Evaluating health risks associated with exposure to ambient surface waters during recreational activities: A systematic review and meta-analysis

Association between Combined Sewer Overflow Events and Gastrointestinal Illness in Massachusetts Municipalities with and without River-Sourced Drinking Water, 2014-2019

BACKGROUND

Combined sewer overflow (CSO) events release untreated wastewater into surface waterbodies during heavy precipitation and snowmelt. Combined sewer systems serve ∼ 40  million people in the United States, primarily in urban and suburban municipalities in the Midwest and Northeast. Predicted increases in heavy precipitation events driven by climate change underscore the importance of quantifying potential health risks associated with CSO events.

OBJECTIVES

The aims of this study were to a) estimate the association between CSO events (2014-2019) and emergency department (ED) visits for acute gastrointestinal illness (AGI) among Massachusetts municipalities that border a CSO-impacted river, and b) determine whether associations differ by municipal drinking water source.

METHODS

A case time-series design was used to estimate the association between daily cumulative upstream CSO discharge and ED visits for AGI over lag periods of 4, 7, and 14 days, adjusting for temporal trends, temperature, and precipitation. Associations between CSO events and AGI were also compared by municipal drinking water source (CSO-impacted river vs. other sources).

RESULTS

Extreme upstream CSO discharge events (> 95 th percentile by cumulative volume) were associated with a cumulative risk ratio (CRR) of AGI of 1.22 [95% confidence interval (CI): 1.05, 1.42] over the next 4 days for all municipalities, and the association was robust after adjusting for precipitation [1.17 (95% CI: 0.98, 1.39)], although the CI includes the null. In municipalities with CSO-impacted drinking water sources, the adjusted association was somewhat less pronounced following 95th percentile CSO events [CRR = 1.05 (95% CI: 0.82, 1.33)]. The adjusted CRR of AGI was 1.62 in all municipalities following 99th percentile CSO events (95% CI: 1.04, 2.51) and not statistically different when stratified by drinking water source.

DISCUSSION

In municipalities bordering a CSO-impacted river in Massachusetts, extreme CSO events are associated with higher risk of AGI within 4 days. The largest CSO events are associated with increased risk of AGI regardless of drinking water source. https://doi.org/10.1289/EHP14213.

Recreational water exposures and illness outcomes at a freshwater beach in Toronto, Canada: A prospective cohort pilot study

BACKGROUND

Swimming and other recreational water activities in surface waters are popular in Canada during the summer. However, these activities can also increase the risk of recreational water illness. While routine monitoring of beach water quality is conducted by local authorities each summer, little research is available in Canada about beach exposures and illness risks.

METHODS

We conducted a pilot of a prospective cohort study at a popular beach in Toronto, Ontario, Canada, in 2022 to determine characteristics of beachgoers, common water and sand exposures, the incidence of recreational water illness, and the feasibility for a larger, national cohort study. We enrolled beachgoers on-site and surveyed about their exposures at the beach and conducted a follow-up survey 7 days following their beach visit to ascertain acute gastrointestinal, respiratory, skin, ear, and eye illness outcomes. We descriptively tabulated and summarized the collected data.

RESULTS

We enrolled 649 households, consisting of 831 beachgoers. Water contact activities were reported by 56% of beachgoers, with swimming being the most common activity (44% of participants). Similarly, 56% of beachgoers reported digging in the sand or burying themselves in the sand. Children (≤14 years) and teenagers (15-19 years) were most likely to report engaging in water contact activities and swallowing water, while children were most likely to report sand contact activities and getting sand in their mouth. Boys and men were more likely than women and girls to report swallowing water (15.2% vs. 9.4%). Water and sand exposures also differed by household education level and participant ethno-racial identity. E. coli levels in beach water were consistently low (median = 20 CFU/100 mL, range = 10-58). The incidence of illness outcomes was very low (0.3-2.8%) among the 287 participants that completed the follow-up survey.

CONCLUSIONS

The identified beach exposure patterns can inform future risk assessments and communication strategies. Excellent water quality was observed at the studied beach, likely contributing to the low incidence of illnesses. A larger, national cohort study is needed in Canada to examine risks of illness at beaches at higher risk of fecal contamination.

Waterborne exposure during non-consumptive domestic use of surface water: a population study across WASH service levels in rural India

Exposure to pathogens from domestic use of surface water is understudied. In many low- and middle-income countries, surface water is used for hygiene, sanitation, amenity, and recreational purposes. In this study, self-reported use of and structured observations at community ponds were collected to measure waterborne exposure across water and sanitation service levels in a rural population of Khorda District, India. Overall, 86% of households (n = 200) reported using ponds on a regular basis. Among observed people (n = 765), 82% put water into their mouth at least once, with a median frequency of five occurrences per visit. Reported and observation data were combined to estimate the proportion (p) of the population that put water in their mouth at least once per day, and their mean daily rate of oral exposure (OE). These were highest for individuals with neither safely managed water nor basic sanitation access (p = 93%, OE = 14 day^-1), but still high among those with both (p = 67%, OE = 6 day^-1). The results suggest widespread exposure to waterborne pathogens in settings where non-potable surface water bodies continue to be used for domestic purposes, even among households with access to safely managed drinking water.

Recreational water illness in Canada: a changing risk landscape in the context of climate change

Swimming and other recreational water activities at public beaches are popular outdoor leisure activities among Canadians. However, these activities can lead to increased risks of acquiring acute gastrointestinal illness and other illnesses among beachgoers. Young children have much higher rates of exposure and illness than other age groups. These illnesses have a significant health and economic burden on society. Climate change is expected to influence both the risk of exposure and illness. A warming climate in Canada, including more severe summer heatwave events, will likely lead to increased recreational water use. Warmer temperatures will also contribute to the growth and increased range of harmful algal blooms and other climate-sensitive pathogens. Increased precipitation and heavy rainfall events will contribute to fecal and nutrient contamination of beach waters, increasing risks of gastrointestinal illness and harmful algal bloom events. There is a need to enhance recreational water research and surveillance in Canada to prepare for and adapt to these changing risks. Key research and policy needs are suggested and discussed, including evaluating and monitoring risks of recreational water illness in Canadian contexts, improving timely reporting of recreational water quality conditions, and enhancing approaches for routine beach water surveillance.

Detangling Seasonal Relationships of Fecal Contamination Sources and Correlates with Indicators in Michigan Watersheds

Despite the widely acknowledged public health impacts of surface water fecal contamination, there is limited understanding of seasonal effects on (i) fate and transport processes and (ii) the mechanisms by which they contribute to water quality impairment. Quantifying relationships between land use, chemical parameters, and fecal bacterial concentrations in watersheds can help guide the monitoring and control of microbial water quality and explain seasonal differences. The goals of this study were to (i) identify seasonal differences in Escherichia coli and Bacteroides thetaiotaomicron concentrations, (ii) evaluate environmental drivers influencing microbial contamination during baseflow, snowmelt, and summer rain seasons, and (iii) relate seasonal changes in B. thetaiotaomicron to anticipated gastrointestinal infection risks. Water chemistry data collected during three hydroclimatic seasons from 64 Michigan watersheds were analyzed using seasonal linear regression models with candidate variables including crop and land use proportions, prior precipitation, chemical parameters, and variables related to both wastewater treatment and septic usage. Adaptive least absolute shrinkage and selection operator (LASSO) linear regression with bootstrapping was used to select explanatory variables and estimate coefficients. Regardless of season, wastewater treatment plant and septic system usage were consistently selected in all primary models for B. thetaiotaomicron and E. coli. Chemistry and precipitation-related variable selection depended upon season and organism. These results suggest a link between human pollution (e.g., septic systems) and microbial water quality that is dependent on flow regime.

IMPORTANCE In this study, a data set of 64 Michigan watersheds was utilized to gain insights into fecal contamination sources, drivers, and chemical correlates across seasons for general E. coli and human-specific fecal indicators. Results reaffirmed a link between human-specific sources (e.g., septic systems) and microbial water quality. While the importance of human sources of fecal contamination and fate and transport variables (e.g., precipitation) remain important across seasons, this study provides evidence that fate and transport mechanisms vary with seasonal hydrologic condition and microorganism source. This study contributes to a body of research that informs prioritization of fecal contamination source control and surveillance strategy development to reduce the public health burden of surface water fecal contamination.

Integrating field and satellite monitoring for assessing environmental risk associated with bacteria in recreational waters of a large reservoir

In a large South American Reservoir (750 km², limit between Uruguay and Argentina), we characterized the environmental risk posed by cyanobacteria proxies (abundance, toxin concentration, chlorophyll-a) and Escherichia coli abundances, integrating field (six sites, summers 2011-2015) and satellite (750 km², summers 2011-2017) monitoring. We further assessed how well field cyanobacteria quantitative proxies (abundance, toxin concentration, chlorophyll-a and scum formation) used to build a local risk communication system for recreational (bathing) use of waters named "cyano-traffic-light", ongoing since 2011, reflected its outcome. Cyanobacteria abundance in the field ranged from moderate (>20,000 to <100,000 cells mL^-1) to high-risk (>100,000 cells mL^-1), and its abundance was positively related to toxin (microcystin) concentration. Mean microcystin concentrations was within the low (≤2 μg L^-1, 50% sites) or moderate (>2 < 10 μg L^-1, 50% sites) risk categories. On rare occasions, toxin concentration posed a high-risk for human health. E. coli abundance was within the high-risk category (>126 CFU 100 mL^-1) for human health, mostly in the northern part of the reservoir. Cyanobacteria proxies (abundance and toxins) and E. coli abundance were, however, unrelated. The predictive model showed that, out of the four cyanobacteria proxies used to construct the cyano-traffic-light only cyanobacteria abundance (p < 0.05) explained the outcome of the reports, yet with low explanatory power (41%). The satellite monitoring allowed delimiting the extent and magnitude of the environmental risk posed by cyanobacteria at landscape scale (highest risk in the meander parts of the Argentinean side of the reservoir) and producing risk maps that can be used by water management agencies. Based upon our results we propose including E. coli abundances and satellite derived cyanobacteria abundances in the building of the cyano-traffic-light, among other modifications.

Hazard identification and risk assessment of the organic, inorganic and microbial contaminants in the surface water after the high magnitude of flood event

The present work has been oriented to the qualitative and quantitative assessments of the aftermath effects of 2014 flood tragedy on the organic, inorganic and microbial contaminants in the floodwater, with a particular emphasis on their relative health risks and microbial infectious hazards to the flood-affected population, using average daily dose, hazard quotient, hazard index (HI), cancer risk (CR) and quantitative microbial risk assessment. Statistical comparison of the organic and inorganic contents was performed using the paired t-tests, while the predominant socio-demographic profiles and health attributes of the respondents to flood-induced health risks (HI) were verified by the chi-square test and binary logistic regression analysis. Among all, Fe, Cu, Pb, Ni, Zn, Cr, Cd, chlorpyrifos, diazinon, polycyclic aromatic hydrocarbons, estriol, 17α-ethinylestradiol, estrone, β-estradiol and bisphenol A were detected at the study area after flooding. The microbiological quality of the floodwater samples has been tracked positive for Escherichia coli, Salmonella typhimurium and Shigella flexneri, with the mean concentrations of 6500, 50 and 180 CFU/100 mL, respectively. Exposure and health risk assessments revealed that the overall HI value for organic and inorganic contaminants in the water samples was 1.19, exceeding the USEPA maximum limit of 1, after the flood incidence. The largest CR contributors were Ni, Cr and Cd, while the infection risks (P_inf,single) associated with the exposure of E. coli, Salmonella spp. and Shigella spp. were identified to be 3.1 × 10^-2, 1.2 × 10^-4 and 3.2 × 10^-5 for incidental scenario; and 8.3 × 10^-1, 3.9 × 10^-1 and 1.9 × 10^-1 for intentional scenario, respectively. The findings of these integrated tools are critically important to provide a more reliable quantitative assessment of human health hazards and microbial risks for different environmental settings, to safeguard water resource, and preservation of public health and the overall river ecosystem.

Dissemination of antibiotic resistance genes in swimming pools and implication for human skin

Swimming pools are crowd-gathering places that are associated with numerous outbreaks of water-borne diseases. Herein, we investigated the distribution of antibiotic resistance genes (ARGs) and bacterial communities in swimming pools and determined the influencing factors and potential human exposure. Sixteen swimming pools with different bather loads (0.01-0.16 person/m²·h) were investigated. Water samples were collected, before opening and after closing of the facilities, from six swimming pools, and skin samples were collected from volunteers. Comprehensive approaches, high-throughput qPCR and 16S rRNA gene sequencing, were used. The results showed that swimming pools contained a higher relative abundance (0.62 gene copies/16S rRNA) and absolute abundance (6.57×10⁸ gene copies/L) of ARGs on average. Bather loads contributed to the increase of core ARGs, and the absolute abundance of ARGs significantly increased by 1.47-1.94 orders of magnitude when the bather load was more than 0.1 person/m²·h. Dermal contact was estimated as the main exposure route of ARGs. Eighteen ARGs that were not detected before swimming were found on human skin and remained after showering. Furthermore, the event intake burden of ARGs via dermal contact was higher than that via ingestion when swimming. This study provides an assessment of ARGs and antibiotic-resistant bacteria (ARB) in swimming pools and helps to define the health risks to swimmers.

Effect of virtual water trade on freshwater pollution in trading partners: a systematic literature review

Systematic reviews are a more complete, repeatable, and less biased form of literature reviews leading to evidence-based conclusions. A systematic review was conducted on articles that have investigated the trade of virtual gray water (VGW) and its effect on freshwater pollution in importer and exporter partners. Scopus and ScienceDirect databases were searched for journal articles covering VGW trade on global, international, and national scales. The relevant articles then were selected and using snowball approach led to more relevant articles. Then, the required data were extracted and recorded. A total of 34 articles met the inclusion criteria, of which 13 articles studied VGW trade on a national scale, 13 on an international scale, and the rest on a global scale. The present study developed a critical appraisal tool to evaluate the methodological quality of the included articles. The results of the critical appraisal showed that none of the included articles can undergo quantitative synthesis. Research gaps regarding VGW trade were observed in the water-scarce developing countries that need to be covered. One of the policy implications to reduce pollution impacts on water bodies would be agricultural and industrial reforms by VGW exporters. Besides, changes in economic structure in both sides of the trade, and goods or water consumption patterns, especially by VGW importers, can also play an important role in water resource conservation. Therefore, international and multi-stockholder cooperation should be taken to alleviate the environmental impacts of the VGW trade.

Evaluating the potential for exposure to organisms of public health concern in naturally occurring bathing waters in Europe: A scoping review

Globally, water-based bathing pastimes are important for both mental and physical health. However, exposure to waterborne organisms could present a substantial public health issue. Bathing waters are shown to contribute to the transmission of illness and disease and represent a reservoir and pathway for the dissemination of antimicrobial resistant (AMR) organisms. Current bathing water quality regulations focus on enumeration of faecal indicator organisms and are not designed for detection of specific waterborne organisms of public health concern (WOPHC), such as antimicrobial resistant (AMR)/pathogenic bacteria, or viruses. This investigation presents the first scoping review of the occurrence of waterborne organisms of public health concern (WOPHC) in identified natural bathing waters across the European Union (EU), which aimed to critically evaluate the potential risk of human exposure and to assess the appropriateness of the current EU bathing water regulations for the protection of public health. Accordingly, this review sought to identify and synthesise all literature pertaining to a selection of bacterial (Campylobacter spp., Escherichia coli, Salmonella spp., Shigella spp., Vibrio spp., Pseudomonas spp., AMR bacteria), viral (Hepatitis spp., enteroviruses, rotavirus, adenovirus, norovirus), and protozoan (Giardia spp., and Cryptosporidium spp.) contaminants in EU bathing waters. Sixty investigations were identified as eligible for inclusion and data was extracted. Peer-reviewed investigations included were from 18 countries across the EU, totalling 87 investigations across a period of 35 years, with 30% published between 2011 and 2015. A variety of water bodies were identified, with 27 investigations exclusively assessing coastal waters. Waterborne organisms were classified into three categories; bacteria, viruses, and protozoa; amounting to 58%, 36% and 17% of the total investigations, respectively. The total number of samples across all investigations was 8,118, with detection of one or more organisms in 2,449 (30%) of these. Viruses were detected in 1281 (52%) of all samples where WOPHC were found, followed by bacteria (865(35%)) and protozoa (303(12%)). Where assessed (442 samples), AMR bacteria had a 47% detection rate, emphasising their widespread occurrence in bathing waters. Results of this scoping review highlight the potential public health risk of exposure to WOPHC in bathing waters that normally remain undetected within the current monitoring parameters.

Effects of tetrabromobisphenol A (TBBPA) on the reproductive health of male rodents: A systematic review and meta-analysis

Tetrabromobisphenol A (TBBPA) is a type of brominated flame retardant widely detected in the environment and organisms. It has been reported to cause cytotoxicity and disrupt endocrine system of animals. However, the effect of TBBPA on the reproductive system of male rodents is still controversial. Hence, this meta-analysis aims to determine whether TBBPA exposure damage to the reproductive system of male rodents. In this study, a thorough search of literatures was undertaken to select papers published before December 1st, 2020. The standard mean difference (SMD) and 95% confidence interval (CI) were calculated by random model. The results showed a statistically significant association between TBBPA exposure and the reproductive system health of male rodents (SMD = -0.35, 95% CI -0.50 to -0.19). The SMD for the reproductive system index organ weight, sperm quality, hormone levels, and gene expression were 0.03 (95% CI -0.18 to 0.23), -0.47 (95% CI -0.78 to -0.16), -0.51 (95% CI -0.75 to -0.27), and -0.98 (95% CI -1.36 to -0.60), respectively. There was a significant dose-effect relationship between TBBPA exposure and the reproductive health of male rodents, with the SMD values of low, medium, and high doses -0.20 (95% CI -0.34 to -0.05), -0.24 (95% CI -0.56 to 0.07), and -0.48 (95% CI -0.83 to -0.13), respectively. For exposure duration of TBBPA, an exposure time of >10 weeks (SMD = -0.33, 95% CI -0.54 to -0.12) showed more significant effect than an exposure time of ≤10 weeks (SMD = -0.22, 95% CI -0.43 to -0.02). Moreover, TBBPA exposure exhibited significant negative effects on sperm count (SMD = -0.49, 95% CI -0.82 to -0.17) while also reduced the content of triiodothyronine (T3), thyroxine (T4), and thyroid stimulating hormone (TSH) hormones. To summarize, our meta-analysis indicated that TBBPA had a toxicity effect to the reproductive system of male rodents.

Environmental factors associated with freshwater recreational water quality in Niagara Region, Ontario, Canada: A path analysis

Escherichia coli concentration levels in recreational water are used by beach managers to evaluate the risk of gastrointestinal illness among beachgoers. We examined the relationship between specific environmental factors and E. coli concentration in recreational beaches in the Niagara Region. We analysed E. coli geometric means collected from eight beaches from two of the Great Lakes in the Niagara Region in Ontario, between 2011 and 2019. We applied path analysis to evaluate the relationship between the environmental factors and E. coli concentrations, including whether effects were direct or indirect via a mediator. Turbidity was found to be an important mediator for the indirect effect of environmental variables overall and in beach-specific models. Rainfall and streamflow had a positive indirect effect on E. coli via turbidity and a direct effect in five out of seven beach models. Streamflow was also a mediator for the indirect effect of previous day air temperature in five out of seven models. In three subset models, outfall E. coli concentration was a mediator for the effect of the environmental factors. Using a novel methodological approach, this study identifies important relationships and pathways that predict beach E. coli concentration in freshwater beaches located on two of the Great Lakes.

Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19

The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 102-105 gc/ml) and feces (ca. 102-107 gc/ml) is much lower than in nasopharyngeal fluids (ca. 105-1011 gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.

Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19

The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 10²-10⁵ gc/ml) and feces (ca. 10²-10⁷ gc/ml) is much lower than in nasopharyngeal fluids (ca. 10⁵-10¹¹ gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.

Shedding of SARS-CoV-2 in feces and urine and its potential role in person-to-person transmission and the environment-based spread of COVID-19

The recent detection of SARS-CoV-2 RNA in feces has led to speculation that it can be transmitted via the fecal-oral/ocular route. This review aims to critically evaluate the incidence of gastrointestinal (GI) symptoms, the quantity and infectivity of SARS-CoV-2 in feces and urine, and whether these pose an infection risk in sanitary settings, sewage networks, wastewater treatment plants, and the wider environment (e.g. rivers, lakes and marine waters). A review of 48 independent studies revealed that severe GI dysfunction is only evident in a small number of COVID-19 cases, with 11 ± 2% exhibiting diarrhea and 12 ± 3% exhibiting vomiting and nausea. In addition to these cases, SARS-CoV-2 RNA can be detected in feces from some asymptomatic, mildly- and pre-symptomatic individuals. Fecal shedding of the virus peaks in the symptomatic period and can persist for several weeks, but with declining abundances in the post-symptomatic phase. SARS-CoV-2 RNA is occasionally detected in urine, but reports in fecal samples are more frequent. The abundance of the virus genetic material in both urine (ca. 10²-10⁵ gc/ml) and feces (ca. 10²-10⁷ gc/ml) is much lower than in nasopharyngeal fluids (ca. 10⁵-10¹¹ gc/ml). There is strong evidence of multiplication of SARS-CoV-2 in the gut and infectious virus has occasionally been recovered from both urine and stool samples. The level and infectious capability of SARS-CoV-2 in vomit remain unknown. In comparison to enteric viruses transmitted via the fecal-oral route (e.g. norovirus, adenovirus), the likelihood of SARS-CoV-2 being transmitted via feces or urine appears much lower due to the lower relative amounts of virus present in feces/urine. The biggest risk of transmission will occur in clinical and care home settings where secondary handling of people and urine/fecal matter occurs. In addition, while SARS-CoV-2 RNA genetic material can be detected by in wastewater, this signal is greatly reduced by conventional treatment. Our analysis also suggests the likelihood of infection due to contact with sewage-contaminated water (e.g. swimming, surfing, angling) or food (e.g. salads, shellfish) is extremely low or negligible based on very low predicted abundances and limited environmental survival of SARS-CoV-2. These conclusions are corroborated by the fact that tens of million cases of COVID-19 have occurred globally, but exposure to feces or wastewater has never been implicated as a transmission vector.

Impact of Freeze-Thaw Cycles on Die-Off of E. coli and Intestinal Enterococci in Deer and Dairy Faeces: Implications for Landscape Contamination of Watercourses

Characterising faecal indicator organism (FIO) survival in the environment is important for informing land management and minimising public health risk to downstream water users. However, key gaps in knowledge include understanding how wildlife contribute to catchment-wide FIO sources and how FIO survival is affected by low environmental temperatures. The aim of this study was to quantify E. coli and intestinal enterococci die-off in dairy cow versus red deer faecal sources exposed to repeated freeze–thaw cycles under controlled laboratory conditions. Survival of FIOs in water exposed to freeze–thaw was also investigated to help interpret survival responses. Both E. coli and intestinal enterococci were capable of surviving sub-freezing conditions with the faeces from both animals able to sustain relatively high FIO concentrations, as indicated by modelling, and observations revealing persistence in excess of 11 days and in some cases confirmed beyond 22 days. Die-off responses of deer-derived FIOs in both faeces and water exposed to low temperatures provide much needed information to enable better accounting of the varied catchment sources of faecal pollution and results from this study help constrain the parameterisation of die-off coefficients to better inform more integrated modelling and decision-making for microbial water quality management.

Electrically Tuning Ultrafiltration Behavior for Efficient Water Purification

Conventional ultrafiltration (UF) technology suffers from membrane fouling and limited separation performance. This work demonstrates a novel electrical tuning strategy to improve the separation efficiency of the UF process. An electrically enhanced UF (EUF) system with two sets of oppositely placed membrane-electrode modules was set up. A series of multicycle treatment experiments were conducted to reveal the performance and tuning mechanism of the EUF system. The applied electrical tuning operation brought about an up to 68% reduction of average transmembrane pressure increasing rate (R_p), indicating a strong capability in inhibiting membrane fouling. This fouling reduction can be mainly ascribed to the applied electrophoretic force, changes in solution chemistry, and generation of peroxide, which repulses foulants away from the membrane, hampers foulant adsorption owing to enhanced electrostatic repulsion, and degrades foulants, respectively. The 1.2 V voltage was identified as an effective voltage for stably inhibiting membrane fouling. Besides, the electrical tuning operation led to an up to ∼32% increase in foulant retention rate (φ) owing to both non-Faradaic effects (including electrosorption and electrophoretic repulsion) and Faradaic oxidative degradation. Moreover, the electrical tuning operation allowed a remarkable desalination capability with a significantly higher desalination rate and an up to ∼43% greater salt adsorption capacity as compared with a conventional capacitive deionization process. Additionally, the EUF system achieved a good performance in removing heavy metals (Ag, Cu, Pb, Se, and Sb). The overall enhanced EUF performance suggests promising prospects for practical applications.