Exposure to SARS-CoV-2 in Aerosolized Wastewater: Toilet Flushing, Wastewater Treatment, and Sprinkler Irrigation

Impacts of lid closure during toilet flushing and of toilet bowl cleaning on viral contamination of surfaces in United States restrooms

BACKGROUND

Viral aerosols generated during toilet flushing represent a potential route of pathogen transmission. The goal of this study was to determine the impact of toilet lid closure prior to flushing on the generation of viral aerosols and cross-contamination of restroom fomites.

METHODS

A surrogate for human enteric viruses (bacteriophage MS2) was added to household and public toilet bowls and flushed. The resulting viral contamination of the toilet and other restroom surfaces was then determined.

RESULTS

After flushing the inoculated toilets, toilet seat bottoms averaged >107 PFU/100 cm2. Viral contamination of restroom surfaces did not depend on toilet lid position (up or down). After toilet bowls were cleaned using a bowl brush with or without a commercial product (hydrochloric acid), a >4 log10 (>99.99%) reduction in contamination of the toilet bowl water was observed versus no product. Bowl brush contamination was reduced by 1.6 log10 (97.64%) when the product was used versus no product.

CONCLUSIONS

These results demonstrate that closing the toilet lid prior to flushing does not mitigate the risk of contaminating bathroom surfaces and that disinfection of all restroom surfaces (ie, toilet rim, floors) may be necessary after flushing or after toilet brush used for the reduction of virus cross-contamination.

Perspectives on Sampling and New Generation Sequencing Methods for Low-Biomass Bioaerosols in Atmospheric Environments

Bioaerosols play essential roles in the atmospheric environment and can affect human health. With a few exceptions (e.g., farm or rainforest environments), bioaerosol samples from wide-ranging environments typically have a low biomass, including bioaerosols from indoor environments (e.g., residential homes, offices, or hospitals), outdoor environments (e.g., urban or rural air). Some specialized environments (e.g., clean rooms, the Earth's upper atmosphere, or the international space station) have an ultra-low-biomass. This review discusses the primary sources of bioaerosols and influencing factors, the recent advances in air sampling techniques and the new generation sequencing (NGS) methods used for the characterization of low-biomass bioaerosol communities, and challenges in terms of the bias introduced by different air samplers when samples are subjected to NGS analysis with a focus on ultra-low biomass. High-volume filter-based or liquid-based air samplers compatible with NGS analysis are required to improve the bioaerosol detection limits for microorganisms. A thorough understanding of the performance and outcomes of bioaerosol sampling using NGS methods and a robust protocol for aerosol sample treatment for NGS analysis are needed. Advances in NGS techniques and bioinformatic tools will contribute toward the precise high-throughput identification of the taxonomic profiles of bioaerosol communities and the determination of their functional and ecological attributes in the atmospheric environment. In particular, long-read amplicon sequencing, viability PCR, and meta-transcriptomics are promising techniques for discriminating and detecting pathogenic microorganisms that may be active and infectious in bioaerosols and, therefore, pose a threat to human health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41745-023-00380-x.

First report on the toxicity of SARS-CoV-2, alone and in combination with polyethylene microplastics in neotropical fish

The COVID-19 pandemic has caused unprecedented negative impacts in the modern era, including economic, social, and public health losses. On the other hand, the potential effects that the input of SARS-CoV-2 in the aquatic environment from sewage may represent on non-target organisms are not well known. In addition, it is not yet known whether the association of SARS-CoV-2 with other pollutants, such as microplastics (MPs), may further impact the aquatic biota. Thus, we aimed to evaluate the possible ecotoxicological effects of exposure of male adults Poecilia reticulata, for 15 days, to inactivated SARS-CoV-2 (0.742 pg/L; isolated SARS.CoV2/SP02.2020.HIAE.Br) and polyethylene MP (PE MPs) (7.1 × 10⁴ particles/L), alone and in combination, from multiple biomarkers. Our data suggest that exposure to SARS-CoV-2 induced behavioral changes (in the open field test), nephrotoxic effect (inferred by the increase in creatinine), hepatotoxic effect (inferred by the increase in bilirubin production), imbalance in the homeostasis of Fe, Ca, and Mg, as well as an anticholinesterase effect in the animals [marked by the reduction of acetylcholinesterase (AChE) and butyrylcholinesterase (BChE) activity]. On the other hand, exposure to PE MPs induced a genotoxic effect (assessed by the comet assay), as well as an increase in enzyme activity alpha-amylase, alkaline phosphatase, and carboxylesterases. However, we did not show synergistic, antagonistic, or additive effects caused by the combined exposure of P. reticulata to SARS-CoV-2 and PE MPs. Principal component analysis (PCA) and values from the "Integrated Biomarker Response" index indicate that exposure to SARS-CoV-2 was determinant for a more prominent effect in the evaluated animals. Therefore, our study sheds light on the ecotoxicity of the new coronavirus in non-target organisms and ratifies the need for more attention to the impacts of COVID-19 on aquatic biota.

SARS-CoV-2 air sampling: A systematic review on the methodologies for detection and infectivity

This systematic review aims to present an overview of the current aerosol sampling methods (and equipment) being used to investigate the presence of SARS-CoV-2 in the air, along with the main parameters reported in the studies that are essential to analyze the advantages and disadvantages of each method and perspectives for future research regarding this mode of transmission. A systematic literature review was performed on PubMed/MEDLINE, Web of Science, and Scopus to assess the current air sampling methodologies being applied to SARS-CoV-2. Most of the studies took place in indoor environments and healthcare settings and included air and environmental sampling. The collection mechanisms used were impinger, cyclone, impactor, filters, water-based condensation, and passive sampling. Most of the reviewed studies used RT-PCR to test the presence of SARS-CoV-2 RNA in the collected samples. SARS-CoV-2 RNA was detected with all collection mechanisms. From the studies detecting the presence of SARS-CoV-2 RNA, fourteen assessed infectivity. Five studies detected viable viruses using impactor, water-based condensation, and cyclone collection mechanisms. There is a need for a standardized protocol for sampling SARS-CoV-2 in air, which should also account for other influencing parameters, including air exchange ratio in the room sampled, relative humidity, temperature, and lighting conditions.

The One Health concept for the threat of severe acute respiratory syndrome coronavirus-2 to marine ecosystems

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a global health threat. This virus is the causative agent for coronavirus disease 2019 (COVID-19). Pandemic prevention is best addressed through an integrated One Health (OH) approach. Understanding zoonotic pathogen fatality and spillover from wildlife to humans are effective for controlling and preventing zoonotic outbreaks. The OH concept depends on the interface of humans, animals, and their environment. Collaboration among veterinary medicine, public health workers and clinicians, and veterinary public health is necessary for rapid response to emerging zoonotic pathogens. SARS-CoV-2 affects aquatic environments, primarily through untreated sewage. Patients with COVID-19 discharge the virus in urine and feces into residential wastewater. Thus, marine organisms may be infected with SARS-CoV-2 by the subsequent discharge of partially treated or untreated wastewater to marine waters. Viral loads can be monitored in sewage and surface waters. Furthermore, shellfish are vulnerable to SARS-CoV-2 infection. Filter-feeding organisms might be monitored to protect consumers. Finally, the stability of SARS-CoV-2 to various environmental factors aids in viral studies. This article highlights the presence and survival of SARS-CoV-2 in the marine environment and its potential to enter marine ecosystems through wastewater. Furthermore, the OH approach is discussed for improving readiness for successive outbreaks. This review analyzes information from public health and epidemiological monitoring tools to control COVID-19 transmission.

Can spike fragments of SARS-CoV-2 induce genomic instability and DNA damage in the guppy, Poecilia reticulate? An unexpected effect of the COVID-19 pandemic

The identification of SARS-CoV-2 particles in wastewater and freshwater ecosystems has raised concerns about its possible impacts on non-target aquatic organisms. In this particular, our knowledge of such impacts is still limited, and little attention has been given to this issue. Hence, in our study, we aimed to evaluate the possible induction of mutagenic (via micronucleus test) and genotoxic (via single cell gel electrophoresis assay, comet assay) effects in Poecilia reticulata adults exposed to fragments of the Spike protein of the new coronavirus at the level of 40 μg/L, denominated PSPD-2002. As a result, after 10 days of exposure, we have found that animals exposed to the peptides demonstrated an increase in the frequency of erythrocytic nuclear alteration (ENA) and all parameters assessed in the comet assay (length tail, %DNA in tail and Olive tail moment), suggesting that PSPD-2002 peptides were able to cause genomic instability and erythrocyte DNA damage. Besides, these effects were significantly correlated with the increase in lipid peroxidation processes [inferred by the high levels of malondialdehyde (MDA)] reported in the brain and liver of P. reticulata and with the reduction of the superoxide dismutase (SOD) and catalase (CAT) activity. Thus, our study constitutes a new insight and promising investigation into the toxicity associated with the dispersal of SARS-CoV-2 peptide fragments in freshwater environments.

Laser-Induced Graphene (LIG) as a Smart and Sustainable Material to Restrain Pandemics and Endemics: A Perspective

A healthy environment is necessary for a human being to survive. The contagious COVID-19 virus has disastrously contaminated the environment, leading to direct or indirect transmission. Therefore, the environment demands adequate prevention and control strategies at the beginning of the viral spread. Laser-induced graphene (LIG) is a three-dimensional carbon-based nanomaterial fabricated in a single step on a wide variety of low-cost to high-quality carbonaceous materials without using any additional chemicals potentially used for antiviral, antibacterial, and sensing applications. LIG has extraordinary properties, including high surface area, electrical and thermal conductivity, environmental-friendliness, easy fabrication, and patterning, making it a sustainable material for controlling SARS-CoV-2 or similar pandemic transmission through different sources. LIG's antiviral, antibacterial, and antibiofouling properties were mainly due to the thermal and electrical properties and texture derived from nanofibers and micropores. This perspective will highlight the conducted research and the future possibilities on LIG for its antimicrobial, antiviral, antibiofouling, and sensing applications. It will also manifest the idea of incorporating this sustainable material into different technologies like air purifiers, antiviral surfaces, wearable sensors, water filters, sludge treatment, and biosensing. It will pave a roadmap to explore this single-step fabrication technique of graphene to deal with pandemics and endemics in the coming future.

Determination of murine norovirus aerosol concentration during toilet flushing

Murine norovirus (MNV) was used as a surrogate for human viral pathogens (e.g., norovirus) to determine if toilet flushing resulted in the aerosolization of virus. A flushometer type toilet was seeded with a viral solution of 105 and 106 PFU mL-1 of MNV and then flushed. Upon flushing, two bioaerosol samplers were activated to collect aerosolized MNV. Prior to the experiment, two optical particle counters monitored particle size and number distribution of aerosol produced from flushing a toilet across height, position, and side. The location with the highest mean particle concentration, was behind the toilet and 0.15 m above the toilet bowl rim, which is where bioaerosol sampling occurred. Bioaerosol and toilet water samples were collected, extracted and then quantified using RT-ddPCR. The concentration of MNV collected after seeding the toilet water ranged from 2.18 × 105 to 9.65 × 106 total copies of MNV. Positive samples of airborne MNV were detected with collected concentrations ranging from 383 to 684 RNA copies/m3 of air. This study provides evidence that viral pathogens may be aerosolized when a toilet is flushed. Furthermore, the MNV used in this study is a model organism for human norovirus and may be generalizable to other viral pathogens (e.g., coronavirus). This study suggests that virus is aerosolized from toilet flushing and may contribute to human exposure to viral pathogens.

On the Critical Role of Human Feces and Public Toilets in the Transmission of COVID-19: Evidence from China

The surprising spread speed of the COVID-19 pandemic creates an urgent need for investigating the transmission chain or transmission pattern of COVID-19 beyond the traditional respiratory channels. This study therefore examines whether human feces and public toilets play a critical role in the transmission of COVID-19. First, it develops a theoretical model that simulates the transmission chain of COVID-19 through public restrooms. Second, it uses stabilized epidemic data from China to empirically examine this theory, conducting an empirical estimation using a two-stage least squares (2SLS) model with appropriate instrumental variables (IVs). This study confirms that the wastewater directly promotes the transmission of COVID-19 within a city. However, the role of garbage in this transmission chain is more indirect in the sense that garbage has a complex relationship with public toilets, and it promotes the transmission of COVID-19 within a city through interaction with public toilets and, hence, human feces. These findings have very strong policy implications in the sense that if we can somehow use the ratio of public toilets as a policy instrument, then we can find a way to minimize the total number of infections in a region. As shown in this study, pushing the ratio of public toilets (against open defecation) to the local population in a city to its optimal level would help to reduce the total infection in a region.

The existence, spread, and strategies for environmental monitoring and control of SARS-CoV-2 in environmental media

Coronavirus disease 2019 (COVID-19) is the most influential infectious disease to emerge in the early 21st century. The outbreak of COVID-19 has caused a great many deaths and has had a negative impact on the world's economic development. The etiological agent of COVID-19 is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2, which is highly infectious and variable, can be transmitted through different environmental media (gaseous, liquid, and solid). There are many unanswered questions surrounding this virus. This review summarizes the current knowledge on the latest global COVID-19 epidemic situation, SARS-CoV-2 variants, the progress in SARS-CoV-2 vaccine use, and the existence and spread of SARS-CoV-2 in gaseous, liquid, and solid media, with particular emphasis on the prevention and control of further spread of the disease. This review aims to help people worldwide to become more familiar with the transmission characteristics of SARS-CoV-2 in environmental media, so as targeted measures to fight the epidemic, reduce deaths, and restore the economy can be implemented under the pressure of global SARS-CoV-2 vaccine shortages.

Wastewater aerosols produced during flushing toilets, WWTPs, and irrigation with reclaimed municipal wastewater as indirect exposure to SARS-CoV-2

The detection of SARS-CoV-2 RNA in raw and treated wastewater can open up a fresh perspective to waterborne and aerosolized wastewater as a new transmission route of SARS-CoV-2 RNA during the current pandemic. The aim of this paper is to discuss the potential transmission of SARS-CoV-2 RNA from wastewater aerosols formed during toilet flushing, plumbing failure, wastewater treatment plants, and municipal wastewater reuse for irrigation. Moreover, how these aerosols might increase the risk of exposure to this novel coronavirus (SARS-CoV-2 RNA). This article supplies a review of the literature on the presence of SARS-CoV-2 RNA in untreated wastewater, as well as the fate and stability of SARS-CoV-2 RNA in wastewater. We also reviewed the existing literatures on generation and transmission of aerosolized wastewater through flush a toilet, house's plumbing networks, WWTPs, wastewater reuse for irrigation of agricultural areas. Finally, the article briefly studies the potential risk of infection with exposure to the fecal bioaerosols of SARS-CoV-2 RNA for the people who might be exposed through flushing toilets or faulty building plumbing systems, operators/workers in wastewater treatment plants, and workers of fields irrigated with treated wastewater - based on current knowledge. Although this review highlights the indirect transmission of SARS-CoV-2 RNA through wastewater aerosols, no research has yet clearly demonstrated the role of aerosolized wastewater in disease transmission regarding the continuation of this pandemic. Therefore, there is a need for additional studies on wastewater aerosols in transmission of COVID-19.

Water Quality Assessments for Urban Water Environment

Since ages, human societies have witnessed the intrinsic connection between their all-encompassing development and freshwater resources [...]