August 17, 2020
The ColoSSoS (Collaboration on Sewage Surveillance of SARS-CoV-2) project is well underway in parts of Australia and New Zealand, and is considered world-leading due to its integrated approach between water utilities, labs and health departments (state and Commonwealth) that enable the efficient, timely and seamless integration of sewage surveillance and clinical data, and therefore delivers a superior response capability.
The ColoSSoS project has 4 key phases:
An integral part of the ColoSSoS Program is the Guiding Principles, and all partners who sign up to the program are committing to adhere to these principles. The principles have been developed in collaboration internationally with the Canadian Water Network and require partners to; adopt the collaborative framework, conduct all research and activities in a direct response to end-user needs to support public health decision making, to openly share ideas and thoughts, and openly share learnings, work conducted in this program will not be used for commercial gain, or unduly delayed in the pursuit of publication.
Expert groups in ColoSSoS offer peer review as well as collaboration and fast development, ensuring that national experts are liaising and using the most reliable and robust methods and techniques.
The innovative design of the ColoSSoS Program has an established State-node structure, gathering and analysing results and integration with epidemiology data in each jurisdiction before coming together into a national reporting structure to enHealth (national environmental health unit for Australia).
The Node structure is hugely valuable as it brings together the expertise of water utilities who understand their sewerage networks and where to sample to capture a particular population, as well as laboratories undertaking molecular analysis who understand any limitations to the test methods and data and health departments to help provide advice on appropriate sampling locations and timing etc.
All parties are working collaboratively so that capability can be built in centres that currently lack local testing capability - the ability to process samples quickly and within state borders is important to the long term success of the program.
The ColoSSoS Project has the formal support of the Water Services Association of Australia, who are working with the NCCC for the resourcing of materials for the ColoSSoS program of sewage testing to scale-up in a manner that does not detract from clinical testing priorities through competition for resources.
Starting from the beginning, understanding where and when to sample.This collaborative and operational-focussed design really comes into display.
Firstly, the location of sampling. While early on in the pandemic WWTPs were most easily accessible, samples were collected there as per usual sampling runs (for e.coli etc.) to avoid any additional burden on water utility staffing.
The sample locations and sewerage networks across states in Australia, commonly mapped by utilities for their internal reference and tracking, developed in an overlay, and updated daily with health surveillance data and case number data in GIS layering.
The maps have been used to identify key sampling areas, which can be, have been refined beyond WWTPs and identified key areas in the sewerage networks where sampling into pump stations, hospital networks and other key areas identified by the health department.
It is important to acknowledge the value of understanding that the represented water authority has, for example, we have seen, in an operational sense that the morning flush “first flush if you will”, has actually changed over the pandemic period, in synchronisation with the working from home cycle, now that we are all working from home, we are sleeping in that little bit longer perhaps because the commute from the bedroom to the study is much faster, and as a result we are showering on average 30-60mins later per day. This target period capturing the first flush is also important for countries with combined sewers capturing the morning wash, brushing teeth etc. as we see higher gene copy numbers in the sputum / phlegm, than we do in the stools.
Over to the next phase of the program where we move from informed sample collection to analysis, the ColoSSoS Program highlights the operationalising of the work, and the need to use the most robust and informed laboratories within Australia for this work, while also noting the need to create localised (state based) nodes where possible.
So these are some examples of laboratories offering NATA accredited testing of adenoviruses, and enteroviruses in wastewater, environmental water and in biosolids. NATA sis the Australian National accreditation body that works according to ISO/IEC 17025 (National Association of Testing Authorities), and these laboratories are ideally placed to informed health departments and feed the most robust data.
By setting up state nodes in each jurisdiction we can operationalise in a way that avoids delays in samples reaching the laboratories, and therefore thawing (or getting too warm), and therefore degrading the virus signal, it also allows us to scale up, increasing testing capacity in each state.
Not only have we used our national accredited laboratories for the analysis, we have also selected laboratories and organisations for the reference standard development and approval. VIDRL are the national reference laboratory for this work, they are also the national reference laboratory for the national polio work. This is similarly supported by the National Measurement Institute (in the same way CDC is supported by NIST in the US) NMI are aligned to the ISO Guide 34 and will be releasing the reference standards developed to our participating ColoSSoS laboratories.
The laboratory collaboration through this program feeds off the expert task groups created and is facilitated by the collaborative principles of open sharing and learning. This has accelerated our work in developing highly sensitive testing and analysis for limit of detection case numbers in the community, which we can now reliably use for prediction of spread / outbreaks.
These groups participate in peer review, proficiency testing and have conducted interlaboratory trials across our accredited laboratories to review and validate results and techniques. We also conduct regular methods meetings with the expert groups and will be producing summaries of various method developed, the methods used to make them more sensitive as well as our sampling protocols developed from that collaborative group, adjust for metropolitan and regional / remote sampling.
The data interpretation and integration part of the ColoSSoS program is vital, and an expert group of epidemiologist have been working together to develop a case control study to analyse the sewage data in conjunction with the clinical data, which has been peer reviewed internationally.
The approach taken by this project has a strong emphasis on collaboration, sharing methodology, protocols and outputs to enable growth in Australia’s capacity and expertise in using sewage monitoring for public health interventions.
Sewage samples from the participating utilities across Australia will be analysed and results verified and compared in highly specialised laboratories. The purpose is to tailor the techniques currently used for virus detection specifically for COVID-19.
It is essential that the data from around the country can be interpreted consistently and reliably.
The team have also developed:
Keep your eyes open for the Water Research Australia Good Practices Guide as we will go into detail on the practices under each of the 4 categories; sampling protocols, analysis method evaluations and sensitivity improvements for low case numbers, as well as, the data integration case control study approach and communications artefacts such as the communications plan and communications matrix, with fact sheets that you can take away on each of these.