Antidrug resistance in the Indian ambient waters of Ahmedabad during the COVID-19 pandemic

MOF UiO-66 and its composites: design strategies and applications in drug and antibiotic removal

Antibiotics and pharmaceuticals exert significant environmental risks to aquatic ecosystems and human health. Many effective remedies to this problem have been developed through research. Metal-organic frameworks (MOFs) are potential constituents, for drug and antibiotic removal. This article explores the potential of MOFs like UiO-66 (University of Oslo-66) to remove pharmaceutical and antibiotic contaminants from water. Zr-based MOF UiO-66 is used in water treatment due to its well-known chemical, thermal, and mechanical stability. The review covers several modifications, including metal doping, organic-group functionalization, and composite construction, to increase the UiO-66 selectivity and adsorption capacity for various pollutants. Recent studies have shown that UiO-66 is an effective material for pharmaceutical pollutants such as ciprofloxacin, tetracycline, and sulfamethoxazole removal. Practical application, photostability, and large-scale synthesis remain challenges in water treatment methods. Moreover, recent studies indicate the recycling potential of UiO-66 that validates its capability to retain its efficiency over multiple cycles, indicating its cost-effectiveness and sustainability. Besides, the toxicity of UiO-66 and its derivatives, which occur during water treatment, has also been highlighted, addressing the health and environmental risks. Prospective research directions include designing flaws, producing stable analogs of UiO-66, and transforming powdered UiO-66 into other forms that might be utilized, including films and membranes. This review is crucial as no comprehensive literature is currently available that thoroughly discusses the design techniques and applications of UiO-66 and its composites for drug and antibiotic removal. Our study specifically concentrates on the latest developments, emphasizing particular alterations that improve performance in water treatment.

Source apportionment and specific-source-site risk of quinolone antibiotics for effluent-receiving urban rivers and groundwater in a city, China

There is a large surface-groundwater exchange downstream of wastewater treatment plants (WWTPs), and antibiotics upstream may influence sites downstream of rivers. Thus, samples from 9 effluent-receiving urban rivers (ERURs) and 12 groundwater sites were collected in Shijiazhuang City in December 2020 and April 2021. For ERURs, 8 out of 13 target quinolone antibiotics (QNs) were detected, and the total concentration of QNs in December and April were 100.6-4,398 ng/L and 8.02-2,476 ng/L, respectively. For groundwater, all target QNs were detected, and the total QNs concentration was 1.09-23.03 ng/L for December and 4.54-170.3 ng/L for April. The distribution of QNs was dissimilar between ERURs and groundwater. Most QN concentrations were weakly correlated with land use types in the system. The results of a positive matrix factorization model (PMF) indicated four potential sources of QNs in both ERURs and groundwater, and WWTP effluents were the main source of QNs. From December to April, the contribution of WWTP effluents and agricultural emissions increased, while livestock activities decreased. Singular value decomposition (SVD) results showed that the spatial variation of most QNs was mainly contributed by sites downstream (7.09%-88.86%) of ERURs. Then, a new method that combined the results of SVD and PMF was developed for a specific-source-site risk quotient (SRQ), and the SRQ for QNs was at high level, especially for the sites downstream of WWTPs. Regarding temporal variation, the SRQ for WWTP effluents, aquaculture, and agricultural emissions increased. Therefore, in order to control the antibiotic pollution, more attention should be paid to WWTP effluents, aquaculture, and agricultural emission sources for the benefit of sites downstream of WWTPs.

Genomic investigation unveils high-risk ESBL producing Enterobacteriaceae within a rural environmental water body

Antimicrobial resistance is regarded as a global threat to public health, animals, and the environment, emerging in response to extensive utilization of antimicrobials. The determinants of antimicrobial resistance are transported to susceptible bacterial populations through genetic recombination or through gene transfer, mediated by bacteriophages, plasmids, transposons, and insertion sequences. To determine the penetration of antimicrobial resistance into the bacterial population of the Thiruvandarkoil Lake, a water body located in the rural settings of Puducherry, India, culture-based microbiological and genomic approaches were used. Resistant bacterial isolates obtained from microbiological screening were subjected to whole genome sequencing and the genetic determinants of antimicrobial resistance were identified using in silico genomic tools. Cephalosporin-resistant isolates were found to produce extended spectrum beta lactamases, encoded by blaVEB-6 (in Proteus mirabilis PS01), blaSHV-12 and ompK36 mutation (in Klebsiella quasipneumoniae PS02) and blaSHV-12, blaACT-16, blaCTX-M and blaNDM-1 in (Enterobacter hormaechei PS03). Genes encoding heavy metal resistance, virulence and resistance to detergents were also detected in these resistant isolates. Among ESBL-producing organisms, one mcr-9-positive Enterobacter hormaechei was also identified in this study. To our knowledge, this is the first report of mcr-9 carrying bacterium in the environment in India. This study seeks the immediate attention of policy makers, researchers, government officials and environmental activists in India, to develop surveillance programs to monitor the dissemination of antimicrobial resistance in the environment.

Antibiotic resistance in wastewater: Indian scenario

The surge of Antibiotic Resistant Bacteria (ARB) in the environment is poised to be the next health threat. World Health Organisation's (WHO's) Global Antimicrobial Surveillance System (GLASS) report indicates that developing countries may be at a greater risk. Among various factors, the major driver here could be untreated wastewater and poor sanitation. Bacteria are extremely adaptable to their surroundings and develop Antimicrobial Resistance (AMR) when exposed to antibiotics and other pollutants that cause microbial stress. Thus, untreated domestic wastewater drains could easily become hotspots for the occurrence of ARBs. This study reports surveillance of sewage-carrying drains across four urban cities in India and demonstrated the presence of ARBs in the bacterial community against 7 classes of antibiotics, namely, β-Lactams, Chloramphenicol, Glycopeptides, Macrolides, Tetracycline, Third Generation Cephalosporin, and Quinolones. Untreated domestic wastewater flowing in target drains was collected twice a month, for a period of six months and the microbial community was subjected to Antibiotic Susceptibility Testing (AST) by plate assays. The zone of inhibition was recorded and interpreted as per the interpretive chart of The Clinical & Laboratory Standards Institute (CLSI) & The European Committee on Antimicrobial Susceptibility Testing (EUCAST). The total number of samples showing resistance against antibiotics was used to define an Antibiotic Resistance Index (ARI), calculated for all 20 sampling sites (drains). Results demonstrated that the highest ARI was observed in Delhi and Mumbai, ranging from 0.81 to 0.92 in Delhi and 0.49-0.56 in Mumbai. This surveillance study reveals the antibiotic resistance pattern of the representative bacterial community in the drains and goes beyond few targeted bacterial species. The alarming presence of antibiotic resistant bacterial community highlights the concern of ARBs being the next looming health threat. This report aims to demonstrates the importance of considering sewage surveillance on routine basis by state authorities.

A mega study of antibiotics contamination in Eastern aquatic ecosystems of China: occurrence, interphase transfer processes, ecotoxicological risks, and source modeling

Understanding the occurrence, sources, transfer mechanisms, fugacity, and ecotoxicological risks of antibiotics play a pivotal role in improving the sustainability and ecological health of freshwater ecosystems. Therefore, in order to determine the levels of antibiotics, water and sediment samples were collected from multiple Eastern freshwater ecosystems (EFEs) of China, including Luoma Lake (LML), Yuqiao Reservoir (YQR), Songhua Lake (SHL), Dahuofang Reservoir (DHR), and Xiaoxingkai Lake (XKL), and were analyzed using Ultra Performance Liquid Chromatography/Tandem Mass Spectrometry (UPLC-MS/MS). EFEs regions are particularly interesting due to higher urban density, industrialization, and diverse land use in China. The findings revealed that a collective total of 15 antibiotics categorized into four families, which included sulfonamides (SAs), fluoroquinolones (FQs), tetracyclines (TCs), and macrolides (MLs), exhibited high detection frequencies, indicating widespread antibiotic contamination. The pollution levels in the water phase were in the order of LML > DHR > XKL > SHL > YQR. The sum concentration of individual antibiotics for each water body ranged from not detected (ND) to 57.48 ng/L (LML), ND to 12.25 ng/L (YQR), ND to 57.7 ng/L (SHL), ND to 40.50 ng/L (DHR), and ND to 26.30 ng/L (XKL) in the water phase. Similarly, in the sediment phase, the sum concentration of individual antibiotics ranged from ND to 15.35 ng/g, ND to 198.75 ng/g, ND to 1233.34 ng/g, ND to 388.44 ng/g, and ND to 862.19 ng/g, for LML, YQR, SHL, DHR, and XKL, respectively. Interphase fugacity (ff_sw) and partition coefficient (K_d) indicated dominant resuspension of antibiotics from sediment to water, causing secondary pollution in EFEs. Two groups of antibiotics, namely MLs (erythromycin, azithromycin, and roxithromycin) and FQs (ofloxacin and enrofloxacin), showed a medium-high level of adsorption tendency on sediment. Source modeling (PMF5.0) identified wastewater treatment plants, sewage, hospitals, aquaculture, and agriculture as the major antibiotic pollution sources in EFEs, contributing between 6% and 80% to different aquatic bodies. Finally, the ecological risk posed by antibiotics ranged from medium to high in EFEs. This study offers valuable insights into the levels, transfer mechanisms, and risks associated with antibiotics in EFEs, enabling the formulation of large-scale policies for pollution control.

Hormesis-tempting stressors driven by evolutionary factors for mitigating negative impacts instigated over extended exposure to chemical elements

The adaptive responses to moderate environmental challenges by the biological systems have usually been credited to hormesis. Since the hormetic biphasic dose-response illustrates a prominent pattern towards biological responsiveness, the studies concerning such aspects will get much more significance in risk assessment practices and toxicological evaluation research. From this point of view, the past few epochs have witnessed the extending recognition of the notion concerning hormesis. The extraction of its basic foundations of evolutionary perspectives-along with the probable underlying molecular and cellular mechanisms followed by the practical implications to enhance the quality of life. To get better and more effective output in this regard, the present article has evaluated the various observations of previous investigations. The intent of integrating the novel inferences concerning the hormesis-tempting stressors driven by predominant evolutionary factors for mitigating the adverse impacts that were prompted over frequent and continuous exposure to the various chemical elements. Such inferences can offer extensive insight into the implications concerning the risk assessment of hormesis.

Ventilation reconstruction in bathrooms for restraining hazardous plume: Mitigate COVID-19 and beyond

Converging evidence reports that the probability of vertical transmission patterns via shared drainage systems, may be responsible for the huge contactless community outbreak in high-rise buildings. Publications indicate that a faulty bathroom exhaust fan system is ineffective in removing lifted hazardous virus-laden aerosols from the toilet bowl space. Common strategies (boosting ventilation capability and applying disinfection tablets) seem unsustainable and remain to date untested. Using combined simulation and experimental approaches, we compared three ventilation schemes in a family bathroom including the traditional ceiling fan, floor fan, and side-wall fan. We found that the traditional ceiling fan was barely functional whereby aerosol particles were not being adequately removed. Conversely, a side-wall fan could function efficiently and an enhanced ventilation capability can have increased performance whereby nearly 80.9% of the lifted aerosol particles were removed. There exists a common, and easily-overlooked mistake in the layout of the bathroom, exposing occupants to a contactless vertical pathogen aerosol transmission route. Corrections and dissemination are thus imperative for the reconstruction of these types of family bathrooms. Our findings provide evidence for the bathroom and smart ventilation system upgrade, promoting indoor public health and human hygiene.

Genetic sequencing detected the SARS-CoV-2 delta variant in wastewater a month prior to the first COVID-19 case in Ahmedabad (India)

Wastewater-based genomic surveillance can identify a huge majority of variants shed by the infected individuals within a population, which goes beyond genomic surveillance based on clinical samples (i.e., symptomatic patients only). We analyzed four samples to detect key mutations in the SARS-CoV-2 genome and track circulating variants in Ahmedabad during the first wave (Sep/Nov 2020) and before the second wave (in Feb 2021) of COVID-19 in India. The analysis identified a total of 34 mutations in the spike protein across samples categorized into 23 types. The spike protein mutations were linked to the VOC-21APR-02; B.1.617.2 lineage (Delta variant) with 57% frequency in wastewater samples of Feb 2021. The key spike protein mutations were T19R, L452R, T478K, D614G, & P681R and deletions at 22029 (6 bp), 28248 (6 bp), & 28271 (1 bp). Interestingly, these mutations were not seen in the samples from Sep/Nov 2020 but did appear before the massive second wave of COVID-19 cases, which in India started in early April 2021. In fact, genetic traces of the Delta variant were found in samples of early Feb 2021, more than a month before the first clinically confirmed case of this in March 2021 in Ahmedabad, Gujarat. The present work describes the circulating of SARS-CoV-2 variants in Ahmedabad and confirms the consequential value of wastewater surveillance for the early detection of variants of concerns (VOCs). Such monitoring must be included as a major component of future health protection systems.

Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown, Part 1: Traffic, Drugs, Mental Health, and Disinfectants

The early months of the COVID-19 pandemic and the associated shutdowns disrupted many aspects of daily life and thus caused changes in the use and disposal of many types of chemicals. While records of sales, prescriptions, drug overdoses, and so forth provide data about specific chemical uses during this time, wastewater and sewage sludge analysis can provide a more comprehensive overview of chemical changes within a region. We analyzed primary sludge from a wastewater-treatment plant in Connecticut, USA, collected March 19 to June 30, 2020. This time period encompassed the first wave of the pandemic, the initial statewide stay at home order, and the first phase of reopening. We used liquid chromatography-high-resolution mass spectrometry and targeted and suspect screening strategies to identify 78 chemicals of interest, which included pharmaceuticals, illicit drugs, disinfectants, ultraviolet (UV) filters, and others. We analyzed trends over time for the identified chemicals using linear trend analyses and multivariate comparisons (p < 0.05). We found trends related directly to the pandemic (e.g., hydroxychloroquine, a drug publicized for its potential to treat COVID-19, had elevated concentrations in the week following the implementation of the US Emergency Use Authorization), as well as evidence for seasonal changes in chemical use (e.g., increases for three UV-filter compounds). Though wastewater surveillance during the pandemic has largely focused on measuring severe acute respiratory syndrome-coronavirus-2 RNA concentrations, chemical analysis can also show trends that are important for revealing the public and environmental health effects of the pandemic. Environ Toxicol Chem 2022;41:1179-1192. © 2021 SETAC.

Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown, Part 1: Traffic, Drugs, Mental Health, and Disinfectants

The early months of the COVID-19 pandemic and the associated shutdowns disrupted many aspects of daily life and thus caused changes in the use and disposal of many types of chemicals. While records of sales, prescriptions, drug overdoses, and so forth provide data about specific chemical uses during this time, wastewater and sewage sludge analysis can provide a more comprehensive overview of chemical changes within a region. We analyzed primary sludge from a wastewater-treatment plant in Connecticut, USA, collected March 19 to June 30, 2020. This time period encompassed the first wave of the pandemic, the initial statewide stay at home order, and the first phase of reopening. We used liquid chromatography-high-resolution mass spectrometry and targeted and suspect screening strategies to identify 78 chemicals of interest, which included pharmaceuticals, illicit drugs, disinfectants, ultraviolet (UV) filters, and others. We analyzed trends over time for the identified chemicals using linear trend analyses and multivariate comparisons (p < 0.05). We found trends related directly to the pandemic (e.g., hydroxychloroquine, a drug publicized for its potential to treat COVID-19, had elevated concentrations in the week following the implementation of the US Emergency Use Authorization), as well as evidence for seasonal changes in chemical use (e.g., increases for three UV-filter compounds). Though wastewater surveillance during the pandemic has largely focused on measuring severe acute respiratory syndrome-coronavirus-2 RNA concentrations, chemical analysis can also show trends that are important for revealing the public and environmental health effects of the pandemic. Environ Toxicol Chem 2022;41:1179-1192. © 2021 SETAC.

Delineating the impact of COVID-19 on antimicrobial resistance: An Indian perspective

The COVID-19 pandemic has shattered millions of lives globally and continues to be a challenge to public health due to the emergence of variants of concern. Fear of secondary infections following COVID-19 has led to an escalation in antimicrobial use during the pandemic, while some antimicrobials have been repurposed as treatments for SARS-CoV-2, further driving antimicrobial resistance. India is one of the largest producers and consumers of antimicrobials globally, hence the task of curbing antimicrobial resistance is a huge challenge. Practices like empirical antimicrobial prescription and repurposing of drugs in clinical settings, self-medication and excessive use of antimicrobial hygiene products may have negatively impacted the prevalence of antimicrobial resistance in India. However, the expanded production of antimicrobials and disinfectants during the pandemic in response to increased demand may have had an even greater impact on the threat of antimicrobial resistance through major impacts on the environment. The review provides an outline of the impact COVID-19 can have on antimicrobial resistance in clinical settings and the possible outcomes on the environment. This review calls for the upgrading of existing antimicrobial policies and emphasizes the need for research studies to understand the impact of the pandemic on antimicrobial resistance in India.

Spectre of SARS-CoV-2 RNA in the ambient urban waters of Ahmedabad and Guwahati: A tale of two Indian cities

COVID-19 positive patients can egest live SARS-CoV-2 virus and viral genome fragments through faecal matter and urine, raising concerns about viral transmission through the faecal-oral route and/or contaminated aerosolized water. These concerns are amplified in many low- and middle-income countries, where raw sewage is often discharged into surface waterways and open defecation is common. Nonetheless, there has been no evidence of COVID-19 transmission via ambient urban water, and the virus viability in such aquatic matrices is believed to be minimal and not a matter of concern. In this manuscript, we attempt to discern the presence of SARS-CoV-2 genetic material (ORF-1ab, N and S genes) in the urban water (lakes, rivers, and drains) of the two Indian cities viz., Ahmedabad (AMD), in western India with 9 wastewater treatment plants (WWTPs) and Guwahati (GHY), in the north-east of the country with no such treatment facilities. The present study was carried out to establish the applicability of environmental water surveillance (E-wat-Surveillance) of COVID-19 as a potential tool for public health monitoring at the community level. 25.8% and 20% of the urban water samples had detectable SARS-CoV-2 RNA load in AMD and GHY, respectively. N-gene > S-gene > ORF-1ab-gene were readily detected in the urban surface water of AMD, whereas no such observable trend was noticed in the case of GHY. The high concentrations of SARS-CoV-2 genes (e.g., ORF-1ab; 800 copies/L for Sabarmati River, AMD and S-gene; 565 copies/L for Bharalu urban river, GHY) found in urban waters suggest that WWTPs do not always completely remove the virus genetic material and that E-wat-Surveillance of COVID-19 in cities/rural areas with poor sanitation is possible.

Phage therapy in the Covid-19 era: Advantages over antibiotics

Today, the entire world is battling to contain the spread of COVID-19. Massive efforts are being made to find a therapeutic solution in the shortest possible time. However, the research community is becoming increasingly concerned about taking a shortsighted strategy without contemplating the long-term consequences. For example, It has been reported that only 8.4% of total COVID-19 patients develop a secondary bacterial infection. In comparison, 74.6% of them are administered with antibiotics as prophylactic treatment. We contend that overuse of broad-spectrum antibiotics increases the likelihood of AMR development and negatively affects the patient's recovery due to the prevalence of the "gut-lung axis.". Consequently, the use of antibiotics to treat COVID-19 patients must be rationalized, or an alternative treatment must be sought that does not risk contributing to AMR development and positively impacts the treatment outcomes. Phage therapy, a century-old concept, is one of the most promising approaches that can be adapted to serve this purpose. This review emphasizes the negative impact of excessive antibiotic use in COVID-19 treatment and provides an overview of how phage therapy can be used as an alternative treatment option. We have argued that targeted killing (narrow spectrum) and anti-inflammatory (which can target the primary cause of mortality in COVID-19) properties of phages can be an effective alternative to antibiotics.

COVID-19 lockdown shows how much natural mountain regions are affected by heavy tourism

Mountain areas in Poland are among the most frequented tourist destinations and such intensive tourism negatively affects the natural environment. The COVID-19 pandemic and the resulting lockdown restricted travel for a few months in 2020, providing a unique opportunity to observe the studied mountain environment without the impact of typical tourist traffic. This study is based on the determination of antibiotic content, hydrochemical parameters, enumeration of culturable bacterial water quality indicators, antimicrobial susceptibility tests together with extended spectrum beta-lactamase (ESBL) gene detection in waterborne E. coli and NGS-based bacterial community composition at six sites along the Białka river valley (one of the most popular touristic regions in Poland) in three periods: in summer and winter tourist seasons and during the COVID-19 lockdown. The results of individual measurements showed decreased numbers of bacterial indicators of water contamination (e.g. numbers of E. coli dropped from 99 × 104 CFU/100 ml to 12 CFU/100 ml at the most contaminated site) and the share of antimicrobial resistant E. coli (total resistance dropped from 21% in summer to 9% during lockdown, share of multidrug resistant strains from 100 to 44%, and ESBL from 20% in summer to none during lockdown). Antibiotic concentrations were the highest during lockdown. The use of multivariate analysis (principal component analysis - PCA and heatmaps) revealed a clear pattern of tourism-related anthropogenic pressure on the water environment and positive impact of COVID-19 lockdown on water quality. PCA distinguished three major factors determining water quality: F1 shows strong effect of anthropogenic pressure; F2 describes the lockdown-related quality restoration processes; F3 is semi-natural and describes the differences between the most pristine and most anthropogenically-impacted waters.

Implications of COVID-19 pandemic on environmental compartments: Is plastic pollution a major issue?

The COVID-19 anthropause has impacted human activities and behaviour, resulting in substantial environmental and ecological changes. It has assisted in restoring the ecological systems by improving, for instance, air and water quality and decreasing the anthropogenic pressure on wildlife and natural environments. Notwithstanding, such improvements recessed back, even to a greater extent, when considering increased medical waste, hazardous disinfectants and other chemical compounds, and plastic waste disposal or mismanagement. This work critically reviews the short- and long-term implications of measures against COVID-19 spreading, namely on human activities and different environmental compartments. Furthermore, this paper highlights strategies towards environmental restoration, as the recovery of the lost environment during COVID-19 lockdown suggests that the environmental degradation caused by humans can be reversible. Thus, we can no longer delay concerted international actions to address biodiversity, sustainable development, and health emergencies to ensure environmental resilience and equitable recovery.

Disinfectant-induced hormesis: An unknown environmental threat of the application of disinfectants to prevent SARS-CoV-2 infection during the COVID-19 pandemic?

Massive additional quantities of disinfectants have been applied during the COVID-19 pandemic as infection preventive and control measures. While the application of disinfectants plays a key role in preventing the spread of SARS-CoV-2 infection, the effects of disinfectants applied during the ongoing pandemic on non-target organisms remain unknown. Here we collated evidence from multiple studies showing that chemicals used for major disinfectant products can induce hormesis in various organisms, such as plants, animal cells, and microorganisms, when applied singly or in mixtures, suggesting potential ecological risks at sub-threshold doses that are normally considered safe. Among other effects, sub-threshold doses of disinfectant chemicals can enhance the proliferation and pathogenicity of pathogenic microbes, enhancing the development and spread of drug resistance. We opine that hormesis should be considered when evaluating the effects and risks of such disinfectants, especially since the linear-no-threshold (LNT) and threshold dose-response models cannot identify or predict their effects.

Reflections of COVID-19 cases in the wastewater loading of SARS-CoV-2 RNA: A case of three major cities of Gujarat, India

Wastewater-based epidemiology (WBE) is a promising approach to understand the actual prevalence of COVID-19 disease at the community level. Different studies have cited the presence of SARS-CoV-2 in wastewater samples. In the present study, eighteen influent wastewater samples from different sewage treatment plants and pumping stations (5 samples from Vadodara city, 4 from Gandhinagar, and 9 from Ahmedabad city) were collected and analyzed for the presence of SARS-CoV-2 RNA in Gujarat state, India. The results showed the highest SARS-CoV-2 effective gene concentration in Vadodara (3078 copies/L), followed by Ahmedabad (2968 copies/L) and Gandhinagar (354 copies/L). On comparing the virus gene concentration in wastewater samples, the SARS-CoV-2 genetic material exhibited a positive relationship with the number of confirmed and active cases in in all three cities. However, a minor variation in SARS-CoV-2 effective gene concentration was seen between Vadodara and Ahmedabad despite a >2.5 and >1.5 folds differences in the cumulative number of confirmed and active cases, respectively. This may occur primarily due to the greater test positivity ratio in Vadodara (3.30%) than Ahmedabad (1.40%) and might be the higher number of asymptomatic patients in Vadodara. The study confirms the potential of the WBE that can be used at a large scale around the globe for better dealing with the pandemic situation.

Mass Spectrometry in Wastewater-Based Epidemiology for the Determination of Small and Large Molecules as Biomarkers of Exposure: Toward a Global View of Environment and Human Health under the COVID-19 Outbreak

Wastewater-based epidemiology (WBE) estimates collective consumption or exposure to chemicals or pathogens by monitoring the substances excreted in the population's wastewater. Advances in mass spectrometry (MS) and the application of some clinical diagnostic tools and proteomics to wastewater fingerprinting have been linked to the discovery of new biomarkers and indicators of population health and are broadening the scope of WBE that nowadays cover not only small molecule biomarkers but also genetic biomarkers, large molecules, viruses, infection diseases, resistance, etc. This mini-review highlights recent WBE advances using MS and how this progress can create a fingerprint of a city's health hazards, habits, and lifestyle, which is gaining in public health emphasis.

Wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness powered by early warning: A perspectives of temporal variations in SARS-CoV-2-RNA in Ahmedabad, India

Following the proven concept, capabilities, and limitations of detecting the RNA of Severe Acute Respiratory Coronavirus 2 (SARS-CoV-2) in wastewater, it is pertinent to understand the utility of wastewater surveillance data on various scale. In the present work, we put forward the first wastewater surveillance-based city zonation for effective COVID-19 pandemic preparedness. A three-month data of Surveillance of Wastewater for Early Epidemic Prediction (SWEEP) was generated for the world heritage city of Ahmedabad, Gujarat, India. In this expedition, 116 wastewater samples were analyzed to detect SARS-CoV-2 RNA, from September 3rd to November 26th, 2020. A total of 111 samples were detected with at least two out of three SARS-CoV-2 genes (N, ORF 1ab, and S). Monthly variation depicted a significant decline in all three gene copies in October compared to September 2020, followed by a sharp increment in November 2020. Correspondingly, the descending order of average effective gene concentration was: November (~10,729 copies/L) > September (~3047 copies/L) > October (~454 copies/L). Monthly variation of SARS-CoV-2 RNA in the wastewater samples may be ascribed to a decline of 20.48% in the total number of active cases in October 2020 and a rise of 1.82% in November 2020. Also, the monthly recovered new cases were found to be 16.61, 20.03, and 15.58% in September, October, and November 2020, respectively. The percentage change in the gene concentration was observed in the lead of 1-2 weeks with respect to the percentage change in the provisional figures of confirmed cases. SWEEP data-based city zonation was matched with the heat map of the overall COVID-19 infected population in Ahmedabad city, and month-wise effective gene concentration variations are shown on the map. The results expound on the potential of WBE surveillance of COVID-19 as a city zonation tool that can be meaningfully interpreted, predicted, and propagated for community preparedness through advanced identification of COVID-19 hotspots within a given city.

Rapid and sustained decline in CXCL-10 (IP-10) annotates clinical outcomes following TNF-α antagonist therapy in hospitalized patients with severe and critical COVID-19 respiratory failure

BACKGROUND

A feed-forward pathological signaling loop generated by TNFα and IFN-γ in inflamed lung tissue, driving CXCL-10 (IP-10) and CXCL-9 chemokine-mediated activated T-cell and monocyte/macrophage tissue recruitment, may define, sustain and amplify the inflammatory biology of lethal COVID-19 respiratory failure.

METHODS

To assess TNFα-antagonist therapy, 18 hospitalized adults with hypoxic respiratory failure and COVID-19 pneumonia received single-dose infliximab-abda therapy 5mg/kg intravenously between April and December 2020. The primary endpoint was time to increase in oxygen saturation to fraction of inspired oxygen ratio (SpO2/FiO2) by ≥ 50 compared to baseline and sustained for 48 hours. Secondary endpoints included 28-day mortality, dynamic cytokine profiles (Human Cytokine 48-Plex Discovery Assay, Eve Technologies), secondary infections, duration of supplemental oxygen support and hospitalization.

FINDINGS

Patients were predominantly in critical respiratory failure (15/18, 83%), male (14/18, 78%), above 60 years (median 63 yrs, range 31-80), race-ethnic minorities (13/18, 72%), lymphopenic (13/18, 72%), steroid-treated (17/18, 94%), with a median ferritin of 1953ng/ml. Sixteen patients (89%) met the primary endpoint within a median of 4 days, 15/18 (83%) recovered from respiratory failure, and 14/18 (78%) were discharged in a median of 8 days and were alive at 28-day follow-up. Deaths among three patients ≥ 65yrs age with pre-existing lung disease or multiple comorbidities were attributed to secondary lung infection. Mean plasma IP-10 levels declined sharply from 9183 pg/ml to 483 pg/ml at Day 3 and further to 146 pg/ml at Day 14/discharge. Significant declines in IFN- γ , TNFα, IL-27, CRP and ferritin were specifically observed at Day 3 whereas other cytokines were unmodified. IL-6 levels declined sharply among patients with baseline levels >10 pg/ml. Among 13 lymphopenic patients, six (46%) had resolution of lymphopenia by day 3, and 11 by day 14. CXCR3-ligand (IP-10 and CXCL-9) declines were strongly correlated among patients with lymphopenia reversal (Day 3, Pearson r: 0.98, p-value: 0.0006).

INTERPRETATION

Consistent with a pathophysiological role of TNFα, the clinical and cytokine data indicate that infliximab-abda may rapidly abrogate pathological inflammatory signaling to facilitate clinical recovery in severe and critical COVID-19. Randomized studies are required to formally assess mortality outcomes. Funding: National Center for Advancing Translational Sciences.