Information System (GIS) mapping of COVID-19 hotspots in the IGBRB showed an increase in the spread along the direct sewage discharge points. The social inequalities expose the vulnerabilities of the urban poor in terms of the burden, risks and access to Water, Sanitation, and Hygiene (WASH) needs. Such an evidence-based image of the actual SARS-CoV-2 viral load in the community along the IGBRB can provide valuable insights and recommendations to deal with the future waves of COVID-19 pandemic in this region that can go a long way in achieving the UN-SDGs.

The Indus-Ganga-Brahmaputra River Basin (IGBRB) is a trans-boundary river basin flowing through four major countries in South Asia viz . India, Pakistan, Bangladesh, and Nepal. Contamination of surface water by untreated or inadequately treated wastewater has been a huge problem for pathogenic microorganisms in economies in transition. Recent studies have reported that sewage surveillance can provide prior information of the outbreak data, because faeces can contain the novel coronavirus (SARS-CoV-2) shed by infected humans. Hence, in this study we have geo-spatially mapped the COVID-19 hotspots during the peak time in the first and second wave of pandemic to demonstrate the need and usefulness of wastewater surveillance strategy in IGBRB during ongoing pandemic.

Further we discussed the status of sanitation, health and hand-hygiene in the IGBRB along with characterization of the challenges posed by the pandemic in achieving the United Nations Sustainable Development Goals (UN-SDGs). Monthly Geographical Information System (GIS) mapping of COVID-19 hotspots in the IGBRB showed an increase in the spread along the direct sewage discharge points. The social inequalities expose the vulnerabilities of the urban poor in terms of the burden, risks and access to Water, Sanitation, and Hygiene (WASH) needs. Such an evidence-based image of the actual SARS-CoV-2 viral load in the community along the IGBRB can provide valuable insights and recommenda- and peri-urban regions in the IGBRB. 92 In view of the above, and owing to the importance of 93 detecting SARS-CoV-2 not only in symptomatic and asymp-94 tomatic patients but also in the municipal wastewater, the 95 aim of our study was to map the COVID-19 hotspots in 96 the IGBRB in relation to the sewer outlets and wastewa-97 ter discharge points as well as to chart an overall wastew-98 ater management strategy in IGBRB countries. Based on 99 our knowledge and available literature, this is the first re-100 port oriented towards the distribution of the novel coro-101 navirus, SARS-CoV-2 in the IGBRB (in relation to wastewa-102 ter discharge hotspots) as either the potential source of the 103 spread of epidemic or a useful tool to monitor and man-104 age the epidemic propagation. Our objective is not to focus 105 only on SARS-CoV-2, but to make a good basis for future 106 Global Moran's I , an index of spatial autocorrelation based 191 on cross products is mathematically expressed as follows:

where n is the number of regions; x i the attribute value at on the obtained results, the authors identified WBE as a 215 potential tool for assessing and managing the novel coro-216 navirus pandemic, which needs to be followed by clinical 217 testing. They predicted that to monitor approximately 30% 218 of the world's population in terms of coronavirus spread, 219 wastewater from 105,600 STPs need to be tested. 220 Most infectious viruses are transmitted through water-221 borne routes. Studies indicate that the waterborne route of 222 infection is relevant for Hepatitis E virus (HEV), a positive-223 sense, and single-stranded, RNA virus that cause infec-224 tion in pregnant women and in children with high mor-225 tality. The HEV is detected in untreated wastewater and 226 river water ( 245 In western India, presence of SARS-CoV-2 three genes 246 ( ORF1ab , Nucleocapsid (N) and Spike (S) ) has been reported 247 during the earlier phase after the outbreak of pandemic in 248 the wastewater from WWTP of Ahmedabad city, Gujarat 249 ( Kumar et al., 2020 ) . The number of gene copies increased 250 ten-fold between 8 and 27 May 2020 (i.e. 0.78 × 10 2 copies 251 L −1 and 8.05 × 10 copies L −1 , respectively), which corre-252 sponded to more than the doubling in the number of 253 active COVID-19 cases in Ahmedabad city (i.e. 4912 and 254 10674 individuals on 8 and 27 May, respectively). Number 255 of gene copies in this study were found comparable to that 256 reported in the untreated wastewaters of Australia, China, 257 and Turkey and lower than that of the USA, France, and 258 Spain. A similar study was conducted in hospital wastewa-259 ter samples as well as from WWTPs of Jaipur (Rajasthan), 260 which has been a pandemic hotspot (red zone) since April 261 2020 ( Arora et al., 2020 ). In this study, authors further 262 reported that the presence of SARS-CoV-2 viral genome, 263 correlated with the increased number of reported COVID-264 19 positive patients. This study reported the presence of 265 SARS-CoV-2 viral genome in wastewater at higher ambi-266 ent temperature of above 40 °C. In southern India, the first 267 surveillance of SARS-CoV-2 and organic tracers (OTs) in 268 community wastewater showed that Caffeine was as a po-269 tential indicator for removal of SARS-CoV-2 in STPs, and as 270 an effective marker to understand the efficacy of the STPs 271 ( Wastewater surveillance not just facilitates the early 334 prevention of the virus but can also help to identify ar-335 eas where current vaccination efforts are inadequate. There 336 are several barriers to COVID-19 vaccination at present. 337 Wastewater surveillance may reveal the anthropogeogra-338 phy of unvaccinated communities and help in informed 339 decision making, in terms of facilitating interventions like 340 enhancing public awareness, generating resources, or cre-341 ating convenient vaccination access points. This can speed 342 up the process of achieving mass vaccination goals to at-343 tain herd immunity. 344 The surveillance study of SARS-CoV-2 of community 345 wastewater in Chennai ( Chakraborty et al., 2021a ) offered 346 some interesting insights on the importance of wastewa-347 ter monitoring. The predicted estimated number of COVID-348 19 cases from the study was found to be in line with the 349 available clinical data from the catchments. For instance, 350 during post lockdown phase, the estimated number of in-351 fected persons found for a given catchment was in line 352 with the number of actual active COVID-19 cases. Further, 353 the study highlighted that the number of infected persons 354 were higher in the densely populated regions especially 355 where sanitation conditions were poor. Such studies have 356 indicated that wastewater monitoring is an effective tool 357 to monitor and manage the spread the pandemic. Such 358 wastewater surveillance initiatives can go a long way in 359 controlling the pandemic in the vast and densely popu-360 lated IGBRB region. The COVID-19 hotspots areas in the IGBRB have been 372 mapped geospatially for the months from March to Au-373 gust 2020 and April 2021 ( Figure 2 ). Monthly mapping of 374 COVID-19 hotspots in the IGBRB showed maximum spread 375 in the highly populated regions from June 2020 onwards 376 with the maximum spread in August 2020 after the post 377 lock down ( Figure 2 ) , mainly along the Indus and Ganga 378 river basins. In the Indus river basin (Pakistan), the num-379 ber of COVID-19 cases had spiked in June 2020, followed 380 by the flattening of the curve in August/September 2020, 381 and then spiked again in April 2021. Figure 3 shows the 382 increasing number of COVID-19 hotspots in the IGBRB dur-383 ing 2021 after the hit of second wave of pandemic. The 384 incidence of Covid-19 in the 216 administrative regions 385 around the basin is illustrated in Figure 4 depicting the 386 situation as on 30th April 2021 (Table S13) to Global Moran's I calculations is given in Figure S3 . With an estimated population of about 1.7 million, 513 Guwahati, one of the smart cities under the Indian gov-514 ernment's Smart Cities Mission, neither has sewerage (net-515 work of pipelines to carry sewage), nor any municipal 516 STP to treat the wastewater. About 39 drains empty into 517 Bahini-Bharalu River, of which 17 are major drains. The 518 sewage generation is expected to increase to around 280 519 MLD by 2025. Presently, there is no sewerage system in 520 Guwahati City. Untreated or semi-treated sewage is dis-521 posed of into the storm water drains, which again ends up 522 into River Brahmaputra. 523 There are eight WWTPs along the border line of river 524 Brahmaputra. All the COVID-19 hotspots in this region sur-525 round these WWTPs. Although no death case has been re-526 ported in the region, the number of confirmed cases stands 527 high in Dhubri district located along the bank of Brahma-528 putra. Kamrup Metro district in Assam is witnessing an 529 alarming spike in COVID-19 spread with the highest death 530 toll in Assam being reported from this district. The area 531 remained to be a COVID-19 hotspot zone all throughout 532 the months of March to July 2020 ( Figure 2 a-e) . Accord-533 ing to the CPCB, an overall improvement in water quality 534 The United Nations Sustainable Development Goals 606 have been introduced to call for action by all countries 607 -poor, rich and middle-income -to promote prosperity 608 while protecting the planet. The SDGs through address-609 ing the global challenges constitute a proposal to achieve 610 a better and more sustainable future for all before 2030. 611 At the same time, the outbreak of the COVID-19 pan-612 demic has posed a significant threat to the healthy lives 613 and well-being of billions of people worldwide, especially 614 in highly vulnerable developing countries ( Ahmed et al., 615 2020 , Sumner et al., 2020 . From the perspective of water-616 sanitation-health nexus, the current COVID-19 pandemic in 617 the IGBRB influences mostly the following SDGs: GOAL 3: 618 Good Health and Well-being; GOAL 6: Clean Water and 619 Sanitation; GOAL 10: Reduced inequalities; GOAL 11: Sus-620 tainable Cities and Communities. 621 The progress of Goal 3 ( Good Health and Well-Being ) has 622 been hindered by COVID-19 as it poses a global health risk 623 and has shown the critical need for preparedness. In the 624 face of COVID-19 pandemic, the developing countries, such 625 as those located in the IGBRB, struggle with far greater 626 problems than developed countries. During pandemic, the 627 limited availability of medical services in the IGBRB coun-628 tries seriously affects the health of citizens and may lead 629 to significant delay in achieving the SDG 3 in that area. 630 Therefore, the wastewater surveillance for early detection 631 of SARS-CoV-2 and maintenance of WASH infrastructure, 632 especially mobile hand washing and sanitation facilities as 633 provided by some Governments of IGBRB during the cur-634 rent pandemic, are crucial to achieve and maintain good 635 health and well-being for the people of the region. 636 The importance of sanitation, hygiene, and adequate ac-637 cess to clean water (Goal 6: Clean Water & Sanitation) is 638 crucial in fighting with diseases including COVID-19 pan-639 demic. WHO indicates handwashing as one of the most 640 effective actions to reduce the spread of pathogens and 641 viruses, including the SARS-CoV-2 virus, and in this way, 642 minimize spread of the disease. At the same time, world-643 wide,one in three people do not have access to safe drink-644 ing water, two out of five people do not have a basic 645 hand-washing facility with soap and water (United Na-646 tions 2020). In the IGBRB, the wastewater treatment ca-647 pacity ranged from 5% in Nepal to 33% in India. Only 648 about 50% and 40% of people in the Indus and Ganga-649 Brahmapura-Meghna Basins respectively have access to 650 improved sanitation facilities ( UNEP, 2008 ), indicating the 651 need for further investments, but also demonstrating the 652 for concern for the UN, the COVID-19 has deepened exist- tive tool in arresting the "second" and "third waves" of the 712 pandemic by way of detecting the coronavirus in sewage 713 long before manifestations of reinfection are witnessed in 714 the community. Identification of potential chemical and bi-715 ological markers present in faeces and urine of infected in-716 dividuals that are released in the wastewater could pro-717 vide an efficient and prompt way to predict the potential 718 spread of SARS-CoV-2. Conventional wastewater treatment 719 processes should be able to reduce risk posed by SARS-720 CoV-2. At this point, wastewater treatment using various 721 approaches are analysed and optimized, but chlorination, 722 ultraviolet (UV) radiation light and ozone treatment of wa-723 ter are the most promising ones. 724 The increasing number of COVID-19 cases during the 725 post lockdown phase emphasizes the fact that there is a 726 need to understand the situation in a catchment to prevent 727 another wave of pandemic. WBE is a cost-effective tool to 728 manage the spread of coronavirus pandemic. 729 Although we are still not close to finding a fast rem-730 edy for COVID-19, it can be pragmatic to make a sig-731 nificant contribution, which will offer key benefits in ar-732 eas of critical importance for people and the environment. 733 By establishing a system for monitoring of SARS-CoV-2 in 734 the sewage and wastewater treatment plants or discharge 735 points in the Indus-Ganga-Brahmaputra River Basin, we 736 will get closer towards the path of fulfilling at least eight 737 SDGs. This could be of tremendous importance for South 738 Asia, as it may lead to positive impacts on the water-739 sanitation-health nexus. Further, the results of the study 740 are applicable to monitor the spread of other pathogenic 741 microorganisms including antibiotic-resistant bacteria and 742 related diseases and epidemics that may be a potential 743 threat to human health in the future. The authors declare that they have no known compet-748 ing financial interests or personal relationships that could 749 have appeared to influence the work reported in this pa-750 per. 

Assessment of the risk for human health of 768 Enterovirus and Hepatitis A virus in clinical and water sources from 769 three metropolitan cities of Pakistan

First confirmed de-773 tection of SARS-CoV-2 in untreated wastewater in Australia: A proof 774 of concept for the wastewater surveillance of COVID-19 in the com-775 munity

Sewage surveillance for the presence of SARS-CoV-778 2 genome as a useful wastewater based epidemiology (WBE) tracking 779 tool in India

Nepal: Kathmandu Valley Wastew-781 ater Management Project. Sovereign Project 43524-014. Accessed 782 on

Communities Through Wastewater Surveillance-a Potential 786 Approach for Estimation of Disease Burden. Curr Pollution Rep

Survival of sur-789 rogate coronaviruses in water

First surveillance of SARS-CoV-2 and organic tracers 793 in community wastewater during post lockdown in Chennai. South In-794 dia: Methods, occurrence and concurrence

Surveillance of plasticizers, bisphenol A, steroids and 797 caffeine in surface water of River Ganga and Sundarban wetland along 798 the Bay of Bengal: occurrence, sources, estrogenicity screening and 799 ecotoxicological risk assessment

The presence of SARS-CoV-2 RNA in the feces 802 of COVID-19 patients

Gastrointestinal manifestations of SARS-805

CoV-2 infection and virus load in fecal samples from the Hong Kong 806 cohort and systematic review and meta-analysis

Centre on Hygiene, Sanitation, Sewage Treatment Systems 808 and Technology

2019 novel coronavirus infection and 811 gastrointestinal tract

COVID-19: mitigating transmis-813 sion via wastewater plumbing systems. The Lancet Global Health 8

Survival of Coronaviruses in 816 Water and Wastewater

First environmental 818 surveillance for the presence of SARS-CoV-2 RNA in wastewater and 819 river water in Japan

Computational analysis of SARS-CoV-821

COVID-19 surveillance by wastewater-based epidemiology locally 822 and globally: Feasibility, economy, opportunities and challenges. Sci-823 ence of The Total Environment

Detection of pathogenic viruses in 826 sewage provided early warnings of hepatitis A virus and norovirus 827 outbreaks

COVID-19: faecal-oral transmission?

First case of 834 2019 novel coronavirus in the United States

Combining geostatis-837 tics with Moran's I analysis for mapping soil heavy metals in Bejing

COVID-19: A case 840 report from Bangladesh perspective. Respiratory medicine case re-841 ports 30

Wastewater Treatment Technologies in 843 Nepal

Global estimates for basic hygiene services in households, 845 schools and health care facilities are a call to action to prevent the 846 spread of COVID-19

Hepatitis E virus in-849 fection

SARS-CoV-2 in wastewater: State of 852 the knowledge and research needs

The first proof of the capability of wastewater surveillance for 856 COVID-19 in India through the detection of the genetic material of 857 SARS

First detection of 860 SARS-CoV-2 in untreated wastewaters in Italy. Science of The Total 861 Environment

Global 864 spatio-temporally harmonised datasets for producing high-resolution 865 gridded population distribution datasets

Spatial association techniques for 868 analysing trio distribution in an urban area

871 Presence of SARS-Coronavirus-2 in sewage

Estimating 873 the asymptomatic proportion of coronavirus disease 2019 (COVID-19) 874 cases on board the Diamond Princess cruise ship

Wastewater production, treatment and use 877 in Pakistan. Second regional workshop of the project 'Safe use of

881 National Mission for Clean Ganga (NMCG), Ministry of Jal Shakti 882 Department of Water Resources, River Development & Ganga Re-883 juvenation

Estimating clin-891 ical severity of COVID-19 from the transmission dynamics in Wuhan

Estimation of the asymptomatic ratio of novel coronavirus in-893 fections (COVID-19)

SARS-CoV-2 RNA in wastewater anticipated COVID-896 19 occurrence in a low prevalence area

Detection of SARs-CoV-2 in wastewater, using the existing 898 environmental surveillance network: An epidemiological gateway to 899 an early warning for COVID-19 in communities

Water and wastewater in Bangladesh, current status 901 and a design of a decentralized solution

Future perspectives of wastewater-903 based epidemiology: monitoring infectious disease spread and 904 resistance to the community level

Pathogen surveil-907 lance through monitoring of sewer systems

Indus Basin Waters A Main Re-910 source of Water in Pakistan: An Analytical Approach

Estimates of the Impact of 913 COVID-19 on Global Poverty. WIDER; UNU-WIDER

Open Defecation continues along Ganga in Harid-915 war

Accessed on 16th

Au-919 gusto

ECOHYD [m3Gdc

COVID-19: PCR screening of asymptomatic health-921 care workers at London hospital

Mouch-923 touri

detection of GI. P2_GI. 2 and GII. P16_GII. 13 unusual 926 strains

Freshwater under Threat

COVID-19: water and sanitation-related infor-930 mation

Ger-934 ber, S.I., 2020. Aerosol and surface stability of SARS-CoV-2 as com-935 pared with SARS-CoV-1

Accessed on

Coronavrus is a hygiene crisis

Prolonged presence of SARS-CoV-2 viral RNA in 945 faecal samples

Time course 947 quantitative detection of SARS-CoV-2 in Parisian wastewaters corre-948 lates with COVID-19 confirmed cases

Wastewater-based epidemiology for early 950 detection of viral outbreaks. Women in Water Quality

Evidence for 953 gastrointestinal infection of SARS-CoV-2

Pro-956 longed presence of SARS-CoV-2 in feces of pediatric patients during 957 the convalescent phase

SARS-CoV-959 2 and COVID-19: The most important research questions