Last summer, Dr Natalie Prystajecky (Principal Investigator) and Dr Melissa Glier (lead researcher) provided an introduction to wastewater testing for SARS-CoV-2. Here, Drs Glier and Prystajecky provide an update on research progress and how wastewater data continues to be used in the pandemic response.         

Soon after the World Health Organization declared the global outbreak of COVID-19 a pandemic, the BC Centre for Disease Control (BCCDC) Public Health Laboratory (PHL) and Metro Vancouver began working together to test wastewater for SARS-CoV-2.

We quickly leveraged an existing collaboration, methods, and equipment for testing enteric viruses in wastewater to be able to test for SARS-CoV-2, the virus that causes COVID-19. But we weren’t the only lab in Canada doing this work–across the nation, researchers like us were developing and optimizing methods. To ensure that the methods used across Canada were robust and that the data were comparable, the Canadian Water Network’s COVID-19 Wastewater Coalition conducted an Inter-Laboratory Study, hosted by Canada’s National Microbiology Laboratory.

The goal of this study was to better understand the variability associated with methods that are being used in Canada, with a focus on method optimization. This study set the stage for sharing methods and data amongst Canadian experts to achieve the collective goal of rapid development of methods that can support public health. The study’s key finding and recommendations have been captured in an outcomes report and a publication where Dr Glier is the second author.

By participating in the inter-laboratory study, our team was able to optimize our methods and apply them to testing for SARS-CoV-2 in five wastewater treatment plants in Metro Vancouver, which cover nearly 50% of BC’s population and located within two regional health authorities.

The SARS-CoV-2 wastewater data is compared to trends in the incidence of community cases by BCCDC’s public health physician Dr David McVae, medical geographer Sunny Mak, and data analyst Michael Kuo. Weekly reports are shared with medical health officers and epidemiologists at the regional health authorities, staff at the BCCDC and Metro Vancouver. In addition, Metro Vancouver launched an online tool which allows residents to track the SARS-CoV-2 viral load in wastewater at each of the region’s five treatment plants. The results (wastewater data graphed with the case data over time) are also available online within the bi-weekly BC COVID-19 Data Summaries.

Furthermore, last year we collaborated with UBC’s assistant professor Dr Ryan Ziels and PhD student Xuan Lin to develop methods to detect SARS-CoV-2 variants of concern in positive wastewater samples. This project led to the development of a rapid sequencing method (3-day) to effectively track COVID-19 variants of concern within a region. More details pertaining to this study can be found on the UBC News website and in this publication.

Our team continues to work on method development and recently adopted an alternative sampling method. For the work to date, we have focused on sampling from wastewater influent (as the wastewater enters the wastewater treatment plant). This allows us to test wastewater from an entire community.

We are now evaluating a method to test wastewater as it exits a building; this allows us to test the wastewater for a specific community. Wastewater samples are collected by placing a testing device called the COVID-19 sewer cage (COSCa) into a manhole as wastewater exits a building.

The COSCa device, which is 3D printed, was created by PhD student Emalie Hayes at Dalhousie University and emphasizes the role of innovation in responding to the pandemic. We are using the COSCa sampling method, in collaboration with the Ziels laboratory, to investigate SARS-CoV-2 and the variants of concern in wastewater discharged from UBC residences. By the end of the project, we will have developed a robust wastewater testing program to support public health decision makers respond to the COVID-19 pandemic in BC.

We are already starting to plan for wastewater testing beyond COVID-19, with an aim to build a comprehensive enhanced wastewater surveillance system for BC. This includes adding additional testing targets of public health concern, such as for surveillance of flu, foodborne pathogens or organisms carrying antimicrobial resistance. We anticipate the wastewater-based testing will have an important role in surveillance systems of the future.

We’d like to recognize our funders: the BCCDC Foundation for Public Health, NSERC, Metro Vancouver, and Health Canada.

We also recognize the enormous contribution of our team and collaborators, including the team that processes and tests the samples: Liam Byrne and Tina Lee (current coops), Tenysha RossVanMierlo, Matthias Krushel, Ziwen Ran (previous co-ops), and Jennifer Kopetzky (technician). We recognize the contributions of the following as well; Christine Tchao, Daisy Yu, Tracy Chan, Dr John Tyson (BCCDC PHL); Dr Ryan Ziels, Xuan Lin, Kevin Kuchinski, (UBC); Dr David McVea, Sunny Mak, Michael Kuo (BCCDC) Farida Bishay, Alvin Louie, Daisy Espinosa, Dr Andjela Knezevic-Stevanovic (Metro Vancouver), Dr. Chand Mangat, Dr. Michael Mulvey, Dr. Anil Nichani (NML/PHAC); Dr. Alex Chik, Bernadette Conant, and Dr. Steve Hrudey (CWN).

The post Project Update: BCCDC’s COVID-19 Wastewater Surveillance in Metro Vancouver Communities appeared first on Pacific Public Health Foundation.

The post Newsletter #24: May 2021 appeared first on Pacific Public Health Foundation.

COVID-19 Vaccine Roll-out

COVID-19 vaccine development has been unprecedented, with researchers working day and night to develop, test, seek approval for, manufacture, and now distribute vaccines across Canada. The timeline of this work has been incredible and has shifted the tide of the pandemic towards a brighter future.

While we all must continue to use all our layers of protection (handwashing, mask-wearing, physical distancing, etc.), the introduction of novel vaccines and roll-out plans, have offered us all hope in a dark time. However, this will take some time; it will be many months before everyone in BC is vaccinated.

We can, and must, learn during this time, and moving forward. It is imperative we gather evidence that will help us through the rest of this pandemic and vaccination program, and importantly to prepare for any future threats.

In other words, now is the time to invest in and learn more about this new phase of the global pandemic.

Why do we Need Vaccine Research?

The work that has been undertaken to bring vaccines to the people is not a question; however, understanding the effectiveness (how well a vaccine works in real-world conditions) and immunogenicity (the ability of an antigen (i.e., vaccine) to provoke an immune response in an individual) of the vaccines remains.

In addition, logistical challenges and vaccine hesitancy require research, and we must assure equitable distribution to priority populations, which requires new knowledge.

We have a lot to learn to keep people safe into the future, and it is critical, as we roll out the vaccine program that we undertake this work immediately and in real-time. Researchers and public health experts will gather invaluable information during this time, information that will be lost if we don’t act now.

This is not about questioning whether the COVID-19 vaccines are safe. Rigorous approvals are required before a vaccine is put into use and the available vaccines are safe and effective in phase 3 trials. However, they are of novel design and must be evaluated in real settings and populations, and this means asking key questions, such as:

1. What is the effectiveness of the vaccine in preventing illness and infection?
2. What is the effectiveness of the vaccine in reducing transmission? 
3. What is the immunogenicity of the vaccine?
4. What concerns do British Columbians have about the vaccine?
5. How do we deliver equitable access to vaccination?

Our Role

As a public health foundation, it was our responsibility in early 2020 to rapidly pivot our work to support COVID-19 response, and to ensure that evidence-based information is being shared.

It is now our duty to support the COVID-19 vaccine roll-out—a critical part of our efforts to address the pandemic.

While we remain committed to BC’s public health pandemic response, our partners have informed us that we’re facing an urgent need for vaccine-related research. This requires rapid-response funding that can allow us to learn from the vaccine roll-out, in real-time. 

What does this mean for the Foundation?

It means that for the near future, we’ll be incorporating vaccine research into our Emergency Response Fund.

Plus, we’re reaching out to our partners to combine our efforts, because by collaborating, we can leverage our collective strengths to support research better, and faster. When we work together, we accomplish so much more.

In other words, bringing philanthropy together with government and other partners means we are working collectively to leverage all our efforts and strengths to achieve an even greater impact. As our government and health authority partners are implementing the vaccination roll-out, it is our responsibility to support research.

However, supporting research in an ever-changing landscape is not easy. Working in real-time, with new information constantly coming at us, is not easy. But, during this pandemic it has remained critical to stay on top of the priorities, and it’s our call-to-action to go where we’re most needed—we’re facing a new landscape that we’re ready to tackle to help keep all British Columbians safe.

How You Can Help

As British Columbians, we have a unique opportunity to learn in real-time in a way like no other, and we have a responsibility to undertake this work. However, in order to move quickly, we need your help to support our public health leaders, experts, and researchers, now.

We’re with you—we’re all ready to celebrate the end of this pandemic. And with vaccines now being administered, we’re one colossal step closer.

We’re calling on you to come alongside us in this final push—please help us to ensure we don’t lose this opportunity to gain valuable evidence that will protect us now and long into the future.

The post Why We Need to Support Vaccine Effectiveness Research, Right Now appeared first on Pacific Public Health Foundation.

To understand who is not looking to Dr. Bonnie Henry, we broke our analysis down by age and ethnicity.  We can see a clear opportunity to work to increase Dr. Henry’s reach into South Asian and Indigenous communities.

However, we also know it’s more important to meet people where they already look for information. Select examples include the greater use of Facebook amongst Indigenous respondents and the use of YouTube and WhatsApp by South Asian respondents. Younger respondents, as expected, were much less likely to seek information from TV news and much more likely to look to social media like Instagram.

Stigma: 38% of Chinese respondents reported being more aware of their ethnic background due to COVID-19. 1 in 3 Chinese British Columbians also observed someone being badly treated because of their race and association with COVID-19. This is also true for 1 in 4 Indigenous and South Asian respondents. While only 1 in 10 White respondents report the same.

So what does this all mean and what are the next steps?
We found that non-white ethnic groups in BC are experiencing the COVID-19 crisis differently than white publics. Not only do non-white publics tend to seek information from different sources, but they also experience stigma at a much higher intensity. Since April we have been working with external and internal partners to find solutions to our communications gaps, and to help improve the public health response to COVID-19. Some examples include the development of the BCCDC COVID-19 Language Guide and personas of social media users to guide messaging. We are also planning to re-run the survey to see what’s changed over time.

Interested how you can help combat misinformation everyday? Click through to Addressing the Infodemic: Everyone Must Play a Role in Stopping Mis- and Disinformation.

*Bios:
Katie Fenn has supported numerous quality improvement initiatives within public health including the patient to population project, making space for health equity, improving data quality, and point of care testing for HCV.  Her interests are in process improvement and strategic planning through partnerships and communication.  She has worked across many sectors including the Commonwealth Games, Advertising, Community Living, and Event Planning.

Dr. Emily Rempel is a mixed white and Métis public engagement and social sciences researcher. She has a PhD in policy and public engagement from the University of Bath in the UK. Her current role is a Knowledge Translation Lead at the BC Centre for Disease Control. Her work focuses on equity in public engagement and knowledge exchange in the fields of public health, critical data studies and biostatistics.

Harlan Pruden (nēhiyo/First Nations Cree Nation), works with and for the Two-Spirit community locally, nationally and internationally. Currently, Harlan is an Educator at Chee Mamuk, an Indigenous public health program at BC Centre for Disease Control; the Managing Editor of the TwoSpiritJournal.com; and an Advisory Board Member for CIHR’s Institute of Gender and Health, whose mission is to foster research excellence regarding the influence of sex and gender on health and to apply these findings to identify and address pressing health challenges facing men, women, girls, boys and gender-diverse people including Two-Spirit people.

The post From Epidemic to Infodemic: COVID-19 and Misinformation in BC appeared first on Pacific Public Health Foundation.

Q. Your COVID-19 research that we’re able to support through our Emergency Response Fund includes the population health survey, serological testing, and sentinel surveillance: why is this three-pronged approach the best way to proceed?

We are experiencing a continuing global spread of SARS-COV2 (the virus that causes COVID-19) that will require heightened coordinated public health surveillance and response activities for the foreseeable future. As this core work continues, there remains a number of unanswered questions on the efficacy of interventions; adverse consequences from public health measures; whether having experienced the infection affords any protection from re-infection; and, whether there are opportunities to identify earlier signs of community transmission.

My work at the BC Centre for Disease Control is to lead this three-pronged investigation.  We will examine these issues and provide some of the key information necessary to guide policy and planning decisions over the short-to-medium term response activities. These policy and planning decisions are aimed at keeping British Columbians safe and healthy.

All British Columbians have been impacted by the pandemic and have been very engaged on the progression of the local epidemic. Our approach is intended to further engage the public in supporting the response by informing the pertinent issues under consideration.

Q. What was a standout learning or piece of data from the BCCDC’s “Your Story, Our Future” population health survey that’s really stuck with you?

The results from the population health survey indicate that overall British Columbians have been very compliant with the measures in place and have adopted good personal preventive practices to limit exposure and spread of COVID-19. However, the results also reveal that these measures are having adverse consequences for British Columbians, in particular young adults, households with school-aged children, and those from some visible minority backgrounds.

Q. What do you hope to achieve from serological testing? What do you want to learn and how will that help protect our population?

Serological (antibody) testing is conducted to help understand if someone has contracted COVID-19. When we’re exposed to a new virus our immune system produces antibodies which help fight off infections and can provide protection against getting that disease again—this is immunity. Serological, or antibody tests, tell us about a past infection and cannot be used to diagnose a current infection.

We use serological tests to understand the extent to which a population has been infected with COVID-19; it provides information on population susceptibility and the potential for the virus to continue to propagate in the absence of an effective vaccine.

Secondly, it may help us understand which population sub-groups have had more exposure to COVID-19. Understanding how specific sub-groups are impacted, like households with children, can guide prevention efforts which allows us to better target possible chains of transmission in the community.

Thirdly, we don’t currently know how much protection the antibodies for COVID-19 may provide to subsequent infections or how long this protection may last. In other words, we don’t know how long people who have had COVID-19 are immune for. It is very important we examine this over time with repeated testing in the short to medium term.

Q. “Surveillance” sounds scary. What does the third phase of this work, sentinel surveillance, actually mean and how will it help?

Surveillance is the monitoring, or information gathering, to help better characterize a particular health condition. Public health regularly uses surveillance to keep track of many different communicable diseases. However, most information is captured after an individual experiences an illness and has a diagnosis.

“Until an effective vaccine is developed and widely distributed, we have to rely on a public health response of keeping transmission low.”

Sentinel surveillance provides an opportunity to seek out COVID-19 illness at an earlier stage by monitoring self-reported symptoms within a defined setting (for example, households) across British Columbia’s population. With appropriate technology to distinguish relevant symptoms, it can provide an efficient and early warning system of potential increase in community transmission.

Q. Why do research? Why not just develop a vaccine?

COVID-19 is caused by a novel pathogen that has emerged with significant global consequences, and there is much around its transmission, adverse physical health impacts, and immune response we are still trying to understand.  Vaccine development typically requires years of safety and efficacy trials before it is approved for general use at scale.

Until that time, we need to maintain focus on the core public health response of testing and tracing, which are essential steps to suppressing community transmission. The more effectively and quickly this is done, the better we prevent the escalation of localized cases into broader community transmission that may result in greater burden on the health care system.

Until an effective vaccine is developed and widely distributed, we have to rely on a public health response of keeping transmission low, and our research will indicate the best ways of doing that for our population.

Q. How does your work, and the work of the BCCDC, fit into the larger response in BC and align with the Ministry, the health authorities, and what other experts and researchers are doing? What piece of the puzzle is the BCCDC bringing to this work?

Our provincial collaboration is critical to public health. Working together ensures we have the greatest collective impact. Public health leadership across BC includes the BCCDC, the Provincial Health Officer, and the Chief Medical Health Officers who have the responsibility for carrying out legislated requirements under the Public Health Act and to monitor, assess, and advise on health in BC. It is this leadership group who are actively providing critical tactical and strategic guidance for managing the public health emergency and part of this role is providing key direction that guides this project and associated work.

This leadership group also allows us to bring together information from all the relevant experts that support public health practice and applied research in BC. This ensures decisions are based on available data, such as the survey results, emerging research and the best evidence.

BCCDC is a critical hub in this larger response effort; from testing to research to providing guidance on public health direction for the PHO, BCCDC’s leadership and experts are an invaluable resource for not only this project but for so many of the public health efforts currently underway to keep British Columbians safe. 

Dr. Jat Sandhu is a Consultant in Epidemiology & Population Health Management at the BC Centre for Disease Control, and Clinical Associate Professor at UBC’s School of Population and Public Health. Dr. Sandhu has been seconded to the BCCDC part time from his primary role at Vancouver Coastal Health as Executive Director for Data Analytics and Decision Support.

View more of the population health survey results, and BCCDC modelling updates here.

You can support Dr. Sandhu’s research and the BCCDC’s public health response to COVID-19 by donating to our Emergency Response Fund. We’re more than 80% of the way to our goal of $500,000. Donations will support the serology and sentinel surveillance phases of this work.

The post Interview with Dr Jat Sandhu: BCCDC’s COVID-19 Pandemic Response Research appeared first on Pacific Public Health Foundation.

To most, wastewater (aka sewage) is something that is flushed down the toilet and out of sight, out of mind. But to us as researchers at the BC Centre for Disease Control Public Health Laboratory (BCCDC PHL), wastewater may serve as an important tool for tracking the spread of COVID-19.

We (Dr Prystajecky as principal investigator and Dr Glier as lead researcher) have been working together with Metro Vancouver, studying viruses in wastewater since 2018. Our work initially focused on the occurrence of enteric viruses that cause gastrointestinal illness (e.g. vomiting and diarrhea) in wastewater and understanding how they could be removed by wastewater treatment. Furthermore, this wastewater testing could also be used as a tool to monitor viruses such as norovirus, because it can serve as a proxy for diarrheal illness in BC communities. 

On March 11, the World Health Organization declared the global outbreak of COVID-19 a pandemic and our research on enteric viruses in wastewater was put on hold, so the BCCDC PHL could focus on COVID-19. Interestingly, although COVID-19 is primarily a respiratory illness, a significant proportion of people who have tested positive for COVID-19 shed the virus in their feces. In March, researchers in the in Netherlands were the first to report the detection of SARS-CoV-2 genetic material in the city of Amersfoort’s wastewater, even before the first COVID-19 cases were confirmed in that city. Since then, numerous researchers around the globe have been able to detect SARS-CoV-2 in wastewater and apply this work as part of their pandemic response. By testing for SARS-CoV-2 in wastewater, researchers can assess the occurrence of the virus in an entire community.

With methods already developed to detect enteric viruses in wastewater at the BCCDC PHL, we were able to quickly to switch gears and apply these methods to detect SARS-CoV-2 in BC’s wastewater. 

With the support of Metro Vancouver and the BCCDC Foundation, the testing of SARS-CoV-2 RNA, Dr Glier and co-op student Ziwen-Jo Ran have rapidly developed and validated a series of methods to test wastewater for SARS-CoV-2. Our next steps are to carry out a prospective pilot study to detect and quantify SARS-CoV-2 genetic material on a weekly basis in order to identify trends in community transmission. We anticipate that this study will provide crucial data to support the integration of wastewater testing as an important surveillance tool in the fight against COVID-19 in BC.

We’re proud to support cutting-edge research at the BCCDC, and our donors are what help turn evidence into action. You can support more COVID-19 public health research by making a donation to our Emergency Response Fund today.

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The post Newsletter #14: July 2020 appeared first on Pacific Public Health Foundation.

We believe we can improve the quality of life for British Columbians by investing in projects that improve health equity and social justice, by supporting upstream solutions to our modern problems, and by empowering people to take control of their health.

In other words: when we have equality and equity in our society, we all benefit. When we address root causes of issues, we see positive changes in our health and communities. When we take an active role in improving the health of our population, we’re better protected and can drive well-being in all aspects of our lives.

These core values have come through in the work we’ve done, and chosen to support at the BC Centre for Disease Control over the past year.

Reducing harms, the overdose crisis, and stigma

Through our Reducing Harms Priority, we worked closely with Toward the Heart (BCCDC’s Harm Reduction Services). The overdose crisis and stigma against people who use drugs has been ravaging our province for years. This is having catastrophic outcomes; people are not getting the support they need and are dying at alarming rates because of systemic inequities. We launched an anti-stigma campaign to break it down: your words matter. Change your language, remove the stigma, help curb the overdose crisis.

We also funded the expansion of a BCCDC program: Compassion, Inclusion, Engagement (CIE). CIE provides peer groups (people with lived experience of substance use), particularly those that are Indigenous and in remote/rural communities, with funding and capacity-building support to lead overdose response, harm reduction, and anti-stigma projects across BC. CIE empowers peers to create change at a local level, engage in life-saving overdose prevention work, and change the conversation with their local community about substance use.

During the #COVID19 pandemic, one of the groups we funded through CIE, Vernon Entrenched People Against Discrimination (VEPAD), set up a booth outside a library to hand out #naloxone & provide education on #overdose response: https://t.co/h038WYeOW1@towardtheheart @fnha

— BCCDC Foundation (@BCCDCFoundation) June 30, 2020

Activate Health

Activate Health is our battle cry for British Columbia (check it out on Instagram). It’s about empowering you to take control of your health and illustrate how our individual actions make a population-level difference.

Taking control of your health isn’t just about eating healthy and going for a jog (though, those are good, too!). You can take control of your health and improve our population’s health by being kind, curbing air pollution, recycling, using regular soap instead of antimicrobial soaps, and standing up against injustice. It’s all linked—social movements, the environment, social connectedness, law and policy, racial justice, and everything in-between impacts our health. And we have the power to improve it for ourselves and for others, making a difference to the health of society.

COVID-19

We couldn’t look back on the last year without including COVID-19. The pandemic has shown the world why we need public health, and why we need to invest in solutions before a crisis hits. Public health experts (like our superhero colleagues at the BC Centre for Disease Control) have been working to protect us and prevent a situation like this since…well, public health emerged as a field. Their work has prevented other epidemics and outbreaks, and what will get us through this. And yet, public health still receives less than 5% of government health funding in BC.

COVID-19 is scary, but we’re glad to see people invested in public health like never before. By partnering with the BCCDC we’re helping ensure that we’re prepared if something like this happens again—and you are making that possible. With the help of our donors, together we’re funding the research that will protect British Columbians from a second wave and future outbreaks.

Because of your support, we’re able to show BC that you don’t have to be a scientist to make a difference and fight this pandemic: you have the power to protect yourself, your community, and improve public health. You can wash your hands, you can stay home when you’re sick, and you can donate to the solutions that will prevent a future pandemic. Whatever you do, you’re making a difference. But we need all of us to be all-in to make it really work.

It’s been a full year. COVID-19 will be around for some time. But, we’re going to keep working with our BCCDC colleagues and with you to fight it every step of the way.

We’re going to continue advocating for health equity, and supporting public health solutions that tackle the root causes of health disparities. And of course, we’re going to keep inviting you to take control of your health and join us in our battle cry: Activate Health.

We’ll see what another year does for the health of our province. We think that with your help, it’ll look bright.

The post BCCDC Foundation Year in Review appeared first on Pacific Public Health Foundation.

Our Executive Director, Kristy Kerr, was a guest on Doug Nelson’s The Discovery Pod in March, just as we were finding ourselves entering new territory, within our organization and the world.

Doug asked Kristy “What’s motivating those donors to make gifts to this Emergency Response Fund?”

“… a gift to us in our Emergency Response Fund is a gift to support the people of British Columbia. It’s that genuine sense of, ‘I want to give back to help others’… It’s giving [people] that sense of control that they are doing something to make a difference to slow the spread of COVID-19 and ultimately stop this pandemic.”

Reflecting back on those words, and to their conversation, it couldn’t have been more prescient–over 1,000 individuals have donated so far, providing more than $400,000 to support one of the key BC-wide pandemic response projects that will help our public health experts understand, prevent, and prepare for future waves of COVID-19.

We understood early on that the world was changing; and we knew that people wanted to help, to have some control over a very uncontrollable situation. So to all our donors, we are grateful for your support, we appreciate all the kind messages, and you are a major part of the success we have seen in BC.

To those who have championed evidence-based information, we see you, we feel a connection to you, and we thank you. To the staff team and Board of Directors at the Foundation, to all the amazing people we have the privilege to work with at the BCCDC, and to Dr Bonnie Henry and BC’s political leadership, we express our gratitude.

To everyone in BC who is playing their part, we’re immensely grateful to all of you. The collectivity of our individual actions has made a visible, population-level difference. We’re watching British Columbians take actions to protect broader society; we’re watching Activate Health in action.

To all those who’ve played a role, we appreciate you. This is your success.

Thanks to our collective leadership, good decision-making at the right times, dedicated experts and the public, and a little dose of luck, we’re in a place we can be proud of and grateful for. But BC: we’re not done yet. While we’ve seen incredible success in BC, we need to remain cautious, vigilant, prepared, and aware. And it’s imperative we continue to invest in research that will keep us safe in the future. We at the Foundation are committed to that, and we’re all-in. We hope you remain all-in with us.

Check out our COVID-19 resource page for resources, infographics, and information on how you can help.

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