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The World Health Organization (WHO) has published a report concluding that "there is still not enough evidence" to recommend the analysis of wastewater for the presence of the COVID-19 virus as a standard strategy for surveillance. of the new coronavirus.

In its report, the international health body details that this type of analysis has "a long history" of use in public health, particularly for the polio virus and, more recently, for antimicrobial resistance (AMR). In the context of the current Covid-19 pandemic, it is being used for the detection of SARS-CoV-2 discharged in wastewater from the upper gastrointestinal and upper respiratory system and through feces.

Specifically, they point out that the detection of non-infectious SARS-CoV-2 RNA fragments in untreated wastewater and / or sludge has been reported in several places, such as Milan (Italy), Murcia, Brisbane (Australia), several locations in the Netherlands, New Haven, Connecticut and eastern Massachusetts (United States), Paris (France) and existing polio virus surveillance sites in Pakistan.

WHO regrets that most of the studies published to date on the use of environmental monitoring for Sars-CoV-2 have been conducted in high-resource settings. "However, approaches are needed that can be applied in lower-resource settings , where a greater proportion of the population is not connected to sewers and instead uses well toilets or septic tanks," they argue.

In this context, they consider that " even in high-resource settings it is difficult to carry out generalized environmental monitoring for early warning, because this approach requires frequent sampling to obtain actionable data." "In addition, a high volume of sampling is also required due to low sensitivity. One possible approach could be to reserve environmental monitoring for joint testing in particularly high-risk settings where the response can be rapidly applied, such as environments closed residential (eg, nursing homes, prisons, workers' dormitories), large crowded workplaces or in the context of mass gatherings, "they add.

"While environmental monitoring has been shown to have the potential to be used to monitor Covid-19 prevalence and temporal trends, this approach would need to be tested in low- and middle-income settings to demonstrate its added value to surveillance. clinic ", they insist.

In low-resource settings, establishing new environmental monitoring systems "could risk diverting scarce resources away from essential monitoring activities and critical water, sanitation and hygiene (WASH) activities, such as scaling up hand hygiene in all settings and guaranteeing the continuity and expansion of water supply and sanitation services ".

"Thus, the cost-benefit ratio of environmental monitoring must be carefully evaluated in relation to these other essential measures . Environmental monitoring may be more justified in places where environmental monitoring for polio, resistance to polio, and resistance to polio has already been established. antimicrobials or other types of environmental surveillance. However, these places have been selected to meet different objectives and, therefore, their suitability for the purposes of surveillance of Covid-19 should be evaluated , "they insist.

Regarding its ethical and legal aspects, the WHO argues that "it can be used to identify the circulation of Sars-CoV-2 in a community without any consent for testing being given and it can lead to stigmatization of the community" . "However, given the inability to target specific individuals due to the pooled nature of environmental samples, stigmatization is likely to be much less than in the case of individual clinical trials. It would be important not to use environmental surveillance to disproportionately target to communities already stigmatized with public health and social measures ", they urge.

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