DC Health continues to grapple with its wastewater surveillance project to support the CDC’s National Wastewater Surveillance System (NWSS). Despite joining the national program in December of 2020, D.C. has contended with limited funding, equipment delays, and other hiccups that have pushed the city to repeatedly adjust its strategy in the hopes of finally attaining a functioning, city-wide surveillance program.  

While DC Health declined to give DCist/WAMU a date when their data would be publicly available, they said they were close in spite of delays that leave the District lagging behind Maryland and Virginia’s wastewater surveillance programs, both of which started releasing data last year.

“Over the past 2 months, we have been gathering the required information in order to submit our data to the CDC,” a representative of DC Health said via email. “Currently, we have now met the criteria and have sent a test upload to the CDC for approval to have our data shared on the COVID Data Tracker.”

People can shed COVID-19 in their feces, which means that public health workers can collect samples from the sewage system and treatment plants to determine levels of community spread in different areas around the city. Wastewater surveillance is a broad approach to tracking disease, used not only for COVID-19 but also for food borne illnesses and other viruses. It’s particularly useful with COVID because of the high number of asymptomatic cases (according to a July study, about a third of COVID cases are asymptomatic). Paired with low testing and reporting rates, it’s challenging to track accurately. 

“Wastewater is important because it’s going to tell us in certain areas, COVID is high,” said D.C. state epidemiologist Dr. Anil Mangla, adding that the ability to register asymptomatic cases gives them a potentially more powerful projection tool to stop community spread before it starts. “That way you could kind of create active programs, say, ‘get your masks on, get vaccinated,’ or whatever, so you can be proactive in helping that community to be vigilant [about] COVID spreading in this area.”

This ability to measure spread on a neighborhood level is particularly vital in communities with limited access to healthcare or testing. These numbers could be helpful in identifying gaps within D.C., like how COVID hit predominantly Black neighborhoods early in the pandemic.

However, the past couple of years have presented repeated barriers to launching the project. First, DC Health didn’t receive funding from the CDC for the program until November of 2021, despite agreeing to participate almost a year earlier, according to reporting by Axios. 

When DC Health finally did start the project in January of 2022, they were working with LuminUltra, a diagnostics lab contracted with the CDC, to process samples from D.C.’s Blue Plains Wastewater Treatment Plant, which is operated by D.C. Water and Sewer Authority. DC Health relied on Blue Plains’ ability to collect samples given their own limited personnel and equipment. This data was then sent to the CDC and posted on their national wastewater data dashboard.

When the CDC’s partnership with LuminUltra ended in May, DC Health was left without a lab to process wastewater samples resulting in a month-long pause of sample collection.

DC Health says that overstretched staffing due to limited funds has been an ongoing struggle for the agency in wastewater surveillance. 

“We have two people. One is hired in the laboratory doing the testing. And then one is an epidemiologist who gathers data and then sends it to CDC and does all the outreach and talking to the vendors and contractors —and then it’s me,” Mangla says. “We don’t have enough funding to hire more than [those] two people.”

Neighboring Virginia started their program in September of 2021, which was hastened by their pre-existing partnerships with labs and engineering firms that helped them get equipment and testing quickly. Maryland received $1 million from Governor Hogan for their Sewer Sentinel Initiative which allowed them to jumpstart its surveillance without CDC funding. (That program is now phasing out, but Montgomery County and Baltimore are stepping in to create their own programs.)

At the same time wastewater collection paused, there was a lapse in COVID test data reporting to the CDC from DC Health, which prompted D.C. Council to call for improvements to the city’s COVID reporting.

“As residents continue to fall ill and suffer from Long COVID, we hope we can agree that they should have confidence in our data tracking and the tools they need to keep themselves safe,” read a letter from Ward 1 Councilmember Brianne Nadeau and five of her council colleagues, calling for an investigation into the missing data and a resumption of wastewater surveillance.

While the delays were clearly cause for concern for some city officials, Dr. Birthe Kjellerup, an environmental and civil engineering professor who runs a wastewater program at the University of Maryland, says it’s critical to have substantial resources and a sizable team to implement this kind of a program quickly.

“If you have a dedicated team and dedicated resources, then a couple of months is probably reasonable,” Kjellerup says, of starting a program from scratch. “If you’re somewhat well equipped, and we are lucky that we are, then it’s not a big deal.”

Kjellerup estimates their team had 15 people, and that they already had most of the equipment and lab capacity established when they started testing for COVID-19.

In addition to only having a team of three for a citywide program, Dr. Mangla attributed the delays to pandemic-induced supply chain issues and backorders.

“Instruments we were ordering were on a waitlist because the entire country wanted to do this. So we had to just wait,” Mangla says.

Dr. Kjellerup confirmed that autosamplers, the devices that automatically collect wastewater at set times or by a certain liquid amount, could take anywhere from two months to a year to receive. 

DC Health, however, still hasn’t received their autosamplers. While the agency wouldn’t confirm to DCist/WAMU when they gave up receiving them at all, they said they eventually decided to fully rethink their approach to collecting, testing, and analyzing samples.

“DC Health has been very proactive in finding solutions when faced with project challenges,” the DC Health representative said. “Once there was no longer a clear date for the arrival of the autosamplers, we began reaching out to partners and finding other potential options to expedite the process.”

Kjellerup said one solution DC Health could have considered was utilizing manual grab samples, where public health workers can scoop the wastewater manually using a cup attached to a long pole, a method she says can be “faster and simpler.”

But Mangla says their efforts to use this technique were thwarted for logistical reasons.“These manholes [are] almost 15 feet deep…So it’s almost impossible to kind of do that on a manual basis.” (In fact, sample dip poles can be as long as 20 feet.)

Instead, DC Health opted to wait and partner directly with Biobot Analytics, the CDC’s new contractor, to collect and analyze samples. 

DC Health says that this collaboration has allowed them to expand their capacity to a current total of 16 sites — including eight community sites and eight public school sites. Over time it will expand to 24 by adding eight charter schools.

Now, with most of the kinks worked out, DC Health and Biobot have finally submitted sample data from July and August to the CDC. For D.C., Mangla says case rates have been decreasing over the past 10 months, but the program will continue until numbers have stabilized to a relatively low case rate.

While the delays in getting information to the public have been frustrating for some residents and D.C. Officials, the D.C. Council confirmed they’re now in regular communication about the program.

“I have been getting updates from DC Health about the progress on the plan to test wastewater for signs of outbreaks like COVID and polio through weekly check-ins,” Councilmember Gray said via email. “I believe the approach DC Health is taking is going to give us a better barometer of the health of our community.”

Kjellerup says that while the delays aren’t ideal, when it comes to establishing this kind of a surveillance program, faster isn’t always better.

“We are going into fall and it’s bad. But there’ll be another fall and another fall and another fall. So I do think that it’s better to get it right than to rush it. We are not done for the next many, many years with this.”