COVID-19 Testing Trend: A Retrospective Analysis of the Three Major Pandemic Waves in Punjab, Pakistan.

BACKGROUND/OBJECTIVES: There is some evidence in the literature of under-testing of COVID-19 cases in Pakistan. This study aims to explore COVID-19 testing trends and the factors affecting them in a lower middle-income country for future infectious disease policy-making and intervention strategies. METHODOLOGY: The study was conducted as a serial cross-sectional study during the three major peaks from March 2020 to June 2021 on 1616 participants in Punjab, Pakistan. This is the first study to explore COVID-19 testing trends in association with flu-like symptoms (FLS) and the factors affecting all three major waves in Pakistan. RESULTS: The results show that in all three waves, only 18.8% reported COVID-19 tested despite that 86.7% thought they had already had COVID-19, with 51.3% reporting having FLS and 35.6% with exposure to FLS from their families and 19.8% of positive testing rate among their family members. Out of the survey participants, 66% received vaccination, and over 80% had their eligible family members immunized. Fear of contracting COVID-19 was 69.7% in all three waves. Factors positively associated with the uptake of testing were the age group of 31-40 years with an adjusted odds ratio of 3.27 (95% confidence interval (CI): 2.09-5.12) for the second wave and an adjusted odds ratio of 13.75 (95% CI: 9.43-20.01) for the third wave and traveling abroad with odds of 3.08 times when the reference was inland traveling. The adjusted odds ratio to test for FLS was 1.62 (95% CI: 1.21-2.16). CONCLUSION: In this study, there is convincing evidence of COVID-19 under-testing and thus under-reporting. This study also suggests that fear-based interventions may be counterproductive; however, economic factors such as education, employment, and traveling are significant in guiding the behavior for infectious disease prevention and management.

Mitigating risks and maximizing sustainability of treated wastewater reuse for irrigation.

Scarcity of freshwater for agriculture has led to increased utilization of treated wastewater (TWW), establishing it as a significant and reliable source of irrigation water. However, years of research indicate that if not managed adequately, TWW may deleteriously affect soil functioning and plant productivity, and pose a hazard to human and environmental health. This review leverages the experience of researchers, stakeholders, and policymakers from Israel, the United-States, and Europe to present a holistic, multidisciplinary perspective on maximizing the benefits from municipal TWW use for irrigation. We specifically draw on the extensive knowledge gained in Israel, a world leader in agricultural TWW implementation. The first two sections of the work set the foundation for understanding current challenges involved with the use of TWW, detailing known and emerging agronomic and environmental issues (such as salinity and phytotoxicity) and public health risks (such as contaminants of emerging concern and pathogens). The work then presents solutions to address these challenges, including technological and agronomic management-based solutions as well as source control policies. The concluding section presents suggestions for the path forward, emphasizing the importance of improving links between research and policy, and better outreach to the public and agricultural practitioners. We use this platform as a call for action, to form a global harmonized data system that will centralize scientific findings on agronomic, environmental and public health effects of TWW irrigation. Insights from such global collaboration will help to mitigate risks, and facilitate more sustainable use of TWW for food production in the future.

Coronavirus Disease 2019 (COVID-19): Forecast of an Emerging Urgency in Pakistan.

Background/Aims Novel coronavirus disease 2019 (COVID-19) is a global challenge due to little available knowledge and treatment protocols. Thus, there is a great need for collecting data related to COVID-19 from all around the world. Hence, we conducted this study, collecting daily data on COVID-19, to map the epidemiology outbreak and forecast its trajectory for May 2020. Methodology The data was collected from the officially released reports of the National Institute of Health (NIH), Pakistan, and the World Health Organization (WHO). The analysis was done using Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp., Armonk, NY), and forecasting was done using a simple moving average in time series modeler/expert modeler. Results The purpose of this study is to draw the attention of international, as well as national, governing bodies to the rapidly rising number of COVID-19 cases in Pakistan, and the urgency of evaluating the efficacy of the currently implemented strategy against COVID-19. According to this study, there is now an alarming increase in the number of COVID-19 patients in Pakistan, despite a contained spread in the beginning. The predicted number of COVID-19 cases can go over 35,000 by the end of May 2020. Conclusion It is crucial for governing bodies, administrators, and researchers to re-evaluate the current situation, designed policies, and implemented strategies.

Drivers of Microbial Risk for Direct Potable Reuse and de Facto Reuse Treatment Schemes: The Impacts of Source Water Quality and Blending.

Although reclaimed water for potable applications has many potential benefits, it poses concerns for chemical and microbial risks to consumers. We present a quantitative microbial risk assessment (QMRA) Monte Carlo framework to compare a de facto water reuse scenario (treated wastewater-impacted surface water) with four hypothetical Direct Potable Reuse (DPR) scenarios for Norovirus, Cryptosporidium, and Salmonella. Consumer microbial risks of surface source water quality (impacted by 0-100% treated wastewater effluent) were assessed. Additionally, we assessed risks for different blending ratios (0-100% surface water blended into advanced-treated DPR water) when source surface water consisted of 50% wastewater effluent. De facto reuse risks exceeded the yearly 10-4 infections risk benchmark while all modeled DPR risks were significantly lower. Contamination with 1% or more wastewater effluent in the source water, and blending 1% or more wastewater-impacted surface water into the advanced-treated DPR water drove the risk closer to the 10-4 benchmark. We demonstrate that de facto reuse by itself, or as an input into DPR, drives microbial risks more so than the advanced-treated DPR water. When applied using location-specific inputs, this framework can contribute to project design and public awareness campaigns to build legitimacy for DPR.

Impact of virus surface characteristics on removal mechanisms within membrane bioreactors.

In this study we investigated the removal of viruses with similar size and shape but with different external surface capsid proteins by a bench-scale membrane bioreactor (MBR). The goal was to determine which virus removal mechanisms (retention by clean backwashed membrane, retention by cake layer, attachment to biomass, and inactivation) were most impacted by differences in the virus surface properties. Seven bench-scale MBR experiments were performed using mixed liquor wastewater sludge that was seeded with three lab-cultured bacteriophages with icosahedral capsids of ∼30 nm diameter (MS2, phiX174, and fr). The operating conditions were designed to simulate those at a reference, full-scale MBR facility. The virus removal mechanism most affected by virus type was attachment to biomass (removals of 0.2 log for MS2, 1.2 log for phiX174, and 3 log for fr). These differences in removal could not be explained by electrostatic interactions, as the three viruses had similar net negative charge when suspended in MBR permeate. Removals by the clean backwashed membrane (less than 1 log) and cake layer (∼0.6 log) were similar for the three viruses. A comparison between the clean membrane removals seen at the bench-scale using a virgin membrane (∼1 log), and the full-scale using 10-year old membranes (∼2-3 logs) suggests that irreversible fouling, accumulated on the membrane over years of operation that cannot be removed by cleaning, also contributes towards virus removal. This study enhances the current mechanistic understanding of virus removal in MBRs and will contribute to more reliable treatment for water reuse applications.

Mechanisms of pathogenic virus removal in a full-scale membrane bioreactor.

Four pathogenic virus removal mechanisms were investigated in a full-scale membrane bioreactor (MBR; nominal pore size 0.04 µm): (i) attachment of virus to mixed liquor solids; (ii) virus retention by a just backwashed membrane; (iii) virus retention by the membrane cake layer; and (iv) inactivation. We quantified adenovirus, norovirus genogroup II (GII), and F+ coliphage in the influent wastewater, the solid and liquid fractions of the mixed liquor, return flow, and permeate using quantitative PCR (adenovirus and norovirus GII) and infectivity assays (F+ coliphage). Permeate samples were collected 4-5 days, 1 day, 3 h, and immediately after chlorine enhanced backwashes. The MBR achieved high log removals for adenovirus (3.9 to 5.5), norovirus GII (4.6 to 5.7), and F+ coliphage (5.4 to 7.1). The greatest contribution to total removal was provided by the backwashed membrane, followed by inactivation, the cake layer, and attachment to solids. Increases in turbidity and particle counts after backwashes indicated potential breakthrough of particles, but virus removal following backwashes was still high. This study demonstrates the ability of the MBR process to provide over 4 logs of removal for adenovirus and norovirus GII, even after a partial loss of the cake layer, and provides evidence for assigning virus disinfection credit to similar MBRs used to reclaim wastewater for reuse.