Mansfeldt, Cresten

Cresten Mansfeldt is an Assistant Professor at the University of Colorado Boulder in the Civil, Environmental, and Architectural Engineering Department and Environmental Engineering Program. He leads the Creative-Microbial Bio Maintenance for Greener Environments and Municipalities research group, with active projects in tracing the fingerprint of the built environment biome in natural waters, tracing biomarkers of hazard exposure and disease, and predicting the ecological risk associated with synthetic microorganisms. He previously worked at Eawag and recieved his PhD from Cornell University.

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Description: Alternate: Applying Established Frameworks for Surveillance Ethics to Wastewater...

Alternate: Applying Established Frameworks for Surveillance Ethics to Wastewater Monitoring Campaigns

Abstract

Information is power. Advances within molecular biology and analytical chemistry enable environmental engineers, public health officials, and regulators to transform wastes, such as municipal solid waste and wastewaters, into quantifiable and actionable data. Monitoring campaigns have been successfully established characterizing a variety of targets including pathogens, pharmaceuticals, and illicit substances across communities, within sewer-sheds, and at buildings. These campaigns have been increasingly reported in literature, with terms such as 'wastewater-based epidemiology' expanding near seven-fold in article usage from 101 articles in all of 2018 to 746 in 2021 (to date). Additionally, with the formulization of support and resources through the establishment of government programs such as the National Wastewater Surveillance System (NWSS) at the Centers for Disease Control in the United States and the proposed Sentinel Sewage Surveillance Program in the European Union, the field is maturing rapidly and achieving regulatory framework. This advancement, however, utilizes an evolutionary shift in our domestic materials management that has ethical ramifications that must be considered: waste as a material to treat and dispose versus waste as a diagnostic and informative signal. Therefore, this paper reviews ethical frameworks previously described for monitoring either municipal solid waste streams or wastewaters, utilizes these frameworks in a metanalysis to score reported SARS-CoV-2 monitoring campaigns, and provides suggestions of best practices to tackle areas that are identified as of common ethical concern. Two main ethical guidelines are considered in this analysis: the Canadian Water Network's interpretation of the 2017 World Health Organization surveillance guidelines (CWN; Hudley et al., 2021) and the framework proposed by Marx for new surveillance (MNS; Marx 1998). CWN provides a broader framework, comprising 14 high-level metrics that focus on the need, equity, and proper implementation of the monitoring programs. MNS, however, breaks the interpretation into 29 specific points details the means, context, and uses of the data collection effort. Additionally, CWN distinguishes itself from MNS by focusing on the ethical imperative for participation in public health crisis, whereas MNS highlights the inherit expectation to privacy to waste streams. Previous sampling campaigns are interpreted utilizing these 43 combined metrics. Overall, at least 50 reported sampling campaigns with peer-reviewed publications are considered within this analysis. These articles are binned into the following scales: building (20), collection system (10), and community (20). An additional split is made between the selected building-scale studies between primarily residential (15) or non (5). A score is applied for each of the analyzed metrics based on a four-tier system: violating (2), potentially violating/passing (1), passing (0), and not applicable. The mean scores (not applicable scores are masked from this analysis) are analyzed for each category for all sites to highlight areas of general concern for wastewater surveillance. Additionally, differences are determined between scales to identify scale-driven ethical considerations. This analysis highlighted several areas of concern. At the building scale in which direct actions are taken with increased viral concentrations, the monitored populations primarily lack the ability to appeal against the data, a problematic implementation when considering fair review of the data. Across scales, care must be taken in directly utilizing wastewater information to account for the potential intentional or accidental contamination of a publicly accessible signal. Finally, a conceptual concern highlighted within these studies was the repercussions from opening a new objective for monitoring. Surveillance systems targeting SARS-CoV-2 advanced wastewater monitoring from a concept of surveying the wastewater to treat to quantifying a signal to diagnose the connected population. A diagnosis mindset adds to an already wide range of applications for wastewater surveillance, with the ethical considerations driven by the specific context. Expanding beyond the demonstrated SARS-CoV-2 analysis, the ethical framework is applied to five potential monitoring scenarios: (1) virus tracking within a pandemic, (2) virus tracking when at or below seasonal baseline values, (3) bacterial tracking of an infrastructure related pathogen (e.g., Legionella), (4) small molecule tracking of a consumed product (e.g., pharmaceuticals, illicit substances), and (5) small molecule tracking of a human metabolite. Within this analysis, a respiratory pandemic in the United States is considered as when the percent of all deaths that result from pneumonia, influenza, and COVID-19 (PIC) exceeds a seasonally adjusted threshold of approximately 6-8%, as tabulated and reported by the National Center for Health Statistics. These scenarios challenge both the CWN and MNS framework uniquely. For example, monitoring outside of a pandemic potentially removes the ethical imperative of participation highlighted by the CWN (scenarios (2), (3), and (4)). However, monitoring for human exposure to air, water, or soil contaminants (scenario (5)) may provide a necessary tool to assess non-pathogenic community exposure hazards and inequality. Uniquely, scenario (3) underscores an ethical imperative within water distribution and wastewater collection services: ensuring the safety and reliability of the infrastructure. Finally, each of these contexts have nuanced considerations, for example whether the virus being tracked has associated historical stigma, the small molecule is classified as an illicit substance, or that the small molecule can be directly associated with the consumption behavior of a subset of the monitored community. With the rapidly advancing wastewater surveillance field, this ethical analysis highlights areas that should be further considered when designing and implementing a monitoring campaign. Overall, equal access to sanitation cannot be impeded by public health data collection. Therefore, each campaign must carefully consider not only the engineered approach but also the ethical framework to ensure the power obtained from wastewater monitoring is used as a public health tool and not an invasive weapon.

The following conference paper was presented at the Public Health and Water Conference & Wastewater Disease Surveillance Summit in Cincinnati, OH, March 21-24, 2022.

SpeakerMansfeldt, Cresten

Presentation time

13:30:00

15:00:00

Session time

13:30:00

15:00:00

SessionSeeing Challenges and Progress with Data

Session number11

Session locationDuke Energy Convention Center, Cincinnati, Ohio

TopicData Management, Public Acceptance, Restoring Public Credibility, wastewater

Author(s)