Leaving no stone unturned in light of the COVID-19 faecal-oral hypothesis? A water, sanitation and hygiene (WASH) perspective targeting low-income countries

Emerging organic contaminants in drinking water systems: Human intake, emerging health risks, and future research directions

Few earlier reviews on emerging organic contaminants (EOCs) in drinking water systems (DWS) focused on their detection, behaviour, removal and fate. Reviews on multiple exposure pathways, human intake estimates, and health risks including toxicokinetics, and toxicodynamics of EOCs in DWS are scarce. This review presents recent advances in human intake and health risks of EOCs in DWS. First, an overview of the evidence showing that DWS harbours a wide range of EOCs is presented. Multiple human exposure to EOCs occurs via ingestion of drinking water and beverages, inhalation and dermal pathways are discussed. A potential novel exposure may occur via the intravenous route in dialysis fluids. Analysis of global data on pharmaceutical pollution in rivers showed that the cumulative concentrations (μg L-1) of pharmaceuticals (mean ± standard error of the mean) were statistically more than two times significantly higher (p = 0.011) in South America (11.68 ± 5.29), Asia (9.97 ± 3.33), Africa (9.48 ± 2.81) and East Europe (8.09 ± 4.35) than in high-income regions (2.58 ± 0.48). Maximum cumulative concentrations of pharmaceuticals (μg L-1) decreased in the order; Asia (70.7) had the highest value followed by South America (68.8), Africa (51.3), East Europe (32.0) and high-income regions (17.1) had the least concentration. The corresponding human intake via ingestion of untreated river water was also significantly higher in low- and middle-income regions than in their high-income counterparts. For each region, the daily intake of pharmaceuticals was highest in infants, followed by children and then adults. A critique of the human health hazards, including toxicokinetics and toxicodynamics of EOCs is presented. Emerging health hazards of EOCs in DWS include; (1) long-term latent and intergenerational effects, (2) the interactive health effects of EOC mixtures, (3) the challenges of multifinality and equifinality, and (4) the Developmental Origins of Health and Disease hypothesis. Finally, research needs on human health hazards of EOCs in DWS are presented.

Human viral pathogens in the wastewater-source water-drinking water continuum: Evidence, health risks, and lessons for future outbreaks in low-income settings

Human viral pathogens, including SARS-CoV-2 continue to attract public and research attention due to their disruption of society, global health, and the economy. Several earlier reviews have investigated the occurrence and fate of SARS-CoV-2 in wastewater, and the potential to use such data in wastewater-based epidemiology. However, comprehensive reviews tracking SARS-CoV-2 and other viral pathogens in the wastewater-water-drinking water continuum and the associated risk assessment are still lacking. Therefore, to address this gap, the present paper makes the following contributions: (1) critically examines the early empirical results to highlight the occurrence and stability of SARS-CoV-2 in the wastewater-source water-drinking water continuum, (2) discusses the anthropogenic and hydro(geo)logical processes controlling the circulation of SARS-CoV-2 in the wastewater-source water-drinking water continuum, (3) discusses the risky behaviour, drivers and high-risk settings in the wastewater-source water-drinking water continuum, (4) uses the available empirical data on SARS-CoV-2 occurrence in the wastewater-source water-drinking water continuum to discuss human health risks from multiple exposure pathways, gendered aspects of SARS-CoV-2 transmission via shared on-site sanitation systems, and (5) develops and risk mitigation strategy based on the available empirical evidence and quantitative human risk assessment data. Finally, it presents a comprehensive research agenda on SARS-CoV-2/COVID-19 to guide the mitigation of future similar outbreaks in low-income settings.

Quantitative SARS-CoV-2 exposure assessment for workers in wastewater treatment plants using Monte-Carlo simulation

Several studies on COVID-19 pandemic have shown that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originating from human stool are detected in raw sewage for several days, leading to potential health risks for workers due to the production of bioaerosols and droplets during wastewater treatment process. In this study, data of SARS-CoV-2 concentrations in wastewater were gathered from literatures, and a quantitative microbial risk assessment with Monte Carlo simulation was used to estimate the daily probability of infection risk through exposure to viable infectious viral airborne particles of the workers during four seasons and under six environmental conditions. Inhalation of bioaerosols and direct ingestion of wastewater droplets were selected as exposure pathways. Spearman rank correlation coefficients were used for sensitivity analysis to identify the variables with the greatest influence on the infection risk probability. It was found that the daily probability of infection risk decreased with temperature (T) and relative humidity (RH) increase. The probability of direct droplet ingestion exposure pathway was higher than that of the bioaerosol inhalation pathway. The sensitivity analysis indicated that the most sensitive variable for both exposure pathways was the concentration of SARS-CoV-2 in stool. So, appropriate aeration systems, covering facilities, and effective ventilation are suggested to implement in wastewater treatment plants (WWTPs) to reduce emission concentration. Further to this, the exposure time (t) had a larger variance contribution than T and RH for the bioaerosol inhalation pathway. Implementing measures such as adding more work shifts, mandating personal protective equipment for all workers, and implementing coverage for treatment processes can significantly reduce the risk of infection among workers at WWTPs. These measures are particularly effective during environmental conditions with low temperatures and humidity levels.

A narrative review of alternative transmission routes of COVID 19: what we know so far

The Coronavirus disease 19 (COVID-19) pandemics, caused by severe acute respiratory syndrome coronaviruses, SARS-CoV-2, represent an unprecedented public health challenge. Beside person-to-person contagion via airborne droplets and aerosol, which is the main SARS-CoV-2's route of transmission, alternative modes, including transmission via fomites, food and food packaging, have been investigated for their potential impact on SARS-CoV-2 diffusion. In this context, several studies have demonstrated the persistence of SARS-CoV-2 RNA and, in some cases, of infectious particles on exposed fomites, food and water samples, confirming their possible role as sources of contamination and transmission. Indeed, fomite-to-human transmission has been demonstrated in a few cases where person-to-person transmission had been excluded. In addition, recent studies supported the possibility of acquiring COVID-19 through the fecal-oro route; the occurrence of COVID-19 gastrointestinal infections, in the absence of respiratory symptoms, also opens the intriguing possibility that these cases could be directly related to the ingestion of contaminated food and water. Overall, most of the studies considered these alternative routes of transmission of low epidemiological relevance; however, it should be considered that they could play an important role, or even be prevalent, in settings characterized by different environmental and socio-economic conditions. In this review, we discuss the most recent findings regarding SARS-CoV-2 alternative transmission routes, with the aim to disclose what is known about their impact on COVID-19 spread and to stimulate research in this field, which could potentially have a great impact, especially in low-resource contexts.

Anti-pandemic resilience assessment for countries along the Belt and Road route

Background

The COVID-19 pandemic is sweeping the world, and countries along the Belt and Road (B&R) route have also been hit hard. However, the impact varied greatly from country to country, some severely and others mildly. What factors have led to such a wide variation?

Method

In this paper, we considered institutional, infrastructural, economic, social, and technological resilience as components of overall anti-pandemic resilience, and constructed a set of indicators to evaluate this resilience for B&R countries in 2020. We evaluated the anti-pandemic resilience using the combined empowerment-VIKOR method, and classified the countries into different resilience levels by means of hierarchical clustering. The validity of the evaluation indicator system was verified by analyzing the consistency between the actual performance and the assessed resilience.

Results

The ranking results showed that Israel and Bahrain were representative of countries that had the highest resilience, Hungary and Estonia represented countries with moderate resilience, and Laos and Cambodia represented countries with the lowest resilience. We also found that countries with high resilience had much better institutional and economic resilience than countries with moderate resilience, whereas countries with low resilience lagged behind in both infrastructural and social resilience. Based on these findings, policy recommendations were offered to help B&R countries respond to future pandemics.

COVID-19 on the spectrum: a scoping review of hygienic standards

The emergence of COVID-19 in Wuhan, China, rapidly escalated into a worldwide public health crisis. Despite numerous clinical treatment endeavors, initial defenses against the virus primarily relied on hygiene practices like mask-wearing, meticulous hand hygiene (using soap or antiseptic solutions), and maintaining social distancing. Even with the subsequent advent of vaccines and the commencement of mass vaccination campaigns, these hygiene measures persistently remain in effect, aiming to curb virus transmission until the achievement of herd immunity. In this scoping review, we delve into the effectiveness of these measures and the diverse transmission pathways, focusing on the intricate interplay within the food network. Furthermore, we explore the virus's pathophysiology, considering its survival on droplets of varying sizes, each endowed with distinct aerodynamic attributes that influence disease dispersion dynamics. While respiratory transmission remains the predominant route, the potential for oral-fecal transmission should not be disregarded, given the protracted presence of viral RNA in patients' feces after the infection period. Addressing concerns about food as a potential viral vector, uncertainties shroud the virus's survivability and potential to contaminate consumers indirectly. Hence, a meticulous and comprehensive hygienic strategy remains paramount in our collective efforts to combat this pandemic.

Coverage of safely managed water, sanitation and hygiene: An application of small area estimation

Disaggregated information on welfare indicators is useful for targeted policies. This study constructs geographic maps of water, sanitation, and hygiene (WASH) for provinces and districts in Vietnam (which has 63 provinces and 712 districts). The study finds that poorer provinces and districts tend to have remarkably lower access to safely managed sanitation and water. Provinces in the Northern Midlands and Mountain Areas, and Central Highlands have the lowest level of access to safely managed sanitation and drinking water. There is a great variation in the availability of WASH facilities between districts within the same provinces. Additionally, the study highlights that districts with a higher population of ethnic minorities tend to experience lower rates of access to safely managed sanitation and drinking water. Even within the same district, moreover, ethnic minorities face greater challenges in accessing safely managed sanitation and drinking water compared to the majority Kinh population.

Risk factor for children in the pandemic: the use of cleaning products at home

Background

Intensified cleaning protocols to maintain a safe environment during the pandemic caused an increase in the use of disinfectants. The use of cleaning products in safer conditions by mothers is one of the important practices that will reduce the risk of household accidents.

Objective

The aim of research was determine the practices of mothers about the safe use of cleaning and disinfectant products in the COVID-19.

Methods

Data were collected by online survey among 255 mothers of the children 0-6 age from April and July 2021. Percentage, mean and chi-square tests were used to evaluate the data.

Results

It was reported that the amount of cleaning product usage (69%) increased significantly, 26.3% of the mothers store the products in a locked cabinet and 29.4% use the product in the recommended amount. It was detected 28.7% of the mothers use disinfectants close to children. It was detected that 37.6% of the families were exposed to cleaning and disinfectant products. There was not significant difference between exposure situations and maternal age, education, employment status.

Conclusions

It can be suggested that health workers should organize screening and training programs for the community about safe cleaning and disinfection practices.

The pit latrine paradox in low-income settings: A sanitation technology of choice or a pollution hotspot?

Pit latrines are widely promoted to improve sanitation in low-income settings, but their pollution and health risks receive cursory attention. The present narrative review presents the pit latrine paradox; (1) the pit latrine is considered a sanitation technology of choice to safeguard human health, and (2) conversely, pit latrines are pollution and health risk hotspots. Evidence shows that the pit latrine is a 'catch-all' receptacle for household disposal of hazardous waste, including; (1) medical wastes (COVID-19 PPE, pharmaceuticals, placenta, used condoms), (2) pesticides and pesticide containers, (3) menstrual hygiene wastes (e.g., sanitary pads), and (4) electronic wastes (batteries). Pit latrines serve as hotspot reservoirs that receive, harbour, and then transmit the following into the environment; (1) conventional contaminants (nitrates, phosphates, pesticides), (2) emerging contaminants (pharmaceuticals and personal care products, antibiotic resistance), and (3) indicator organisms, and human bacterial and viral pathogens, and disease vectors (rodents, houseflies, bats). As greenhouse gas emission hotspots, pit latrines contribute 3.3 to 9.4 Tg/year of methane, but this could be an under-estimation. Contaminants in pit latrines may migrate into surface water, and groundwater systems serving as drinking water sources and pose human health risks. In turn, this culminates into the pit latrine-groundwater-human continuum or connectivity, mediated via water and contaminant migration. Human health risks of pit latrines, a critique of current evidence, and current and emerging mitigation measures are presented, including isolation distance, hydraulic liners/ barriers, ecological sanitation, and the concept of a circular bioeconomy. Finally, future research directions on the epidemiology and fate of contaminants in pit latrines are presented. The pit latrine paradox is not meant to downplay pit latrines' role or promote open defaecation. Rather, it seeks to stimulate discussion and research to refine the technology to enhance its functionality while mitigating pollution and health risks.

Is SARS-CoV-2 a concern in the largest wastewater treatment plant in middle east?

The surveillance of wastewater treatment plant (WWTP) as the end point of SARS-CoV-2 shed from infected people arise a speculation on transmission of this virus of concern from WWTP in epidemic period. To this end, the present study was developed to comprehensively investigate the presence of SARS-CoV-2 in raw wastewater, effluent and air inhaled by workers and employee in the largest WWTP in Tehran for one-year study period. The monthly raw wastewater, effluent and air samples of WWTP were taken and the SARS-CoV-2 RNA were detected using QIAamp Viral RNA Mini Kit and real-time RT-PCR assay. According to results, the speculation on the presence of SARS-CoV-2 was proved in WWTP by detection this virus in raw wastewater. However, no SARS-CoV-2 was found in both effluent and air of WWTP; this presents the low or no infection for workers and employee in WWTP. Furthermore, further research are needed for detection the SARS-CoV-2 in solid and biomass produced from WWTP processes due to flaks formation, followed by sedimentation in order to better understand the wastewater-based epidemiology and preventive measurement for other epidemics probably encountered in the future.

Responsiveness of water-sector regulation in Brazil to the Covid-19 pandemic: A view through the human rights lens

This paper provides an overview of the regulatory responses to Covid-19 from the regulatory authorities of Brazilian states. This paper aims to provide new insights into the operationalization of the human rights to water and sanitation in the Brazilian regulatory authorities' actions during a health emergency. We find that communities located in unserved areas were not mentioned in the regulatory responses, nor were people in vulnerable situations. Equity and non-discrimination principles were correlated more with economic measures. This study has also identified the absence of responses related to access to sanitation facilities, with normative contents related to the issue not appearing in the content analysis.

Comparative evaluation of advanced oxidation processes (AOPs) for reducing SARS-CoV-2 viral load from campus sewage water

Presence of SARS-CoV-2 in wastewater is a major concern as the wastewater meets rivers and other water bodies and is used by the population for various purposes. Hence it is very important to treat sewage water in an efficient manner in order to reduce the public health risk. In the present work, various advanced oxidation processes (AOPs) have been evaluated for disinfection of SARS-CoV-2 from sewage water collected from STP inlet of academic institutional residential. The sewage water was subjected to ten AOPs, which include Ozone (O₃), Hydrodynamic cavitation (HC), Ultraviolet radiation (UV), and their hybrid combinations like HC/O₃, HC/O₃/H₂O₂, HC/H₂O_2, O₃/UV, UV/H₂O₂, UV/H₂O₂/O_3, and O₃/H₂O₂ to reduce SARS-CoV-2 viral load. Further, AOP treated sewage water was subjected to total nucleic acid isolation followed by RT-qPCR for viral load estimation. The sewage water treatment techniques were evaluated based on their viral concentration-reducing efficiency. It was found that ozone and ozone-coupled hybrid AOPs showed the most promising result with more than 98 % SARS-CoV-2 viral load reducing efficiency from sewage water. Interestingly, the best six AOPs used in this study significantly reduced both the SARS-CoV-2 and PMMoV (faecal indicator) viral load and improved water quality in terms of increasing DO and decreasing TOC.

Wastewater monitoring in tourist cities as potential sentinel sites for near real-time dynamics of imported SARS-CoV-2 variants

Wastewater-based epidemiology (WBE) complements the clinical surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its variants' distribution in populations. Many developed nations have established national and regional WBE systems; however, governance and budget constraints could be obstacles for low- and middle-income countries. An urgent need thus exists to identify hotspots to serve as sentinel sites for WBE. We hypothesized that representative wastewater treatment plants (WWTPs) in two international gateway cities, Bangkok and Phuket, Thailand, could be sentineled for SARS-CoV-2 and its variants to reflect the clinical distribution patterns at city level and serve as early indicators of new variants entering the country. Municipal wastewater samples (n = 132) were collected from eight representative municipal WWTPs in Bangkok and Phuket during 19 sampling events from October 2021 to March 2022, which were tested by reverse transcription-quantitative polymerase chain reaction (RT-qPCR) using the US CDC N1 and N2 multiplex and variant (Alpha, Delta, and Omicron BA.1 and BA.2) singleplex assays. The variant detection ratios from Bangkok and Phuket followed similar trends to the national clinical testing data, and each variant's viral loads agreed with the daily new cases (3-d moving average). Omicron BA.1 was detected in Phuket wastewater prior to Bangkok, possibly due to Phuket's WWTPs serving tourist communities. We found that the Omicron BA.1 and BA.2 viral loads predominantly drove the SARS-CoV-2 resurgence. We also noted a shifting pattern in the Bangkok WBE from a 22-d early warning in early 2021 to a near real-time pattern in late 2021. The potential application of tourist hotspots for WBE to indicate the arrival of new variants and re-emerging or unprecedented infectious agents could support tourism-dependent economies by complementing the reduced clinical regulations while maintaining public health protection via wastewater surveillance.

Assessing the impact of COVID-19 restrictions on the microbial quality of an urban water catchment and the associated probability of waterborne infections

The World Health Organization reported that COVID-19 cases reached 611,421,786 globally by September 23, 2022. Six months after the first reported case, the disease had spread rapidly, reaching pandemic status, leading to numerous preventive measures to curb the spread, including a complete shutdown of many activities worldwide. Such restrictions affected services like waste management, resulting in waste accumulation in many communities and increased water pollution. Therefore, the current study investigated if lockdown impacted surface water microbial quality within an urban water catchment in South Africa. Using quantitative microbial risk assessment, the study further assessed changes in the probability of infection (Pi) with gastrointestinal illnesses from exposure to polluted water in the catchment. Escherichia coli data for 2019, 2020 and 2021 - pre-COVID, lockdown, and post-lockdown periods, respectively - were collected from the area's wastewater treatment management authorities. The Pi was determined using a beta-Poisson model. Mean overall E. coli counts ranged from 2.93 ± 0.16 to 5.30 ± 1.07 Log₁₀ MPN/100 mL. There was an overall statistically significant increase in microbial counts from 2019 to 2021. However, this difference was only accounted for between 2019 and 2021 (p = 0.008); the increase was insignificant between 2019 and 2020, and 2020 and 2021. The Pi revealed a similar trend for incidental ingestion of 100 mL and 1 mL of polluted water. No statistically significant difference was observed between the years based on multiple exposures. Although the overall microbial load and Pi estimated within the catchment exceeded the local and international limits recommended for safe use by humans, especially for drinking and recreation, these were not significantly affected by the COVID-19 restrictions. Nevertheless, these could still represent a health hazard to immunocompromised individuals using such water for personal and household hygiene, especially in informal settlements without access to water and sanitation services.

COVID-19 and Water Variables: Review and Scientometric Analysis

COVID-19 has changed the world since 2020, and the field of water specifically, boosting scientific productivity (in terms of published articles). This paper focuses on the influence of COVID-19 on scientific productivity with respect to four water variables: (i) wastewater, (ii) renewable water resources, (iii) freshwater withdrawal, and (iv) access to improved and safe drinking water. The field's literature was firstly reviewed, and then the maps were built, emphasizing the strong connections between COVID-19 and water-related variables. A total of 94 countries with publications that assess COVID-19 vs. water were considered and evaluated for how they clustered. The final step of the research shows that, on average, scientific productivity on the water topic was mostly conducted in countries with lower COVID-19 infection rates but higher development levels as represented by gross domestic product (GDP) per capita and the human development index (HDI). According to the statistical analysis, the water-related variables are highly significant, with positive coefficients. This validates that countries with higher water-related values conducted more research on the relationship with COVID-19. Wastewater and freshwater withdrawal had the highest impact on the scientific productivity with respect to COVID-19. Access to safe drinking water becomes insignificant in the presence of the development parameters.

Recent advances of nanotechnology in COVID 19: A critical review and future perspective

The global anxiety and economic crisis causes the deadly pandemic coronavirus disease of 2019 (COVID 19) affect millions of people right now. Subsequently, this life threatened viral disease is caused due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). However, morbidity and mortality of infected patients are due to cytokines storm syndrome associated with lung injury and multiorgan failure caused by COVID 19. Thereafter, several methodological advances have been approved by WHO and US-FDA for the detection, diagnosis and control of this wide spreadable communicable disease but still facing multi-challenges to control. Herein, we majorly emphasize the current trends and future perspectives of nano-medicinal based approaches for the delivery of anti-COVID 19 therapeutic moieties. Interestingly, Nanoparticles (NPs) loaded with drug molecules or vaccines resemble morphological features of SARS-CoV-2 in their size (60–140 nm) and shape (circular or spherical) that particularly mimics the virus facilitating strong interaction between them. Indeed, the delivery of anti-COVID 19 cargos via a nanoparticle such as Lipidic nanoparticles, Polymeric nanoparticles, Metallic nanoparticles, and Multi-functionalized nanoparticles to overcome the drawbacks of conventional approaches, specifying the site-specific targeting with reduced drug loading and toxicities, exhibit their immense potential. Additionally, nano-technological based drug delivery with their peculiar characteristics of having low immunogenicity, tunable drug release, multidrug delivery, higher selectivity and specificity, higher efficacy and tolerability switch on the novel pathway for the prevention and treatment of COVID 19.

Persistence and occurrence of SARS-CoV-2 in water and wastewater environments: a review of the current literature

As the world continues to cope with the COVID-19 pandemic, emerging evidence indicates that respiratory transmission may not the only pathway in which the virus can be spread. This review paper aims to summarize current knowledge surrounding possible fecal-oral transmission of SARS-CoV-2. It covers recent evidence of proliferation of SARS-CoV-2 in the gastrointestinal tract, as well as presence and persistence of SARS-CoV-2 in water, and suggested future directions. Research indicates that SARS-CoV-2 can actively replicate in the human gastrointestinal system and can subsequently be shed via feces. Several countries have reported SARS-CoV-2 RNA fractions in wastewater systems, and various factors such as temperature and presence of solids have been shown to affect the survival of the virus in water. The detection of RNA does not guarantee infectivity, as current methods such as RT-qPCR are not yet able to distinguish between infectious and non-infectious particles. More research is needed to determine survival time and potential infectivity, as well as to develop more accurate methods for detection and surveillance.

A safe haven of SARS-CoV-2 in the environment: Prevalence and potential transmission risks in the effluent, sludge, and biosolids

The novel coronavirus, SARS-CoV-2, which has caused millions of death globally is recognized to be unstable and recalcitrant in the environment, especially in the way it has been evolving to form new and highly transmissible variants. Of particular concerns are human-environment interactions and the handling and reusing the environmental materials, such as effluents, sludge, or biosolids laden with the SARS-CoV-2 without adequate treatments, thereby suggesting potential transmission and health risks. This study assesses the prevalence of SARS-CoV-2 RNA in effluents, sludge, and biosolids. Further, we evaluate the environmental, ecological, and health risks of reusing these environmental materials by wastewater/sludge workers and farmers. A systematic review of literature from the Scopus database resulted in a total of 21 articles (11 for effluents, 8 for sludge, and 2 for biosolids) that met the criteria for meta-analysis, which are then subdivided into 30 meta-analyzed studies. The prevalence of SAR-CoV-2 RNA in effluent and sludge based on random-effect models are 27.51 and 10^12.25, respectively, with a 95% CI between 6.14 and 48.89 for the effluent, and 10^4.78 and 10^19.71 for the sludge. However, the prevalence of SARS-CoV-2 RNA in the biosolids based on the fixed-effect model is 30.59, with a 95% CI between 10.10 and 51.08. The prevalence of SARS-CoV-2 RNA in environmental materials indicates the inefficiency in some of the treatment systems currently deployed to inactivate and remove the novel virus, which could be a potential health risk concern to vulnerable wastewater workers in particular, and the environmental and ecological issues for the population at large. This timely review portends the associated risks in handling and reusing environmental materials without proper and adequate treatments.

Study of the correlation between Covid-19 cases and deaths and basic sanitation in Brazil: Is this a possible secondary route of virus transmission?

People with COVID-19 may excrete viable SARS-CoV-2 virus through urine and faeces, which has raised concerns about the possibility of transmission of COVID-19 via water contaminated or sewage. These concerns are especially exacerbated in underdeveloped countries like Brazil, where untreated sewage is usually discharged to surface water or soil. Because of that, a hypothesis emerged that was addressed in this study, which seeks to understand whether access to basic sanitation services can influence the proliferation of the virus. A correlation study was carried out between the cases of COVID-19 and the indicators of basic sanitation from all regions of Brazil. The results showed that there was a correlation only with the water supply indicator. A hypothesis that would explain the presented correlation would be the inefficiency of the water treatment systems in Brazil, not totally inactivating the virus, or possible contamination of the water distribution networks by sanitary sewage. In general, the data presented reinforce the need to expand and monitor basic sanitation services, especially to ensure the effective and efficient disinfection of drinking water. This monitoring could be useful for early warning surveillance of the spread of the virus.

A critical review on the existing wastewater treatment methods in the COVID-19 era: What is the potential of advanced oxidation processes in combatting viral especially SARS-CoV-2?

The COVID-19 epidemic has put the risk of virus contamination in water bodies on the horizon of health authorities. Hence, finding effective ways to remove the virus, especially SARS-CoV-2, from wastewater treatment plants (WWTPs) has emerged as a hot issue in the last few years. Herein, this study first deals with the fate of SARS-CoV-2 genetic material in WWTPs, then critically reviews and compares different wastewater treatment methods for combatting COVID-19 as well as to increase the water quality. This critical review sheds light the efficiency of advanced oxidation processes (AOPs) to inactivate virus, specially SARS-CoV-2 RNA. Although several physicochemical treatment processes (e.g. activated sludge) are commonly used to eliminate pathogens, AOPs are the most versatile and effective virus inactivation methods. For instance, TiO₂ is the most known and widely studied photo-catalyst innocuously utilized to degrade pollutants as well as to photo-induce bacterial and virus disinfection due to its high chemical resistance and efficient photo-activity. When ozone is dissolved in water and wastewater, it generates a wide spectrum of the reactive oxygen species (ROS), which are responsible to degrade materials in virus membranes resulting in destroying the cell wall. Furthermore, electrochemical advanced oxidation processes act through direct oxidation when pathogens react at the anode surface or by indirect oxidation through oxidizing species produced in the bulk solution. Consequently, they represent a feasible choice for the inactivation of a wide range of pathogens. Nonetheless, there are some challenges with AOPs which should be addressed for application at industrial-scale.

Global occurrence of SARS-CoV-2 in environmental aquatic matrices and its implications for sanitation and vulnerabilities in Brazil and developing countries

This paper includes a systematic review of the SARS-CoV-2 occurrence in environmental aquatic matrices and a critical sanitation analysis. We discussed the interconnection of sanitation services (wastewater, water supply, solid waste, and stormwater drainage) functioning as an important network for controlling the spread of SARS-CoV-2 in waters. We collected 98 studies containing data of the SARS-CoV-2 occurrence in aquatic matrices around the world, of which 40% were from developing countries. Alongside a significant number of people infected by the virus, developing countries face socioeconomic deficiencies and insufficient public investment in infrastructure. Therefore, our study focused on highlighting solutions to provide sanitation in developing countries, considering the virus control in waters by disinfection techniques and sanitary measures, including alternatives for the vulnerable communities. The need for multilateral efforts to improve the universal coverage of sanitation services demands urgent attention in a pandemic scenario.

Elucidating the role of environmental management of forests, air quality, solid waste and wastewater on the dissemination of SARS-CoV-2

The increasing frequency of zoonotic diseases is amongst several catastrophic repercussions of inadequate environmental management. Emergence, prevalence, and lethality of zoonotic diseases is intrinsically linked to environmental management which are currently at a destructive level globally. The effects of these links are complicated and interdependent, creating an urgent need of elucidating the role of environmental mismanagement to improve our resilience to future pandemics. This review focused on the pertinent role of forests, outdoor air, indoor air, solid waste and wastewater management in COVID-19 dissemination to analyze the opportunities prevailing to control infectious diseases considering relevant data from previous disease outbreaks. Global forest management is currently detrimental and hotspots of forest fragmentation have demonstrated to result in zoonotic disease emergences. Deforestation is reported to increase susceptibility to COVID-19 due to wildfire induced pollution and loss of forest ecosystem services. Detection of SARS-CoV-2 like viruses in multiple animal species also point to the impacts of biodiversity loss and forest fragmentation in relation to COVID-19. Available literature on air quality and COVID-19 have provided insights into the potential of air pollutants acting as plausible virus carrier and aggravating immune responses and expression of ACE2 receptors. SARS-CoV-2 is detected in outdoor air, indoor air, solid waste, wastewater and shown to prevail on solid surfaces and aerosols for prolonged hours. Furthermore, lack of protection measures and safe disposal options in waste management are evoking concerns especially in underdeveloped countries due to high infectivity of SARS-CoV-2. Inadequate legal framework and non-adherence to environmental regulations were observed to aggravate the postulated risks and vulnerability to future waves of pandemics. Our understanding underlines the urgent need to reinforce the fragile status of global environmental management systems through the development of strict legislative frameworks and enforcement by providing institutional, financial and technical supports.

Sustainable Development Goals in the COVID-19 Pandemic: A Narrative Review

The present narrative review aimed to analyze the impact of the COVID-19 pandemic on the sustainable development goals (SDGS). This information would allow a better comprehension of the actual state of the SDGS and a more efficient programming in future interventions. To achieve the objective of the study, a consensual and critical review was carried out using both primary sources, such as scientific articles, and secondary sources, such as bibliographic indexes, web pages and databases. The Sustainable Development Goals are a global call to action to end poverty, close the gender gap, protect the planet, and improve the lives of people around the world. In 2015, the United Nations General Assembly adopted 17 goals as part of the 2030 Agenda for Sustainable Development, which sets out a plan to achieve the goals in 15 years. However, the COVID-19 pandemic crisis has been a turning point in the achievement of these goals, due to all its consequences at the political, economic, and socio-cultural levels. This review can be used as a guide for future research and reviews in order to understand the status of each of the SDGs and what actions have been taken and proposed in the aftermath of the pandemic in recent years.

A Review on SARS-CoV-2 Genome in the Aquatic Environment of Africa: Prevalence, Persistence and the Future Prospects

The COVID-19 pandemic (Coronavirus disease 2019) remains problematic in all its manifestations on the global stage where countless events of human-to-human exposure have led to fatal cases; thus, the aftermath being an unprecedented public health concern, with inaccessible health care and the instability of economies and financial institutions. These pose massive obstacles that can insatiably devour existing human resources causing negative impacts, especially in developing countries. Tracking the origin, dissemination and mutating strains of the novel severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) on population-wide scales is a somewhat overwhelming task, with the urgent need to map the dissemination and magnitude of SARS-CoV-2 in near real-time. This review paper focuses on the poor sanitation of some waterbodies and wastewater management policies in low-income African countries, highlighting how these contribute to the COVID-19 pandemic on the continent. Since the outbreak of the novel coronavirus pandemic, there has been an upsurge in scientific literature and studies concerning SARS-CoV-2 with different opinions and findings. The current paper highlights the challenges and also summarizes the environmental aspects related to the monitoring and fate of the SARS-CoV-2 genomes in the aquatic milieu of Sub-Saharan Africa.

The critical need for WASH in emergency preparedness in health settings, the case of COVID-19 pandemic in Kisumu Kenya

The devastating effects of inadequate basic utilities such as water, sanitation, hygiene, waste management and environmental cleaning (WASH) is underscored by the current global pandemic declared on March 11, 2020. This paper explores the experiences of key informants (n = 15) ie government and non-government organization officials on the impacts of the COVID-19 pandemic in health care facilities (HCFs) and the role of WASH in emergency preparedness in health settings and the communities they serve using Kisumu, Kenya as a case study. The results from interviews with the key informants indicate socioecological challenges shaping access to hygiene services in HCFs and related disparities in social determinants of health such as WASH that serve as barriers to the pandemic response. All participants indicated the healthcare system was ill-prepared for the pandemic. Health care workers experienced such severe psychosocial impacts due to the lack of preparedness that they subsequently embarked on strikes in protest. These situations influenced citizens' perceptions of the COVID-19 pandemic as a hoax and resulted in a surge in other population health indicators (e.g., increased maternal mortality; decreased vaccination rates for other illnesses such as measles). We recommend authentic partnerships among all stakeholders to develop and implement context-driven sustainable solutions that integrate WASH and emergency preparedness in HCFs and the communities they serve across all spatial scales, from the global to the local.

Opportunities and limits of wastewater-based epidemiology for tracking global health and attainment of UN sustainable development goals

Wastewater-based epidemiology (WBE) emerged as a powerful, actionable health management tool during the COVID-19 pandemic. Hypothesizing future uses, we explored its potential for real-time, tracking of progress in attaining United Nations Sustainable Development Goals (SDGs) globally as a non-expensive method using existing infrastructure. We inventoried (i) literature-documented sewerage infrastructure, (ii) demographics of populations served, and (iii) WBE markers informative of 9 SDGs. Among the 17 different sustainable development goals listed by the UN 2030 agenda, more than half of these may be monitored by using WBE monitoring at centralized treatment infrastructure as tabulated in this study. Driven mainly by COVID-19, WBE currently is practiced in at least 55 countries, reaching about 300 million people. Expansion of WBE to 109,000 + treatment plants inventoried in 129 countries would increase global coverage 9-fold to 34.7% or 2.7 billion, leaving out 5 billion people not served by centralized sewerage systems. Associations between population demographics and present-day infrastructure are explored, and geospatial regions particularly vulnerable to infectious disease outbreaks are identified. The results suggest that difference in the differential outcomes in well-being is an outcome of the sanitation infrastructure inequalities and lack of sanitation infrastructure creates doubly disadvantaged populations at risk of poor hygiene and cut off from the early-warning benefits of conventional WBE. This is the first study to explore the feasibility and potential barriers to the use of WBE for tracking the attainment of SDGs globally with at least 9 out of 17 SDGs.

Successful application of wastewater-based epidemiology in prediction and monitoring of the second wave of COVID-19 with fragmented sewerage systems-a case study of Jaipur (India)

The present study tracked the city-wide dynamics of severe acute respiratory syndrome-corona virus 2 ribonucleic acids (SARS-CoV-2 RNA) in the wastewater from nine different wastewater treatment plants (WWTPs) in Jaipur during the second wave of COVID-19 out-break in India. A total of 164 samples were collected weekly between February 19th and June 8th, 2021. SARS-CoV-2 was detected in 47.2% (52/110) influent samples and 37% (20/54) effluent samples. The increasing percentage of positive influent samples correlated with the city's increasing active clinical cases during the second wave of COVID-19 in Jaipur. Furthermore, wastewater-based epidemiology (WBE) evidence clearly showed early detection of about 20 days (9/9 samples reported positive on April 20th, 2021) before the maximum cases and maximum deaths reported in the city on May 8th, 2021. The present study further observed the presence of SARS-CoV-2 RNA in treated effluents at the time window of maximum active cases in the city even after tertiary disinfection treatments of ultraviolet (UV) and chlorine (Cl₂) disinfection. The average genome concentration in the effluents and removal efficacy of six commonly used treatments, activated sludge process + chlorine disinfection (ASP + Cl₂), moving bed biofilm reactor (MBBR) with ultraviolet radiations disinfection (MBBR + UV), MBBR + chlorine (Cl₂), sequencing batch reactor (SBR), and SBR + Cl₂, were compared with removal efficacy of SBR + Cl₂ (81.2%) > MBBR + UV (68.8%) > SBR (57.1%) > ASP (50%) > MBBR + Cl₂ (36.4%). The study observed the trends and prevalence of four genes (E, RdRp, N, and ORF1ab gene) based on two different kits and found that prevalence of N > ORF1ab > RdRp > E gene suggested that the effective genome concentration should be calculated based on the presence/absence of multiple genes. Hence, it is imperative to say that using a combination of different detection genes (E, N, RdRp, & ORF1ab genes) increases the sensitivity in WBE.

Are leading urban centers predisposed to global risks- A analysis of the global south from COVID-19 perspective

COVID-19 initially spread among prominent global cities and soon to the urban centers of countries across the globe. While cities are the hotbeds of activities, they also seem highly exposed to global risks including the pandemic. Using the case of COVID-19 and the World Risk Index framework, this paper examines if the leading cities from the global south are inherently vulnerable and exposed to global risks and can they exacerbate the overall risk of their respective nations. Compared against their respective national averages, most of the 20 cities from 10 countries analyzed in this paper, have higher exposure, lower adaptive capacity, higher coping capacity and varied susceptibility. As this relative understanding is based on respective national averages which are often lower than the global standards, even high performance on certain indicators may still result in elevated predisposition. This paper concludes that the leading urban centers from the global south are highly likely to be predisposed to global risks due to their inherent vulnerability and exposure, and many of the drivers of this predisposition are related to the process of urbanization itself. This predisposition can enhance the overall exposure and vulnerability of the nation in which they are located.

Antimicrobial Resistance in Rivers: A Review of the Genes Detected and New Challenges

River ecosystems are very important parts of the water cycle and an excellent habitat, food, and drinking water source for many organisms, including humans. Antibiotics are emerging contaminants which can enter rivers from various sources. Several antibiotics and their related antibiotic resistance genes (ARGs) have been detected in these ecosystems by various research programs and could constitute a substantial problem. The presence of antibiotics and other resistance cofactors can boost the development of ARGs in the chromosomes or mobile genetic elements of natural bacteria in rivers. The ARGs in environmental bacteria can also be transferred to clinically important pathogens. However, antibiotics and their resistance genes are both not currently monitored by national or international authorities responsible for controlling the quality of water bodies. For example, they are not included in the contaminant list in the European Water Framework Directive or in the US list of Water-Quality Benchmarks for Contaminants. Although ARGs are naturally present in the environment, very few studies have focused on non-impacted rivers to assess the background ARG levels in rivers, which could provide some useful indications for future environmental regulation and legislation. The present study reviews the antibiotics and associated ARGs most commonly measured and detected in rivers, including the primary analysis tools used for their assessment. In addition, other factors that could enhance antibiotic resistance, such as the effects of chemical mixtures, the effects of climate change, and the potential effects of the coronavirus disease 2019 pandemic, are discussed. Environ Toxicol Chem 2022;41:687-714. © 2022 SETAC.

SARS-CoV-2 RNA surveillance in large to small centralized wastewater treatment plants preceding the third COVID-19 resurgence in Bangkok, Thailand

Wastewater surveillance for SARS-CoV-2 RNA has been a successful indicator of COVID-19 outbreaks in populations prior to clinical testing. However, this has been mostly conducted in high-income countries, which means there is a dearth of performance investigations in low- and middle-income countries with different socio-economic settings. This study evaluated the applicability of SARS-CoV-2 RNA monitoring in wastewater (n = 132) to inform COVID-19 infection in the city of Bangkok, Thailand using CDC N1 and N2 RT-qPCR assays. Wastewater influents (n = 112) and effluents (n = 20) were collected from 19 centralized wastewater treatment plants (WWTPs) comprising four large, four medium, and 11 small WWTPs during seven sampling events from January to April 2021 prior to the third COVID-19 resurgence that was officially declared in April 2021. The CDC N1 assay showed higher detection rates and mostly lower Ct values than the CDC N2. SARS-CoV-2 RNA was first detected at the first event when new reported cases were low. Increased positive detection rates preceded an increase in the number of newly reported cases and increased over time with the reported infection incidence. Wastewater surveillance (both positive rates and viral loads) showed strongest correlation with daily new COVID-19 cases at 22-24 days lag (Spearman's Rho = 0.85-1.00). Large WWTPs (serving 432,000-580,000 of the population) exhibited similar trends of viral loads and new cases to those from all 19 WWTPs, emphasizing that routine monitoring of the four large WWTPs could provide sufficient information for the city-scale dynamics. Higher sampling frequency at fewer sites, i.e., at the four representative WWTPs, is therefore suggested especially during the subsiding period of the outbreak to indicate the prevalence of COVID-19 infection, acting as an early warning of COVID-19 resurgence.

Wastewater, waste, and water-based epidemiology (WWW-BE): A novel hypothesis and decision-support tool to unravel COVID-19 in low-income settings?

Traditional wastewater-based epidemiology (W-BE) relying on SARS-CoV-2 RNA detection in wastewater is attractive for understanding COVID-19. Yet traditional W-BE based on centralized wastewaters excludes putative SARS-CoV-2 reservoirs such as: (i) wastewaters from shared on-site sanitation facilities, (ii) solid waste including faecal sludge from non-flushing on-site sanitation systems, and COVID-19 personal protective equipment (PPE), (iii) raw/untreated water, and (iv) drinking water supply systems in low-income countries (LICs). A novel hypothesis and decision-support tool based on Wastewater (on-site sanitation, municipal sewer systems), solid Waste, and raw/untreated and drinking Water-based epidemiology (WWW-BE) is proposed for understanding COVID-19 in LICs. The WWW-BE conceptual framework, including components and principles is presented. Evidence on the presence of SARS-CoV-2 and its proxies in wastewaters, solid materials/waste (papers, metals, fabric, plastics), and raw/untreated surface water, groundwater and drinking water is discussed. Taken together, wastewaters from municipal sewer and on-site sanitation systems, solid waste such as faecal sludge and COVID-19 PPE, raw/untreated surface water and groundwater, and drinking water systems in LICs act as potential reservoirs that receive and harbour SARS-CoV-2, and then transmit it to humans. Hence, WWW-BE could serve a dual function in estimating the prevalence and potential transmission of COVID-19. Several applications of WWW-BE as a hypothesis and decision support tool in LICs are discussed. WWW-BE aggregates data from various infected persons in a spatial unit, hence, putatively requires less resources (analytical kits, personnel) than individual diagnostic testing, making it an ideal decision-support tool for LICs. The novelty, and a critique of WWW-BE versus traditional W-BE are presented. Potential challenges of WWW-BE include: (i) biohazards and biosafety risks, (ii) lack of expertise, analytical equipment, and accredited laboratories, and (iii) high uncertainties in estimates of COVID-19 cases. Future perspectives and research directions including key knowledge gaps and the application of novel and emerging technologies in WWW-BE are discussed.

COVID-19 in Latin America and the Caribbean Region: Symptoms and Morbidities in the Epidemiology of Infection

The COVID-19 pandemic has widespread economic and social effects on Latin America (LA) and the Caribbean (CA). This region, which has a high prevalence of chronic diseases, has been one of the most affected during the pandemic. Multiple symptoms and comorbidities are related to distinct COVID-19 outcomes. However, there has been no explanation as to why different patients present with different arrays of clinical presentations. Studies report that similar to comorbidities, each country in LA and the CA has its own particular health issues. Moreover, economic and social features have yet to be studied in detail to obtain a complete perspective of the disease in the region. Herein, the impact of demographic and economic characteristics in LA and the CA on COVID-19 are presented in combination with symptoms and comorbidities related to the disease as important aspects that can influence management and treatment.

Evaluation of potentiality of traditional hygienic practices for the mitigation of the 2019-2020 Corona Pandemic

The coronavirus outbreak threatens global well-being, costing thousands of lives and an unstable economy. Traditional hand-washing (HaWa) with clean water and hand-washing sanitizers (HaWaSas) are among WHO recommended practices against the outbreaks. HaWaSa and HaWa lacked proper quality monitoring evaluation that may pose health risks. The current study investigates the potential of traditional hygienic practices adopted to mitigate the 2019-2020 Pandemic. It involved assessing the effectiveness of 15 HaWaSa collected from the Dodoma market. Thirty volunteered participants were subjected to different hygienic practices involving HaWa and HaWaSa. The obtained hand-swabbed samples were subjected to the streak plate technique for inoculation, followed by counting colonies. The results revealed that, among the collected HaWaSa brands, only 33.3% were certified by the Tanzania Bureau of Standards (TBS). In the setting under no hand-wash, each client had a different number of colony counts. HaWa did not eliminate all colonies since water acted as a secondary source while only one sanitizer proved effective. The p-values obtained in either setting were greater than 0.05, indicating that each variable was independent. Despite global awareness and fighting against the Coronavirus Disease 2019 (Covid-19) outbreak, quality monitoring of all diagnostic tools, preventive HaWaSa, and related drugs should be prioritized for human safeguard.

Addressing Inequalities Toward Inclusive Governance for Achieving One Health: A Rapid Review

Sustainable development goals (SDGs) adopted in 2015 are geared toward sustainable development through various pathways, one being reducing inequality as covered in SDG 10. Inequalities are a threat to health and wellbeing of populations and a planet Earth in which we live. This rapid review aims to identify key issues that are likely to exacerbate inequalities around the six SDGs directly related to One Health, which are SDG 3, 6, 11, 13, 14 and 15, and suggest some actions that may help to address them using inclusive governance taking into account the coronavirus disease of 2019 (COVID-19) pandemic. Informed by the literature on SDGs and using the “inclusive development concept” by Gupta and Vegelin, literature search was done in Google Scholar, PubMed Central, as well as, searching of references in the relevant articles identified using search terms from the six SDGs that are directly related to One Health. In the context of the SDGs, in order to achieve One Health through inclusive governance, and tackle inequalities, the following needs to be considered and addressed: increasing number of armed conflicts; ongoing COVID-19 pandemic; ensuring availability of water and sanitation facilities; improving city and urban areas planning to cope with climate change; improving governance arrangements for addressing climate change factoring gender and human rights; multisectoral planning for conservation of oceans, seas, and marine resources; balancing trade regulation of wildlife trade with conservation efforts; need for a research collaborative involving experts from environmental sciences, wildlife, agriculture and human health to study and develop scientific evidence on contribution of changes in land use practices to occurrence of zoonotic diseases; and need of a legislation for promoting animal welfare to protect public health. Also, inclusion of people with disabilities in the use of digital technologies is critical.

SARS-CoV-2 and other pathogens in municipal wastewater, landfill leachate, and solid waste: A review about virus surveillance, infectivity, and inactivation

This review discusses the techniques available for detecting and inactivating of pathogens in municipal wastewater, landfill leachate, and solid waste. In view of the current COVID-19 pandemic, SARS-CoV-2 is being given special attention, with a thorough examination of all possible transmission pathways linked to the selected waste matrices. Despite the lack of works focused on landfill leachate, a systematic review method, based on cluster analysis, allows to analyze the available papers devoted to sewage sludge and wastewater, allowing to focalize the work on technologies able to detect and treat pathogens. In this work, great attention is also devoted to infectivity and transmission mechanisms of SARS-CoV-2. Moreover, the literature analysis shows that sewage sludge and landfill leachate seem to have a remote chance to act as a virus transmission route (pollution-to-human transmission) due to improper collection and treatment of municipal wastewater and solid waste. However due to the incertitude about virus infectivity, these possibilities cannot be excluded and need further investigation. As a conclusion, this paper shows that additional research is required not only on the coronavirus-specific disinfection, but also the regular surveillance or monitoring of viral loads in sewage sludge, wastewater, and landfill leachate. The disinfection strategies need to be optimized in terms of dosage and potential adverse impacts like antimicrobial resistance, among many other factors. Finally, the presence of SARS-CoV-2 and other pathogenic microorganisms in sewage sludge, wastewater, and landfill leachate can hamper the possibility to ensure safe water and public health in economically marginalized countries and hinder the realization of the United Nations' sustainable development goals (SDGs).

Impact of sewer overflow on public health: A comprehensive scientometric analysis and systematic review

Sewer overflow (SO), which has attracted global attention, poses serious threat to public health and ecosystem. SO impacts public health via consumption of contaminated drinking water, aerosolization of pathogens, food-chain transmission, and direct contact with fecally-polluted rivers and beach sediments during recreation. However, no study has attempted to map the linkage between SO and public health including Covid-19 using scientometric analysis and systematic review of literature. Results showed that only few countries were actively involved in SO research in relation to public health. Furthermore, there are renewed calls to scale up environmental surveillance to safeguard public health. To safeguard public health, it is important for public health authorities to optimize water and wastewater treatment plants and improve building ventilation and plumbing systems to minimize pathogen transmission within buildings and transportation systems. In addition, health authorities should formulate appropriate policies that can enhance environmental surveillance and facilitate real-time monitoring of sewer overflow. Increased public awareness on strict personal hygiene and point-of-use-water-treatment such as boiling drinking water will go a long way to safeguard public health. Ecotoxicological studies and health risk assessment of exposure to pathogens via different transmission routes is also required to appropriately inform the use of lockdowns, minimize their socio-economic impact and guide evidence-based welfare/social policy interventions. Soft infrastructures, optimized sewer maintenance and prescreening of sewer overflow are recommended to reduce stormwater burden on wastewater treatment plant, curtail pathogen transmission and marine plastic pollution. Comprehensive, integrated surveillance and global collaborative efforts are important to curtail on-going Covid-19 pandemic and improve resilience against future pandemics.

Absence of virological and epidemiological evidence that SARS-CoV-2 poses COVID-19 risks from environmental fecal waste, wastewater and water exposures

This review considers evidence for infectious severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) presence and COVID-19 infection and illness resulting from exposure to environmental fecal wastes and waters. There is no documented evidence that (1) infectious, replication-capable SARS-CoV-2 is present in environmental fecal wastes, wastewater or water, and (2) well-documented epidemiological evidence of COVID-19 infection, illness or death has never been reported for these exposure media. COVID-19 is transmitted mainly by direct personal contact and respiratory secretions as airborne droplets and aerosols, and less so by respiratory-secreted fomites via contact (touch) exposures. While SARS-CoV-2 often infects the gastrointestinal tract of infected people, its presence as infectious, replication-capable virus in environmental fecal wastes and waters has never been documented. There is only rare and unquantified evidence of infectious, replication-capable SARS-CoV-2 in recently shed feces of COVID-19 hospital patients. The human infectivity dose-response relationship of SARS-CoV-2 is unknown, thereby making it impossible to estimate evidence-based quantitative health effects assessments by quantitative microbial risk assessment methods requiring both known exposure assessment and health effects assessment data. The World Health Organization, Water Environment Federation, US Centers for Disease Control and Prevention and others do not consider environmental fecal wastes and waters as sources of exposure to infectious SARS-CoV-2 causing COVID-19 infection and illness.

COVID-19 pandemic and antimicrobial resistance in developing countries

A wide range of antimicrobial agents were touted as potential remedies during the COVID-19 pandemic. While both developed and developing countries have recorded an increase in the use of antimicrobial drugs, use and misuse have occurred to a far greater degree in developing countries. This can have deleterious consequences on antimicrobial resistance, especially when various developing countries have already reported the emergence of various drug-resistant organisms even before the pandemic. Telemedicine services, societal and cultural pressures, and bacterial co-infections can predispose to overwhelming antimicrobial prescriptions. The emergence of new multidrug resistance species is a major concern for the developing world especially since health services are already overburdened and lack the diagnostic capabilities and basic amenities for infection prevention and control. This can lead to outbreaks and the rampant spread of such microorganisms. Improper waste management and disposal from hospitals and communities establish freshwater runoffs as hubs of various microorganisms that can predispose to the rise of multidrug-resistant species. Microplastics' ability to act as vectors for antibiotic-resistant organisms is also particularly concerning for lower-middle-income countries. In this review, we aim to study the impact of antimicrobial use during the COVID-19 pandemic and antimicrobial resistance in lower middle-income countries, by understanding various determinants of resistance unique to the developing world and exploring solutions to combat the problem.

Escalating SARS-CoV-2 circulation in environment and tracking waste management in South Asia

The novel coronavirus disease of 2019 (COVID-19) pandemic has caused an exceptional drift of production, utilization, and disposal of personal protective equipment (PPE) and different microplastic objects for safety against the virus. Hence, we reviewed related literature on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detected from household, biomedical waste, and sewage to identify possible health risks and status of existing laws, regulations, and policies regarding waste disposal in South Asian (SA) countries. The SARS-CoV-2 RNA was detected in sewage and wastewater samples of Nepal, India, Pakistan, and Bangladesh. Besides, this review reiterates the enormous amounts of PPE and other single-use plastic wastes generated from healthcare facilities and households in the SA region with inappropriate disposal, landfilling, and/or incineration techniques wind-up polluting the environment. Consequently, the Delta variant (B.1.617.2) of SARS-CoV-2 has been detected in sewer treatment plant in India. Moreover, the overuse of non-biodegradable plastics during the pandemic is deteriorating plastic pollution condition and causes a substantial health risk to the terrestrial and aquatic ecosystems. We recommend making necessary adjustments, adopting measures and strategies, and enforcement of the existing biomedical waste management and sanitation-related policy in SA countries. We propose to adopt the knowledge gaps to improve COVID-19-associated waste management and legislation to prevent further environmental pollution. Besides, the citizens should follow proper disposal procedures of COVID-19 waste to control the environmental pollution.

COVID-19 pandemic in Africa: Is it time for water, sanitation and hygiene to climb up the ladder of global priorities?

In the current pandemic context, it is necessary to remember the lessons learned from previous outbreaks in Africa, where the incidence of other diseases could rise if most resources are directed to tackle the emergency. Improving the access to water, sanitation and hygiene (WASH) could be a win-win strategy, because the lack of these services not only hampers the implementation of preventive measures against SARS-CoV-2 (e.g. proper handwashing), but it is also connected to high mortality diseases (for example, diarrhoea and lower respiratory infections (LRI)). This study aims to build on the evidence-based link between other LRI and WASH as a proxy for exploring the potential vulnerability of African countries to COVID-19, as well as the role of other socioeconomic variables such as financial sources or demographic factors. The selected methodology combines several machine learning techniques to single out the most representative variables for the analysis, classify the countries according to their capacity to tackle public health emergencies and identify behavioural patterns for each group. Besides, conditional dependences between variables are inferred through a Bayesian network. Results show a strong relationship between low access to WASH services and high LRI mortality rates, and that migrant remittances could significantly improve the access to healthcare and WASH services. However, the role of Official Development Assistance (ODA) in enhancing WASH facilities in the most vulnerable countries cannot be disregarded, but it is unevenly distributed: for each 50-100 US$ of ODA per capita, the probability of directing more than 3 US$ to WASH ranges between 48% (Western Africa) and 8% (Central Africa).

Impacts of COVID-19 on the Aquatic Environment and Implications on Aquatic Food Production

The COVID-19 pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), resulted in ecological changes of aquatic ecosystems, affected the aquatic food supply chain, and disrupted the socio-economy of global populations. Due to reduced human activities during the pandemic, the aquatic environment was reported to improve its water quality, wild fishery stocks, and biodiversity. However, the sudden surge of plastics and biomedical wastes during the COVID-19 pandemic masked the positive impacts and increased the risks of aquatic pollution, especially microplastics, pharmaceuticals, and disinfectants. The transmission of SARS-CoV-2 from wastewater treatment plants to natural water bodies could have serious impacts on the environment and human health, especially in developing countries with poor waste treatment facilities. The presence and persistence of SARS-CoV-2 in human excreta, wastewaters, and sludge and its transmission to aquatic ecosystems could have negative impacts on fisheries and aquaculture industries, which have direct implications on food safety and security. COVID-19 pandemic-related environmental pollution showed a high risk to aquatic food security and human health. This paper reviews the impacts of COVID-19, both positive and negative, and assesses the causes and consequences of anthropogenic activities that can be managed through effective regulation and management of eco-resources for the revival of biodiversity, ecosystem health, and sustainable aquatic food production.

The impact of coronavirus SARS-CoV-2 (COVID-19) in water: potential risks

This review summarizes research data on SARS-CoV-2 in water environments. A literature survey was conducted using the electronic databases Science Direct, Scopus, and Springer. This complete research included and discussed relevant studies that involve the (1) introduction, (2) definition and features of coronavirus, (2.1) structure and classification, (3) effects on public health, (4) transmission, (5) detection methods, (6) impact of COVID-19 on the water sector (drinking water, cycle water, surface water, wastewater), (6.5) wastewater treatment, and (7) future trends. The results show contamination of clean water sources, and community drinking water is vulnerable. Additionally, there is evidence that sputum, feces, and urine contain SARS-CoV-2, which can maintain its viability in sewage and the urban-rural water cycle to move towards seawater or freshwater; thus, the risk associated with contracting COVID-19 from contact with untreated water or inadequately treated wastewater is high. Moreover, viral loads have been detected in surface water, although the risk is lower for countries that efficiently treat their wastewater. Further investigation is immediately required to determine the persistence and mobility of SARS-CoV-2 in polluted water and sewage as well as the possible potential of disease transmission via drinking water. Conventional wastewater treatment systems have been shown to be effective in removing the virus, which plays an important role in pandemic control. Monitoring of this virus in water is extremely important as it can provide information on the prevalence and distribution of the COVID-19 pandemic in different communities as well as possible infection dynamics to prevent future outbreaks.

Challenges to detect SARS-CoV-2 on environmental media, the need and strategies to implement the detection methodologies in wastewaters

Understanding risks, putting in place preventative methods to seamlessly continue daily activities are essential tools to fight a pandemic. All social, commercial and leisure activities have an impact on the environmental media. Therefore, to accurately predict the fate and behavior of viruses in the environment, it is necessary to understand and analyze available detection methods, possible transmission pathways and preventative techniques. The aim of this review is to critically analyze and summarize the research done regarding SARS-COV-2 virus detection, focusing on sampling and laboratory detection methods in environmental media. Special attention will be given to wastewater and sewage sludge. This review has summarized the survival of the virus on surfaces to estimate the risk carried by different environmental media (water, wastewater, air and soil) in order to explain which communities are under higher risk. The critical analysis concludes that the detection of SARS-CoV-2 with current technologies and sampling strategies would reveal the presence of the virus. This information could be used to design systematic sampling points throughout the sewage systems when available, taking into account peak flows and more importantly economic factors on when to sample. Such approaches will provide clues for potential future viral outbreak, saving financial resources by reducing testing necessities for viral detection, hence contributing for more appropriate confinement policies by governments and could be further used to define more precisely post-pandemic or additional waves measures if/ when needed.

Jean DT. COVID-19 & Sociocultural Determinants of Global Sanitation: An Aide-Mémoire and Call to Decolonize Global Sanitation Research & Practice

COVID-19 has highlighted and exacerbated many global health inequities. Emerging evidence suggests that SARS-CoV-2 can spread through fecal aerosols, making sanitation a critical part of the COVID-19 mitigation strategy and providing an opportunity to reflect on current challenges and opportunities related to global sanitation at large. Global sanitation interventions continue to fall short of their target expectations, leading to millions of deaths and illnesses worldwide. Eurocentric approaches to sanitation fail to account for sociocultural determinants of sanitation behaviors and health, leading to low sanitation intervention uptake. Global public health needs to take a decolonial approach to our research and practice, and meaningfully involve local communities to progress towards global health equity.

The role of airborne particles and environmental considerations in the transmission of SARS-CoV-2

Corona Virus Disease 2019 (COVID-19) caused by the novel coronavirus, results in an acute respiratory condition coronavirus 2 (SARS-CoV-2) and is highly infectious. The recent spread of this virus has caused a global pandemic. Currently, the transmission routes of SARS-CoV-2 are being established, especially the role of environmental transmission. Here we review the environmental transmission routes and persistence of SARS-CoV-2. Recent studies have established that the transmission of this virus may occur, amongst others, in the air, water, soil, cold-chain, biota, and surface contact. It has also been found that the survival potential of the SARS-CoV-2 virus is dependent on different environmental conditions and pollution. Potentially important pathways include aerosol and fecal matter. Particulate matter may also be a carrier for SARS-CoV-2. Since microscopic particles can be easily absorbed by humans, more attention must be focused on the dissemination of these particles. These considerations are required to evolve a theoretical platform for epidemic control and to minimize the global threat from future epidemics.

Monitoring the presence and persistence of SARS-CoV-2 in water-food-environmental compartments: State of the knowledge and research needs

The recent spread of severe acute respiratory syndrome coronavirus (SAR-CoV-2) and the accompanied coronavirus disease 2019 (COVID-19) has continued ceaselessly despite the implementations of popular measures, which include social distancing and outdoor face masking as recommended by the World Health Organization. Due to the unstable nature of the virus, leading to the emergence of new variants that are claimed to be more and rapidly transmissible, there is a need for further consideration of the alternative potential pathways of the virus transmissions to provide the needed and effective control measures. This review aims to address this important issue by examining the transmission pathways of SARS-CoV-2 via indirect contacts such as fomites and aerosols, extending to water, food, and other environmental compartments. This is essentially required to shed more light regarding the speculation of the virus spread through these media as the available information regarding this is fragmented in the literature. The existing state of the information on the presence and persistence of SARS-CoV-2 in water-food-environmental compartments is essential for cause-and-effect relationships of human interactions and environmental samples to safeguard the possible transmission and associated risks through these media. Furthermore, the integration of effective remedial measures previously used to tackle the viral outbreaks and pandemics, and the development of new sustainable measures targeting at monitoring and curbing the spread of SARS-CoV-2 were emphasized. This study concluded that alternative transmission pathways via human interactions with environmental samples should not be ignored due to the evolving of more infectious and transmissible SARS-CoV-2 variants.

Detection of SARS-CoV-2 RNA in the Danube River in Serbia associated with the discharge of untreated wastewaters

In Serbia less than 13% of collected municipal wastewaters is being treated before their release in the environment. This includes all municipal wastewater discharges from Belgrade (capital city of Serbia; population 1,700,000). Previous research has identified the impacts of raw wastewater discharges from Belgrade on the Danube River, and this study investigated if such discharges also provided a pathway for SARS-CoV-2 RNA material. Samples were collected during the most critical circumstances that occurred so far within the COVID-19 pandemics in Serbia. Grab and composite samples were collected in December 2020, during the peak of the third wave (in terms of reported cases) at the site which receives the wastewater loads in Belgrade. Grab samples collected upstream and downstream of Belgrade were also analyzed. RNA was quantified using RT-qPCR with primer sets targeting nucleocapsid (N1 and N2) and envelope (E) protein genes. SARS-CoV-2 RNA (5.97 × 10³ to 1.32 × 10⁴ copies/L) was detected only in samples collected at the site strongly impacted by the wastewaters where all three applied primer sets gave positive signals. Determined concentrations correspond to those reported in wastewater influents sampled at treatment plants in other countries indicating an epidemiological indicator function of used approach for rivers with high pollution loads in countries with poor wastewater treatment.

Coronavirus in water media: Analysis, fate, disinfection and epidemiological applications

Considerable attention has been recently given to possible transmission of SARS-CoV-2 via water media. This review addresses this issue and examines the fate of coronaviruses (CoVs) in water systems, with particular attention to the recently available information on the novel SARS-CoV-2. The methods for the determination of viable virus particles and quantification of CoVs and, in particular, of SARS-CoV-2 in water and wastewater are discussed with particular regard to the methods of concentration and to the emerging methods of detection. The analysis of the environmental stability of CoVs, with particular regard of SARS-CoV-2, and the efficacy of the disinfection methods are extensively reviewed as well. This information provides a broad view of the state-of-the-art for researchers involved in the investigation of CoVs in aquatic systems, and poses the basis for further analyses and discussions on the risk associated to the presence of SARS-CoV-2 in water media. The examined data indicates that detection of the virus in wastewater and natural water bodies provides a potentially powerful tool for quantitative microbiological risk assessment (QMRA) and for wastewater-based epidemiology (WBE) for the evaluation of the level of circulation of the virus in a population. Assays of the viable virions in water media provide information on the integrity, capability of replication (in suitable host species) and on the potential infectivity. Challenges and critical issues relevant to the detection of coronaviruses in different water matrixes with both direct and surrogate methods as well as in the implementation of epidemiological tools are presented and critically discussed.