Environmental impact assessment of COVID-19 therapeutic solutions. A prospective analysis

Tracing COVID-19 drugs in the environment: Are we focusing on the right environmental compartment?

The Coronavirus Disease 2019 (COVID-19) pandemic led to over 770 million confirmed cases, straining public healthcare systems and necessitating extensive and prolonged use of synthetic chemical drugs around the globe for medical treatment and symptom relief. Concerns have arisen regarding the massive release of active pharmaceutical ingredients (APIs) and their metabolites into the environment, particularly through domestic sewage. While discussions surrounding this issue have primarily centered on their discharge into aquatic environments, particularly through treated effluent from municipal wastewater treatment plants (WWTPs), one often overlooked aspect is the terrestrial environment as a significant receptor of pharmaceutical-laden waste. This occurs through the disposal of sewage sludge, for instance, by applying biosolids to land or non-compliant disposal of sewage sludge, in addition to the routine disposal of expired and unused medications in municipal solid wastes. In this article, we surveyed sixteen approved pharmaceuticals for treating COVID-19 and bacterial co-infections, along with their primary metabolites. For this, we delved into their physiochemical properties, ecological toxicities, environmental persistence, and fate within municipal WWTPs. Emphasis was given on lipophilic substances with log Kow >3.0, which are more likely to be found in sewage sludge at significant factions (25.2%-75.0%) of their inputs in raw sewage and subsequently enter the terrestrial environment through land application of biosolids, e.g., 43% in the United States and as high as 96% in Ireland or non-compliant practices of sewage sludge disposal in developing communities, such as open dumping and land application without prior anaerobic digestion. The available evidence underscores the importance of adequately treating and disposing of sewage sludge before its final disposal or land application in an epidemic or pandemic scenario, as mismanaged sewage sludge could be a significant vector for releasing pharmaceutical compounds and their metabolites into the terrestrial environment.

Occurrence, distribution and environmental risk of 19 anthelmintic drugs in river water and sediment from the Jinjiang River, China

This study explored the occurrence and distribution of 19 anthelmintic drugs (ADs) including the benzimidazole group, salicylanilide group, imidazothiazole group, tetrahydropyrimidine group, diphenylsulfide group, macrocyclic lactone group and hexahydropyrazine group in river water and sediment of the Jinjiang River in Sichuan, China, during summer and winter seasons. All targets were detected in river water (up to 74.64 ng L-1) and sediment (up to 1701 ng g-1) samples. The predominant ADs were benzimidazoles regardless of seasons and matrices, accounting for 43-82% of the total anthelmintic abundance. Obvious seasonal variation of AD concentrations in the two matrices was observed, which could be attributed to the seasonality of human and veterinary uses of ADs. Evident spatial variation (urban and rural areas) of ADs in winter was indicative of the influence of anthropogenic activities on the environmental concentration of ADs. Though benzimidazoles accumulated in the water and sediment with the highest concentration among all the ADs, macrocyclic lactones were of the highest risk to non-target organisms through ecological risk assessment, with an RQEcotox value up to 2713. This work contributes to comprehensively assessing the contamination level, ecological level and transmission characteristics of ADs in the environment.

An anode and cathode cooperative oxidation system constructed with Ee-GF as anode and CuFe2O4/Cu2O/Cu@EGF as cathode for the efficient removal of sulfamethoxazole

This study aimed to further improve the degradation efficiency of pollutants by electrochemical oxidation system and reduce the consumption of electric energy. A simple method of electrochemical exfoliation was used to modify graphite felt (GF) to prepare an anode material (Ee-GF) with high degradation performance. An anode and cathode cooperative oxidation system was constructed with Ee-GF as the anode and CuFe₂O₄/Cu₂O/Cu@EGF as the cathode to efficiently degrade sulfamethoxazole (SMX). Complete degradation of SMX was achieved within 30 min. Compared with anodic oxidation system alone, the degradation time of SMX was reduced by half and the energy consumption was reduced by 66.8 %. The system displayed excellent performance for the degradation of different concentrations (10-50 mg L^-1) of SMX, different pollutants, and under different water quality conditions. In addition, the system still maintained 91.7 % removal rate of SMX after ten consecutive runs. At least 12 degradation products and seven possible degradation routes of SMX were generated in the degradation process by the combined system. The eco-toxicity of degradation products of SMX was reduced after the proposed treatment. This study provided a theoretical basis for the safe, efficient, and low energy consumption removal of antibiotic wastewater.

Antiviral drugs in wastewater are on the rise as emerging contaminants: A comprehensive review of spatiotemporal characteristics, removal technologies and environmental risks

Antiviral drugs (ATVs) are widely used to treat illnesses caused by viruses. Particularly, ATVs were consumed in such large quantities during the pandemic that high concentrations were detected in wastewater and aquatic environment. Since ATVs are not fully absorbed by the human or animal body, this results in large amounts of them being discharged into the sewage through urine or feces. Most ATVs can be degraded by microbes at wastewater treatment plants (WWTPs), while some ATVs either require deep treatment to reduce concentration and toxicity. Parent and metabolites residing in effluent posed a varying degree of risk when entering the aquatic environment, while increasing the potential of natural reservoirs for environmentally acquired antiviral drug resistance potential. There is a rising research on the behavior of ATVs in the environment has surged since the pandemic. In the context of multiple viral diseases worldwide, especially during the current COVID-19 pandemic, a comprehensive assessment of the occurrence, removal, and risk of ATVs is urgently needed. This review aims to discuss the fate of ATVs in WWTPs from various regions in the world with wastewater as the main analyzing object. The ultimate goal is to focus on ATVs with high ecological impact and regulate their use or develop advanced treatment technologies to mitigate the risk to the environment.

COVID-19 related antiviral drugs are less adsorbable on sediment under alkaline and high cation conditions

The COVID-19 pandemic resulted in unprecedented usage and elevated environmental concentrations of antiviral drugs. However, very limited studies have reported their sorption characteristics on environmental matrices. This study investigated the sorption of six COVID-19 related antivirals on Taihu Lake sediment with varied aqueous chemistry. Results showed that the sorption isotherms for arbidol (ABD), oseltamivir (OTV), and ritonavir (RTV) were linear, while the Freundlich model was the best-fit for ribavirin (RBV) and the Langmuir model for favipiravir (FPV) and remdesivir (RDV). Their distribution coefficient, K_d, varied between 5.051 L/kg to 248.6 L/kg with the sorption capacities ranked as FPV > RDV > ABD > RTV > OTV > RBV. Alkaline conditions (pH 9) and elevated cation strength (0.05 M to 0.1 M) decreased the sorption capacities of the sediment for these drugs. Thermodynamic analysis revealed that the spontaneous sorption of RDV, ABD, and RTV was between physisorption and chemisorption while FPV, RBV, and OTV were mainly physisorption. Functional groups related to hydrogen bonds, π - π interaction, and surface complexation were implicated in the sorption processes. These findings enhance our understanding about the environmental fate of COVID-19 related antivirals and provide basic data for predicting their distribution and risk in the environment.

Copper Nanoparticles and Reduced Graphene Oxide as an Electrode Modifier for the Development of an Electrochemical Sensing Platform for Chloroquine Phosphate Determination

This study describes the use of copper nanoparticles (CuNPs) and reduced graphene oxide (rGO) as an electrode modifier for the determination of chloroquine phosphate (CQP). The synthetized rGO-CuNPs composite was morphologically characterized using scanning electron microscopy and electrochemically characterized using cyclic voltammetry. The parameters were optimized and the developed electrochemical sensor was applied in the determination of CQP using square-wave voltammetry (SWV). The analytical range for the determination of CQP was 0.5 to 110 μmol L^-1 (one of the highest linear ranges for CQP considering electrochemical sensors), with limits of detection and quantification of 0.23 and 0.78 μmol L^-1, respectively. Finally, the glassy carbon (GC) electrode modified with rGO-CuNPs was used for quantification of CQP in tap water; a study was carried out with interferents using SWV and obtained great results. The use of rGO-CuNP material as an electrode modifier was thus shown to be a good alternative for the development of low-cost devices for CQP analysis.

Are we ready to combat the ecotoxicity of COVID-19 pharmaceuticals? An in silico aquatic risk assessment

To fight COVID-19 with uncountable medications and bioproducts throughout the world has taken us to another challenge of ecotoxicity. The indiscriminate usage followed by improper disposal of unused antibacterials, antivirals, antimalarials, immunomodulators, angiotensin II receptor blockers, corticosteroids, anthelmintics, anticoagulants etc. can lead us to an unimaginable ecotoxicity in the long run. A series of studies already identified active pharmaceutical ingredients (APIs) of the mentioned therapeutic classes and their metabolites in aquatic bodies as well as in wastewater treatment plants. Therefore, an initial ecotoxicity assessment of the majorly used pharmaceuticals is utmost requirement of the present time. The present in silico risk assessment study is focused on the aquatic toxicity prediction of 81 pharmaceuticals where 77 are most-used pharmaceuticals for COVID-19 throughout the world based on the literature along with one drug nirmatrelvir [PF-07321332] approved for emergency use by US-FDA and three other molecules under clinical trial. The ecotoxicity of the studied compounds were predicted based on the three aquatic species fish, algae and crustaceans employing the highest quality QSAR models available from the literature as well as using ECOSAR and QSAR Toolbox. To compare the toxicity thresholds, we have also used 4 control pharmaceuticals based on the worldwide occurrence from river, lake, STP, WWTPs, influent and effluent followed by high reported aquatic toxicity over the years as per the literature. Based on the statistical comparison, we have proposed top 3 pharmaceuticals used for the COVID-19 most toxic to the aquatic environment. The study will provide confident predictions of aquatic ecotoxicity data related to abundant use of COVID-19 drugs. The major aim of the study is to fill up the aquatic ecotoxicity data gap of major medications used for COVID-19.

Application of ToxCast/Tox21 data for toxicity mechanism-based evaluation and prioritization of environmental chemicals: Perspective and limitations

In response to the need to minimize the use of experimental animals, new approach methodologies (NAMs) using advanced technology have emerged in the 21st century. ToxCast/Tox21 aims to evaluate the adverse effects of chemicals quickly and efficiently using a high-throughput screening and to transform the paradigm of toxicity assessment into mechanism-based toxicity prediction. The ToxCast/Tox21 database, which contains extensive data from over 1400 assays with numerous biological targets and activity data for over 9000 chemicals, can be used for various purposes in the field of chemical prioritization and toxicity prediction. In this study, an overview of the database was explored to aid mechanism-based chemical prioritization and toxicity prediction. Implications for the utilization of the ToxCast/Tox21 database in chemical prioritization and toxicity prediction were derived. The research trends in ToxCast/Tox21 assay data were reviewed in the context of toxicity mechanism identification, chemical priority, environmental monitoring, assay development, and toxicity prediction. Finally, the potential applications and limitations of using ToxCast/Tox21 assay data in chemical risk assessment were discussed. The analysis of the toxicity mechanism-based assays of ToxCast/Tox21 will help in chemical prioritization and regulatory applications without the use of laboratory animals.

SARS-CoV-2 pharmaceutical drugs: a critical review on the environmental impacts, chemical characteristics, and behavior of advanced oxidation processes in water

This review summarizes research data on the pharmaceutical drugs used to treat the novel SARS-CoV-2 virus, their characteristics, environmental impacts, and the advanced oxidation processes (AOP) applied to remove them. A literature survey was conducted using the electronic databases Science Direct, Scopus, Taylor & Francis, Google Scholar, PubMed, and Springer. This complete research includes and discusses relevant studies that involve the introduction, pharmaceutical drugs used in the SARS-CoV-2 pandemic: chemical characteristics and environmental impact, advanced oxidation process (AOP), future trends and discussion, and conclusions. The results show a full approach in the versatility of AOPs as a promising solution to minimize the environmental impact associated with these compounds by the fact that they offer different ways for hydroxyl radical production. Moreover, this article focuses on introducing the fundamentals of each AOP, the main parameters involved, and the concomitance with other sources and modifications over the years. Photocatalysis, sonochemical technologies, electro-oxidation, photolysis, Fenton reaction, ozone, and sulfate radical AOP have been used to mineralize SARS-CoV-2 pharmaceutical compounds, and the efficiencies are greater than 65%. According to the results, photocatalysis is the main technology currently applied to remove these pharmaceuticals. This process has garnered attention because solar energy can be directly utilized; however, low photocatalytic efficiencies and high costs in large-scale practical applications limit its use. Furthermore, pharmaceuticals in the environment are diverse and complex. Finally, the review also provides ideas for further research needs and major concerns.

Risk Assessment and Prevention Strategy of Virus Infection in the Context of University Resumption

The risk assessment system of virus infection probability and the prevention measures for virus transmission are keys to controlling epidemics. In the context of university resumption, this study identifies the risk elements in terms of the mechanism of virus transmission. The effect of two recognized effective measures, i.e., occupancy constraints and ventilation intervention, on the infection risk are quantified and compared using the improved Wells–Riley model. Considering the priority of these two measures, the controlling quantity are determined, and the optimal schemes are proposed based on the targeted infection risk. The results show that the effect of reducing infection risk by constraining occupancy within 25% of all public campus buildings is better than that achieved by increasing the ventilation rate alone. If the ventilation system of the building type is operated by occupiers, it is a priority to prevent the risk of virus infection by restricting occupancy and ensuring the distance between occupants, while if the ventilation system of the building type is centrally controlled, it is a priority to increase the ventilation rate and then limit the occupancy rate during peak periods to 75%.

Drugs used during the COVID-19 first wave in Vitoria-Gasteiz (Spain) and their presence in the environment

The city of Vitoria-Gasteiz was one of the probable first entrances of the SARS-CoV2 in Spain, one of the worst affected countries in the world during the first COVID 19 wave. Driven by the urgency of the situation, multiple drugs with antiviral activity were used off label. Sadly, most of these treatments were of little or no benefit and thus, the number of patients suffering from COVID-19 attended in intensive care units (ICUs) multiplied. After being administered to patients, a variable proportion of these drugs reach the environment where they may have detrimental effects, although this aspect is usually ignored by healthcare professionals. In this study we measured the patterns of hospital drug use in the city of Vitoria-Gasteiz (Spain) during the first COVID-19 wave pandemic, focusing on those with antiviral activity and those used in the ICUs. Subsequently, we measured concentrations of selected drugs in the city's wastewater treatment plant influent and effluent and estimated the potential risk for the environment. The hospital use of certain antivirals and drugs used for sedo-analgesia were dramatically increased during the first wave (cisatracurium was multiplied by 25 and lopinavir/ritonavir by 20). A mean of 1.632 daily defined doses of hydroxychloroquine were used during the period of February-May 2020. In this study we report the first positive detection of hydroxychloroquine ever in the environment. We also show the second positive report of lopinavir. Low risk was estimated for hydroxychloroquine, lopinavir and ritonavir (Risk quotients (RQ) <1), and medium risk for azithromycin (RQ 0f 0.146).

Water Quality and Water Pollution in Time of COVID-19: Positive and Negative Repercussions

On 11 March 2020, the World Health Organization declared the new COVID-19 disease a pandemic. Most countries responded with a lockdown to reduce its effects, which brought beneficial consequences to the environment in many regions, but the pandemic also raised a series of challenges. This review proposes an assessment of the COVID-19 pandemic positive and negative impacts on water bodies on different continents. By applying a search protocol on the Web of Science platform, a scientific bank of 35 compatible studies was obtained out of the 62 open-access articles that were initially accessible. Regarding the positive impacts, the SARS-CoV-2 monitoring in sewage waters is a useful mechanism in the promptly exposure of community infections and, during the pandemic, many water bodies all over the world had lower pollution levels. The negative impacts are as follows: SARS-CoV-2 presence in untreated sewage water amplifies the risk to human health; there is a lack of adequate elimination processes of plastics, drugs, and biological pollution in wastewater treatment plants; the amount of municipal and medical waste that pollutes water bodies increased; and waste recycling decreased. Urgent preventive measures need to be taken to implement effective solutions for water protection.

Pharmaceutical compounds used in the COVID-19 pandemic: A review of their presence in water and treatment techniques for their elimination

During the COVID-19 pandemic, high consumption of antivirals, antibiotics, antiparasitics, antiprotozoals, and glucocorticoids used in the treatment of this virus has been reported. Conventional treatment systems fail to efficiently remove these contaminants from water, becoming an emerging concern from the environmental field. Therefore, the objective of the present work is to address the current state of the literature on the presence and removal processes of these drugs from water bodies. It was found that the concentration of most of the drugs used in the treatment of COVID-19 increased during the pandemic in water bodies. Before the pandemic, Azithromycin concentrations in surface waters were reported to be in the order of 4.3 ng L^-1, and during the pandemic, they increased up to 935 ng L^-1. Laboratory scale studies conclude that adsorption and advanced oxidation processes (AOPs) can be effective in the removal of these drugs. Up to more than 80% removal of Azithromycin, Chloroquine, Ivermectin, and Dexamethasone in aqueous solutions have been reported using these processes. Pilot-scale tests achieved 100% removal of Azithromycin from hospital wastewater by adsorption with powdered activated carbon. At full scale, treatment plants supplemented with ozonation and artificial wetlands removed all Favipiravir and Azithromycin, respectively. It should be noted that hybrid technologies can improve removal rates, process kinetics, and treatment cost. Consequently, the development of new materials that can act synergistically in technically and economically sustainable treatments is required.

COVID-19 drugs in aquatic systems: a review

The outbreak of the human coronavirus disease 2019 (COVID-19) has induced an unprecedented increase in the use of several old and repurposed therapeutic drugs such as veterinary medicines, e.g. ivermectin, nonsteroidal anti-inflammatory drugs, protein and peptide therapeutics, disease-modifying anti-rheumatic drugs and antimalarial drugs, antiretrovirals, analgesics, and supporting agents, e.g. azithromycin and corticosteroids. Excretion of drugs and their metabolites in stools and urine release these drugs into wastewater, and ultimately into surface waters and groundwater systems. Here, we review the sources, behaviour, environmental fate, risks, and remediation of those drugs. We discuss drug transformation in aquatic environments and in wastewater treatment systems. Degradation mechanisms and metabolite toxicity are poorly known. Potential risks include endocrine disruption, acute and chronic toxicity, disruption of ecosystem functions and trophic interactions in aquatic organisms, and the emergence of antimicrobial resistance.

Overview of coronavirus pandemic

During the last months of 2019, numerous cases of respiratory illness such as pneumonia and acute respiratory distress syndrome were described in Wuhan, the capital city of Hubei province in China. At the same time, several research groups identified and reported the etiological agent, that included within the Coronaviridae family and the order Nidovirales, named SARS-CoV-2. Subsequently, the pathological and clinical status caused by the pathogen is commonly known as Coronavirus disease 2019 (COVID-19).

In a short period, the outbreak of emerging spread across the world. Therefore the World Health Organization declared a public health emergency of international concern on January 30, 2020, and as a pandemic on March 11, 2020.

Many different public health and epidemiological studies have been published since the COVID-19 outbreak, but fatality rates (those that relate the number of cases to mortality) are difficult to assess with certainty. Mean and median case-fatality rates worldwide are near to 3% and 2%, respectively. The median infection fatality calculated from serologic prevalence varies from 0.00% to 1.63% but is mostly estimated between 0.27% and 0.9%. These indexes are influenced by geographic location, socioeconomic status, sex, age, and health conditions, among others.

Candidate antiviral drugs for COVID-19 and their environmental implications: a comprehensive analysis

Emerging from Wuhan, China, SARS-CoV-2 is the new global threat that killed millions of people, and many are still suffering. This pandemic has not only affected people but also caused economic crisis throughout the world. Researchers have shown good progress in revealing the molecular insights of SARS-CoV-2 pathogenesis and developing vaccines, but effective treatment against SARS-CoV-2-infected patients are yet to be found. Several vaccines are available and used in many countries, while many others are still in clinical or preclinical studies. However, this involves a long-term process, considering the safety procedures and requirements and their long-term protection capacity and in different age groups are still questionable. Therefore, at present, the drug repurposing of the existing therapeutics previously designed against other viral diseases seems to be the only practical approach to mitigate the current situation. The safety of most of these therapeutic agents has already been tested. Recent clinical reports revealed promising therapeutic efficiency of several drugs such as remdesivir, tenofovir disoproxil fumarate, azithromycin, lopinavir/ritonavir, chloroquine, baricitinib, and cepharanthine. Besides, plasma therapies were used to treat patients and prevent fatal outcomes. Thus, in this article, we have summarized the epidemiological and clinical data from several clinical trials conducted since the beginning of the pandemic, emphasizing the efficiency of the known agents against SARS-CoV-2 and their harmful side effects on the human body as well as their environmental implications. This review shows a clear overview of the current pharmaceutical perspective on COVID-19 treatment.

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.

Impact of the COVID-19 pandemic on household disinfectant consumption behaviors and related environmental concerns: A questionnaire-based survey in China

Considering the potential hazardous effects of disinfectant residues on environment, organisms and biodiversity, the sharp rise in use of disinfectants during COVID-19 pandemic has been considered highly likely to cause worldwide secondary disasters in ecosystems and human health. This questionnaire-based survey investigated the impact of COVID-19 outbreak on household disinfectant product consumption levels and behavior of 3667 Chinese residents. In particular, in the context that no strategy is currently available to minimize the disinfectant pollution, based on the similarities between disinfectants and pharmaceuticals, we proposed a perspective of ecopharmacovigilance (EPV), which is an effective measure to minimize the environmental risks posed by pharmaceuticals using drug administration protocols, for disinfectant environmental risk management. The public's environmental perceptions, attitudes and the related practices regarding household disinfectant consumption from an EPV perspective were also included in the study. The results showed that the COVID-19 outbreak caused a tremendous rise in the public's household disinfectant consumption and usage levels in China. After the COVID-19 outbreak, the chlorine-based and alcohol-based disinfectants were considered as the most preferred products for household disinfection and hand sanitization, respectively. Importantly, the Chinese public's environmental perceptions and practice on disinfectants were poor. Less than half respondents had positive attitudes toward the source control of disinfectant pollution. The population groups including females, the middle aged adults, those having healthcare professional background, as well as the higher-educated could be focused on to develop targeted efforts for the future control of disinfectant pollution in environment.

Emerging contaminants, SARS-COV-2 and wastewater treatment plants, new challenges to confront: A short review

The current pandemic caused by SARS-CoV-2 has put public health at risk, being wastewater-based epidemiology (WBE) a potential tool in the detection, prevention, and treatment of present and possible future outbreaks, since this virus enters wastewater through various sources such as feces, vomit, and sputum. Thus, advanced technologies such as advanced oxidation processes (AOP), membrane technology (MT) are identified through a systematic literature review as an alternative option for the destruction and removal of emerging contaminants (drugs and personal care products) released mainly by infected patients. The objectives of this review are to know the implications that the new COVID-19 outbreak is generating and will generate in water compartments, as well as the new challenges faced by wastewater treatment plants due to the change in a load of contaminants and the solutions proposed based on the aforementioned technologies to be applied to preserve public health and the environment.

Ivermectin & COVID-19: Let's keep a One Health perspective

Despite uncertainty about its clinical benefit, ivermectin has been used for COVID 19, even in prophylaxis. The European Medicines Agency (EMA) has advised against its use for the prevention or treatment of COVID-19 outside randomised clinical trials. Although the potential negative environmental effects of ivermectin have been widely recognised when used in veterinary medicine, scarce attention has been devoted to the potential ecotoxicological impact of human use. We believe is time to include One Health's philosophy in our daily practice. In the specific case of ivermectin & COVID 19, environmental aspects should also be on the table.