WEBVTT 1 00:00:01.159 --> 00:00:04.000 Oh hey, it's me. It's your Internet dad uncle back 2 00:00:04.040 --> 00:00:08.759 with a highly erotic, not uncomfortable at all episode about 3 00:00:09.640 --> 00:00:12.839 diseases and toilet water. Please don't leave me, Please don't go, 4 00:00:12.960 --> 00:00:17.920 don't go, stay, please stay. But if this is your 5 00:00:17.920 --> 00:00:21.359 first ever Ologies episode, there are way less gross ones. 6 00:00:21.480 --> 00:00:24.440 Let's be real, So go listen to a less gross one. 7 00:00:24.480 --> 00:00:26.359 If this is your first ever or you know what, 8 00:00:26.600 --> 00:00:29.120 pull up a throne, because this episode, when you get 9 00:00:29.120 --> 00:00:30.039 down to it, is amazing. 10 00:00:30.079 --> 00:00:30.800 It's so good. 11 00:00:31.239 --> 00:00:34.399 I nervously showed up early to chat with this government 12 00:00:34.920 --> 00:00:40.039 pathogen expert. I heard about this field wastewater surveillance and 13 00:00:40.359 --> 00:00:44.799 environmental microbiology a few months back, and on February fourth, 14 00:00:45.359 --> 00:00:49.920 I tweeted desperately, I'm just a podcast Twitter account standing 15 00:00:49.920 --> 00:00:53.640 before microbiologists who tests sewer water for plagues, hoping they 16 00:00:53.640 --> 00:00:57.840 follow me back, and amid much enthusiasm, this guest replied 17 00:00:57.960 --> 00:01:00.640 with a jiff that said I got you to and 18 00:01:00.719 --> 00:01:03.439 here we are, and yes it's Jeff. It's not Giff, 19 00:01:03.520 --> 00:01:06.959 he said it was Jeff. So after one thousand clearances 20 00:01:07.000 --> 00:01:09.799 with our nation's centers for disease control, we are off 21 00:01:09.879 --> 00:01:13.480 the races now. This ologists got an undergrad degree in microbiology, 22 00:01:13.560 --> 00:01:16.879 a PhD in microbiology from the University of Buffalo, and 23 00:01:16.920 --> 00:01:19.680 then also got a Master of Public Health in epidemiology 24 00:01:19.680 --> 00:01:22.840 from Emory University. She is now a Senior Service Fellow 25 00:01:22.879 --> 00:01:26.040 at the CDC And additionally she has a dog who's 26 00:01:26.079 --> 00:01:28.560 a very good dog and sweet and sometimes the dog 27 00:01:28.599 --> 00:01:31.000 weighs in from time to time in the background. Enjoy. 28 00:01:31.400 --> 00:01:33.000 So thank you for weighing in, by the way, and 29 00:01:33.040 --> 00:01:36.560 spreading the word of ologies like a pathogen, and for 30 00:01:36.680 --> 00:01:39.640 supporting at patreon dot com slash ologies for as little 31 00:01:39.680 --> 00:01:41.959 as a block a month. Thank you for rating and 32 00:01:42.040 --> 00:01:44.680 reviewing and keeping us up in the charts. I read 33 00:01:44.799 --> 00:01:47.920 every single review you've ever left, and as proof, here's 34 00:01:47.959 --> 00:01:52.519 one it's still we just left yesterday from Eon Blue Ophelia, 35 00:01:52.560 --> 00:01:55.799 who said that the ADHD episodes were life saving. Rachel 36 00:01:55.840 --> 00:01:58.120 also left a review saying that they were life changing. 37 00:01:58.560 --> 00:02:01.879 Also smells like maple syrup. A self described construction worker 38 00:02:01.879 --> 00:02:05.120 who randomly laughs at work. Go get that eco hydrology career. 39 00:02:05.200 --> 00:02:06.359 I hope you enjoy this one too. 40 00:02:06.640 --> 00:02:06.920 Y'all. 41 00:02:07.000 --> 00:02:08.960 A bunch of you left really sweet reviews this week. 42 00:02:09.000 --> 00:02:11.039 I read every single one. Thank you so much. Also, 43 00:02:11.120 --> 00:02:13.800 As a bonus, there's a surprise cameo in this episode 44 00:02:13.800 --> 00:02:17.719 from your favorite virologist about what to do now that 45 00:02:17.759 --> 00:02:21.039 mandates and masks are starting to fall Because this episode, 46 00:02:21.199 --> 00:02:23.879 boy do we talk about covid. Oh also, I cold 47 00:02:23.919 --> 00:02:26.719 called a listener in this and I threw money at them, 48 00:02:26.800 --> 00:02:28.879 so that's in there too. But onto the show. So 49 00:02:29.360 --> 00:02:36.800 environmental microbiology, bacteria, covid in toilet water, medications in the waterways, plumbing, 50 00:02:36.840 --> 00:02:40.599 the sewers, for medical mysteries, things you can learn from 51 00:02:40.680 --> 00:02:44.919 studying stomach bugs, the weirdest things that get flushed. How 52 00:02:44.960 --> 00:02:48.199 gross is it? For real? Can you get COVID from 53 00:02:48.240 --> 00:02:51.560 your stepdad's farts? And what is out there swimming in 54 00:02:51.599 --> 00:02:54.240 the world, and how can we measure it to our advantage? 55 00:02:54.280 --> 00:02:57.000 Including what's on the horizon with covid? So if you 56 00:02:57.039 --> 00:02:59.639 are getting excited, well there must be some in the water. 57 00:02:59.719 --> 00:03:18.240 So do enjoy the brain of environmental microbiologist doctor Amy Kirby. 58 00:03:24.199 --> 00:03:26.960 I like so did not want to mess up anything 59 00:03:27.000 --> 00:03:29.360 with this interview that I got here earlier than I 60 00:03:29.400 --> 00:03:30.759 have ever been for any at all. 61 00:03:31.800 --> 00:03:32.840 I'm so excited. 62 00:03:34.680 --> 00:03:38.879 So Hi, I'm Ali, Hi, I'm Amy. Nice to meet you. 63 00:03:39.120 --> 00:03:41.280 Could I have you say your first and last names 64 00:03:41.280 --> 00:03:43.639 in the pronouns that you use. 65 00:03:43.879 --> 00:03:46.479 Sure. My name is Amy Kirby and I use she 66 00:03:46.639 --> 00:03:47.520 hers pronouns. 67 00:03:47.560 --> 00:03:49.639 I'm so excited to talk to you. You're doing very 68 00:03:49.639 --> 00:03:53.319 important work, and I imagine as we're cresting a little 69 00:03:53.319 --> 00:03:57.039 bit of a swell here for BA two, you're probably 70 00:03:57.039 --> 00:03:58.840 pretty busy. 71 00:03:59.240 --> 00:04:03.080 We have busy since twenty twenty, and so I feel like, 72 00:04:03.759 --> 00:04:06.319 you know, I tell my team a lot. We're busy 73 00:04:06.400 --> 00:04:08.439 right now, but it's going to get better, and then 74 00:04:08.919 --> 00:04:13.280 something new happens, a new variant, a new surge, and 75 00:04:13.319 --> 00:04:14.639 we are busy again. 76 00:04:16.240 --> 00:04:18.759 I'm going to ask right out of the gate right now, 77 00:04:18.959 --> 00:04:23.439 how are we doing at the moment, BA two, How 78 00:04:23.480 --> 00:04:24.759 are we? How are we doing? 79 00:04:25.879 --> 00:04:26.000 So? 80 00:04:26.639 --> 00:04:31.079 We are doing good. So we are seeing overall very 81 00:04:31.120 --> 00:04:33.800 low levels in wastewater. So we have come down out 82 00:04:33.800 --> 00:04:36.759 of the omicron surge and we're back to very low 83 00:04:36.839 --> 00:04:40.279 levels in wastewater. However, that said, we are starting to 84 00:04:40.319 --> 00:04:43.279 see some communities that are seeing some increases, and so 85 00:04:43.360 --> 00:04:46.560 we're watching those very closely to see if those increases 86 00:04:46.600 --> 00:04:51.839 turn into sustained increases and regional increases that would indicate 87 00:04:51.920 --> 00:04:55.759 another surge is coming in the wastewater system. Right now, 88 00:04:55.800 --> 00:04:58.560 we can't distinguish between BA one and BA two. We 89 00:04:58.639 --> 00:05:01.920 just see total omicron, which to be fair, is not 90 00:05:02.199 --> 00:05:05.639 very informative at the moment. Everything is omicron, so that 91 00:05:05.680 --> 00:05:08.319 particular data point isn't super useful at the moment, but 92 00:05:08.360 --> 00:05:11.319 we will be able to distinguish those sublineages soon. 93 00:05:11.519 --> 00:05:15.879 I mean, I imagine it's just curveball after curveball after curveball. 94 00:05:16.680 --> 00:05:19.759 It is. And the variant tracking part has been really 95 00:05:19.800 --> 00:05:22.319 a challenge because you're always running to keep up with 96 00:05:22.360 --> 00:05:24.920 the next variant. There's two different methods that we use 97 00:05:24.959 --> 00:05:27.920 for variant tracking in wastewater, so one of them is 98 00:05:28.160 --> 00:05:31.800 PCR based, so you're getting and it's very quick and 99 00:05:31.839 --> 00:05:35.600 it's very quantitative, so we can use it to track 100 00:05:35.839 --> 00:05:38.480 changes in variants. Like it was very helpful to see 101 00:05:38.720 --> 00:05:41.439 the omicron surge because we could see delta going down 102 00:05:41.480 --> 00:05:45.920 and omicron going up and we got good numbers around that. However, 103 00:05:46.800 --> 00:05:49.000 you're always in a race to keep up with the 104 00:05:49.040 --> 00:05:53.279 newest variant, right that PCR only detects that one variant. 105 00:05:53.560 --> 00:05:56.600 Sequencing as a better approach because then we can see 106 00:05:56.600 --> 00:05:59.639 evidence of any of the variants of concern and easily 107 00:05:59.680 --> 00:06:02.800 adapt to new variants. But it's a slower process and 108 00:06:02.959 --> 00:06:06.639 isn't as quantitative, so the measures around how much of 109 00:06:06.720 --> 00:06:09.519 a variant as president a community are not as accurate 110 00:06:09.600 --> 00:06:10.319 for that approach. 111 00:06:10.800 --> 00:06:12.800 Just a quick COVID check in, where are we at? Okay, 112 00:06:12.839 --> 00:06:16.240 So I'm recording this on April twelfth, twenty twenty two. Yes, 113 00:06:16.399 --> 00:06:19.240 it is the same day it's released. That's how we roll. 114 00:06:19.560 --> 00:06:22.879 And right now, epidemiologists have their eyes on the omicron 115 00:06:23.000 --> 00:06:26.120 subvariant BA two and that was first identified in November, 116 00:06:26.160 --> 00:06:29.399 but it happens to cause more gastro and testinal issues, 117 00:06:29.680 --> 00:06:31.480 so a lot of people right now are mistaking it 118 00:06:31.519 --> 00:06:33.560 for our stomach book and it's known as the stealth 119 00:06:33.680 --> 00:06:37.160 variant because it looks like an earlier delta variant. But 120 00:06:37.519 --> 00:06:40.519 BA two is estimated to make up nearly ninety four 121 00:06:40.600 --> 00:06:43.439 percent of cases in the US right now. In the US, 122 00:06:43.480 --> 00:06:45.920 cases are up about ten percent, but in New York 123 00:06:46.360 --> 00:06:49.959 up about forty percent. Philly, I'm sorry, you're up fifty 124 00:06:49.959 --> 00:06:53.120 percent from two weeks ago. And it's probable that rates 125 00:06:53.120 --> 00:06:55.959 are higher as people are relying on at home rapid 126 00:06:56.040 --> 00:06:58.439 tests that they don't report, or just no tests at all. 127 00:06:58.839 --> 00:07:02.560 So what is on the horizon? Perhaps another wave as 128 00:07:02.639 --> 00:07:08.519 masks come off, warm weather gatherings, commens disco makeouts ramp up. 129 00:07:08.839 --> 00:07:12.040 It's summer, people get wild. But keep your ears open 130 00:07:12.079 --> 00:07:15.959 for another variant called XE. It sounds like a human 131 00:07:16.040 --> 00:07:18.680 mix of grimes and elon musk, but X is really 132 00:07:18.680 --> 00:07:21.720 a hybrid of Omicron's BA one and BA two strains, 133 00:07:22.079 --> 00:07:25.240 but with a few fresh mutations. According to Time magazine, 134 00:07:25.279 --> 00:07:28.319 early research suggests that X is around ten percent more 135 00:07:28.399 --> 00:07:31.600 transmissible than BA two. These variants, they come on like 136 00:07:31.680 --> 00:07:34.480 software upgrades in the middle of the night that nobody wants. 137 00:07:34.759 --> 00:07:37.240 But just check the news and you'll find plenty of 138 00:07:37.279 --> 00:07:41.800 headlines like latest wastewater data suggest rising COVID levels and 139 00:07:41.959 --> 00:07:46.000 COVID nineteen wastewater numbers skyrocket, And so, of course, of 140 00:07:46.079 --> 00:07:48.120 course I had to show up early to talk to 141 00:07:48.120 --> 00:07:51.360 the top CDC scientist who is elbowed deep in the data. 142 00:07:51.959 --> 00:07:55.920 Any cities at the moment that you're seeing little bit 143 00:07:55.959 --> 00:07:59.079 of elevation, New York, I understand, Eastern seaboard New Jersey. 144 00:07:59.639 --> 00:08:02.399 Yeah, I wouldn't call out a specific city at this point, 145 00:08:02.399 --> 00:08:05.560 but certainly we're seeing concerning increases in the northeast, and 146 00:08:05.600 --> 00:08:08.279 there we're seeing more and more of our communities starting 147 00:08:08.319 --> 00:08:11.959 to see these consistent increases, So looking similar to what 148 00:08:12.000 --> 00:08:15.040 we've seen in the past with surges, where a certain 149 00:08:15.079 --> 00:08:18.800 region will start sort of set off the surge and 150 00:08:18.800 --> 00:08:21.319 then it will move across the country, staying on high 151 00:08:21.319 --> 00:08:21.920 alert for that. 152 00:08:22.439 --> 00:08:26.560 Were you always someone who is very up on latest trends? 153 00:08:26.720 --> 00:08:29.279 Are you obsessed with TikTok trends? How do you feel 154 00:08:29.319 --> 00:08:32.360 in general about keeping up with what's happening. 155 00:08:32.879 --> 00:08:33.200 I don't. 156 00:08:33.320 --> 00:08:36.440 I mean, I'm a typical science nerd, right, how trendy 157 00:08:36.559 --> 00:08:40.279 can we be? But yeah, I mean I think it's 158 00:08:40.279 --> 00:08:42.840 always fun to stay on the cutting edge of what's coming. 159 00:08:42.960 --> 00:08:47.639 And I don't necessarily think of wastewater surveillance as being trendy. 160 00:08:47.720 --> 00:08:49.919 It's something that we've been thinking about for a long 161 00:08:50.000 --> 00:08:52.759 time in various fields, and we've been using it for 162 00:08:52.840 --> 00:08:55.600 polio for decades, and so it was really about seeing 163 00:08:55.639 --> 00:08:59.279 the opportunity to apply a technique to a new problem. 164 00:08:59.799 --> 00:09:02.440 Aready had the information that we needed and sort of 165 00:09:02.440 --> 00:09:04.759 how wastewater surveillance works. We just had to build the 166 00:09:04.840 --> 00:09:08.720 right system to use it. For COVID at the national scale. 167 00:09:09.159 --> 00:09:11.200 That is something I do like to do is watch 168 00:09:11.240 --> 00:09:14.879 for these opportunities and see, you know, where can we 169 00:09:15.240 --> 00:09:18.840 leverage the unique skills we have. So I'm an environmental 170 00:09:18.879 --> 00:09:22.960 microbiologist by training. We are not usually part of the 171 00:09:23.000 --> 00:09:27.399 public health infrastructure that's very skewed towards clinical microbiology, and 172 00:09:27.440 --> 00:09:29.200 so it was great to be able to hop in 173 00:09:29.240 --> 00:09:33.279 early and say there is a role for environmental microbiology here. 174 00:09:33.559 --> 00:09:35.039 Here's what we can bring to the table. 175 00:09:35.559 --> 00:09:39.320 What we can bring to the table is wastewater. Maybe 176 00:09:39.320 --> 00:09:40.840 we can bring it to the table, but set it 177 00:09:40.879 --> 00:09:43.840 down on the ground next to the table. I would 178 00:09:43.919 --> 00:09:47.320 love to know a little bit about the history of this. 179 00:09:47.519 --> 00:09:49.840 You mentioned other diseases. Can you tell me a little 180 00:09:49.840 --> 00:09:52.440 bit about where this started and where you started getting 181 00:09:52.480 --> 00:09:55.200 really excited about what we can find from wastewater. 182 00:09:55.919 --> 00:09:58.480 Sure, so the long history of the field is really 183 00:09:58.519 --> 00:10:02.639 based on polio valance. So when we started working towards 184 00:10:02.759 --> 00:10:06.840 polio eradication back in the sixties, one of the challenges 185 00:10:06.879 --> 00:10:10.639 there is that the clinical outcome that you're most concerned 186 00:10:10.639 --> 00:10:15.120 about for polio is of course a cute flacid paralysis, right, 187 00:10:15.159 --> 00:10:18.159 but that is rare most people that are infected with 188 00:10:18.159 --> 00:10:21.320 the poliovirus do not go on to have that very 189 00:10:21.360 --> 00:10:24.080 acute outcome. In fact, most of them don't have any 190 00:10:24.120 --> 00:10:24.919 symptoms at all. 191 00:10:25.360 --> 00:10:28.080 Just a little history lesson here in a trivia tidbit. So, 192 00:10:28.159 --> 00:10:32.440 we didn't have vaccine for poliomylitis virus until the nineteen fifties, 193 00:10:32.759 --> 00:10:36.799 and then in the nineteen sixties, polio inoculations arrived not 194 00:10:36.879 --> 00:10:40.080 by needles so much, but via a liquid tincture of 195 00:10:40.360 --> 00:10:44.399 weakened virus saturating a sugar cube. Hey, what you did, 196 00:10:44.440 --> 00:10:49.720 Mary Poppins come out is the nineteen sixty four spoonful 197 00:10:49.840 --> 00:10:54.039 of sugar helps them medicine go down the mix? Yep, 198 00:10:54.320 --> 00:10:57.159 that song was written the day that the songwriter's sun 199 00:10:57.720 --> 00:11:02.960 got his delicious polio vaccine. Cheeky, but yes. Scientific sewer 200 00:11:03.080 --> 00:11:06.840 spying also aided in the poliophyte And so we. 201 00:11:06.879 --> 00:11:08.879 Knew that if we were looking only for this very 202 00:11:08.919 --> 00:11:12.879 severe outcome, we were going to miss we. I wasn't involved, 203 00:11:12.919 --> 00:11:17.200 but you know, we collectively the field recognize that they 204 00:11:17.320 --> 00:11:20.679 would miss most of the cases in a community. And 205 00:11:20.759 --> 00:11:23.720 as you move towards eradication, that's more and more important 206 00:11:23.799 --> 00:11:26.519 because every one of those cases that you miss could 207 00:11:26.519 --> 00:11:30.720 be a source for another case. Poliovirus is an enteric virus. 208 00:11:31.120 --> 00:11:34.480 It's transmitted through fecal oral transmission, so shed and stool, 209 00:11:34.799 --> 00:11:36.600 You get it on your hands or on your food, 210 00:11:36.639 --> 00:11:39.759 and then consume it, and that's the transmission mechanism. Yeah, 211 00:11:39.799 --> 00:11:42.039 but okay, And so they knew that they could look 212 00:11:42.080 --> 00:11:45.879 in stool and in wastewater to detect the poliovirus, and 213 00:11:46.000 --> 00:11:50.919 they use it to identify neighborhoods where polio is circulating, 214 00:11:51.320 --> 00:11:53.919 and then they go into those neighborhoods and do a 215 00:11:54.039 --> 00:11:57.879 vaccination campaign to protect everybody. And so that's how they've 216 00:11:57.919 --> 00:12:00.759 been using it. It works very well to target that 217 00:12:01.120 --> 00:12:04.720 intensive polio vaccination where it's most needed, and that was 218 00:12:04.759 --> 00:12:09.360 where it's stayed basically until twenty twenty. Previous to working 219 00:12:09.399 --> 00:12:13.440 at CDC, I worked on neurovirus, which causes the stomach 220 00:12:13.519 --> 00:12:16.240 flu basically, and one of the things that we always 221 00:12:16.320 --> 00:12:17.720 used to say in the field is like, wouldn't it 222 00:12:17.799 --> 00:12:21.320 be nice if we could have a community stool sample, 223 00:12:21.399 --> 00:12:24.399 because so many people get neurovirus, they suck it up 224 00:12:24.399 --> 00:12:26.639 for a day and feel terrible and they never go 225 00:12:26.720 --> 00:12:29.720 to the doctor and so we don't measure those people, 226 00:12:29.919 --> 00:12:32.759 and wastewater surveillance was a way to think about doing that, 227 00:12:33.120 --> 00:12:36.159 but there wasn't enough benefit. The return on investment to 228 00:12:36.320 --> 00:12:40.519 establishing a wastewater surveillance system for neurovirus was not high 229 00:12:40.639 --> 00:12:44.360 enough to get the infrastructure built, and so we always 230 00:12:44.360 --> 00:12:47.960 just kind of hoped for it and never never really 231 00:12:48.000 --> 00:12:50.519 were able to move on it. And then when COVID 232 00:12:50.600 --> 00:12:54.039 hit and we saw that it behaves very similar to 233 00:12:54.159 --> 00:12:57.000 SARS one, which we knew was shed and stool, we 234 00:12:57.080 --> 00:12:59.639 immediately started thinking that we might be able to use 235 00:12:59.679 --> 00:13:02.679 wastewater surveillance for this, and were engaged with some early 236 00:13:02.759 --> 00:13:06.759 collaborators that had systems where they were already testing wastewater 237 00:13:07.080 --> 00:13:10.000 and so we could fund them to look specifically for 238 00:13:10.080 --> 00:13:13.320 SARS Kobe two to in wastewater to see, if you know, 239 00:13:13.360 --> 00:13:15.840 can we see early evidence that this will in fact work. 240 00:13:16.320 --> 00:13:19.480 More on this exact moment of inspiration in a bit 241 00:13:19.519 --> 00:13:22.200 and it's good trust me. But Amy says that they 242 00:13:22.279 --> 00:13:25.840 began building the foundational data in early twenty twenty and 243 00:13:25.879 --> 00:13:29.720 by May, around the time you were whisking up Folger's 244 00:13:29.759 --> 00:13:34.360 crystals into history's most disappointing treat adel goona coffee. We 245 00:13:34.399 --> 00:13:37.879 all fell for it. Amy's team at that time spring 246 00:13:37.960 --> 00:13:41.279 twenty twenty felt confident in the biology and the epidemiology 247 00:13:41.440 --> 00:13:45.080 of wastewater testing, so they moved fast and they needed 248 00:13:45.120 --> 00:13:47.039 to establish a system. 249 00:13:47.320 --> 00:13:49.919 And very quickly we started pulling together. You know, how 250 00:13:49.919 --> 00:13:52.519 do we get utilities on board to take the samples, 251 00:13:52.559 --> 00:13:54.799 what labs are going to be able to do the testing, 252 00:13:55.159 --> 00:13:57.159 What data system are we going to stand up to 253 00:13:57.200 --> 00:13:59.600 collect the data at the national level. Spent a few 254 00:13:59.600 --> 00:14:02.519 months all of that together, and the system was officially 255 00:14:02.600 --> 00:14:05.360 launched in September of twenty twenty and has been growing 256 00:14:05.960 --> 00:14:09.000 rapidly since then. Experts say, if you want to understand 257 00:14:09.000 --> 00:14:11.879 how COVID spreads, check your toilet and just like what 258 00:14:11.919 --> 00:14:14.399 you'll find there. The news isn't all that pretty. Wastewater 259 00:14:14.440 --> 00:14:18.679 samples revealing record levels of coronavirus across the US. We 260 00:14:18.759 --> 00:14:22.320 have over seven hundred sites reporting into the system, and 261 00:14:22.600 --> 00:14:25.919 collectively they represent just shy of one hundred million people, 262 00:14:26.000 --> 00:14:28.720 so we're already covering almost thirty percent of the US population. 263 00:14:28.840 --> 00:14:32.960 Wow, and do you have to train people at different 264 00:14:33.039 --> 00:14:36.120 sites how to collect samples? Do they ship them to 265 00:14:36.600 --> 00:14:41.519 CDC headquarters in Atlanta. How are you gathering all of 266 00:14:41.559 --> 00:14:42.559 the sampling? 267 00:14:42.799 --> 00:14:46.639 Yeah, that has been a huge effort. So one key 268 00:14:46.799 --> 00:14:49.559 was recognizing that there's already a lot of expertise out 269 00:14:49.600 --> 00:14:52.240 there in how to do these things well. So working 270 00:14:52.279 --> 00:14:56.120 with our utility partners, who are absolutely critical for this. 271 00:14:56.279 --> 00:14:58.639 If they won't take the samples, there's nothing to test. 272 00:14:58.679 --> 00:15:01.120 So working with them and ask king them what are 273 00:15:01.440 --> 00:15:03.840 the best ways to take this sample? Where in a 274 00:15:03.919 --> 00:15:07.320 treatment process should we be sampling, Are there better ways 275 00:15:07.320 --> 00:15:09.559 to do it? What equipment can help us, how can 276 00:15:09.600 --> 00:15:13.200 we normalize for how much sewage is flowing through the pipes, 277 00:15:13.279 --> 00:15:16.720 And really engaging with them around their expertise, talking to 278 00:15:16.799 --> 00:15:20.840 the laboratories about testing. We do not have a standard 279 00:15:20.879 --> 00:15:24.799 method for testing measuring sarscob too and wastewater. There's a 280 00:15:24.840 --> 00:15:27.720 handful of methods that have proven to all work reliably, 281 00:15:27.840 --> 00:15:30.600 and so we support all of those. And largely it 282 00:15:30.679 --> 00:15:34.559 was our academic laboratories where this expertise lie. They were 283 00:15:34.720 --> 00:15:38.799 very engaged in developing and really optimizing the methods and 284 00:15:38.879 --> 00:15:40.799 are still part of it. I mean, many of our 285 00:15:40.840 --> 00:15:45.799 states are using academic laboratories as their surveillance laboratories right now. 286 00:15:46.120 --> 00:15:49.360 So the field work, shall we say, involves utility workers 287 00:15:49.480 --> 00:15:53.159 gathering samples at seven hundred and fifty five different treatment 288 00:15:53.240 --> 00:15:56.200 plants all over the country, and the analysis work goes 289 00:15:56.240 --> 00:15:59.399 to different labs, and then the CDC manages all the 290 00:15:59.480 --> 00:16:03.120 datasets and figures out what in crap's name is going 291 00:16:03.159 --> 00:16:07.320 on below our feet and in our bodies. But like 292 00:16:07.360 --> 00:16:11.039 a drain, let's back up, and can you tell me 293 00:16:11.080 --> 00:16:13.840 a little bit about your start in this when you 294 00:16:14.559 --> 00:16:17.879 began your science journey. What kind of questions do you 295 00:16:17.879 --> 00:16:20.720 want to ask and what kind of tinkering and collecting 296 00:16:20.799 --> 00:16:22.159 and field sampling were you doing. 297 00:16:23.039 --> 00:16:27.440 So my history, like many people in public health, I think, 298 00:16:27.679 --> 00:16:29.879 was not a straight line to this work. So I 299 00:16:29.879 --> 00:16:32.679 always knew that I was really interested in infectious diseases, 300 00:16:33.080 --> 00:16:37.279 in the pathogenic process, and how something so tiny can 301 00:16:37.399 --> 00:16:43.279 cause such big impacts on people on society. I wasn't 302 00:16:43.320 --> 00:16:47.080 sure in like high school and college, what scale I 303 00:16:47.120 --> 00:16:49.960 wanted to work, you know, I think looking at things 304 00:16:49.960 --> 00:16:54.480 as detailed as gene regulation, which is what my graduate 305 00:16:54.519 --> 00:16:57.519 work was on, it's fascinating all the details of how 306 00:16:57.559 --> 00:17:00.679 these systems work at a molecular lefl but I also 307 00:17:00.759 --> 00:17:05.039 think things like infectious disease history are fascinating and how 308 00:17:05.200 --> 00:17:08.640 big pandemics like this can really shape history. As I said, 309 00:17:08.680 --> 00:17:11.319 my initial training was at the molecular level. So after 310 00:17:11.359 --> 00:17:14.240 I got my PhD in molecular microbiology, I got a 311 00:17:14.279 --> 00:17:17.839 master's of public health and epidemiology and continued to work 312 00:17:17.880 --> 00:17:21.599 at Emory University for about five years doing public health research. 313 00:17:21.680 --> 00:17:25.440 That's where I did the neurovirus research, and then in 314 00:17:25.480 --> 00:17:30.799 twenty seventeen came to CDC, initially focused on environmental antibiotic resistance, 315 00:17:31.000 --> 00:17:34.039 so starting our program to look at environmental AR and 316 00:17:34.079 --> 00:17:37.599 then when the pandemic started in twenty twenty, we knew 317 00:17:37.599 --> 00:17:41.519 there was a need or an opportunity for environmental microbiology 318 00:17:41.559 --> 00:17:45.839 to contribute even more broadly than wastewater surveillance. We remember 319 00:17:45.880 --> 00:17:48.759 there were a lot of questions about things like surface 320 00:17:48.799 --> 00:17:52.319 survival or disinfection and all of that. When SARS COB 321 00:17:52.440 --> 00:17:56.039 two is new, those are environmental microbiology questions. And so 322 00:17:56.319 --> 00:17:59.720 in February of twenty twenty, I was we say, deployed 323 00:17:59.839 --> 00:18:03.279 to the response, so still reporting to CDC campus, but 324 00:18:03.359 --> 00:18:06.559 a different room. So now instead of instead of doing 325 00:18:06.559 --> 00:18:09.799 my regular work, I was doing response work for COVID, 326 00:18:09.880 --> 00:18:13.680 and those early days were focused on disinfection, surface survival, 327 00:18:14.160 --> 00:18:17.160 all of the things that went along with that response work. 328 00:18:17.240 --> 00:18:19.359 I mean, for anybody that's interested in public health, it 329 00:18:19.480 --> 00:18:21.400 is the thing that we all live for because you 330 00:18:21.440 --> 00:18:24.680 get to answer the questions that matter and you never 331 00:18:24.759 --> 00:18:26.839 know what's going to be on your desk. 332 00:18:27.319 --> 00:18:30.200 What will be on your desk is so many things. 333 00:18:30.519 --> 00:18:33.279 But yes, always in the back of her mind was what. 334 00:18:33.279 --> 00:18:37.480 About wastewater surveillance? Can we generate data for wastewater surveillance? And, 335 00:18:37.519 --> 00:18:39.559 like I said, by about May of twenty twenty, that 336 00:18:39.640 --> 00:18:41.000 had become my full time job. 337 00:18:41.279 --> 00:18:44.079 You know, shit gets real when they use the word deployed, 338 00:18:44.200 --> 00:18:46.519 by the way. 339 00:18:45.839 --> 00:18:48.000 A lot of people get confused by that, and it's 340 00:18:48.039 --> 00:18:50.920 like we're in the same building, just a different room. 341 00:18:51.480 --> 00:18:54.880 Yeah, but a little bit higher stakes almost. It feels 342 00:18:54.880 --> 00:18:57.799 like it feels much more emergent. For sure, at least 343 00:18:57.839 --> 00:19:01.319 it sounds like it. But what what is your day 344 00:19:01.359 --> 00:19:04.680 to day lab work? Like how much are you analyzing 345 00:19:04.759 --> 00:19:07.880 data sets and how much are you tinkering with pipettes 346 00:19:08.079 --> 00:19:10.119 and teaching other people how to do it? 347 00:19:10.400 --> 00:19:12.400 Yeah? So I think one of the things that people 348 00:19:13.279 --> 00:19:16.759 often misunderstand about the way surveillance systems work that are 349 00:19:16.839 --> 00:19:20.000 run by CDC, we actually don't do the lab testing. 350 00:19:20.559 --> 00:19:23.960 So it's much more efficient for a large scale system 351 00:19:24.039 --> 00:19:27.640 to set up the testing in each state so it's 352 00:19:27.680 --> 00:19:29.960 close to where the samples are coming from. Right, a 353 00:19:30.039 --> 00:19:32.920 distributed method for testing. So we do a lot of 354 00:19:32.960 --> 00:19:36.359 technical assistance for labs and answer questions and help them 355 00:19:36.400 --> 00:19:39.799 get connected to all of the resources that they need, 356 00:19:39.920 --> 00:19:43.960 but we're not doing any routine surveillance testing on campus. 357 00:19:44.079 --> 00:19:47.519 What we primarily do here in the laboratory is method 358 00:19:47.559 --> 00:19:50.680 development and validation. So we're already thinking about this is 359 00:19:50.720 --> 00:19:53.200 a great system. We've built it for COVID, but we 360 00:19:53.240 --> 00:19:55.279 could look for so many other things. Right, I can 361 00:19:55.359 --> 00:20:00.839 go back to my old friend norovirus, oh hella, and 362 00:20:00.880 --> 00:20:04.799 now we've put in the investment to build this infrastructure. 363 00:20:05.240 --> 00:20:08.640 Now it's a much lower bar to also look for neurovirus, 364 00:20:08.880 --> 00:20:10.599 and so we can get that data in the future. 365 00:20:10.680 --> 00:20:14.920 So we're method development, validation, tinkering, make sure we really 366 00:20:15.039 --> 00:20:18.480 thoroughly understand how those lab methods work, so that when 367 00:20:18.480 --> 00:20:20.119 we're on the phone with the labs that are doing 368 00:20:20.119 --> 00:20:23.759 the work. We can be as good as possible in 369 00:20:23.799 --> 00:20:24.920 our technical assistance. 370 00:20:25.799 --> 00:20:28.160 Where do you get your practice wastewater? 371 00:20:30.839 --> 00:20:33.640 We have our sources, so we're based here in Atlanta, 372 00:20:33.680 --> 00:20:37.799 and Atlanta has, like many large cities, actually has multiple 373 00:20:37.839 --> 00:20:41.799 wastewater treatment systems, and so we have long standing collaborations 374 00:20:41.839 --> 00:20:44.440 with our local utilities. We can call them up and 375 00:20:44.480 --> 00:20:47.319 say can we get you know, five liters of wastewater 376 00:20:47.400 --> 00:20:50.279 on Tuesday? And I say sure, and we go get 377 00:20:50.319 --> 00:20:52.440 it and that becomes our sample matrix. 378 00:20:52.920 --> 00:20:56.319 How treated is it? Be real with me, where along 379 00:20:56.359 --> 00:20:57.640 the assembly line is it? 380 00:20:58.519 --> 00:21:01.039 So we collect it so the way it comes in 381 00:21:01.160 --> 00:21:03.920 and this is actually fascinating. I should say that all 382 00:21:03.960 --> 00:21:07.680 of the people that work certainly in news, the news 383 00:21:07.759 --> 00:21:10.559 is our acronym, right, A good government program has to 384 00:21:10.559 --> 00:21:14.480 have a pronounceable acronym. Where the National Wastewater Surveillance System 385 00:21:14.480 --> 00:21:16.720 and we pronounce it news. But all of our news folks, 386 00:21:16.839 --> 00:21:21.000 we're we get a little nerdy about wastewater systems, so 387 00:21:21.039 --> 00:21:22.759 we really like to go out and see how they work. 388 00:21:22.880 --> 00:21:26.480 For news testing, the wastewater comes into the plant, there's 389 00:21:26.559 --> 00:21:30.279 usually a very large grate that acts as a pre screen, 390 00:21:30.400 --> 00:21:33.680 and so it filters out all of the really big things. 391 00:21:33.839 --> 00:21:37.480 The I mean, they get all kinds of things, furniture, 392 00:21:37.599 --> 00:21:42.599 teddy bears, branches, sticks, tires, all the things that flow 393 00:21:42.599 --> 00:21:45.119 into sewer mains, and so it's going to get rid 394 00:21:45.119 --> 00:21:47.119 of all of those big things, but everything else is 395 00:21:47.160 --> 00:21:49.160 going to come through, and that is where we take 396 00:21:49.200 --> 00:21:51.400 our sample, so it is completely untreated. 397 00:21:51.640 --> 00:21:53.799 I've been swimming in raw sewage. 398 00:21:54.400 --> 00:21:57.880 I love it when we get it. People often think 399 00:21:57.920 --> 00:22:01.640 that there's like whole poops floating around there is That's 400 00:22:01.640 --> 00:22:03.359 not what the sample looks like. By the time it 401 00:22:03.400 --> 00:22:05.920