Biosensor-based early warning system to detect SARS-CoV-2

To establish a low cost, high-performance rapid test for the detection
and sequencing of SARS-CoV-2 in wastewater by using nanotechnology in Bangladesh. 

Rehnuma Haque, MBBS, MPH, PhD
Assistant Scientist in the Environmental Interventions Unit, Infectious Disease Division, icddr,b and current Fogarty Global Health Postdoctoral Fellow at School of Medicine, Stanford University. 

About 72% of people in Asia do not have access to improved sanitation. Over 610 million people in South Asia and Africa still practice open defecation. As a result, human feces directly opens into the environment. In Bangladesh, a sanitation crisis exists because of myriad factors such poor fecal sludge management and a lack of treatment facilities. Therefore, we plan to establish biosensor-based wastewater monitoring system to alert the community ahead of the disease outbreaks considering the sanitation challenges. Our proposed biosensor-based wastewater monitoring will detect and perform NSG of SARS-CoV-2 in wastewater. This split into three solutions: 1) Detection capacity and genomics surveillance; 2) Early warning system; 3) Epidemiology and control. Strategically, our designed activities will develop a platform for the public health authority to rapidly pivot into response mode to support the healthcare system and deliver excellent research for current and future epidemic disease threats. Especially in countries with the i) unimproved sanitation system ii) limited detection due to insufficient laboratory capacity iii) lack of access and awareness to healthcare to estimate asymptomatic carriers to control the disease outbreak. Besides the COVID-19 pandemic, this application will support preparedness activities for future epidemics with other pathogens. 

Wastewater-based epidemiology (WBE) surveillance systems offer a practical approach to identifying viruses excreted in the feces and urine in an entire community. Therefore, WBE can be an effective tool for tracing the circulation of viruses in a community, providing the opportunity to estimate their prevalence and geographic distribution. The proposed challenge examines the large-scale feasibility of wastewater surveillance initially among Dhaka City, covering 21 million populations. We will select COVID-19 disease's hot-spots (airport, bus stand, mosque, school, hospital, etc.) to alerts COVID-19 coordination cell Director General Health Service (DGHS), Government of Bangladesh, and other respective authorities such as NGOs and UN organizations currently handling COVID-19 pandemic. We will arrange for a consultative meeting to identify the gap and prepare an action plan to limit the outbreak, such as urge people to stay in quarantine/isolation, maintain social distancing, and get a clinical test in case of severity. Besides, this study will support the capacity building of the government health surveillance team as well as laboratory capacity over conventional methods to nanotechnology for the rapid, feasible, and low-cost technique. The WBE application will reduce the burden of clinical testing and establish a sustainable model to provide healthcare as a service. 

This system will benefit the general population in several ways:

First, this should be taken as a signal of a possible (re)emergence of the pandemic. If the virus is detected in wastewater, but the resident population testing is negative, the undetected infection sources can be explored by tracing the wastewater pathways. Also, the absence of the virus in wastewater could indicate that the corresponding area can be considered low risk. 

Second, the healthcare professionals will alert the general population regarding the proper precautions that they should undertake towards personal protection, such as wearing PPE, avoiding public gatherings, and rapidly seeking healthcare. Besides, we are planning to deliver behavioral change communication (BCC) intervention to the community.  

Third, data from wastewater surveillance should always be used as a complement to epidemiological data. Where no such epidemiological data are available, information on the virus presence in wastewater can help design the most effective non-invasive public health tool in less-favored countries.

Fourth, it will alert the policymakers to allocate resources to the affected areas.

Finally, it will allow for international policy implementation to prevent the trans-border spread of pathogens. This technology is most suitable for airports, cruise ships, and public hotspots.

Though we know that the technology works, we want to have it tested on the field for at least 12 months to ensure that this technology is acceptable, feasible, and affordable in the field that is generating regular and reliable data in the wastewater surveillance system. We will consider our success if there is regular data from the pilot testing sites with real time analysis plan and implementation. We will train the data collection staff from both urban and rural healthcare monitoring facilities to improve their capacity in using this technology and have a sound knowledge of reporting mechanism and primary community based preventive actions to be taken if a pathogen is identified during wastewater surveillance. We can use these data as the epidemiological incident and able to measure the infection prevalence or generate the alert system prior to any infection outbreak in our study area. Furthermore, if the responsible persons, both data collectors and monitoring officers, consider this technology effective, easy-to-use, and finally, if the healthcare system adopts this technology with an operation guideline for use and maintenance, we will consider this technology a successful tool for early warning and detection of epidemic.

In the first year, we want to pilot this technology in Dhaka City to test effectiveness and acceptability. We plan to gather the data and generate evidence to recommend this product for field level and general use in other metropolitan cities in Bangladesh. 

At the end of the first year, we anticipate that the locations where this technology is provided will accept the product and recommend its usage to several other urban and rural areas. 

At the end of the three years, ideally, we plan to incorporate this product in the government health system and develop a monitoring system for data monitoring, evaluation, reporting, and a rapid response mechanism with an operational guideline for usage, monitoring, reporting, and capacity building. Though we hope there will be no epidemic in the three years, we anticipate a thorough and practical operational plan in case of any early detection of viral presence in wastewater.

Early warning systems in resource-poor settings can make the most significant difference through proper mobilizations of healthcare professionals, materials, and governance to tackle a potential epidemic. Through the successful implementation of this technology, we will detect this viral genetic material in the wastewater spending less than $1.00. This mechanism can provide healthcare professionals and policymakers with adequate time to allocate resources, warn the public, and put measures in place to prevent the spread. Through this technology, we anticipate that many lives will be saved from moderate-to-severe morbidity and mortality by early diagnosis of SARS-CoV-2 infections. We believe that this technology is an affordable method to detect, warn, and prevent an epidemic, therefore ensuring the highest quality of life and healthcare for the entire population.

In our ongoing project, we are trying to develop an “Early Warning” system using wastewater-based surveillance. We faced a challenge to get real-time data from wastewater analysis as SARS-CoV-2 infected patient sheds viral genetic materials 2-5 days ahead of any clinical symptoms. Therefore, analyzing wastewater is crucial to developing an alert system before infected individuals are present with symptoms and undergo clinical testing. Our current RT-PCR approach takes time because it is a long step comprising wastewater collection, transportation, storage, and qPCR performance. Implantation of biosensors will overcome this data lagging period. In the first year, we want to pilot in Dhaka City to test effectiveness and acceptability. At the end of the first year, we expect to gather the data and generating evidence to recommend this biosensor for wastewater monitoring in treated and untreated sanitation systems. At the end of the three years, we anticipate incorporating this solution in the government health system and developing a warning system for disease monitoring, evaluation, reporting, and a rapid response mechanism. Though we hope there will be no epidemic in the three years, we still require a thorough and practical operational plan to detect any common or emerging pathogens present in wastewater.

1. Institute of Epidemiology, Disease Control and Research (IEDCR), Bangladesh  
2. Dhaka Water and Sanitation Authority (DWASA), Bangladesh 
3. Department of Public Health Engineering (DPHE), Bangladesh
4. MIT Solve
5. UNICEF
6. WHO
7. KTH Royal Institute of Technology, Sweden
8. CSIRO, Australia 
9. Emory University, USA 
10. University of Buffalo, USA
11. Johns Hopkins University, USA
12. Stanford University, USA

The Trinity Challenge aims to support new data analysis and digital tools that early action against health threats. We believe our technology is a fitting innovation for the current times and for all future times. We have seen several waves of the virus from different variants, and therefore, we are certain that this pandemic is far from over. With the development of this technology and widespread use, we believe it can be considered an affordable technological solution to prevent another pandemic wave. We require the resources and laboratory capacities, including funds, to scale up ongoing SARS-CoV-2 wastewater surveillance in Bangladesh. To make it affordable, we propose a low-cost biosensor-based wastewater monitoring that does not require intensive laboratory support and can be used by our team members with minimal capacity-building training. We expect Trinity Challenge will accept this solution and remove the hindrance of the development of the 'Early Warning' system to mitigate the propagation of viral transmission and combat this pandemic.

We are looking forward to partnering with Professor How Yong Ng, Director, NUS Environmental Research Institute (NERI) at the National University of Singapore, for their excellence and commitment to SARS-CoV-2 wastewater surveillance. 

Dr Zhugen Yang, Lecturer in Sensor Technology, Cranfield Water Science Institute, Cranfield University. He is currently heading the sensors lab for Water-Environment-Health nexus, which focuses on the development of low-cost, rapid and point-of-use sensors for environmental science (e.g. microbial contamination in drinking water) and public health.

Johns Hopkins University, Peter J. Winch, Director, Social and Behavioral Interventions Program can support us in designing behavior change campaigns to uptake the novel environmental monitoring tool in Bangladesh. 

Bill and Melinda Gates Foundation for their groundbreaking work and research support on waste and wastewater management. 

The United Nations Environment Program (UNEP) primarily coordinates environmental issues.

Best Buy for their support in developing and improving the Biosensor with electronic and technical support.

The Elevate Prize for their support for social innovations and scale the efforts of social change-makers.

Beyond the mentioned potential partner, our team is open to communication for all interested partners in development and scale-up and receiving legal assistance for intellectual property rights and commercialization.