Systematic Environmental Surveillance to Boost Public Healthcare Capacity

Overview

Precision Health platform, which works on the principles of Wastewater based Epidemiology or Environmental Surveillance (ES), was launched in Bangalore on 27th May 2021 through a joint and collaborative effort of several local private partners, under the COVID Action Collab (CAC), during the second wave of the COVID pandemic. The vision of the program is to enhance the existing capacity of public health surveillance systems for early detection and prevention of disease outbreaks by creating an early warning surveillance system, by promoting systematic ES.

In the city of Bangalore, this surveillance platform has been set up as an Early Warning System for COVID outbreaks, known as Precision Pandemic Health Surveillance (PPHS) Initiative. This initiative helps understand the trends of SARS-CoV-2 infections within the city and to support the local municipal administration by informing them about the trend of infection within the population. The surveillance system has proven to be effective in disseminating early warning signals to city administration and health officials for further actions and contributes as one of the many surveillance tools of the city's overall public health management systems for COVID control.

Objectives

y To explore, test and show the rationale of Environmental Surveillance in bridging the gap in the overall public health surveillance system in early detection and preparatory action to contain the disease spread. y To support the city administration in controlling and managing the COVID infection rate in Bangalore. y To provide an evidence-based indication of increasing or decreasing infection rates in the city population. y To supplement COVID surveillance through preliminary information on infection rates in specific areas of the city. y To provide information on emerging variants of COVID in the population.

Stakeholders Involved

Bruhat Bengaluru Mahanagara Palike (BBMP), other Urban Local Bodies (ULBs) such as city corporations and sewerage boards, National and State Health Departments, the local scientific community, and common citizens. Solution and Implementation Plan

The implementation of the initiative can be divided into two main sections, sample collection from the sewerage site and sample testing in the laboratory. However, there are several activities to be planned before sample collection at the site and after the obtaining of test results. Thus, broadly the implementation of the program consists of the following components:

y Partnerships were established with different agencies for site selection, sample collection at selected sites, sample processing (RNA extraction) and RT PCR testing and role setting. y Site selection and sampling strategy were developed as a one-time activity. A sampling plan was developed for a sample collection from the selected sites. Sample collection: was done as per plan using standard protocols. Timely delivery of each sample at the laboratory was ensured, and electronic data recording of all samples was done on all weekdays as a routine activity. y Sample processing: including filtration, RNA concentration, RNA extraction, and electronic data recording was routinely conducted on a biweekly basis. y RT PCR test: for RNA extracted sample and electronic data recording was conducted as a routine activity on a biweekly basis. Data analysis and reporting on dashboards and social media were done every week.

Stakeholder communication with the ULBs was regularly conducted through meetings and workshops to make sense of the data emerging from the PPHS initiative and the ways forward.

Other initiatives in Bangalore

y Drug level testing: A study was undertaken to understand the consumption of antibiotics and antipyretic drugs in the city through testing of wastewater for the presence of antibiotics and antipyretic drugs in wastewater. A pilot study was also conducted to assess the prevalence of Antimicrobial Resistance (AMR) to commonly used antibiotics in the city. After establishing an early warning system for Covid Surveillance, a pilot for an Integrated Surveillance System for testing new and emerging infectious diseases caused by

Monkeypox, H1N1 and Influenza A & B is being conducted as part of the PPHS initiative. Use of Geospatial Technologies

y As part of the above-mentioned initiatives conducted under the PPHS Initiative in Bangalore, several GISbased dashboards were developed to effectively interpret the data for evidence-based decision-making, which were designed to interpret the city-level findings. y The initiative currently has 46 open drains sites and all the functional 28 sewer sheds from where the samples are collected and tested. The frequency of sample collection is twice every week from each open drain site and once in ten days from each sewer shed.