The Risks of Killing a COVID Early Warning System

COVID-19 is surging in parts of North America and Europe, and even played a role in ending the presidential campaign of 81-year-old Joe Biden, who was infected for the third time last month.

Nevertheless, on Wednesday the Ontario government shut down its early warning system to detect COVID and other emerging diseases.

Doctors, citizens and researchers are calling the decision to kill the province’s wastewater disease surveillance program both wrong-headed and dangerous. Ending the program will make it harder to track and thwart viral outbreaks, they say, and thereby increase the burden on Ontario’s understaffed hospitals, which experienced more than 1,000 emergency room closures last year.

“Pandemics do not end because science has been muzzled,” Dr. Iris Gorfinkel, a well-known Toronto physician and clinical researcher, told the CBC.

In emails to politicians, more than 5,000 citizens have demanded restoration of the program, with little effect.

In 2020, at the height of the pandemic, Ontario launched one of the world’s most comprehensive disease surveillance systems by sampling wastewater.

For five days a week since then, sewage water has been monitored for signs of COVID and its variants.

The viral particles can be detected in wastewater seven days before people experience symptoms, giving an invaluable head start on public health measures and allowing advance warning of surges in illness. The system was expanded to include wastewater testing for monkeypox, influenza and respiratory syncytial virus, or RSV, and even drug-resistant bacteria, at more than 56 locations in the province. The system covered all 34 public health districts.

Unlike other forms of testing, wastewater surveillance is relatively cheap and can be done in a small university lab. It also provides reliable updates that decision-makers and the public could easily follow in real time.

The monitoring helped millions at high risk from COVID infections, including the elderly and citizens with cancer and other immune suppressive disorders, to determine the incidence of the virus in their communities. It gave them information about when to make medical appointments, where to mask up and when to avoid crowded indoor events.

For many Indigenous communities with substandard and crowded housing, the program also served as an early warning system for waves of respiratory diseases.

The program also provided timely warnings to parents on the risk of infants acquiring RSV, which can cause pneumonia. Hospitals, too, regularly used the results to prepare for staffing and resource challenges in the wake of infectious viral waves including COVID and RSV.

The program, for example, currently shows COVID surging to record levels in the eastern parts of the province. Even a mild COVID infection can result in significant health problems three years down the road.

But in June the Doug Ford government announced it was axing the $15-million program to avoid duplication with a federal program.

"The federal government conducts wastewater surveillance across Canada and is moving to expand its sampling to additional sites in Ontario," Environment Ministry spokesperson Gary Wheeler said to CBC News in an email last month.

"Ontario is working to support this expansion while winding down the provincial wastewater surveillance initiative," he added.

But when Liberal member of the provincial parliament Ted Hsu and his staff reached out to federal officials, they discovered the federal program wouldn't be replacing the provincial one, which included experienced researchers at 13 universities. In addition, they learned that the provincial decision wasn’t co-ordinated with the Public Health Agency of Canada.

In fact, the federal program is far more limited than the cancelled provincial effort.

It operates only four testing sites in the Greater Toronto Area, although it may expand to eight or nine potential sites at a later date. The program does not report daily or in a timely fashion.

The federal program is also spotty and incomplete. Alberta, home to five million people, has only one surveillance site for the federal program, while Saskatchewan has 21 and B.C. five.

The killing of the program provides another example of governments abandoning critical public health measures while the risk of COVID infection still comes with significant consequences, including diabetes and strokes.

“The world is increasingly vulnerable to pandemics,” noted U.S. pandemic expert and physicist Yaneer Bar-Yam. “We must have ways to monitor disease transmission now and in the future. Wastewater surveillance is the main way that people have now to know when transmission of COVID and other diseases is going up and down, and when and where new variants are showing up.”

In September a scientific report from Ontario noted that surveillance data is “critical to understanding outbreaks.”

It recommended “that the Government of Ontario maintain and further invest in an early warning, alert and response system to prepare for and mitigate the impact of annual respiratory epidemics.”

Rob Delatolla, a University of Ottawa engineer whose lab researches wastewater surveillance as an early warning system for pandemics, decried the Ford government’s decision to end the program.

“A lot of institutional knowledge is going to be lost now and... we’ve come to the point where we just realized the cost-benefit analysis of the program,” Delatolla told The Tyee. He holds the Canadian Institutes of Health Research Applied Public Health Chair for environment, climate change and One Health.

Two recent studies by Delatolla and colleagues found that Ontario’s wastewater surveillance program helped provincial health officials more accurately pinpoint the beginning of the RSV season. As a result, physicians were able to provide prophylactic drugs to the most vulnerable children in the province. Those prompt actions prevented hundreds of hospitalizations and saved the province $3.5 million.

In response to the program’s closure, the cities of London and Ottawa have found supplementary funding to keep their surveillance programs going.

Joe Vipond, a Calgary emergency physician and co-chair of the Canadian COVID Society calls Ontario’s decision another example of governments trying to deny the reality of COVID’s ongoing infection risks and its growing burden on society.

In fact, data on the pandemic, which is now disrupting the Olympics, has progressively disappeared. In 2022 the project to track COVID in long-term care facilities ended despite the virus’s ongoing toll on the elderly because provinces didn’t want to share data. Yet Alberta data shows outbreaks are still happening on a regular basis.

Shortly after, Ontario disbanded its COVID-19 Science Advisory Table. This year the federal government stopped reporting on COVID case counts and national trends.

Alberta has even directed the removal of COVID from references in its vaccination campaigns.

And now Ontario is killing the nation’s best wastewater disease surveillance program.

Other provinces have retained their programs, but they are not as comprehensive or timely as Ontario’s network.

British Columbia, for example, monitors disease trends from 12 wastewater treatment plants and actually expanded its program in 2023. In contrast, Alberta monitors from only nine urban locations.

At the same time many public health officials still refuse to recognize the risks of asymptomatic transmission, the critical role of air transmission and the ever-growing burden of long COVID. New and repeat COVID-19 infections translate into millions of new long COVID cases, as well as elevated risk for blood clots, heart attacks, arrhythmias and strokes.

“I am still seeing acute care patients with COVID in the hospital and more long COVID cases,” Vipond told The Tyee. “We ignore this disease at our peril.... There is no end game anyone has planned for here.”

Governments that turn a blind eye to the uncomfortable realities of COVID and the importance of continued disease surveillance are undermining public health, Bar-Yam said.

“COVID is not a respiratory disease; it is a vascular disease, affecting blood vessels, damaging organs, causing long-term harm, reducing the ability to work and quality of life.”

“It is also not a seasonal disease as new variants cause peaks of transmission any time. Infection and reinfection will surely lead to untenable situations for individuals and society.”

The ending of critical reporting and surveillance on COVID will not end the pandemic, added Gorfinkel. “It will blind us to the misery it causes.”