ABSTRACT
Most sewer networks collect domestic wastewater and a variable proportion of extraneous water, such as rainwater, through surface runoff and industrial discharges. Accounting for wastewater dilution is essential to properly quantify wastewater particle loads, whether these are molecular fragments of SARS-CoV-2, or other substances of interest such as illicit drugs or microplastics. This paper presents a novel method for obtaining real-time estimates of wastewater dilution and total daily volume through wastewater treatment works, namely when flow data is not available or unreliable. The approach considers the levels of several physico-chemical markers (ammonia, electrical conductivity, and orthophosphate) in the wastewater against their dry-weather levels. Using high-resolution data from the national Wastewater Surveillance Programme of Wales, we illustrate how the method is robust to spikes in markers and can recover peaks in wastewater flow measurements that may have been capped by hydraulic relief valves. We show the method proves effective in normalising SARS-CoV-2 viral loads in wastewater samples and discuss other applications for this method, looking at wastewater surveillance as a vital tool to monitor both human and environmental health.
ABSTRACT
BACKGROUND: There is increasing interest in persistent interstitial lung disease (ILD) following resolution of acute COVID-19. No studies have yet reported findings in surgical lung biopsies (SLB) from this patient population. METHODS: Our Michigan Medicine pathology database was queried for SLB reviewed between January 2020 and April 2021 from patients with persistent ILD following recovery from acute COVID-19. Slides for our retrospective observational study were independently reviewed by two thoracic pathologists, who were blinded to patient clinical data, radiographic findings, and previous pathologic diagnosis. FINDINGS: Eighteen cases met inclusion criteria. Of these, nine had usual interstitial pneumonia (UIP). These included two patients with superimposed acute lung injury (ALI). Five cases showed a spectrum of ALI that ranged from persistent diffuse alveolar damage to organizing pneumonia. Four patients had desquamative interstitial pneumonia (1), acute and organizing bronchopneumonia (1), or no diagnostic abnormality (2). Compared to patients without UIP, those with UIP tended to be older and have pre-existing lung disease prior to COVID-19. In patients with UIP, pre-SLB chest computed tomography changes included groundglass with interstitial thickening or peripheral reticulations with bronchiectasis; no UIP patients had groundglass only. The most common radiographic finding in patients without UIP was groundglass opacities only. INTERPRETATION: UIP was the most common pathologic finding in patients undergoing evaluation for post-COVID-19 ILD. Our preliminary data suggests that CT changes described as interstitial thickening, peripheral reticulations, and/or bronchiectasis may be helpful in identifying patients with underlying fibrotic chronic interstitial pneumonia for which UIP is the chief concern. FUNDING: No intramural or extramural funding sources supported this work.