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‘Taking a Blood Test of the City’: How Israel’s Sewage Can Fight the Next COVID-19 Wave

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avatar by Sharon Wrobel

Employees of Kando, a wastewater management technology firm, demonstrate a project of sewer surveillance which they say aims to pinpoint unknown outbreaks of coronavirus disease (COVID-19) by identifying traces of the virus in the sewage system, in Ashkelon, southern Israel July 30, 2020. REUTERS/Amir Cohen

Israel is spearheading a project for the early detection of traces of COVID-19 in wastewater in cities around the country, as testing mandates are being lifted following a continued decline in new daily infections of the virus.

Key to the plan is data-gathering on a national scale, with the help of Israeli wastewater intelligence and data analytics company Kando.

Using a network of sensors deployed underground in municipal sewage systems, Kando collects and analyzes reams of data using algorithms and machine learning techniques. Kando’s wastewater intelligence platform aims to provide health authorities with the earliest possible insights on emerging COVID-19 hotspots, to avoid future lockdowns before it’s too late.

“There is an understanding among decision-makers that lockdowns and mask mandates are not sustainable; you can’t force the public how to behave in the long-term,” Kando CEO Ari Goldfarb told The Algemeiner in an interview on Thursday. “The way to manage public health is by providing reliable data that they can trust. The wastewater system is the only way that can give us reliable data about the health of communities in advance before it is too late.”

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Kando has been tracing contamination through wastewater for more than a decade. Born and raised in the coastal city of Ashkelon and living in walking distance to the beach, Goldfarb has always felt at home in the world of water.

“When you live near the ocean you are connected to the sea and learn to surf and dive even maybe before learning to walk,” Goldfarb recounted. “Over the seasons, I have seen what happens after a rainy day, the changes in the Mediterranean getting more and more polluted, what happens to our seas, to the fisheries and the quality of the water.”

Over years spent working in the field of wastewater treatment, Goldfarb realized that existing technologies largely focused on treatment, and on finding solutions for problems of pollution.

“It was very clear to me that this is too late,” said Goldfarb. “Our idea was that if we can see the full picture of wastewater, and read and understand what is the story of where the change is coming from, and how it is produced — then we can understand what happens in cities and we can improve our environment.”

Goldfarb explained that until recently, authorities adopted a wait-and-see approach when fighting outbreaks of influenza and other diseases — first monitoring the severity of an outbreak and only then instructing the public.

“For us, monitoring the sewers is like taking a blood test of a city. We are measuring the blood pressure and the heartbeat of the city based on wastewater data,” said Goldfarb. “Together with research centers in Israel, we developed a solution to identify COVID outbreaks before they happen, so that decision-makers can take action early on, even before residents are symptomatic.”

In a pilot project back in July 2020, in Ashkelon, Kando showed that its system could be used to locate COVID-19 hotspots — down to specific neighborhoods and even city streets in areas that were thought to have a low number of cases.

Earlier this year, Kando joined a national project with the Israel Health Ministry to monitor the municipal sewage systems twice a week in hundreds of towns and cities across the country that have more than 10,000 inhabitants. The first of its kind in the world, the project is conducted in cooperation with the Virology Laboratory at Sheba Medical Center at Tel Hashomer, researchers from Ben Gurion Universit,y and scientists at the Water and the Agricultural Engineering Unit of the Faculty of Civil Engineering at the Technion – Israel Institute of Technology.

Nadav Davidovitch, Director of the School of Public Health at Ben Gurion University, called identifying traces of the coronavirus “extremely challenging,” due to the mixture of substances found in sewage systems. The researchers have devised a way to calculate the concentration of the the coronavirus amid those other substances.

Representative samples are collected in a way that “optimizes the potential to locate indications of the virus, according to the viral load in the wastewater, and to monitor the level of the morbidity in a particular area,” according to Kando.

The collected samples are then sent to the laboratories at Ben Gurion University, where PCR tests for wastewater are conducted. If results are positive, an additional test is carried out to determine the presence of the Omicron variant and other variants. The procedure takes about 24 hours from taking the sample until health authorities receive the results.

Beyond infectious viruses, Kando’s platform can help public health officials monitor traces of amphetamines or other drugs. Goldfarb said one lesson learned from the pandemic is that what happens in one neighborhood quickly affects the next — and that the same is true from country to country.

Other efforts have been ongoing in the US and Europe to use wastewater to monitor the spread of COVID-19, Goldfarb noted. But the Israeli model, he argued, shows the importance to connecting all of the local dots, so that policies can be developed on a national governmental level.

Public health authorities have sought out Kando’s expertise in implementing wastewater monitoring with government bodies, with a UK official coming to learn from the Israeli government’s approach next week. The company has already worked with cities in the UK, Italy, and a number of states in the US, including Texas, California, and Colorado.

“In Israel, we have the ability to take the first step in the world,” Goldfarb remarked. “A lot of countries look at what happens here and very soon will adopt what we are doing — because it’s very clear that you need to bring data about public health to the population. Managing public health is a lot about sharing reliable data.”

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