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Wastewater in Midwest states carries high levels of COVID, says CDC

Wastewater goes through an aeration process to promote algae eating of bacteria and other heavy contaminants at the Bissell Point Water Treatment Plant in St. Louis.
Brian Munoz
COVID-19 lingers in wastewater because infected people can shed the virus, even if they don’t have symptoms.

Wastewater tests are designed to provide an early warning system so that public health officials can ward off outbreaks.

Wastewater testing at the end of 2023 showed relatively high levels of COVID-19 in Iowa, Kansas and Missouri, according to the Centers for Disease Control and Prevention (CDC). In Nebraska wastewater, virus levels were elevated, but not as high as the other states.

The latest CDC data suggests the virus is as prevalent in wastewater in all four states as it was in late 2022 and early 2023.

The CDC started its wastewater testing program in 2020, as one way to help health departments prepare for spikes in cases. The agency tests water from toilets, sinks, and showers around the country for signs of the virus, which lingers in wastewater because infected people can shed the virus, even if they don’t have symptoms.

Dr. Alex Garza, chief community health officer for SSM Health in Missouri, said the wastewater levels are cause for concern, but not panic.

“The test results tell the community that there’s a large amount of virus circulating around the community,” said Garza, who served as incident commander for the St. Louis Metropolitan Pandemic Task Force. “But does that mean more people are coming into the emergency department or getting admitted to the hospital? No.”

Dr. Alex Garza led the St. Louis region's pandemic task force and serves as chief community health officer for SSM Health in Missouri.
Sarah Fentem
Dr. Alex Garza led the St. Louis region's pandemic task force and serves as chief community health officer for SSM Health in Missouri.

Nationwide, 8.7% of hospital admissions in the last week were for COVID-19 patients, according to the CDC. The number of admissions for Iowa, Kansas, Missouri and Nebraska, are significantly lower.

Garza said while the wastewater data is a key indicator of risk, what would really concern public health officials would be seeing more sick people flooding hospitals.

“That's when it starts raising alarm bells,” he said.

The latest COVID-19 variant, JN.1, accounts for about half of the current COVID-19 cases in the country. Garza said it is more easily spread from person to person than earlier variants, but it does not make most people any sicker. The symptoms are similar: cough, fever, body aches and fatigue. A stronger strain would be a different story, he said.

“If we saw signs of a variant of COVID that was causing increased virulence, one that created a lot more people having to come to the emergency department or come or be admitted to the hospital? That would be a concerning piece,” he said.

In mid-December, the CDC sounded the alarm about low vaccination rates for COVID-19 as well as the flu and RSV.

“We are seeing too few folks get vaccinated this season,” CDC Director Dr. Mandy Cohen said at a briefing with the American Medical Association. “The voice of the physician matters so much in whether or not folks decide to get vaccinated.”

The CDC recommends flu and COVID-19 vaccines for everyone ages 6 months and older. The new RSV vaccine is available for adults 60 and up.

About 17% of adults in the United States have the latest COVID-19 vaccine. Regional rates of adults with the booster are between around 14% and 20%.

The number of people getting tested for COVID-19 began to decline in 2022. Garza said that with more people testing at home, it’s hard to track the practice. Still, he worries that COVID-19 cases may be higher than the data shows because many people are not testing at the rates they were at the height of the pandemic.

“Without a doubt, we're under-counting the number of cases that we have out in the community, and that's where that wastewater comes in as a helpful data point,” Garza said.

As of November 2023, the federal government began offering free home-delivered rapid testing kits after pausing the program earlier in the year. Doctors and public health officials urge people to get tested if they suspect they are infected with COVID-19, especially people over the age of 65 and those with medical conditions that affect their immune systems.

Garza said that with COVID-19 now endemic, people need to keep following the guidance provided by the CDC and their own doctors: wear masks in high-risk situations, get tested if you think you have COVID-19 and keep up to date with your vaccines.

“It's the same prevention stories that we've been telling for the last three plus years,” Garza said. “Stay at home or visit your physician or your nurse practitioner if you're feeling sick. Use those really common sense prevention techniques.”

This story comes from the Midwest Newsroom, an investigative journalism collaboration including IPRKCUR 89.3Nebraska Public Media NewsSt. Louis Public Radio and NPR.

Holly Edgell is the managing editor of the Midwest Newsroom, a public radio collaboration among NPR member stations in Missouri, Kansas, Iowa and Nebraska. Based in St. Louis, she has more than 25 years experience as a journalist and journalism education. You can contact Holly at hollyedgell@kcur.org.
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