Oh hey, it's me. It's your Internet dad uncle back with a highly erotic, not uncomfortable at all episode about diseases and toilet water. Please don't leave me, Please don't go, don't go, stay, please stay. But if this is your first ever Ologies episode, there are way less gross ones. Let's be real, So go listen to a less gross one. If this is your first ever or you know what, pull up a throne, because this episode, when you get down to it, is amazing.
It's so good.
I nervously showed up early to chat with this government pathogen expert. I heard about this field wastewater surveillance and environmental microbiology a few months back, and on February fourth, I tweeted desperately, I'm just a podcast Twitter account standing before microbiologists who tests sewer water for plagues, hoping they follow me back, and amid much enthusiasm, this guest replied with a jiff that said I got you to and here we are, and yes it's Jeff. It's not Giff,
he said it was Jeff. So after one thousand clearances with our nation's centers for disease control, we are off the races now. This ologists got an undergrad degree in microbiology, a PhD in microbiology from the University of Buffalo, and then also got a Master of Public Health in epidemiology from Emory University. She is now a Senior Service Fellow at the CDC And additionally she has a dog who's a very good dog and sweet and sometimes the dog
weighs in from time to time in the background. Enjoy. So thank you for weighing in, by the way, and spreading the word of ologies like a pathogen, and for supporting at patreon dot com slash ologies for as little as a block a month. Thank you for rating and reviewing and keeping us up in the charts. I read every single review you've ever left, and as proof, here's one it's still we just left yesterday from Eon Blue Ophelia,
who said that the ADHD episodes were life saving. Rachel also left a review saying that they were life changing. Also smells like maple syrup. A self described construction worker who randomly laughs at work. Go get that eco hydrology career. I hope you enjoy this one too.
Y'all.
A bunch of you left really sweet reviews this week. I read every single one. Thank you so much. Also, As a bonus, there's a surprise cameo in this episode from your favorite virologist about what to do now that mandates and masks are starting to fall Because this episode, boy do we talk about covid. Oh also, I cold called a listener in this and I threw money at them,
so that's in there too. But onto the show. So environmental microbiology, bacteria, covid in toilet water, medications in the waterways, plumbing, the sewers, for medical mysteries, things you can learn from studying stomach bugs, the weirdest things that get flushed. How gross is it? For real? Can you get COVID from your stepdad's farts? And what is out there swimming in the world, and how can we measure it to our advantage?
Including what's on the horizon with covid? So if you are getting excited, well there must be some in the water. So do enjoy the brain of environmental microbiologist doctor Amy Kirby. I like so did not want to mess up anything with this interview that I got here earlier than I have ever been for any at all.
I'm so excited.
So Hi, I'm Ali, Hi, I'm Amy. Nice to meet you.
Could I have you say your first and last names in the pronouns that you use.
Sure. My name is Amy Kirby and I use she hers pronouns.
I'm so excited to talk to you. You're doing very important work, and I imagine as we're cresting a little bit of a swell here for BA two, you're probably pretty busy.
We have busy since twenty twenty, and so I feel like, you know, I tell my team a lot. We're busy right now, but it's going to get better, and then something new happens, a new variant, a new surge, and we are busy again.
I'm going to ask right out of the gate right now, how are we doing at the moment, BA two, How are we? How are we doing?
So?
We are doing good. So we are seeing overall very low levels in wastewater. So we have come down out of the omicron surge and we're back to very low levels in wastewater. However, that said, we are starting to see some communities that are seeing some increases, and so we're watching those very closely to see if those increases turn into sustained increases and regional increases that would indicate another surge is coming in the wastewater system. Right now,
we can't distinguish between BA one and BA two. We just see total omicron, which to be fair, is not very informative at the moment. Everything is omicron, so that particular data point isn't super useful at the moment, but we will be able to distinguish those sublineages soon.
I mean, I imagine it's just curveball after curveball after curveball.
It is. And the variant tracking part has been really a challenge because you're always running to keep up with the next variant. There's two different methods that we use for variant tracking in wastewater, so one of them is PCR based, so you're getting and it's very quick and it's very quantitative, so we can use it to track changes in variants. Like it was very helpful to see the omicron surge because we could see delta going down
and omicron going up and we got good numbers around that. However, you're always in a race to keep up with the newest variant, right that PCR only detects that one variant. Sequencing as a better approach because then we can see evidence of any of the variants of concern and easily adapt to new variants. But it's a slower process and isn't as quantitative, so the measures around how much of a variant as president a community are not as accurate for that approach.
Just a quick COVID check in, where are we at? Okay, So I'm recording this on April twelfth, twenty twenty two. Yes, it is the same day it's released. That's how we roll. And right now, epidemiologists have their eyes on the omicron subvariant BA two and that was first identified in November, but it happens to cause more gastro and testinal issues, so a lot of people right now are mistaking it for our stomach book and it's known as the stealth
variant because it looks like an earlier delta variant. But BA two is estimated to make up nearly ninety four percent of cases in the US right now. In the US, cases are up about ten percent, but in New York up about forty percent. Philly, I'm sorry, you're up fifty percent from two weeks ago. And it's probable that rates are higher as people are relying on at home rapid tests that they don't report, or just no tests at all.
So what is on the horizon? Perhaps another wave as masks come off, warm weather gatherings, commens disco makeouts ramp up. It's summer, people get wild. But keep your ears open for another variant called XE. It sounds like a human mix of grimes and elon musk, but X is really a hybrid of Omicron's BA one and BA two strains, but with a few fresh mutations. According to Time magazine, early research suggests that X is around ten percent more
transmissible than BA two. These variants, they come on like software upgrades in the middle of the night that nobody wants. But just check the news and you'll find plenty of headlines like latest wastewater data suggest rising COVID levels and COVID nineteen wastewater numbers skyrocket, And so, of course, of course I had to show up early to talk to the top CDC scientist who is elbowed deep in the data.
Any cities at the moment that you're seeing little bit of elevation, New York, I understand, Eastern seaboard New Jersey.
Yeah, I wouldn't call out a specific city at this point, but certainly we're seeing concerning increases in the northeast, and there we're seeing more and more of our communities starting to see these consistent increases, So looking similar to what we've seen in the past with surges, where a certain region will start sort of set off the surge and then it will move across the country, staying on high alert for that.
Were you always someone who is very up on latest trends? Are you obsessed with TikTok trends? How do you feel in general about keeping up with what's happening.
I don't.
I mean, I'm a typical science nerd, right, how trendy can we be? But yeah, I mean I think it's always fun to stay on the cutting edge of what's coming. And I don't necessarily think of wastewater surveillance as being trendy. It's something that we've been thinking about for a long time in various fields, and we've been using it for polio for decades, and so it was really about seeing the opportunity to apply a technique to a new problem. Aready had the information that we needed and sort of
how wastewater surveillance works. We just had to build the right system to use it. For COVID at the national scale. That is something I do like to do is watch for these opportunities and see, you know, where can we leverage the unique skills we have. So I'm an environmental
microbiologist by training. We are not usually part of the public health infrastructure that's very skewed towards clinical microbiology, and so it was great to be able to hop in early and say there is a role for environmental microbiology here. Here's what we can bring to the table.
What we can bring to the table is wastewater. Maybe we can bring it to the table, but set it down on the ground next to the table. I would love to know a little bit about the history of this. You mentioned other diseases. Can you tell me a little bit about where this started and where you started getting really excited about what we can find from wastewater.
Sure, so the long history of the field is really based on polio valance. So when we started working towards polio eradication back in the sixties, one of the challenges there is that the clinical outcome that you're most concerned about for polio is of course a cute flacid paralysis, right, but that is rare most people that are infected with the poliovirus do not go on to have that very acute outcome. In fact, most of them don't have any symptoms at all.
Just a little history lesson here in a trivia tidbit. So, we didn't have vaccine for poliomylitis virus until the nineteen fifties, and then in the nineteen sixties, polio inoculations arrived not by needles so much, but via a liquid tincture of weakened virus saturating a sugar cube. Hey, what you did, Mary Poppins come out is the nineteen sixty four spoonful of sugar helps them medicine go down the mix? Yep, that song was written the day that the songwriter's sun
got his delicious polio vaccine. Cheeky, but yes. Scientific sewer spying also aided in the poliophyte And so we.
Knew that if we were looking only for this very severe outcome, we were going to miss we. I wasn't involved, but you know, we collectively the field recognize that they would miss most of the cases in a community. And as you move towards eradication, that's more and more important because every one of those cases that you miss could be a source for another case. Poliovirus is an enteric virus.
It's transmitted through fecal oral transmission, so shed and stool, You get it on your hands or on your food, and then consume it, and that's the transmission mechanism. Yeah, but okay, And so they knew that they could look in stool and in wastewater to detect the poliovirus, and they use it to identify neighborhoods where polio is circulating, and then they go into those neighborhoods and do a vaccination campaign to protect everybody. And so that's how they've
been using it. It works very well to target that intensive polio vaccination where it's most needed, and that was
where it's stayed basically until twenty twenty. Previous to working at CDC, I worked on neurovirus, which causes the stomach flu basically, and one of the things that we always used to say in the field is like, wouldn't it be nice if we could have a community stool sample, because so many people get neurovirus, they suck it up for a day and feel terrible and they never go to the doctor and so we don't measure those people, and wastewater surveillance was a way to think about doing that,
but there wasn't enough benefit. The return on investment to establishing a wastewater surveillance system for neurovirus was not high enough to get the infrastructure built, and so we always just kind of hoped for it and never never really
were able to move on it. And then when COVID hit and we saw that it behaves very similar to SARS one, which we knew was shed and stool, we immediately started thinking that we might be able to use wastewater surveillance for this, and were engaged with some early collaborators that had systems where they were already testing wastewater and so we could fund them to look specifically for SARS Kobe two to in wastewater to see, if you know, can we see early evidence that this will in fact work.
More on this exact moment of inspiration in a bit and it's good trust me. But Amy says that they began building the foundational data in early twenty twenty and by May, around the time you were whisking up Folger's crystals into history's most disappointing treat adel goona coffee. We all fell for it. Amy's team at that time spring twenty twenty felt confident in the biology and the epidemiology of wastewater testing, so they moved fast and they needed to establish a system.
And very quickly we started pulling together. You know, how do we get utilities on board to take the samples, what labs are going to be able to do the testing, What data system are we going to stand up to collect the data at the national level. Spent a few months all of that together, and the system was officially launched in September of twenty twenty and has been growing rapidly since then. Experts say, if you want to understand how COVID spreads, check your toilet and just like what
you'll find there. The news isn't all that pretty. Wastewater samples revealing record levels of coronavirus across the US. We have over seven hundred sites reporting into the system, and collectively they represent just shy of one hundred million people, so we're already covering almost thirty percent of the US population.
Wow, and do you have to train people at different sites how to collect samples? Do they ship them to CDC headquarters in Atlanta. How are you gathering all of the sampling?
Yeah, that has been a huge effort. So one key was recognizing that there's already a lot of expertise out there in how to do these things well. So working with our utility partners, who are absolutely critical for this. If they won't take the samples, there's nothing to test. So working with them and ask king them what are the best ways to take this sample? Where in a treatment process should we be sampling, Are there better ways
to do it? What equipment can help us, how can we normalize for how much sewage is flowing through the pipes, And really engaging with them around their expertise, talking to the laboratories about testing. We do not have a standard method for testing measuring sarscob too and wastewater. There's a handful of methods that have proven to all work reliably, and so we support all of those. And largely it
was our academic laboratories where this expertise lie. They were very engaged in developing and really optimizing the methods and are still part of it. I mean, many of our states are using academic laboratories as their surveillance laboratories right now.
So the field work, shall we say, involves utility workers gathering samples at seven hundred and fifty five different treatment plants all over the country, and the analysis work goes to different labs, and then the CDC manages all the datasets and figures out what in crap's name is going on below our feet and in our bodies. But like a drain, let's back up, and can you tell me a little bit about your start in this when you
began your science journey. What kind of questions do you want to ask and what kind of tinkering and collecting and field sampling were you doing.
So my history, like many people in public health, I think, was not a straight line to this work. So I always knew that I was really interested in infectious diseases, in the pathogenic process, and how something so tiny can
cause such big impacts on people on society. I wasn't sure in like high school and college, what scale I wanted to work, you know, I think looking at things as detailed as gene regulation, which is what my graduate work was on, it's fascinating all the details of how these systems work at a molecular lefl but I also think things like infectious disease history are fascinating and how big pandemics like this can really shape history. As I said,
my initial training was at the molecular level. So after I got my PhD in molecular microbiology, I got a master's of public health and epidemiology and continued to work at Emory University for about five years doing public health research.
That's where I did the neurovirus research, and then in twenty seventeen came to CDC, initially focused on environmental antibiotic resistance, so starting our program to look at environmental AR and then when the pandemic started in twenty twenty, we knew there was a need or an opportunity for environmental microbiology to contribute even more broadly than wastewater surveillance. We remember there were a lot of questions about things like surface
survival or disinfection and all of that. When SARS COB two is new, those are environmental microbiology questions. And so in February of twenty twenty, I was we say, deployed to the response, so still reporting to CDC campus, but a different room. So now instead of instead of doing my regular work, I was doing response work for COVID, and those early days were focused on disinfection, surface survival, all of the things that went along with that response work.
I mean, for anybody that's interested in public health, it is the thing that we all live for because you get to answer the questions that matter and you never know what's going to be on your desk.
What will be on your desk is so many things. But yes, always in the back of her mind was what.
About wastewater surveillance? Can we generate data for wastewater surveillance? And, like I said, by about May of twenty twenty, that had become my full time job.
You know, shit gets real when they use the word deployed, by the way.
A lot of people get confused by that, and it's like we're in the same building, just a different room.
Yeah, but a little bit higher stakes almost. It feels like it feels much more emergent. For sure, at least it sounds like it. But what what is your day to day lab work? Like how much are you analyzing data sets and how much are you tinkering with pipettes and teaching other people how to do it?
Yeah? So I think one of the things that people often misunderstand about the way surveillance systems work that are run by CDC, we actually don't do the lab testing. So it's much more efficient for a large scale system to set up the testing in each state so it's close to where the samples are coming from. Right, a
distributed method for testing. So we do a lot of technical assistance for labs and answer questions and help them get connected to all of the resources that they need, but we're not doing any routine surveillance testing on campus. What we primarily do here in the laboratory is method development and validation. So we're already thinking about this is a great system. We've built it for COVID, but we
could look for so many other things. Right, I can go back to my old friend norovirus, oh hella, and now we've put in the investment to build this infrastructure. Now it's a much lower bar to also look for neurovirus, and so we can get that data in the future. So we're method development, validation, tinkering, make sure we really thoroughly understand how those lab methods work, so that when we're on the phone with the labs that are doing
the work. We can be as good as possible in our technical assistance.
Where do you get your practice wastewater?
We have our sources, so we're based here in Atlanta, and Atlanta has, like many large cities, actually has multiple wastewater treatment systems, and so we have long standing collaborations with our local utilities. We can call them up and say can we get you know, five liters of wastewater on Tuesday? And I say sure, and we go get it and that becomes our sample matrix.
How treated is it? Be real with me, where along the assembly line is it?
So we collect it so the way it comes in and this is actually fascinating. I should say that all of the people that work certainly in news, the news is our acronym, right, A good government program has to have a pronounceable acronym. Where the National Wastewater Surveillance System and we pronounce it news. But all of our news folks, we're we get a little nerdy about wastewater systems, so we really like to go out and see how they work.
For news testing, the wastewater comes into the plant, there's usually a very large grate that acts as a pre screen, and so it filters out all of the really big things. The I mean, they get all kinds of things, furniture, teddy bears, branches, sticks, tires, all the things that flow into sewer mains, and so it's going to get rid of all of those big things, but everything else is going to come through, and that is where we take our sample, so it is completely untreated.
I've been swimming in raw sewage.
I love it when we get it. People often think that there's like whole poops floating around there is That's not what the sample looks like. By the time it gets to us. There's a lot of mixing as all of the pipes come together, and so all of the stool will break down. What it really looks like is if you wade out into a river and kick up the mud on the bottom, or there's been a lot of rain and it's just kind of muddy river water, that's what it looks like.
Yep, that's what I would figure. I feel like it's a lot more translucent than we imagine. Yeah, how do you make sure that you don't get pink eye all the time.
So we have a lot of biosafety restrictions and frankly COVID is one of the least concerning things in wastewater for risk. Yeah. Really, what we're detecting mostly is decayed viruses, so they're no longer infectious, and so the risk for COVID from wastewater exposure is very low. However, plenty of other things. You can get pink eye, you can get neurovirus, you can get ecali.
This is the CDC people. They're not doing sewer water analysis while eating a hot dog and wearing biz cash.
There are rules, there's all kinds of pathogens there. We handle wastewater at a BSL two plus standard, so we have to have gloves, eye protection, force, closed toed shoes, lab coat, and then the plus, so that's a BSL two. The plus is respiratory protection and that's for that low but possible exposure to respiratory pathogens like COVID, so an N ninety five masks in addition to those things.
How often are respiratory illnesses enteric? Like how often are they detectable through wastewater?
That is an excellent question, and I think it's more common than we think because we know other respiratory infections like COVID do this. So SARS one, which luckily did not turn into a pandemic, is shed and stool.
And just a quick background severe acute respiratory syndrome aka SARS covid one. This was a coronavirus that hopped from animals to humans and in two thousand three caused an outbreak with a case fatality rate nearly ten times that of our current SARS KOBE two. However, SARS one infected around eight thousand people in total, it killed seven hundred and seventy four, so we learned a lot from that smaller SARS outbreak, but not enough.
We know that influenza is shed and stool. We know that respiratory sincitio virus, which causes a lot of really
terrible infections in children, is also shed and stool. My guess is that is not an uncommon feature of respiratory infections, but we don't have a lot of data on it because the symptom and the transmission method is all respiratory, so the focus has always been getting those respiratory specimens, and fecal shedding has been sort of thought of as a weird quirk of the infection but not really relevant
to the clinical course. And so we don't have good data on that, but that's people are looking at it now. We are getting more and more data on flu RS and some of the other respiratory viruses as well, so I expect we will learn a lot about that in the coming years.
So just think of the last two years of your life on zooms meeting your friends babies through plate glass windows as our golden age of pandemia, because we're learning so much, so fast. And why I was so thrilled to chat about murky water with Secrets to Tell is because environmental microbiologists such as doctor Kirby can potentially get much more reliable and objective data by overcoming the human
hurdles of test availability and self reporting. But what do they need to accurately predict a disease wave before it comes and crashes on us.
So we can't use wastewater data for COVID to estimate cases right now, and that's because we don't have enough information about that shedding parameter to know, you know, how much virus is shed by a single infected case. So what we see is that the trends align quite well, but we detect them earlier in wastewater then we see them in clinical cases. Omicron peaks in both cases and wastewater are much higher than what we sol for delta, right,
So the magnitude parallels what we expect for cases. And I think one of the things that we have always thought about with surveillance is you know, I know people get tired of hearing about this, but it's the surveillance iceberg has always been our analogy what we can detect in surveillance, particularly clinical surveillance, where you're waiting for someone to go to the doctor get tested. The test has to be correct and reported. Right. Those are a lot
of steps. You're only getting the tip of the iceberg for all the cases because you lose information at each step, and really the biggest one is getting someone to go to the doctor. That's right. You know all of those community cases that we miss because they either don't go to the doctor or they don't even have symptoms, right, And so we can estimate back to get what we think the true burden of infection is. But I think wastewater data is really powerful because we can get at
that community level without having to estimate anything. It's a way to measure it in the lab and So what we have to do now is figure out, Okay, when we get that wastewater level, what is the best model to go from that wastewater number to a number of cases? And I think we'll get there. We're not there yet. There's still more research to do, but that is really where we want to be able to go.
Like, there is a specific algorithm or equation that can that is out there that is undiscovered as of Yeah, but they can maybe show like, if this is the level that's shed, this is a good number to try to figure out how many cases there are.
Right, it's not even undiscovered, So there's already models out there to do this. The problem is, so I'm going to give you a little jargon here. The problem is the models are not what we call fully parameterized. Right. So the easiest way to think about this is, what if we have a certain amount of let's use Saruskobe two, RNA and wastewater. If we want to know how many cases we have from that, one of the things we need to know is how much virus does each case shed? Right,
what's the divisor for that number? And that's the number we're missing. That's a parameter in the model. It's not the only one, but it's one of the key ones, and we don't have good data on that right now. We have very limited data. So what that means is that our model is very uncertain and we get a huge wide range of possibilities. And right now those estimates
are so wide that they're really not useful. I mean, it's equivalent to saying, well, the likelihood is somewhere between one and one hundred percent, which is not a very useful thing. So we need to get those parameters tighter so that our estimates get tighter and more useful.
And what influences the amount of RNA? Is it rna from the virus? It's that you're picking up, like is it the severity of the case. Is it how much fiber someone eats?
It could be all of the above, So you know, certainly we want to look at symptoms versus no symptoms. Early data suggests that doesn't make a difference, but there's not a lot there. It could change with more data. Now we need to think about does vaccination change you're shedding right right? Does it look different if it's a breakthrough vaccinated case versus an unvaccinated case. Does shedding change with variants. Maybe omicron sheds a lot more than delta
or alpha, and so we don't have that information. And then the other piece, so that's the sort of biological piece about the human infections.
So part one is your biological pipes. And then number two is the industrial aspect, so the municipal guts and concrete shoots, this shit show ballet performed every day underneath our communities. It's beautiful.
The other piece is what's the impact of the wastewater system itself, So how long is the virus in the system, in the pipes before it gets to the wastewater treatment plan. We sample it because the longer it's in those pipes, the more it's going to decay. Ah, So we have to take that into account. Also, a lot of things come into a wastewater treatment plant. Some of them can be very harsh, especially if you have a lot of industrial input, So there can be really harsh chemicals there
that can accelerate that decay. And so we would need to know like what else is coming into the system that we need to be able to account for to correct those numbers, to account for those changes in the system. Those are the two big categories of data that we would need to put into that to accurately make that estimate back to cases.
So, yes, our bodies may react to different variants differently, and your guts yours may process viral parts in novel ways with a vaccine fortified immune system. But we are not the only factor because remember that while wastewater treatment plants give us a great overhead view, there may be less control over the sampling conditions. But scientists are always solving problems, which really bowls me over. How do you feel when you have those kind of question marks or
those puzzle pieces? How do you approach them? Because I'm thinking about being at your desk and being like, we don't know how much bleached in the water. We don't know, and I just picture myself sobbing. How do you approach like these hurdles and the curveballs and the new trends and variants, How does your science brain approach it?
I mean, at CDC, it's all about having the right network and being collaborative with the science community at large. So you know, we have our networks of academic collaborators that we can reach out to and say, hey, have you ever thought about this? Problem. How do you measure so the time it takes for some you know, a flushed toilet to get from a house to a So the treatment plan is called residence time. How do you measure residence time? Can we get good estimates of that?
What's the fluctuation? What's the decay? And so asking them all of these questions and getting their ideas, and do you have do you researcher a have a platform available where you could ask that question. If the answer is yes, then the question for me at CDC becomes, well, how can I support them getting the resources they need to answer this critical question. So that's how we solve it, largely is by relying on our collaborative network that's available to us.
Well, I have a basic question here. But does that mean that knowing you have this network and that can help you solve these giant problems, does it make workplace, team building and office politics any more challenging or easier? Like knowing like you better have friends in the building because you're gonna have a lot of questions and you might need help, Like is everyone pretty tight at CDC? And just like doesn't let grudges stick around?
I mean we're human I will say that we are human. You are human people working here. But yeah, I mean it is an excellent place to work. I would, you know, be lying if I said otherwise. I mean, ultimately, we're a very mission driven agency and everybody wants to support the science as best they can. And so if I am willing to go to a colleague and able to convince them that doing this is going to be the key to, you know, moving some public health issue forward,
they are almost always willing to get on board. And so it is a very collaborative agency, both internally and externally, and that's that's how we're able to move quickly.
Let that perfectly diplomatic answer serve as yet another reminder that science is done by human people once who have birthdays and go through breakups, and when they're not trying to fix a pandemic, they buy bathing suits of target, and they have opinions about cauliflower rice and in some people's professions, though, holding a grudge about a parking space could lead to thousands of people needlessly dying. So let's
get along. What about myths that people think about your job or environmental microbiology, anything that you're any jokes that you have heard a thousand times, or any myths that you want to bust.
Well, I don't know about jokes, but we are a bastion of puns. I have a lot of really funny people on my team, and so we talk about, you know, what can your pooh do for you to try and rally people to support wastewater surveillance. Your number two is our number one. We've got quite a few. And I have to tell you that the news acronym when we came up with that, the pun possibilities were a big part of why we we went with it because immediately we were like, oh, when you do your business, we
get the news. That's perfect. So yeah, we do a lot of that.
I had a hunch I could just smell it. Speaking of aromas, how does the legit CDC epidemiologists feel about Twitter user Terry draws stuff November twenty twenty revelation that quote there are angry ladies all over Yankee candles sight reporting none of the candles they got had any smell at all. I wonder if they're feeling a little hot and nothing has much taste for the last couple of
days too. This tweet made the rounds. It led to Stanford psychophysiology PhD student Kate Petrova to decide, you know what, let's look into it and harvested one star reviews from scented candle emporiums all over the internet and then crunched those flaming numbers because sometimes the data it's right under your nose. Uh what about collaborations with the epidemiologists at Yankee Candle. Do you ever have to follow what they're finding?
I do. That's a great question. I had forgotten about that whole piece that they were getting a lot of complaints because no one could smell their candles. You know, we are open to unique collaborations. I don't know that news necessarily has a role with Yankee Candle, but certainly we're always looking for new ways and novel approaches to
get at these questions because they're hard. I mean, like you you said earlier, this is something that there's a lot of challenges and we don't have all the answers, But the way to get to them is to be open to possibilities.
And it's literally life or death. The work that you're doing can can lead to huge breakthroughs that can really protect people. We got so many questions from listeners. Can I lightning around you?
Of course?
Okay, okay. So this first question was asked by patron Amy Naramatsu, who wrote in quote, I work for an environmental nonprofit and water quality is a huge part of our work. We test for bacteria and other nasty stuff and publish our findings. What's the best way to communicate this data, particularly for the general public who may not understand the language. So wait, Amy works for an environmental nonprofit. You know what, Let's make Let's make this episode weird. Okay,
I'm gonna call Amy Naramatsu. Here you go. She's not expecting my call. I'm nervous about this for.
The boys the Queen Rivers on Maryland. Sure, if you know your party, your digito protection, you may dial it now.
Mm hmmm. Oh hi, Amy, I understand you're the community engagement coordinator.
I know I don't like thinking too well.
I'm actually I'm I'm calling from a podcast. It's it's fromologies Hi.
I'm sorry, You're like, who's this bitch calling me? Number one?
I am recording right now?
Do I have your permission?
Is that?
Okay?
Sure?
Okay, it's a very quick call. Essentially, I wanted to call because this week's episode it's with doctor Amy Kirby, who's with the CDC. She's amazing, but because the CDC is a government entity, they can't select a charity. So she's like, I'm gonna leave it up to you. And you submitted a question. You mentioned that you're a community engagement coordinator for essentially for Shore Rivers, which helps clean up waterways. So I was wondering if we can make the donation to y'all instead.
That yay, okay, good.
Can you tell me, like in a nutshell, what shore Rivers does, like what your mission statement is?
Yeah?
Absolutely, So Shore Rivers is an environmental no profit.
Based on there and we have a mission to protect and restore our waterways through science based advocacy, restoration and education. Who nailed it, look at that engaging the community.
Amazing.
Sorry that I seemed like such a creep at the beginning. I realized once you answered that I didn't have a plan for what I was going to say to you.
I was like, oh, fuck my life.
Thank you Amy for letting me completely interrupt your day with some charitable tomfoolery, and thank you doctor Kirby for having us just roll the dice this week for you and to learn more about shore rivers headshore rivers dot org, which will be linked in the show. Notes that donation was made possible by sponsors of the show. Thank you sponsors. Okay, no question too, crappy, Let's see what's coming down the pipe.
So this first one was asked by specs Owl and hey, Artemis wants to know what's the deal with medications down the drain? And they say, I know we're not supposed to because it'll get in the water, but I want to know how it permeates and how much and all
of that. And a bunch of people asked about hormonal birth control in the wastewater, looking right at you, Katie Court right, and first time asker Margaret Reese, is that something that you are also having to find ways to measure and come up with some public health guidelines around.
Yeah.
So I'm like jumping up and down at this question, because yes, please don't put your medications down the drain. Frankly, enough of it comes out in urine and stool on its own. We don't need the added input from the pills themselves going down the drain. Yes, I mean this is something that we are interested in doing. There are researchers that are already out there looking at can we
measure pharmaceuticals in waste water? And what does that tell us about the health of the community right Looking at things like pain medications are one another option that seems like antidepressants. Can we use those as large scale markers of community health issues that we can provide better interventions for.
And luckily scientists are on this and there are reams of studies that you can thumb through, such as the twenty nineteen Banger Pharmaceuticals of Emerging concern in Aquatic systems, Chemistry, occurrence effects and removal methods, which I read late at night. And this paper whispered facts to me such as the presence of pharmaceutical contaminants in groundwaters, surface water, seawater, wastewater treatment plants, soils and sludges has been well documented.
It said.
A range of methods including oxidation, photolysis, UV degradation, nanofiltration, reverse osmosis, and absorption has been used for their remediation from aqueous systems. So there's a lot of shit in there. They're trying a lot of stuff, and this paper warns that despite our efforts, we are clearly not getting at all. It also told me that pharma consumption ebbs and flows just like lapping waves of sewer water. And the study went onto site data that greases. Twenty ten economic crisis
set off surges in the consumption of psychoactive pharmaceuticals. Also, different parts in the world have higher estrogen water toxicity, while antibiotics are all the rage in other raging waters and wastewater filled with antibiotics. Guess what that is. That's just a giant cocktail party for evolution, just a big petri dish. It's a hometown training grounds for antibiotic resistant
germs that we can't kill. And I just can't help but consider the land that we're on, the mountain streams and the bays and the oceans and the deltas, and how they're very chemistry has been altered by the remedies that we rely on to survive and skimming lists of water contaminants like beta blockers and anticoagulants and hormones and pain killers and antidepressants and lipid lowering drugs and anti fungals.
You know, I read that as an American, I couldn't help, but wonder you know, is it cheaper to get my prescriptions by sitting in a creek? And which rivers have the good stuff? Well, Christy Sullivan, I wanted to ask this is it up top listener question? Wants to know who was the person who said, hear me out, I've got a good idea. And the sentence ended with collecting and analyzing wastewater was that.
You I actually am going to give the credit to this, and he's going to die when he hears me say this to our branch manager. So very early on he was like, can't we measure this and pooh? And I was like, yeah, I think we can.
Branch manager's name. Do you want to give him a shout out by name?
Sure? His name is Eric Gross.
His last name is Gross.
Yes, his last name is Gross.
Amazing? Is he a doctor?
He has an MPH. He actually sadly doesn't work in our team anymore. He moved to a different area of CDC. He called himself our resident being counter because he handled all of the finances.
I was gonna say if he's he should get an honorary to say be doctor Gross because a lab coat with doctor Gross is amazing.
He'll love it.
Nina Evesy had a question. I'm sures on a bunch of people's minds. They say, oh, I'm super intrigued by this, but are there any privacy issues with going through people's poop or is it like those fingernail clippings in the waste bind in law and order. Once it's out of your system and in the system, it belongs to the system, right.
Yeah, So, I mean there is a lot of DNA and wastewater, right, So the privacy concerns are not unfounded, and it's definitely something that we need to address head on and be very transparent about what we are testing and what we are not testing, and how that data is going to be used. As far as who actually
owns it. Once it gets to the treatment plant, it's theirs, and actually once it's in the pipes that they control to get there, they are officially owners of it and responsible for whatever happens to it.
This sack of shit is mine.
A lot of the information we're gathering is about the community at large, so we want to be very transparent with the community about you know, how we're using this data.
Yeah, that makes plenty of sense. I also feel like the resources it would take to run a DNA sample on each individual person or each individual fragment, that seems like beyond the capabilities even of the system.
Right, Yeah, I mean it's not something that we're interested in doing. I think about it from what we call a future use perspective, Right, what could people do ten years from now with these samples? Twenty years from now? And so we want to put guardrails on that now because down the road that may be something that's much easier to do. But that is an inappropriate use of public health data. It's not what we're gathering it for.
And so we want to make sure there's protection around these samples so that they are used only for things that are a community good.
But she makes an excellent point and raises the black mirror hypothesis, which is not a real term. It's just something that haunts me when I'm in a scroll hole or I happen upon a jovial news clip about a robotic police dog. Are there any specters in Amy's head? Mallory Nettleton wants to know if you've ever seen anything weird or surprising while you're testing but it is filtered or at least de chunked by the time it gets to correct.
Yeah, we haven't seen it with wastewater, with other poop related studies, absolutely, I mean, you can you learn a lot from people, really from what Yeah, you can learn what they eat and their patterns. I often tell my husband, I'm like, I spent way too much of my adult life pondering people's bathroom habits for various reasons.
Anything you can elaborate on, because I am curious.
The thing that always puzzles me is bathroom patterns. So I used to do neurovirus human challenge studies that I worked at Emory. So we would bring people into the hospital and intentionally give them neurovirus. Of course, all fully they knew what we were doing, right fully consented, they agreed to this to look at immune reactions or treatment methodologies, those sorts of things.
Right, let me just I'm going to hop in here and truncate this for us. All So, doctor Kirby found that some patients were like number two sample, Yeah, I got five of them for you today, and other people, all of us the same species, were like, I just I just gave you one yesterday, come back in like a.
Week, just this huge variation in patterns and then trying to account for that in our data. Like, if you're thinking about daily stool production and daily virus shedding, how do you compare the person that goes three or four times a day to the person that goes once every four days, as long as it's normal for them. We worked around it, but I was surprised at how broad the variation was.
I think it's interesting that you were surprised at the variation, and I am surprised that someone's like, yes, norovirus, where's the waiver, I'll sign it.
We got a lot of that. There are most definitely two types of people in the world, the absolute yes, I'll do it, and then no, way, you could not pay me enough. I haven't met anyone that's like, well, maybe you do.
People get remunerated for their contributions to science in that way.
They do, Yes, okay, Our challenge study subjects did get reimbursed for their time.
Well as someone who was lucky enough to dodge some neurovirus salsa at a barbecue once. I mean, no one at that barbecue got paid. So there are people out there getting it for no money, just for some free salsa. Oh, longtime listeners, know that my inherent revulsion for raw tomatoes saved my actual ass. Now, what about organisms that are not people? Lee was not the only person with this question.
Dana Teter asked, can you tell from wastewater tests if the pathogen you find has human origin or animal origin? And if not, what further sleothing needs to be done?
Sloothing We cannot tell. So when we detect a specific pathogen, we can't tell if it's from humans or animals, assuming it's a pathogen that we know is found in both. Right, If it's strictly a whatever bird pathogen, then we know it's from birds. However, what we can do is we can look for other markers, microbial markers that are only
found in one of those sources. So we use specific microbial markers that are only present in human feces yum, so we can say, okay, there's human feces in this wastewater, which we would expect. We can also look for markers associated with specific animals rats, birds, dogs, cats, and so we can say what other animals have contributed significantly to this wastewater that may be the source of these pathogens.
You know, which brings me to a good question. Timothy Wang and Saddani Scheimler asked, what are the issues with flushing pet poop and are there ways to monitor animal based disease versus human disease? Which you just answered, But should people be flushing cat poop in your opinion as someone who is an environmental microbiologist.
I mean they can. It's a safe way to dispose of pet waste in our household, so that's fine. I mean, I will, you know, stand up for my utility colleagues and say, please don't flush cat litter. It clogs up the system and causes all kinds of problems. But cat poop, dog poop is fine. I think it's an interesting question of whether we could monitor diseases animal diseases that way.
The challenge there would really be scale right. You might predict that, for example, in the city, it's much more likely that pet waste gets flushed than in the country, and so you need to account for that difference in your evaluation.
Also, heads up, cats can be trained to use a toilet, and apparently so can some birds like parrots, which makes sense given that they can learn to insult us in our own language. Now, dogs too have been trained to use toilets and even flush, So imagine New Yorkers. If you start now it's April, perhaps you'll have this training thing on lock before winter comes and you're standing on a frozen sidewalk waiting for poop to drop. I thought furf brownov had a good question. It's a sensitive question.
I'm going to ask it anyway, they said. When I heard about monitoring COVID through wastewater, my immediate fear was, can I get COVID from smelling someone's fart?
So?
Can you get a disease from inhaling particles after someone rips some of that trumpet? Do you ever have to worry about something going from enteric to airborne?
So for COVID, this is not a risk that we are concerned about, And mainly that's because we don't think there's no evidence that the virus that is shed in stool or through the GI tract is infectious. In fact, most of our evidence suggests that it is not. So Paul, we can't totally rule out the possibility, very very low that any virus coming from the GI tract is going to be infectious, and so a fart wouldn't be any
more infectious than a poop, right. However, I think this is an interesting question for other infections where we know that a lot of infectious virus is shed. So we'll go back to my old friend norovirus again. There we know that infectious virus is shed at very high levels and stool. So is there a possibility that aerosolized virus from a part could cause infection?
Wow? This gets grosser.
We don't know that. But what we do have really good evidence of is that when people vomit with neurovirus, which also happens a lot, right, it is the winter vomiting disease, the particle. This is really gross. I'm sorry to throw this out there at the end, but when people vomit, there's lots of aerosolized particles from that, and there's multiple outbreak studies showing that. You know, really, the only exposure we can figure out is that that person
across the room must have inhaled aerosolized vomit. I don't like, we don't know that it goes through their nose necessarily, more likely they were breathing through their mouth and it's kind of equivalent to consuming it.
I think that's the worst thing guys ever heard.
But certainly there's very strong a FI evidence that that can happen with a fecal oral transmitted virus. Whether or not you would actually aerosolize enough virus through a fart through your clothes to be a risk, I don't know. I think it's unlikely, but I wouldn't rule it out. There's a biological pathway there.
I mean, how lucky are we that we have someone answering these questions for us somewhere?
Like I said, I spend way too much time thinking about people's bathroom habits.
What is the hardest part about your job or what do you hate the most? I mean, you are doing the lord's work. But what's the worst part about analyzing poop?
I mean, well, the worst part I think about analyzing poop in anything stool related in public health is the stigma that people still have around poop in their own poop. So there's an immediate revulsion, which I understand it now. It's actually protective if you think about the evolutionary reasons for it. But what that means is that people don't want to participate in studies like our Nora virus study.
They don't want to answer questions about their bathroom habits and how often they poop at work versus pooping at home, which is important for us to understand how wastewater surveillance works and the most effective approaches. They don't really want to think about scientists somewhere digging through their you know, wastewater to answer questions. It's just there's this immediate rejection of it, and that we have to factor that response
into all of our studies. That there's a bias that comes with that right of people that just won't participate because it's gross. I'm used to it at this point, but it is hard to overcome.
That's such a good answer and so understandable that that is a giant psychological barrier of other people's to getting your work done. You know, I can't imagine if birds were like, I don't really want you to see my net. Just don't look at my nest, Just can you not? Just I don't even nest. I don't even have a nest actually, like never, Like that's there's not a lot of shame around so many other fields. That's so interesting. What about the thing that you love the most.
I mean, it's corny, but the thing that I love the most is being able to make a difference. It's the reason I went into public health and got out of molecular micro I wanted to be able to see that the work that I'm doing has an impact in the community. And I mean I loved the work I was doing pre COVID, but man, as soon as you're deployed to the response, that application of your work takes
on a whole different urgency and quickness. You know, you see things going to practice within days instead of weeks or months or years.
Well, thank you for doing it. I'm such a fan of what you do. I just think it's so interesting and it's just the way of the future.
I feel like, oh, thank you. Well, yeah, we think it's going to be absolutely a new paradigm for disease surveillance because it doesn't work require any action from people, right, it's totally passive to the community. So it's been great to talk to you and really thank you for this opportunity.
Ah but wait, we have a little more. I'm speaking in a little insight from a virology guest and repeat guest doctor Shannon Bennett of the California Academy of Arts and Sciences, who I got a chance to see a few weeks ago. We chatted in San Francisco, face to face with multiple layers of polypropylene in between, about variance and advice going into our third COVID summer.
What are we supposed to do?
I mean, and I guess just given what we're talking about, we'll just keep masks on.
Might as well?
We're well, we're in a small space. Yes, Oh, first off, I don't think I had to do this work. But if you could say your first and last name in your.
Pronouns, Shannon Bennett, she here.
Now we last got to hang out in person March of twenty twenty.
You masks, no sittings within six feet comfortably in an indoor setting.
What a luck, What a luxury it was. If another virus emerges, do you think that this SARS Kobe two experience will have us be it all better equipped to handle another outbreak of some kind?
Oh?
Yeah, that's good.
Yeah, no is This has been an amazing time of building capacity around the world to identify these novel events and sequence these viruses and share the data. I mean, just look at how quickly we were able to develop effective vaccines. Honestly, nobody would have ever predicted that we would have been able to have vaccines that at the beginning, we're ninety five percent effective against infection. Nobody tries to even design vaccines to protect against infection. They try to
design them to perfect to protect against disease. And so it's amazing that we have this new vaccine technology. And it's because, in part, we were able to accelerate the vaccines because of a massive sort of data sharing, massive cross sector collaboration, massive infusion in production lines for the vaccine. We've learned so much.
Right, I mean it's kind of forged in fire in some way where well we didn't necessarily have all of this in place, but we have it now. Yeah, that's good. Yeah, you know, things are starting to open up a little bit. You know, we're here at a Science Nightline event that we have not had in two years, though it will be masked for attendees. Anything that as we get into summer, people gets warm, people start to act out, They're like, let's do it, let's get out. Yeah, festivals, I'm ready.
I've been bored anything any cautionary advice or anything any guidelines.
So I'm fully vaccinated and boosted and honestly wearing a mask. I don't want COVID, but if I did get COVID, it would probably be just fine, right, I probably have a pretty mild course. It would be a pain because I'd probably have to control my movements and quarantine. But there are a lot of people that for whatever reason, they're either not eligible, they can't get the vaccine, they don't have a good immune response to the vaccine. And so right now, I mostly wear my mask to protect others.
And I think as a society, we're still seeing this thing called extra deaths.
Right.
That sounds terrible, Yeah.
I know it does sound horrible. We understand that a certain and hopefully entiny proportion of our population will always have a very bad outcome to a disease infection event, and with flu, we just you know, we just you know what that looks like, and we just have to
live with it. People are still dying of COVID, people are still dying of omicron, and even very young people, and so we need to decide how much of that we can live with, And then I will start thinking more and more about where and when I can take my mask off relative to the safety of other people.
Smart consider it. I think it's one of those things where no one's ever like I really regret wearing a mask to that, but there are times when people are probably wish I would have worn a mask somewhere, so you know, yeah, better safe than sorry. They yeah, Well, I imagine you're going to have a lot of young birologists who are sort of shuffled into this field for
motivated by very personal reasons. So there's going to be a lot of people probably who have an interest in tackling things before they really become an outbreak.
So I agree.
So there you have it. Ask three smart people. Doesn't it's a very not smart and truly shameless questions. Thank you for sticking it out. I know that you're like, should I listen to this? You know, you know more now and you have helped with the hardest part of doctor Kirby's work, which is people running away screaming from it. And there are links to the studies we cited. There are references. There's the link to the charity for the episode. There's a link of birds on toilets and more. Up
at Alleywoard dot com slash ologies slash environmental microbiology. That's linked in the show notes. You do not have to write it down. You can follow the CDC. Their handle is at CDC gov. You can follow us if you please, at Ologies on Twitter and Instagram. I'm on those as Ali Ward Ali with one L. You can head to ologiesmerch dot com to put some ologies things on your body. If you tag it ologies merch on Instagram, we repost you on Mondays. There are more links at Alleyward dot com.
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you with a secret if you will. And you know what's weird is I've been doing this show for like two hundred and fifty episodes or something. I should know exactly the number, and I should celebrate that. And I'm still I still get nervous when I record asides. I don't know why I can edit them. If I mess up, I can edit them. It's fine. Why am I? What do you care? Just get into it, you know. And I'm still like, Oh what if I'm Bob? You know what it is? I think I still like this job.
I've been doing it since twenty seventeen. I still like it. Okay, see you next week. Sorry this one was so gross. Love you, bye bye. Give them a cup of sewer water, don't you go