A Review of the Presence of SARS-CoV-2 in Wastewater: Transmission Risks in Mexico.

The appearance of SARS-CoV-2 represented a new health threat to humanity and affected millions of people; the transmission of this virus occurs through different routes, and one of them recently under debate in the international community is its possible incorporation and spread by sewage. Therefore, the present work's research objectives are to review the presence of SARS-CoV-2 in wastewater throughout the world and to analyze the coverage of wastewater treatment in Mexico to determine if there is a correlation between the positive cases of COVID-19 and the percentages of treated wastewater in Mexico as well as to investigate the evidence of possible transmission by aerosol sand untreated wastewater. Methodologically, a quick search of scientific literature was performed to identify evidence the presence of SARS-CoV-2 RNA (ribonucleic acid) in wastewater in four international databases. The statistical information of the positive cases of COVID-19 was obtained from data from the Health Secretary of the Mexican Government and the Johns Hopkins Coronavirus Resource Center. The information from the wastewater treatment plants in Mexico was obtained from official information of the National Water Commission of Mexico. The results showed sufficient evidence that SARS-CoV-2 remains alive in municipal wastewater in Mexico. Our analysis indicates that there is a low but significant correlation between the percentage of treated water and positive cases of coronavirus r = -0.385, with IC (95%) = (-0.647, -0.042) and p = 0.030; this result should be taken with caution because wastewater is not a transmission mechanism, but this finding is useful to highlight the need to increase the percentage of treated wastewater and to do it efficiently. In conclusions, the virus is present in untreated wastewater, and the early detection of SAR-CoV-2 could serve as a bioindicator method of the presence of the virus. This could be of great help to establish surveillance measures by zones to take preventive actions, which to date have not been considered by the Mexican health authorities. Unfortunately, wastewater treatment systems in Mexico are very fragile, and coverage is limited to urban areas and non-existent in rural areas. Furthermore, although the probability of contagion is relatively low, it can be a risk for wastewater treatment plant workers and people who are close to them.

A case series of paediatric kidney transplants during the ongoing COVID-19 pandemic

BackgroundDuring the current COVID-19 pandemic, multiple lockdowns and a high incidence of cases severely impacted many European transplant programs. During the first wave of the pandemic, there was a need to stop both the living donor (LD) and deceased donor (DD) paediatric kidney transplant (KT) programs in our centres, subsequently reopening them fully. In contrast, increased confidence in our processes and outcomes led us to keep our deceased donor paediatric programme open during the UK’s second COVID-19 wave.ObjectivesWe report our experience with 25 children who received a KT during the current ongoing COVID-19 pandemic.MethodsFrom May 2020 to February 2021, all paediatric KT recipients were recorded and followed up in Evelina London Children’s Hospital, Southampton Children’s Hospital and Great Ormond Street Hospital. Covid-secure pathways were established for both LD and recipients following the UK guidelines on COVID-19. We prospectively recorded transplant outcomes and instances of SARS-CoV-2 infection in KT recipients.ResultsThere was 100% patient and 100% renal allograft survival in all 25 (12 (48%) female) KT recipients aged 2 to 17 (median 11) years of whom 18 were from LD (72%) and 7 from DD (28% [5 transplants from donors after brain death and 2 from donors after cardiac death]). Two patients (8%) developed COVID-19;one of them 5 weeks post-KT presenting with low grade fever and high CRP for one week without acute kidney injury during admission for surgical complication. The second one 4 month’s post-KT, presenting with low grade fever without any further complication. Four (16%) transplants were intraperitoneal, with 21 (84%) extraperitoneal, including an en-bloc KT. There were no vascular complications and two ureteric complications requiring surgical intervention. All of the patients shielded as per local guidelines.ConclusionsDuring the COVID-19 pandemic, different strategies had to be taken on the transplant programme to enable paediatric KT programmes to continue. This enabled safe and effective transplantation options from both living and deceased donors. In our experience, two transplant recipients acquired COVID-19 post-transplant without renal allograft dysfunction and did not require any changes to the immunosuppression.