Can drugs in wastewater provide an early warning?

To study drugs in wastewater, UB scientists use the equipment and techniques shown here to isolate chemical compounds from water samples.  (Photo credit: Meredith Forrest Kulwicki / University at Buffalo)

To study drugs in wastewater, UB scientists use the equipment and techniques shown here to isolate chemical compounds from water samples. (Photo credit: Meredith Forrest Kulwicki / University at Buffalo)

Tue July 5, 2022 06:55 AM

Wastewater study finds large spike in acetaminophen ahead of spike in viral RNA during one COVID-19 wave in western New York

By the University at Buffalo

In a pilot project investigating ways to monitor COVID-19, scientists at the University at Buffalo simultaneously hunted pharmaceutical and viral RNA in wastewater in western New York.

The results of their study, published May 18 in the journal Environmental Science & Technology Letters, suggest that measuring drug concentrations in wastewater could add an extra layer to disease monitoring efforts.

“Wastewater-based disease surveillance is performed worldwide through viral RNA monitoring,” said lead scientist Diana Aga, Ph.D., director of the UB RENEW Institute and Henry M. Woodburn Professor of Chemistry in the UB College of Arts and Sciences. “The potential to complement existing efforts with drug detection is exciting. There are many opportunities here, but more research is needed.”

An interesting discovery in the new study involves acetaminophen, a pain reliever and fever reducer that serves as an active ingredient in over-the-counter medications such as Tylenol, Theraflu, and other brands.

At all four wastewater treatment plants included in the project, the study found that acetaminophen concentrations in the wastewater peaked in early 2021 before other measures of COVID-19 in the community, including concentrations of COVID-19 viral RNA in wastewater and the estimated number of confirmed Covid19 cases.

For example, at the Bird Island wastewater treatment plant, which serves Buffalo and some surrounding suburbs, acetaminophen levels in wastewater peaked about two weeks earlier than levels of SARS-CoV-2 RNA in wastewater. The spike in viral RNA, in turn, preceded the spike in the estimated number of confirmed cases of COVID-19 about a week, scientists say.

“Our biggest finding is that there is a massive increase in the concentration of acetaminophen, used in over-the-counter drugs, which predates the peak of viral RNA in wastewater and the peak in clinical detections in our area during the study period,” , says Aga.

“This was very interesting because it suggests that drug detection could act as an early warning sign of a potential disease outbreak in a community,” Aga says. “Our group is one of the first to supplement the detection of SARS-CoV-2 RNA in wastewater with drug levels.”

The research, which was conducted over several months in 2021, was funded by the US National Science Foundation and the SUNY Prepare Innovation and Internship Program, designed to engage students in developing solutions to pandemic-related challenges. Lahiruni M. Halwatura, a Ph.D. student in Aga’s lab, was the lead author of the study.

Potential to improve public health wastewater studies

Wastewater data is becoming a critical part of COVID-19 monitoring as home testing has become more popular, causing many positive cases to go unreported.

During the pandemic, UB engineering researchers Ian M. Bradley and Yinyin Ye worked with partners including Erie County to monitor COVID-19 viral RNA in wastewater.

The new study in Environmental Science & Technology Letters is exciting because it suggests drug detection could add an extra layer to such efforts, Bradley and Ye say. Their labs contributed data to the study, and they are co-authors.

Acetaminophen is not a perfect proxy for COVID-19: People take the drug to treat many types of aches, aches and fevers, and some fluctuations of the drug in wastewater over the study period did not correlate with viral RNA data.

However, the spike in acetaminophen that seemed to match the local COVID-19 surge was large, and this finding points to over-the-counter drug use as a possible early signal of an impending outbreak, the researchers say.

“What’s really exciting is that there’s so much information in wastewater. How can we use this to detect diseases for public health? All of these data are complementary,” said Bradley, Ph.D., assistant professor of civil, structural, and environmental engineering in the UB School of Engineering and Applied Sciences, and a core faculty member in the UB RENEW Institute.

“We’re focusing on public health studies in wastewater, and we want to see if we can integrate more data to get a sense of what’s going on in the community,” said Ye, Ph.D., assistant professor professor of civil, structural and environmental engineering and RENEW faculty branch. “We can extract information from wastewater, but there are still many uncertainties about the interpretation of the data for public health. We want to test not only biological markers, but also chemical markers and all kinds of different layers of information.”

In addition to identifying the spikes in acetaminophen, the study found residues of prescription drugs linked to the pandemic in wastewater, including drugs whose emergency use authorization to treat COVID-19 has been revoked by the U.S. Food and Drug Administration.

Other co-authors of the study were Isabella S. Mclerran, a graduate student in Bradley’s lab who recently graduated; Daniel L. Weglarski, a recent graduate of Aga’s lab; and Zia U. Ahmed, Ph.D., a database/visualization specialist at the UB RENEW Institute.

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