Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 - case studies from South Africa, the Netherlands, Turkey and England.

The COVID-19 pandemic has resulted in over 340 million infection cases (as of 21 January 2022) and more than 5.57 million deaths globally. In reaction, science, technology and innovation communities across the globe have organised themselves to contribute to national responses to COVID-19 disease. A significant contribution has been from the establishment of wastewater-based epidemiological (WBE) surveillance interventions and programmes for monitoring the spread of COVID-19 in at least 55 countries. Here, we examine and share experiences and lessons learnt in establishing such surveillance programmes. We use case studies to highlight testing methods and logistics considerations associated in scaling the implementing of such programmes in South Africa, the Netherlands, Turkey and England. The four countries were selected to represent different regions of the world and the perspective based on the considerable progress made in establishing and implementing their national WBE programmes. The selected countries also represent different climatic zones, economies, and development stages, which influence the implementation of national programmes of this nature and magnitude. In addition, the four countries' programmes offer good experiences and lessons learnt since they are systematic, and cover extensive areas, disseminate knowledge locally and internationally and partnered with authorities (government). The programmes also strengthened working relations and partnerships between and among local and global organisations. This paper shares these experiences and lessons to encourage others in the water and public health sectors on the benefits and value of WBE in tackling SARS-CoV-2 and related future circumstances.

Challenges with up-scaling dry sanitation technologies.

The acceleration of sanitation delivery towards meeting the South African Government's target of completely eradicating the existing backlogs by 2010, has led to a surge of activities. As part of its strategy for ensuring that basic sanitation is provided, the policy has recommended that a ventilated improved pit latrine (VIP) is considered as the basic minimum requirement in the form of a sanitation technology. The up-scaling and delivering of sanitation in many cases in the form of VIPs and its derivatives, as well as urine diversion technology are beginning to pose many technical challenges. The principles on which they have been designed are not always being observed in practice. As a result, some systems are filling up much faster than expected. Research has found that the breakdown in the faeces is not happening as would be expected in an anaerobic reactor, and that the drying of faeces in humid conditions, even with the use of drying agents, is not optimum. These problems, which are being experienced in the field, will have long term repercussions on the sustainability of sanitation provision. This paper aims to share these experiences and findings of research, and the impact it may have on the Sanitation MDG goals.

Emergencies in HIV--part 2.

In a short span of two and a half decades, HIV/AIDS has emerged as second largest killer disease that has affected mankind. The triple drug antiretroviral therapy (ART) has ensured a reasonably good quality of life to HIV infected individuals. Human immunodeficiency virus (HIV) infection is associated with several opportunistic infections/malignancies that may be life threatening and need quick intervention by health care workers. These emergencies could be related to opportunistic infections that are seen at presentation or that occur as the immune system gets weaker, or may bedue to HIV itself per se. The emergencies could also result from use of antiretroviral drugs like lactic acidosis, pancreatitis, bone marrow suppression and may include the immune reconstitution syndromes. The emergencies due to the opportunistic conditions and HIV per se had been dealt with in detail in the part 1, and this part describes various emergencies that could be encountered due to the administration of the anti retroviral treatment. Some patients may present due to emergencies as a result of co-administration of antiretroviral drugs with drugs used for treatment of some opportunistic infections like ATT etc.