Environmental and human health risk assessment of mixture of Covid-19 treating pharmaceutical drugs in environmental waters

Comprehensive eco-geno-toxicity and environmental risk of common antiviral drugs in aquatic environments post-pandemic

The eco-geno-toxicological impacts of the most widely used antiviral drugs against SARS-CoV2 - ribavirin, ritonavir, nirmatrelvir and tenofovir - were investigated in freshwater organisms. Ribavirin and tenofovir exhibited the highest acute toxicity in the rotifer Brachionus calyciflorus at concentrations of a few mg/L while ritonavir and nirmatrelvir showed similar effects at tens of mg/L; acute toxicity of ribavirin was also observed in the crustacean Ceriodaphnia dubia at similar concentrations. In contrast, the crustacean Thamnocephalus platyurus showed the lowest sensitivity to the antiviral drugs tested with no sublethal effects. Chronic toxicity tests revelead that these antivirals induced effects in consumers at concentrations of environmental concern (ng-µg/L). Ribavirin showed the highest toxicity to the alga Raphidocelis subcapitata, while ritonavir showed the highest toxicity to B. calyciflorus and C. dubia. DNA damage and oxidative stress were observed in C. dubia at 0.001 µg/L and 0.1 µg/L when exposed to ritonavir and nirmatrelvir respectively, and at 1 µg/L when exposed to ribavirin and tenofovir. Toxic and genotoxic environmental risks were assessed with risk quotients for ritonavir, tenofovir and ribavirin exceeding the threshold of 1, indicating significant environmental concern.

COVID-19 pandemic-related drugs and microplastics from mask fibers jointly affect soil functions and processes

The COVID-19 pandemic has led to an unprecedented increase in pharmaceutical drug consumption and plastic waste disposal from personal protective equipment. Most drugs consumed during the COVID-19 pandemic were used to treat other human and animal diseases. Hence, their nearly ubiquitous presence in the soil and the sharp increase in the last 3 years led us to investigate their potential impact on the environment. Similarly, the compulsory use of face masks has led to an enormous amount of plastic waste. Our study aims to investigate the combined effects of COVID-19 drugs and microplastics from FFP2 face masks on important soil processes using soil microcosm experiments. We used three null models (additive, multiplicative, and dominative models) to indicate potential interactions among different pharmaceutical drugs and mask MP. We found that the multiple-factor treatments tend to affect soil respiration and FDA hydrolysis more strongly than the individual treatments. We also found that mask microplastics when combined with pharmaceuticals caused greater negative effects on soil. Additionally, null model predictions show that combinations of high concentrations of pharmaceuticals and mask MP have antagonistic interactions on soil enzyme activities, while the joint effects of low concentrations of pharmaceuticals (with or without MP) on soil enzyme activities are mostly explained by null model predictions. Our study underscores the need for more attention on the environmental side effects of pharmaceutical contamination and their potential interactions with other anthropogenic global change factors.

Tracking down pharmaceutical pollution in surface waters of the St. Lawrence River and its major tributaries

A reconnaissance survey was undertaken to evaluate the occurrence and risks of 27 pharmaceuticals and metabolites in the St. Lawrence watershed. Surface water samples were collected over a five-year period (2017-2021) along a 700-km reach of the St. Lawrence River as well as 55 tributary rivers (overall N = 406 samples). Additionally, depth water samples and sediments were collected near a major wastewater effluent. Caffeine, diclofenac, and venlafaxine were the most recurrent substances (detection rates >80 %), and extremely high levels were found near a municipal effluent (e.g., ibuprofen (860 ng/L), hydroxyibuprofen (1800 ng/L) and caffeine (7200 ng/L)). Geographical mapping and statistical analyses indicated that the St. Lawrence River water mass after the Montreal City effluent was significantly more contaminated than the other water masses, and that contamination could extend up to 70 km further downstream. This phenomenon was repeatedly observed over the five years of sampling, confirming that this is not a random trend. A slight increase in contamination was also observed near Quebec City, but concentrations rapidly declined in the estuarine transition zone. Tributaries with the highest pharmaceutical levels (ΣPharmas ∼400-900 ng/L) included the Mascouche, Saint-Régis, and Bertrand rivers, all located in the densely populated Greater Montreal area. When flowrate was factored in, the top five tributaries in terms of mass load (ΣPharmas ∼200-2000 kg/year) were the Des Prairies, Saint-François, Richelieu, Ottawa, and Yamaska rivers. All samples met the Canadian Water Quality Guideline for carbamazepine. Despite the large dilution effect of the St. Lawrence River, a risk quotient approach based on freshwater PNEC values suggested that four compounds (caffeine, carbamazepine, diclofenac, and ibuprofen) could present intermediate to high risks for aquatic organisms in terms of chronic exposure.

Prioritisation of data-poor pharmaceuticals for empirical testing and environmental risk assessment

There are more than 3,500 active pharmaceutical ingredients (APIs) on the global market for human and veterinary use. Residues of these APIs eventually reach the aquatic environment. Although an environmental risk assessment (ERA) for marketing authorization applications of medicinal products is mandatory in the European Union since 2006, an ERA is lacking for most medicines approved prior to 2006 (legacy APIs). Since it is unfeasible to perform extensive ERA tests for all these legacy APIs, there is a need for prioritization of testing based on the limited data available. Prioritized APIs can then be further investigated to estimate their environmental risk in more detail. In this study, we prioritized more than 1,000 APIs used in Europe based on their predicted risk for aquatic freshwater ecosystems. We determined their risk by combining an exposure estimate (Measured or Predicted Environmental Concentration; MEC or PEC, respectively) with a Predicted No Effect Concentration (PNEC). We developed several procedures to combine the limited empirical data available with in silico data, resulting in multiple API rankings varying in data needs and level of conservativeness. In comparing empirical with in silico data, our analysis confirmed that the PEC estimated with the default parameters used by the European Medicines Agency often - but not always - represents a worst-case scenario. Comparing the ecotoxicological data for the three main taxonomic groups, we found that fish represents the most sensitive species group for most of the APIs in our list. We furthermore show that the use of in silico tools can result in a substantial underestimation of the ecotoxicity of APIs. After combining the different exposure and effect estimates into four risk rankings, the top-ranking APIs were further screened for availability of ecotoxicity data in data repositories. This ultimately resulted in the prioritization of 15 APIs for further ecotoxicological testing and/or exposure assessment.

Synergistic approach for synthesis of functionalized biochar for efficient adsorption of Lopinavir from polluted water

The COVID-19 pandemic has led to a significant increase in antibiotic consumption, along with a 70% rise in antiviral drug concentrations in aquatic ecosystems. For the effective adsorption of antibiotics, biochar was modified by incorporating layered double hydroxide (LDH) through hydrothermal method. The results showed that LDH provides additional hydroxyl groups, positive surface charges and ion exchange. Whereas biochar component provides a larger specific surface area (467.8 m2/g). Batch adsorption experiments of biochar @ layered double hydroxide (BC@LDH) showed enhanced adsorption performance (832.9 mg/g), compared to pristine LDH (420.3 mg/g) and unmodified biochar (548.5 mg/g). Adsorption data were best interpreted (R2 = 0.99) by pseudo second order, Freundlich, and Temkin isotherm models. Adsorption was a synergism of LDH and biochar physiochemical properties, whereas pore-filling was the primary mechanism. The recyclability of BC@LDH confirmed its good structural stability. This study introduces a sustainable and efficient method for synthesizing a versatile adsorbent with superior antibiotic removal.

Diclofenac, ibuprofen, and paracetamol biodegradation: overconsumed non-steroidal anti-inflammatories drugs at COVID-19 pandemic

The consumption of non-steroidal anti-inflammatory drugs (NSAIDs) have increased significantly in the last years (2020-2022), especially for patients in COVID-19 treatment. NSAIDs such as diclofenac, ibuprofen, and paracetamol are often available without restrictions, being employed without medical supervision for basic symptoms of inflammatory processes. Furthermore, these compounds are increasingly present in nature constituting complex mixtures discarded at domestic and hospital sewage/wastewater. Therefore, this review emphasizes the biodegradation of diclofenac, ibuprofen, and paracetamol by pure cultures or consortia of fungi and bacteria at in vitro, in situ, and ex situ processes. Considering the influence of different factors (inoculum dose, pH, temperature, co-factors, reaction time, and microbial isolation medium) relevant for the identification of highly efficient alternatives for pharmaceuticals decontamination, since biologically active micropollutants became a worldwide issue that should be carefully addressed. In addition, we present a quantitative bibliometric survey, which reinforces that the consumption of these drugs and consequently their impact on the environment goes beyond the epidemiological control of COVID-19.

A One-Health environmental risk assessment of contaminants of emerging concern in London's waterways throughout the SARS-CoV-2 pandemic

The SARS-CoV-2 pandemic had huge impacts on global urban populations, activity and health, yet little is known about attendant consequences for urban river ecosystems. We detected significant changes in occurrence and risks from contaminants of emerging concern (CECs) in waterways across Greater London (UK) during the pandemic. We were able to rapidly identify and monitor large numbers of CECs in n = 390 samples across 2019-2021 using novel direct-injection liquid chromatography-mass spectrometry methods for scalable targeted analysis, suspect screening and prioritisation of CEC risks. A total of 10,029 measured environmental concentrations (MECs) were obtained for 66 unique CECs. Pharmaceutical MECs decreased during lockdown in 2020 in the R. Thames (p ≤ 0.001), but then increased significantly in 2021 (p ≤ 0.01). For the tributary rivers, the R. Lee, Beverley Brook, R. Wandle and R. Hogsmill were the most impacted, primarily via wastewater treatment plant effluent and combined sewer overflows. In the R. Hogsmill in particular, pharmaceutical MEC trends were generally correlated with NHS prescription statistics, likely reflecting limited wastewater dilution. Suspect screening of ∼ 1,200 compounds tentatively identified 25 additional CECs at the five most impacted sites, including metabolites such as O-desmethylvenlafaxine, an EU Watch List compound. Lastly, risk quotients (RQs) ≥ 0.1 were calculated for 21 compounds across the whole Greater London freshwater catchment, of which seven were of medium risk (RQ ≥ 1.0) and three were in the high-risk category (RQ ≥ 10), including imidacloprid (RQ = 19.6), azithromycin (15.7) and diclofenac (10.5). This is the largest spatiotemporal dataset of its kind for any major capital city globally and the first for Greater London, representing ∼ 16 % of the population of England, and delivering a foundational One-Health case study in the third largest city in Europe across a global pandemic.

Quantification of pharmaceuticals in hospital effluent: Weighted ranking of environmental risk using a fuzzy hybrid multicriteria method

An analytical method for quantification of seventeen pharmaceuticals and one metabolite was validated and applied in the analysis of hospital effluent samples. Two different sampling strategies were used: seasonal sampling, with 7 samples collected bimonthly; and hourly sampling, with 12 samples collected during 12 h. Thus, the variability was both seasonal and within the same day. High variability was observed in the measured concentrations of the pharmaceuticals and the metabolite. The quantification method, performed using weighted linear regression model, demonstrated results of average concentrations in seasonal samples ranged between 0.19 μgL-1 (carbamazepine) and higher than 61.56 μgL-1 (acetaminophen), while the hourly samples showed average concentrations between 0.07 μgL-1 (diazepam) and higher than 54.91 μgL-1 (acetaminophen). It is described as higher because the maximum concentration of the calibration curve took into account the dilution factor provided by DLLME. The diurnal results showed a trend towards higher concentrations in the first and last hours of sampling. The risk quotient (RQ) was calculated using organisms from three different trophic levels, for all the analytes quantified in the samples. Additionally, in order to understand the level of importance of each RQ, an expert panel was established, with contributions from 23 specialists in the area. The results were analyzed using a hybrid decision-making approach based on a Fuzzy Analytic Hierarchy Process (FAHP) and the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) method, in order to rank the compounds by environmental risk priority. The compounds of greatest concern were losartan, acetaminophen, 4-aminoantipyrine, sulfamethoxazole, and metoclopramide. Comparison of the environmental risk priority ranking with the potential human health risk was performed by applying the same multicriteria approach, with the prediction of endpoints using in silico (Q)SAR models. The results obtained suggested that sulfamethoxazole and acetaminophen were the most important analytes to be considered for monitoring.

The photolytic behavior of COVID-19 antivirals ribavirin in natural waters and the increased environmental risk

Increasing drug residues in aquatic environments have been caused by the abuse of antivirals since the global spread of the COVID-19 epidemic, whereas research on the photolytic mechanism, pathways and toxicity of these drugs is limited. The concentration of COVID-19 antivirals ribavirin in rivers has been reported to increase after the epidemic. Its photolytic behavior and environmental risk in actual waters such as wastewater treatment plant (WWTP) effluent, river water and lake water were first investigated in this study. Direct photolysis of ribavirin in these media was limited, but indirect photolysis was promoted in WWTP effluent and lake water by dissolved organic matter and NO3-. Identification of photolytic intermediates suggested that ribavirin was photolyzed mainly via C-N bond cleavage, splitting of the furan ring and oxidation of the hydroxyl group. Notably, the acute toxicity was increased after ribavirin photolysis owing to the higher toxicity of most of the products. Additionally, the overall toxicity was greater when ARB photolysis in WWTP effluent and lake water. These findings emphasize the necessity to concern about the toxicity of ribavirin transformation in natural waters, as well as to limit its usage and discharge.

Yolk@Wrinkled-double shell smart nanoreactors: new platforms for mineralization of pharmaceutical wastewater

Nanomaterials with "yolk and shell" "structure" can be considered as "nanoreactors" that have significant potential for application in catalysis. Especially in terms of electrochemical energy storage and conversion, the nanoelectrode has a large specific surface area with a unique yolk@shell structure, which can reduce the volume change of the electrode during the charging and discharging process and fast ion/electron transfer channels. The adsorption of products and the improvement of conversion reaction efficiency can greatly improve the stability, speed and cycle performance of the electrode, and it is a kind of ideal electrode material. In this research, heterojunction nanoreactors (FZT Y@WDS) Fe3O4@ZrO2-X@TiO2-X were firstly synthesized based on the solvothermal combined hard-template process, partial etching and calcination. The response surface method was used to determine the performance of the FZT Y@WDS heterojunction nanoreactors and the effects of four process factors: naproxen concentration (NAP), solution pH, the amount of charged photocatalyst, and the irradiation time for photocatalytic degradation of NAP under visible light irradiation. To maximize the photocatalytic activity, the parameters of the loaded catalyst, the pH of the reaction medium, the initial concentration of NAP, and the irradiation time were set to 0.5 g/L, 3, 10 mg/L, and 60 min, respectively, resulting in complete removal of NAP and the optimum amount was calculated to be 0.5 g/L, 5.246, 14.092 mg/L, and 57.362 min, respectively. Considering the promising photocatalytic activity of FZT Y@WDS under visible light and the separation performance of the nanocomposite, we proposed this photocatalyst as an alternative solution for the treatment of pharmaceutical wastewater.

Antiviral drugs in wastewater are on the rise as emerging contaminants: A comprehensive review of spatiotemporal characteristics, removal technologies and environmental risks

Antiviral drugs (ATVs) are widely used to treat illnesses caused by viruses. Particularly, ATVs were consumed in such large quantities during the pandemic that high concentrations were detected in wastewater and aquatic environment. Since ATVs are not fully absorbed by the human or animal body, this results in large amounts of them being discharged into the sewage through urine or feces. Most ATVs can be degraded by microbes at wastewater treatment plants (WWTPs), while some ATVs either require deep treatment to reduce concentration and toxicity. Parent and metabolites residing in effluent posed a varying degree of risk when entering the aquatic environment, while increasing the potential of natural reservoirs for environmentally acquired antiviral drug resistance potential. There is a rising research on the behavior of ATVs in the environment has surged since the pandemic. In the context of multiple viral diseases worldwide, especially during the current COVID-19 pandemic, a comprehensive assessment of the occurrence, removal, and risk of ATVs is urgently needed. This review aims to discuss the fate of ATVs in WWTPs from various regions in the world with wastewater as the main analyzing object. The ultimate goal is to focus on ATVs with high ecological impact and regulate their use or develop advanced treatment technologies to mitigate the risk to the environment.

Are we ready to combat the ecotoxicity of COVID-19 pharmaceuticals? An in silico aquatic risk assessment

To fight COVID-19 with uncountable medications and bioproducts throughout the world has taken us to another challenge of ecotoxicity. The indiscriminate usage followed by improper disposal of unused antibacterials, antivirals, antimalarials, immunomodulators, angiotensin II receptor blockers, corticosteroids, anthelmintics, anticoagulants etc. can lead us to an unimaginable ecotoxicity in the long run. A series of studies already identified active pharmaceutical ingredients (APIs) of the mentioned therapeutic classes and their metabolites in aquatic bodies as well as in wastewater treatment plants. Therefore, an initial ecotoxicity assessment of the majorly used pharmaceuticals is utmost requirement of the present time. The present in silico risk assessment study is focused on the aquatic toxicity prediction of 81 pharmaceuticals where 77 are most-used pharmaceuticals for COVID-19 throughout the world based on the literature along with one drug nirmatrelvir [PF-07321332] approved for emergency use by US-FDA and three other molecules under clinical trial. The ecotoxicity of the studied compounds were predicted based on the three aquatic species fish, algae and crustaceans employing the highest quality QSAR models available from the literature as well as using ECOSAR and QSAR Toolbox. To compare the toxicity thresholds, we have also used 4 control pharmaceuticals based on the worldwide occurrence from river, lake, STP, WWTPs, influent and effluent followed by high reported aquatic toxicity over the years as per the literature. Based on the statistical comparison, we have proposed top 3 pharmaceuticals used for the COVID-19 most toxic to the aquatic environment. The study will provide confident predictions of aquatic ecotoxicity data related to abundant use of COVID-19 drugs. The major aim of the study is to fill up the aquatic ecotoxicity data gap of major medications used for COVID-19.

The role of trace N-Oxyl compounds as redox mediator in enhancing antiviral ribavirin elimination in UV/Chlorine process

Ribavirin (RBV) is an antiviral drug used for treating COVID-19 infection. Its release into natural waters would threaten the health of aquatic ecosystem. This study reports an effective approach to degrade RBV by the trace N-oxyl compounds (2,2,6,6-tetramethylpiperidine-N-oxyl (TEMPO) and N-Hydroxyphthalimide (NHPI)) enhanced UV activated free chlorine (UV/Chlorine) process. The results indicated that TEMPO and NHPI at low concentrations (0.1 μM and 1 μM, respectively) could strongly enhance RBV degradation in both deionized water with different pHs and practical surface water. The enhancement was verified to be attributed to the transformation of TEMPO and NHPI into their reactive forms (i.e., TEMPO⁺ and PINO), which generations deeply relied on radicals. The two N-oxyl compounds inhibit ClO• yield by hindering the reaction of free chlorine vs. HO• and Cl•. The analyses on acute toxicities of RBV degradation products indicate that UV/Chlorine/N-oxyl compounds process can detoxify RBV more efficiently than UV/Chlorine process.

Bio-removal of emerging pollutants by advanced bioremediation techniques

This review highlights the relevance of bioremediation techniques for the removal of emerging pollutants (EPs). The EPs are chemical or biological pollutants that are not currently monitored or regulated by environmental authorities, but which can enter the environment and cause harmful effects to the environment and human health. In recent times, an ample range of EPs have been found in water bodies, where they can unbalance ecosystems and cause negative effects on non-target species. In addition, some EPs have shown high rates of bioaccumulation in aquatic species, thus affecting the safety and quality of seafood. The negative impacts of emerging pollutants, their wide distribution in the environment, their bioaccumulation rates, and their resistance to wastewater treatment plants processes have led to research on sustainable remediation. Remediation techniques have been recently directed to advanced biological remediation technologies. Such technologies have exhibited numerous advantages like in-situ remediation, low costs, eco-friendliness, high public acceptance, and so on. Thus, the present review has compiled the most recent studies on bioremediation techniques for water decontamination from emerging pollutants to extend the current knowledge on sustainable remediation technologies. Biological emerging contaminants, agrochemicals, endocrine-disrupting chemicals, and pharmaceutical and personal care products were considered for this review study, and their removal by bioremediation techniques involving plants, bacteria, microalgae, and fungi. Finally, further research opportunities are presented based on current challenges from an economic, biological, and operation perspective.

Development and applications of diffusive gradients in thin films for monitoring pharmaceuticals in surface waters

Pharmaceutical contaminants in surface water have raised significant concerns because of their potential ecological risks. In particular, coronavirus disease 2019 (COVID-19)-related pharmaceuticals can be released to surface water and reduce environmental water quality. Therefore, reliable and robust sampling tools are required for monitoring pharmaceuticals. In this study, passive sampling devices of diffusive gradients in thin films (DGTs) were developed for sampling 35 pharmaceuticals in surface waters. The results demonstrated that hydrophilic-lipophilic balance (HLB) was more suitable for DGT-based devices compared with XAD18 and XDA1 resins. For most pharmaceuticals, the performance of the HLB-DGT devices were independent of pH (5.0-9.0), ionic strength (0.001-0.5 M), and flow velocity (0-400 rpm). The HLB-DGT devices exhibited linear pharmaceutical accumulation for 7 days, and time-weighted average concentrations provided by the HLB-DGT were comparable to those measured by conventional grab sampling. Compared to previous studies, we extended DGT monitoring to include three antiviral drugs used for COVID-19 treatment, which may inspire further exploration on identifying the effects of COVID-19 on ecological and human health.

A sustainable approach for the removal methods and analytical determination methods of antiviral drugs from water/wastewater: A review

In the last years, antiviral drugs especially used for the treatment of COVID-19 have been considered emerging contaminants because of their continuous occurrence and persistence in water/wastewater even at low concentrations. Furthermore, as compared to antiviral drugs, their metabolites and transformation products of these pharmaceuticals are more persistent in the environment. They have been found in environmental matrices all over the world, demonstrating that conventional treatment technologies are unsuccessful for removing them from water/wastewater. Several approaches for degrading/removing antiviral drugs have been studied to avoid this contamination. In this study, the present level of knowledge on the input sources, occurrence, determination methods and, especially, the degradation and removal methods of antiviral drugs are discussed in water/wastewater. Different removal methods, such as conventional treatment methods (i.e. activated sludge), advanced oxidation processes (AOPs), adsorption, membrane processes, and combined processes, were evaluated. In addition, the antiviral drugs and these metabolites, as well as the transformation products created as a result of treatment, were examined. Future perspectives for removing antiviral drugs, their metabolites, and transformation products were also considered.

Impacts of the COVID-19 pandemic on pharmaceuticals in wastewater treated for beneficial reuse: Two case studies in central Pennsylvania

During the COVID-19 pandemic, wastewater surveillance was leveraged as a powerful tool for monitoring community-scale health. Further, the well-known persistence of some pharmaceuticals through wastewater treatment plants spurred concerns that increased usage of pharmaceuticals during the pandemic would increase the concentrations in wastewater treatment plant effluent. We collected weekly influent and effluent samples from May 2020 through May 2021 from two wastewater treatment plants in central Pennsylvania, the Penn State Water Reclamation Facility and the University Area Joint Authority, that provide effluent for beneficial reuse, including for irrigation. Samples were analyzed for severe acute respiratory syndrome coronavirus 2 (influent only), two over-the-counter medicines (acetaminophen and naproxen), five antibiotics (ampicillin, doxycycline, ofloxacin, sulfamethoxazole, and trimethoprim), two therapeutic agents (remdesivir and dexamethasone), and hydroxychloroquine. Although there were no correlations between pharmaceutical and virus concentration, remdesivir detection occurred when the number of hospitalized patients with COVID-19 increased, and dexamethasone detection co-occurred with the presence of patients with COVID-19 on ventilators. Additionally, Penn State decision-making regarding instruction modes explained the temporal variation of influent pharmaceutical concentrations, with detection occurring primarily when students were on campus. Risk quotients calculated for pharmaceuticals with known effective and lethal concentrations at which 50% of a population is affected for fish, daphnia, and algae were generally low in the effluent; however, some acute risks from sulfamethoxazole were high when students returned to campus. Remdesivir and dexamethasone persisted through the wastewater treatment plants, thereby introducing novel pharmaceuticals directly to soils and surface water. These results highlight connections between human health and water quality and further demonstrate the broad utility of wastewater surveillance.