Sewage could reveal true scale of coronavirus outbreak

Before anyone goes collecting sewage samples, consider deriving your scaling factors from discrepencies in ICD-10 diagnostic encoding practices.<p>- Stacked bar chart: <a href="https:&#x2F;&#x2F;twitter.com&#x2F;OccupyWallSt&#x2F;status&#x2F;1246478379064295425&#x2F;photo&#x2F;1" rel="nofollow">https:&#x2F;&#x2F;twitter.com&#x2F;OccupyWallSt&#x2F;status&#x2F;1246478379064295425&#x2F;...</a><p>- Govt data: <a href="https:&#x2F;&#x2F;data.cdc.gov&#x2F;NCHS&#x2F;Provisional-Death-Counts-for-Coronavirus-Disease-C&#x2F;hc4f-j6nb" rel="nofollow">https:&#x2F;&#x2F;data.cdc.gov&#x2F;NCHS&#x2F;Provisional-Death-Counts-for-Coron...</a><p>ICD-10 is really the heart of the matter. Earlier recommendations have asked doctors to encode corona death information using Pneumonia (J12.89) or Bronchitis (J20.8, J40) if positive test results are available, suffixed by B97.29 if authorized by the CDC to do so. We now appear to finally have the pneumonia encoded info thanks to NCHS. Hopefully govt will open source the bronchitis encoded reports too.<p>See also:<p>- <a href="https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;ICD-10-CM-Official-Coding-Gudance-Interim-Advice-coronavirus-feb-20-2020.pdf" rel="nofollow">https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;ICD-10-CM-Official-Coding-...</a><p>- <a href="https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;ICD-10-CM-April-1-2020-addenda.pdf" rel="nofollow">https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;ICD-10-CM-April-1-2020-add...</a><p>- <a href="https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;COVID-19-guidelines-final.pdf" rel="nofollow">https:&#x2F;&#x2F;www.cdc.gov&#x2F;nchs&#x2F;data&#x2F;icd&#x2F;COVID-19-guidelines-final....</a>

Actual paper:<p>Presence of SARS-Coronavirus-2 in sewage &#x2F; Medema, et al.<p><a href="https:&#x2F;&#x2F;www.medrxiv.org&#x2F;content&#x2F;10.1101&#x2F;2020.03.29.20045880v1.full.pdf" rel="nofollow">https:&#x2F;&#x2F;www.medrxiv.org&#x2F;content&#x2F;10.1101&#x2F;2020.03.29.20045880v...</a><p>Check out Table 4.

Interesting. That&#x27;s also been done for recreational drugs. And artificial vanilla flavoring.<p>I wonder whether sampling from sewage pumping units could be done. That might produce higher resolution data. But getting representative samples would be harder. You&#x27;d probably need to take large samples, mix, and subsample.

Ah yes, the quantified toilets joke from SIGCHI 2014 has come to unironic fruition:<p><a href="https:&#x2F;&#x2F;www.theatlantic.com&#x2F;technology&#x2F;archive&#x2F;2014&#x2F;04&#x2F;what-a-toilet-hoax-can-tell-us-about-the-future-of-surveillance&#x2F;361408&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.theatlantic.com&#x2F;technology&#x2F;archive&#x2F;2014&#x2F;04&#x2F;what-...</a><p>It was meant as a prank, not an instruction manual.

What a wonderful symmetry to the cholera outbreak in 1854 in London, where John Snow traced the sources to drinking water wells: <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;1854_Broad_Street_cholera_outbreak" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;1854_Broad_Street_cholera_outb...</a>

I’ve been wondering about this. It would be especially interesting if, after we come out of lockdown, we could sample sewage at many points as the sewer comes together. You might be able for example to identify an infected block and then go around to give individual swabs to each resident if the block came up positive.

This should also allow to monitor for mutations of the Covid 19, whereas it would be impractical to do at an individual level. It would give an early warning signal.

There’s a YC company [0] already doing this.<p>[0] <a href="https:&#x2F;&#x2F;www.biobot.io&#x2F;covid19" rel="nofollow">https:&#x2F;&#x2F;www.biobot.io&#x2F;covid19</a>

Serious question: are there &#x27;pandemics&#x27; we don&#x27;t hear about because the virus doesn&#x27;t hurt us? Are those outbreaks also studied?

I&#x27;m sure there are great reasons, but why is it that we can&#x27;t detect the virus in wastewater at a personal level? Could this be a less invasive way to test for covid19?

Public statement from the Dutch CDC (RIVM) on this method:<p><a href="https:&#x2F;&#x2F;www.rivm.nl&#x2F;node&#x2F;153991" rel="nofollow">https:&#x2F;&#x2F;www.rivm.nl&#x2F;node&#x2F;153991</a>

Maybe. Similar to drug testing an entire city using sewage.

That is interesting. Do we now what the rate at which the virus dies in water?

Incidentally, we can also test sewage for drugs and then swat places where people consume drugs. How very helpful. It&#x27;s just because we need to fight the virus! ️

Except in areas without sewer