Not a waste: Wastewater surveillance to enhance public health

Domestic wastewater, when collected and evaluated appropriately, can provide valuable health-related information for a community. As a relatively unbiased and non-invasive approach, wastewater surveillance may complement current practices towards mitigating risks and protecting population health. Spurred by the COVID-19 pandemic, wastewater programs are now widely implemented to monitor viral infection trends in sewersheds and inform public health decision-making. This review summarizes recent developments in wastewater-based epidemiology for detecting and monitoring communicable infectious diseases, dissemination of antimicrobial resistance, and illicit drug consumption. Wastewater surveillance, a quickly advancing Frontier in environmental science, is becoming a new tool to enhance public health, improve disease prevention, and respond to future epidemics and pandemics.

RATES OF COVID-19 INFECTION IN A FERTILITY TREATMENT POPULATION

OBJECTIVE: To assess rates of COVID-19 positivity in a fertility treatment population who continued to seek care throughout the pandemic. MATERIALS AND METHODS: A retrospective chart review of all patients actively pursuing fertility treatment and had a positive COVID-19 test between March 2020 and February 2021 at a University-affiliated IVF center was performed. Testing was performed on medication start date, and regularly throughout the treatment cycles, approximately once a week. Social distancing, mask use, and temperature and symptomatic screening was implemented early in the process. Rates of infection were calculated by dividing COVID-19 positive patients (whether symptomatic or asymptomatic) by total number of patients in care. This was then multiplied by 100,000, in order to compare our rates to the rate of cases in the state. Information on the general population's COVID-19 positivity rate was obtained from the State Department of Health. RESULTS: Rates of infection in our treatment population varied from 55 in August of 2020 to a high of 2333 per 100,000 in April of 2020. Rates of infection in the general population ranged from 167 per 100,000 to a high of 1367 in Nov of 2020. Our rates of infection did see a trend that was consistent with the curve of infections seen in the general population in the state (Table 1). CONCLUSIONS: Rates of infection were consistently at or below the state's rate per month for much of the 12-month period of study. The exceptions to this included April 2020, where we suspect that patients undergoing treatment were more likely than the general population to receive testing due to the center's testing policies compared to the lack of tests for the general population. Indeed, throughout the studied period, the patients receiving fertility treatment were much more likely than the general population to receive a test, as they were undergoing testing while asymptomatic. Additionally, the rate in February of 2021 was higher than that of the general population. IMPACT STATEMENT: The Covid-19 pandemic was unprecedented in the history of gynecologic endocrinology and infertility, and impacted the ability of patients to access fertility care worldwide. Our findings reveal that with proper mitigation techniques, infertility treatment can be safely delivered even in the face of a pandemic without radically increasing the risk of infection. (Table Presented).

FIRST TRIMESTER OUTCOMES OF PATIENTS SEEKING INFERTILITY CARE AFTER COVID-19 INFECTION

OBJECTIVE: To assess if COVID-19 infection differentially impacts first trimester outcomes in patients seeking infertility care at one large fertility practice. MATERIALS AND METHODS: A retrospective chart review of all female patients actively pursuing fertility care in a single fertility center with positive COVID-19 test results from March 2020 to February of 2021 was performed. Positive COVID-19 test results included PCR tests performed in our clinic and symptomatic patients who informed us of their outside positive test results by phone during their treatment with our clinic. This was compared to a control group of all comers in our clinic in 2020. Information was gathered on infertility treatment type, and pregnancy outcomes. Chemical pregnancy rate (CPR) is documented as a positive pregnancy test and ongoing pregnancy was documented as a positive fetal heart beat between 7-8 weeks of gestation and discharge to routine OBGYN care. Fishers exact test was used to calculate p value, statistically significant associations were considered to exist when the p value ≤0.05. RESULTS: A total of 178 cases of COVID-19 were documented in patients between April 2020 and February 2021. After COVID-19 infection (Covid+) sixty-two pregnancies were documented, with sustained implantation in fifty-three (85%) patients. In the subgroup of Covid+ patients that underwent subsequent fertility treatment the CPR was 30.1% with IUI, and 70.1% with IVF and single frozen embryo transfer. This is in comparison to our control population CPR of 14.1 % with IUI (p=0.002) and 68% (p=0.78) with IVF with single embryo transfer (Table 1). Clinical pregnancy loss rate was recorded and shown in Table 1. CONCLUSIONS: In an infertile population, a recent history of COVID-19 diagnosis did not negatively impact pregnancy outcome as measured against a control population. One of the limitations of this study was the relatively small sample size, which may have conflated our data on COVID-19 patients who underwent IUI, whose higher rate of pregnancy is unlikely to be clinically significant. IMPACT STATEMENT: Patients who have had COVID-19 and then proceeded with infertility treatment were no more likely than our control population to have first trimester complications in one fertility clinic. The findings from this study should provide reassurance that attempts at pregnancy do not need to be delayed after recovery from a COVID-19 diagnosis.