Want to know if COVID-19 is spreading again in Utah? The state wants you to check out the results of its wastewater surveillance, which monitors the presence of the deadly virus in what’s being flushed down the toilets of about 80% of the population.
“Wastewater is great,” Han Kim, a professor of public health at Westminster College in Salt Lake City, said of the monitoring method that picks up infections even if people aren’t showing symptoms or getting tested. “Everybody poops. It’s a really sensitive indicator and a wonderful surveillance tool.”
But Kim has concerns about the state’s new reliance on twice-weekly reports of COVID-19 trends from samples collected at 32 sewage treatment plants throughout Utah to help the public track the virus rather than the state Department of Health’s daily updates to case counts, hospitalizations and deaths that ended March 31.
“I’m an epidemiologist and I’m still trying to get used to it — what does this correlate to, what should I be looking for, if it’s a true rise in cases. For the layperson, it’s even more frustrating,” the professor said, pointing out that while the tracking website may identify an increase in the virus, the actual amount may be very small.
Accompanying charts show the fluctuations in the virus amount, measured in what’s described as millions of gene copies per person per day, as well as case counts for the area. But to find out what those charts mean in terms of risk levels requires a visit to another website, coronavirus.utah.gov.
There, a wastewater level chart spells out how many treatment plants are showing elevated levels of COVID-19 versus those that need to be watched closely, or are considered low or even below reporting limits. So far, even though a half-dozen sites have increasing levels, none are considered elevated.
And while there aren’t any currently listed as needing to be watched, it’s because the state’s coronavirus website is only updated weekly. Nathan LaCross, the state health department’s wastewater surveillance manager, said three treatment sites — in Park City, Moab and Davis County — have actually moved up to the watch category.
“They’re not elevated, but they’re not low anymore,” LaCross said. That should tell Utahns to “use an appropriate level of caution. Again, it doesn’t necessarily indicate there’s an especially alarming outbreak or something of that nature going on. But we’re seeing more signal, we’re detecting more virus.”
While he said “there’s not really defined, good best-practice thresholds to use for this,” to him, the watch category suggests Utahns who are vulnerable to more severe outcomes from COVID-19 may want to wear masks, social distance and take extra care in practicing good hygiene.
LaCross said determining wastewater levels has “turned out to be surprisingly tricky,” in part because the lab analysis moved last summer to the state from a variety of partners. Now, he said, work is underway to come up with “hopefully something better than this” as part of a new website that will be updated weekly.
Just when the current wastewater surveillance website, still hosted by the Department of Environmental Quality but maintained by the state health department, will be replaced is not clear. LaCross said the intent was it would be ready for the April 1 transition from daily case counts but there’s still no launch date.
He’s hopeful, however, once it’s up, the new website will eventually be expanded to track the flu and other diseases in wastewater.
“We want this to be not just a pandemic thing, but an ongoing thing,” LaCross said, a new tool for both health care providers and the public. “One of our overarching goals is to get people used to this being a source of information they can go to, and to get them used to thinking about it.”
At this point, though, Kim said the state’s focus on wastewater monitoring reporting “just feels rushed,” and makes it difficult for Utahns to make decisions about whether they need to take precautions against the virus, especially as so-called “stealth omicron,” known to scientists as BA.2, continues to spread through the country.
The U.S. Centers for Disease Control and Prevention has estimated that the even more contagious subvariant of the COVID-19 omicron variant that raged through the state earlier this year now dominates in the region that includes Utah, responsible for nearly 53% of virus cases, as well as more than 72% nationwide.
“It’s a bit of a mess. My concern is, we’re still not through this. We still have this other surge that may or may not come. But now we are kind of shuffling around in the dark,” Kim said, apparently because Utah decided “we’re passed this already.”
In mid-February, Gov. Spencer Cox announced that as of March 31, daily reporting on COVID-19 by the state health department would stop as part of his new “steady state” response to the pandemic that treats the virus more like the flu or other endemic disease with limited outbreaks that remains deadly.
Cox, who stressed then that Utah was “not spiking the football” in its matchup against COVID-19, said the state would continue to monitor its spread through wastewater surveillance and other measures, such as emergency room visits for the virus, while turning most testing and treatment over to private providers.
The accuracy of daily case counts was already an issue, since many Utahns rely on at-home tests to determine if they’ve got the virus and those results are not reported to the government. Also, during the height of the state’s last COVID-19 surge in January, the governor urged most Utahns with symptoms to skip testing and just stay home.
The final daily update to the media was posted by the state health department last Thursday, noting from now on, Utah’s COVID-19 data dashboard will only be updated once a week, on Thursdays around 1 p.m., “similar to how often data on other respiratory diseases, like flu, are reported.”
The final update reported 140 new cases, bringing Utah’s total COVID-19 case count to 927,922 since the start of the pandemic more than two years ago. The state’s death toll from the virus was at 4,714 lives lost as of last Thursday, including a single new death reported, a Washington County man between 65 and 84 who was hospitalized.
Utah’s “steady state” response to COVID-19 comes as new worries are being expressed about the nation’s readiness to deal with new waves of the virus, thanks to the combination of less data and waning interest in a pandemic that’s entering its third year.
There’s even the suggestion that surges of the BA.2 subvariant seen overseas already could be happening in the U.S. undetected because government data is relying on fewer tests as formerly free state-run testing sites in places like Utah are closed or become for-profit enterprises.
Kim said for Utah, the move came too soon.
“I understand that we want to get to endemic, but we’re nowhere near there. I think it’s premature to get rid of state testing,” the professor said, adding government at all levels “should have been learning from this, and strengthening our capacities.”
Now, Kim said, Utah and much of the rest of the country may not be prepared for what’s coming.
“We’re facing potentially another surge. We don’t know how big it’s going to be,” he said. “And we may never know, because we don’t have the data.”