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As Covid Emergency Ends, Surveillance Shifts to the Sewers

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As Covid Emergency Ends, Surveillance Shifts to the Sewers

When the Covid-19 public health emergency expires in the United States on Thursday, the coronavirus will not disappear. But many of the data streams that have helped Americans monitor the virus will go dark.

The Centers for Disease Control and Prevention will stop tabulating community levels of Covid-19 and will no longer require certain case information from hospitals or testing data from laboratories. And as free testing is curtailed, official case counts, which became less reliable as Americans shifted to at-home testing, may drift even further from reality.

But experts who want to keep tabs on the virus will still have one valuable option: sewage.

People who are infected with the coronavirus shed the pathogen in their stool, whether or not they take a Covid test or seek medical care, enabling officials to track levels of the virus in communities over time and to watch for the emergence of new variants.

This approach expanded rapidly during the pandemic. The National Wastewater Surveillance System, which the C.D.C. established in late 2020, now includes data from more than 1,400 sampling sites, distributed across 50 states, three territories and 12 tribal communities, Amy Kirby, the program lead, said. The data cover about 138 million people, more than 40 percent of the U.S. population, she said.

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And as other tracking efforts wind down, some communities are racing to set up wastewater surveillance programs for the first time, Dr. Kirby noted. “This is actually driving more interest in wastewater,” she said.

In the months ahead, wastewater surveillance will become even more important, scientists said, and it should help officials spot some incipient outbreaks.

But wastewater surveillance is still missing many communities, and more work is needed to turn what began as an ad hoc emergency effort into a sustainable national system, experts said. And officials will need to be thoughtful about how they use the data, as the pandemic continues to evolve.

“Wastewater has to get better,” said David O’Connor, a virologist at the University of Wisconsin-Madison. “And we have to get a bit more savvy about interpreting what the wastewater data is telling us.”

Over the past three years, wastewater surveillance repeatedly proved its worth. When testing was widely available, the wastewater trends mirrored the official Covid-19 case counts. When testing was scarce, spikes in the viral levels in sewage provided early warnings of coming surges, allowing officials to redistribute public health resources and hospitals to prepare for an influx of cases.

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Wastewater sampling helped scientists determine when new variants arrived in particular communities and helped clinicians make more informed decisions about when to use certain treatments, which may not work against all versions of the virus.

“For SARS-CoV-2, our wastewater surveillance system is pretty solid now,” Marisa Eisenberg, an infectious disease epidemiologist at the University of Michigan, said. “We’ve kind of put it through its paces.”

Houston, for instance, now has an extensive wastewater surveillance infrastructure, collecting samples weekly from all 39 of the city’s wastewater treatment plants as well as from individual schools, shelters, nursing homes and jails. The city has no plans to scale back, said Loren Hopkins, the chief environmental science officer for the Houston Health Department and a statistician at Rice University.

“We really don’t know what Covid will do,” she said. “We’ll be continuing to look to the wastewater to tell us how much of the virus is out there.”

The C.D.C. will still track deaths and hospitalizations, but those tend to be lagging indicators. So wastewater is likely to remain a critical early warning system for both officials and members of the public.

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“It can help people who are immunocompromised, who might want to be really cautious,” said Alexandria Boehm, an environmental engineer at Stanford University and a lead investigator for WastewaterSCAN, a sewage surveillance initiative. “It can help us make decisions about whether we want to mask or go to a really crowded concert.”

As clinical testing drops off, wastewater surveillance will also be a key strategy for keeping tabs on new variants and for gauging the threat they pose, scientists said. Variants that quickly take over a sewershed, or whose spread is followed by a rise in local hospitalization rates, for instance, might warrant increased monitoring.

Still, the data will not be available everywhere. Because the existing wastewater surveillance system emerged in a somewhat haphazard way, with interested jurisdictions opting in, coverage of the country is uneven. Wastewater sampling sites tend to be sparse — or absent — in many rural areas and parts of the South and West.

And collecting wastewater data is just the first step. Making sense of it can be trickier, scientists cautioned.

Among the challenges they cited: Now that many Americans have developed some immunity to the virus, wastewater spikes might not necessarily lead to the same wave of hospitalizations that some facilities have come to expect. And scientists still don’t know whether all variants will be equally detectable in wastewater.

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Moreover, simply spotting a new variant in wastewater does not necessarily portend a problem. For instance, since 2021, Marc Johnson, a virologist at the University of Missouri, and his colleagues have found dozens of unusual variants in wastewater samples across the United States.

Some of these variants are radically different from Omicron and could theoretically pose a new public health risk. But so far, at least, these variants do not seem to be spreading. They are probably coming from individual, supershedding patients with long-term coronavirus infections, Dr. Johnson said.

“Wastewater is really good because it can give you a comprehensive view of what’s going on,” Dr. Johnson said. But there are times, he said, “where it can mislead you.”

And although a reduction in Covid case tracking was probably inevitable, wastewater surveillance is most informative when combined with other sources of public health data, scientists said. “I like to think of it more as being a complementary data stream,” Dr. Eisenberg said.

Wastewater surveillance will continue to evolve, Dr. Kirby said. The C.D.C. is talking with some states about how to optimize their network of sampling sites, a process that could involve both adding new sites and scaling back in areas where multiple sampling locations are providing essentially redundant data.

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“We do expect some reduction in the number of sites in some of those states,” Dr. Kirby said. “But we’ll be working with them to be strategic about that, so that we’re not losing information.”

Officials are exploring other possibilities, too. As part of the C.D.C.’s Traveler Genomic Surveillance program, for instance, Ginkgo Bioworks, a Boston-based biotechnology company, is now testing wastewater samples from planes landing at the international terminal at San Francisco International Airport.

“Putting in place these indirect mechanisms that can give you a sense of what’s going on in the world are really important, as other forms of testing start falling off,” said Andrew Franklin, the director of business development at Concentric by Ginkgo, the company’s biosecurity and public health arm.

The American Rescue Plan has provided enough funding to conduct wastewater surveillance in all states and territories through 2025, Dr. Kirby said.

But maintaining wastewater surveillance will require ongoing funding over the longer term, as well as continued buy in from local officials, some of whom might lose interest as the emergency phase of the pandemic winds down. “We’re going to see some fatigue-based dropouts,” said Guy Palmer, an infectious disease pathologist at Washington State University and the chair of the wastewater surveillance committee of the National Academies of Sciences, Engineering and Medicine.

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So proponents of wastewater surveillance are hoping to demonstrate its continued utility, both for Covid-19 and other diseases. Some jurisdictions are already using wastewater to track influenza and other pathogens, and the C.D.C. hopes to roll out expanded testing protocols by the end of the year, Dr. Kirby said.

“This is part of our surveillance portfolio for the long haul,” Dr. Kirby said. “I think we’re really going to see how powerful it can be once we’re out of this emergency response period.”

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Jennifer Hudson Lost 80-Lbs Without Depriving Herself—Learn Her Secrets

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Jennifer Hudson Lost 80-Lbs Without Depriving Herself—Learn Her Secrets


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Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’

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Kennedy’s Plan for the Drug Crisis: A Network of ‘Healing Farms’

Though Mr. Kennedy’s embrace of recovery farms may be novel, the concept stretches back almost a century. In 1935, the government opened the United States Narcotic Farm in Lexington, Ky., to research and treat addiction. Over the years, residents included Chet Baker and William S. Burroughs (who portrayed the institution in his novel, “Junkie: Confessions of an Unredeemed Drug Addict”). The program had high relapse rates and was tainted by drug experiments on human subjects. By 1975, as local treatment centers began to proliferate around the country, the program closed.

In America, therapeutic communities for addiction treatment became popular in the 1960s and ’70s. Some, like Synanon, became notorious for cultlike, abusive environments. There are now perhaps 3,000 worldwide, researchers estimate, including one that Mr. Kennedy has also praised — San Patrignano, an Italian program whose centerpiece is a highly regarded bakery, staffed by residents.

“If we do go down the road of large government-funded therapeutic communities, I’d want to see some oversight to ensure they live up to modern standards,” said Dr. Sabet, who is now president of the Foundation for Drug Policy Solutions. “We should get rid of the false dichotomy, too, between these approaches and medications, since we know they can work together for some people.”

Should Mr. Kennedy be confirmed, his authority to establish healing farms would be uncertain. Building federal treatment farms in “depressed rural areas,” as he said in his documentary, presumably on public land, would hit political and legal roadblocks. Fully legalizing and taxing cannabis to pay for the farms would require congressional action.

In the concluding moments of the documentary, Mr. Kennedy invoked Carl Jung, the Swiss psychiatrist whose views on spirituality influenced Alcoholics Anonymous. Dr. Jung, he said, felt that “people who believed in God got better faster and that their recovery was more durable and enduring than people who didn’t.”

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Children exposed to higher fluoride levels found to have lower IQs, study reveals

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Children exposed to higher fluoride levels found to have lower IQs, study reveals

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The debate about the benefits and risks of fluoride is ongoing, as RFK Jr. — incoming President Trump’s pick for HHS secretary — pushes to remove it from the U.S. water supply.

“Fluoride is an industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders and thyroid disease,” RFK wrote in a post on X in November.

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A new study published in JAMA Pediatrics on Jan. 6 found another correlation between fluoride exposure and children’s IQs.

RFK JR. CALLS FOR REMOVAL OF FLUORIDE FROM DRINKING WATER, SPARKING DEBATE

Study co-author Kyla Taylor, PhD, who is based in North Carolina, noted that fluoridated water has been used “for decades” to reduce dental cavities and improve oral health.

Fluoride exposure has been linked to a variety of negative health effects, yet benefits oral health. (iStock)

“However, there is concern that pregnant women and children are getting fluoride from many sources, including drinking water, water-added foods and beverages, teas, toothpaste, floss and mouthwash, and that their total fluoride exposure is too high and may affect fetal, infant and child neurodevelopment,” she told Fox News Digital.

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The new research, led by scientists at the National Institute of Environmental Health Sciences (NIEHS), analyzed 74 epidemiological studies on children’s IQ and fluoride exposure.

FEDERAL JUDGE ORDERS EPA FURTHER REGULATE FLUORIDE IN DRINKING WATER DUE TO CONCERNS OVER LOWERED IQ IN KIDS

The studies measured fluoride in drinking water and urine across 10 countries, including Canada, China, Denmark, India, Iran, Mexico, Pakistan, New Zealand, Spain and Taiwan. (None were conducted in the U.S.)

The meta-analysis found a “statistically significant association” between higher fluoride exposure and lower children’s IQ scores, according to Taylor.

“[It showed] that the more fluoride a child is exposed to, the more likely that child’s IQ will be lower than if they were not exposed,” she said.

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Little girl drinking water from a glass

Scientists found a “statistically significant association” between higher fluoride exposure and lower children’s IQ scores. (iStock)

These results were consistent with six previous meta-analyses, all of which reported the same “statistically significant inverse associations” between fluoride exposure and children’s IQs, Taylor emphasized.

The research found that for every 1mg/L increase in urinary fluoride, there was a 1.63-point decrease in IQ. 

‘Safe’ exposure levels

The World Health Organization (WHO) has established 1.5mg/L as the “upper safe limit” of fluoride in drinking water.

“There is concern that pregnant women and children are getting fluoride from many sources.”

Meanwhile, the U.S. Public Health Service recommends a fluoride concentration of 0.7 mg/L in drinking water.

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“There was not enough data to determine if 0.7 mg/L of fluoride exposure in drinking water affected children’s IQs,” Taylor noted.

FDA BANS RED FOOD DYE DUE TO POTENTIAL CANCER RISK

Higher levels of the chemical can be found in wells and community water serving nearly three million people in the U.S., the researcher noted.

She encouraged pregnant women and parents of small children to be mindful of their total fluoride intake.

little boy filling fresh water from water tap in sports bottle

Nearly three million people have access to wells and community water with fluoride levels above the levels suggested by the World Health Organization. (iStock)

“If their water is fluoridated, they may wish to replace tap water with low-fluoride bottled water, like purified water, and limit exposure from other sources, such as dental products or black tea,” she said.

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“Parents can use low-fluoride bottled water to mix with powdered infant formula and limit use of fluoridated toothpaste by young children.”

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While the research did not intend to address broader public health implications of water fluoridation in the U.S., Taylor suggested that the findings could help inform future research into the impact of fluoride on children’s health.

Dental health expert shares cautions

In response to this study and other previous research, Dr. Ellie Phillips, DDS, an oral health educator based in Austin, Texas, told Fox News Digital that she does not support water fluoridation.

Mother and her toddler drinking a glass with water from the tap

The study researcher encouraged parents of small children to be mindful of their total fluoride intake. (iStock)

“I join those who vehemently oppose public water fluoridation, and I question why our water supplies are still fluoridated in the 21st century,” she wrote in an email.

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“There are non-fluoridated cities and countries where the public enjoy high levels of oral health, which in some cases appear better than those that are fluoridated.”

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Phillips called the fluoride debate “confusing” even among dentists, as the American Dental Association (ADA) advocates for fluoride use for cavity prevention through water fluoridation, toothpaste and mouthwash — “sometimes in high concentrations.”

mother checks son's brushed teeth

Fluoride is used in water, toothpaste and mouthwash to help prevent cavities. (iStock)

“[But] biologic (holistic) dentists generally encourage their patients to fear fluoride and avoid its use entirely, even if their teeth are ravaged by tooth decay,” she said.

“Topical fluoride is beneficial, while systemic consumption poses risks.”

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Phillips encouraged the public to consider varying fluoride compounds, the effect of different concentrations and the “extreme difference” between applying fluoride topically and ingesting it.

“Topical fluoride is beneficial, while systemic consumption poses risks,” she cautioned. 

“Individuals must take charge of their own oral health using natural and informed strategies.”

The study received funding from the National Institute of Environmental Health Sciences (NIEHS), the National Institutes of Health (NIH) and the Intramural Research Program.

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