MPW Next Gen 2020: Spotlight On: Sewage Data

Thank you news and Mariana for being here with us. So on one of the many forms I had to fill out for my toddlers preschool registration with this question, how should we refer to pee and poo with your child? And I know this is going to come up a lot in our conversation here. This is relevant. Trust me. So, um first question real quick. Are we good with just plain old poop Mariana that works for you? Or do you go with a more scientific version of the word that that works for us? Noosa. We're good. Excellent. Okay. All right. So so let's let's get a little bit more information on how um how your product actually works because this is just fascinating. So my understanding is that you have these small robots, you put them down in manholes. They swim around collecting samples from poop. Um and then that gets analyzed Mariana. Can you explain a little bit more about how this works real quick And and also significantly why this is such valuable data? Yeah. You know, bio but it's a waste water epidemiology company, The 1st 1 in the world. And our science relies on collecting information from wastewater as a collective sample of pee and poop. You may have never thought about it, but every time we lost the toilet we are producing high quality medical samples and information. And at the moment all of that is just being ignored wasted. We have created the technology to extract this information from the wastewater infrastructure to analyze it and to provide it back to communities so they can be very proactive and very equitable in their response to new health threats. And obviously this has uh implications. Currently with Covid Nushka, can you talk a little bit about how this is being applied today, where it's being used and and how early can diffuse to detect outbreaks before they happen. Yeah. Yeah. Absolutely. Um So when we first started the company back in 2017 we were focused on a very different public health challenge, the opioid epidemic. But human health is dynamic, things change. So with much of the The rest of the world, our attention shifted to COVID-19 in February so early this year. Uh that was around the same time that researchers had noted that the stars Kobe to virus. So the novel coronavirus was actually shed in the stool of infected patients. And so we knew that theoretically we could find the virus in wastewater. And so together with collaborators at M. I. T. And Harvard, we set off and were ultimately the first team in the US to successfully detect and quantify the virus. And from there, uh we we really grew this uh techniques its application uh to work with over 400 communities across the US. Representing over 10% of the us population generating samples. On a daily basis. Or sorry on a weekly basis. Um So on a weekly basis we're understanding the concentration of this virus in wastewater and how it's trending in different communities. So what does that mean today? Has it already been used to alert communities or regions to potential outbreaks? You said you want to take that? Yeah. Sure. Um So you know one of the things that we've seen over the last several months hold true across a lot of the different communities that we work with is that data from wastewater is a leading indicator of new cases To be reported anywhere between 5 to 10 days in advance. Uh And the reason for this uh is that you know, we suspect that infected individuals are shedding the virus and stool within days of being infected. Uh so that's many days before individuals present with clinical symptoms choose to go get tested and then receive those test results back. So a lot of the communities that we're working with, our actually generating this data as part of a much larger Covid 19 response or toolkit or framework as a leading indicator for, you know, how the overall health of their community is doing with respect to um this covid outbreak and Mariana. It's interesting. Uh you know, you guys mentioned that you didn't start this company to tackle Covid, you started it well in advance. Was that a big pivot for you? I mean in terms of the product and how you market it or who you partner with, can you share anything on that end and how quickly you could pivot? Yeah, it was very big and important. But for the company When COVID-19 hits, we have to basically drop our opioid products And dedicate 100% of our time To responding quickly to the COVID-19 outbreak. And I think that that approach you know being a startup, it's really paid off because we were the first team to develop the methods and successfully advocate for the detection of the virus in wastewater. And we grew the largest network of communities across the country like nationwide Before COVID-19, we were only working in the states of Massachusetts and North Carolina Post COVID 19. We are deployed across most states in the country and you know, working with communities of all types from rural um who be urban centers and I think that these this has been really a huge moment to educate, to raise awareness for the technology and for people to understand that the data not waste water is valuable from an epidemiology and public health perspective. And there is work To invest in it not only for COVID-19, but in preparation for the next outbreak, because we now have the technology to intervene early and to stop it before it reached The epidemic status that COVID-19 has already taken place this year. So that's that's a great segway to another question. Um, Lucia Where if you started in opioids, um, you've pivoted to Covid? Where else can this take you? Where else can you apply it? And I just want to point out that you have used the word stool. So you're being very scientific about. So, okay, well, I'll try that. I'll try that again. So, um, you know, we can really look at anything that's excreted in pee and poop. Um so anything that at the individual level, almost anything that at the individual level that our doctors can look at, we can start building the same technology to start looking for that in wastewater. So for example, you know, we can move to other infectious diseases such as influenza. Imagine every season, every flu season having a flu tracker. And early warning to that can alert communities to flu outbreaks. Um you know, within a certain geographic footprint, uh Norovirus, So things that are, you know, much more commonplace than COVID-19. But an early warning would just help uh certain location or community better prepare. Um we can look at other types of health indicators such as you know, stress and build a stress index for certain communities, looking at things like Cortisol. And then of course there is, you know, the opioid products that we were um and are still working on with some communities where we're really able to understand, you know, very specific to certain types of communities. What are the types of drugs that are most commonly consumed so that public health department and public health agencies can be more tailored and more effective in their interventions. Uh, you know, the opioid epidemic is not a one size fits all problem and solutions are not going to be one size fits all across the country about it. By the way, if anybody has questions for Anusha and Mariana, please go ahead and put them in the chat box and we'll try to get to you as quickly as possible because we do have just a few minutes left. But um, you know, you you uh you guys mentioned uh this concept of uh basically put being an equalizer, which is fascinating because you are able to get samples from, you know, anybody, right? It's completely inclusive and comprehensive. Um and we have obviously seen some of the disproportionate impact that Covid has had on communities of color. Um and it's highlighted existing uh inequalities in the health care system. Can you talk a little bit more about that and why again, why it's so valuable as a data source? Not only because of all the information that gives you, but because it's unlike some other data sources can be so comprehensive Mariana. Could you say a few words on that end? Yes. Uh everybody peace and books every day. So everybody has a voice in the sewer and that makes this data set the backbone of a public health approach that is proactive, that is equitable and that really distributes resources to those people who need it the most, and not just to those people who use health resources the most. And in fact we have already been showing how, you know, by comparing wastewater data from different parts of uh municipality for example, you can identify hotspots of the communities that are most affected and this information not not always coincide with what you see in the hospital, which is really interesting. So our mission is to bring these technologies everywhere and to really help make public health uh really a science a science where the information and the resources and the money is going to those who need it the most. And now Russia, are you seeing obviously there's a lot of interest in what you're doing as it applies to covid? Um Are you seeing interest coming from from this perspective of, you know, actually being able to go into communities where data has not been collected? Mhm. Yeah, it's been it's been really interesting to see the response. Um you know, as Mariana said, it's been a lot of raising awareness about this technology over the last several months. Uh and you know, one of the things that we've seen is actually a lot of interest from, you know, communities understanding that this is an infrastructure that they're investing in for not just covid 19, but all sorts of human health challenges that they face as a community for future pandemics, but also interests from different types of communities. So we no longer define, you know, a community just as a municipality, but a community can be a place of study. So a university campus, for example, can deploy wastewater epidemiology to promote the health of its students. A community can be a place of work, a community can be a place of worship. So there are many different communities in our in our cities, in our States and they all have an impact on our health. And wastewater epidemiology can be used across all of these communities to help really foster more proactive and equitable health. Right? Well, I want to thank both of you for coming here to be with us today. Um we really look forward to seeing what you guys do next and you know already, it's just it's fascinating what you're doing and so impactful. So thank you very much for joining us. Thank you. Thank you.