Poop might hold the key to tracking the virus, but the state has struggled to bring its wastewater testing laboratory online.

After a series of short-lived efforts by state and county agencies, Hawaii is finally primed to launch its own program to test sewage for coronavirus this summer – nearly two and a half years into the pandemic.

As scientists and policy makers struggled to control this once-in-a-century pandemic, wastewater testing emerged in 2020 as a promising tool for keeping track of the virus, boasting the ability to predict Covid-19 surges in communities days before symptoms emerge and nasal swabs start coming back positive.

Seeing this potential, the Hawaii Department of Health had hoped to bring its wastewater testing laboratory online sooner, but health officials say shortages in equipment and qualified staff, delays in federal funding and the unique challenge of working with partners an ocean away led to the years-long wait.

“Sure, it would have been nice to start testing wastewater earlier,” said state laboratories director Edward Desmond. “We had the money to buy the collection devices, we made our plans and wrote our operating procedures, and we tried to order the equipment and the manufacturers couldn’t keep up with the demand.”

After many months, the DOH has finally assembled the necessary equipment and is in the process of hiring lab personnel, he said.

But even as Hawaii sunsets the last of its major pandemic restrictions, health officials and researchers say it’s not too late for wastewater testing to make a difference in the fight against Covid and other diseases.

“We can detect the presence of new variants if they occur … we’re going to be able to look for antibiotic resistant bacteria,” Desmond said. “So, I have been frustrated by the slow pace at which this developed, but by no means do I think it’s useless going into the future.”

People naturally shed traces of SARS-CoV-2, the virus that causes the Covid-19 disease, in their feces when infected. By testing samples from treatment plants of aggregate wastewater, scientists can essentially monitor the level of Covid circulating in a community at any given time.

And because the shedding process can begin days before an individual begins to feel sick and happens regardless of whether they exhibit symptoms while infected, research shows wastewater testing can help catch missed cases and serve as an early warning system for imminent surges and new variants, especially as at-home nose-swab test kits complicate tracking efforts.

With equipment finally assembled, state lab director Edward Desmond expects the testing lab to be operational by summer.

Wastewater in Houston, New York City and Northern California, for example, showed traces of the omicron variant as early as 11 days before the first case was detected in the U.S., the federal Centers for Disease Control and Prevention reported.

The DOH first toyed with the idea of testing sewage for Covid before cases in Hawaii were widespread, Desmond said. The initial plan early in the pandemic was to monitor wastewater at high-risk buildings, including hospitals and congregate living facilities such as nursing homes and prisons.

Testing sewage for entire neighborhoods was not yet under consideration, he said, as the “usefulness of wastewater treatment plant testing wasn’t obvious early in the pandemic,” which in turn caused delays in federal funding for the state to build its own wastewater testing laboratory.

“The (CDC) has an influence on laboratory grants,” Desmond said. “They had to see the science before they decided this should be a technology they should be pursuing.”

It wasn’t the state, in fact, but the City and County of Honolulu that first started looking for coronavirus in human byproduct as part of the effort to prove the viability of wastewater testing.

In May 2020, the city began working with the Massachusetts firm Biobot to send samples from Oahu treatment plants, said Honolulu Department of Environmental Services deputy director Michael O’Keefe, including from the massive Sand Island facility that serves much of the urban core.

But cross-continental delivery times and nationwide demand for Biobot’s services meant the city had to wait weeks to get results back. So the city turned to local expertise, and in June 2020 began sending samples to University of Hawaii environmental engineering professor Tao Yan, whose lab specializes in managing pathogens in wastewater.

At its peak, the city was harvesting samples from nine treatment plants across the island every week, paying $300 per test and enabling Yan’s team of researchers to refine their testing process.

“When we first developed the methods, it took about three days from the moment we got the wastewater until we got a result,” said UH post-doctoral researcher Doris Di. “But right now, we would be able to get the results at the end of the day or the next morning.”

The UH partnership ended in November 2020, with the experiment largely successful at proving wastewater testing was “more accurate or indicative of the actual case counts in the community,” O’Keefe said. Other studies came to a similar conclusion, and the CDC established the National Wastewater Surveillance System that fall.

Yan’s lab moved on to testing wastewater from individual UH dorms, while the city partnered with Biobot once more as part of a 10-week national study sponsored by the CDC during the summer of 2021.

Throughout this time, the state has worked through the “extremely challenging” process of setting up a new testing lab, said state laboratory post-doctoral fellow Priscilla Seabourn. She said her work has been more administrative than research as she took the lead in sourcing equipment after federal regulators unlocked the necessary grants.

“For example, I ordered an instrument in July and it just got here,” she said in mid-March. “It’s not just shipping; you want to make sure you’re using public funds appropriately. And so, it requires approval from several stakeholders and that can take time.”

Staffing has also been a challenge, with the state in the process of hiring a microbiologist to head the project and a part time lab worker. The state lab also needs a replacement for Seabourn, who is heading to the mainland for her family after a year-long tenure.

“The person before me joined the military, she was here for about a year,” Seabourn said. “Any time you’re in a project, especially one that’s all encompassing like setting up infrastructure, having turnover like that can always be challenging.”

With equipment finally assembled, state lab director Desmond expects the testing lab to be operational by summer. In the meantime, Hawaii is partnering with the CDC and the Canadian firm LuminUltra to supply samples as part of another national study that began in February.

Already, the study is yielding results – the state detected traces of the highly contagious BA.2 omicron subvariant in Kauai’s wastewater weeks before the DOH reported the first confirmed case Tuesday, according to the state’s latest variant report.

“When we identify a new variant in the wastewater … there is a body of scientific knowledge about what kind of treatments can be used for each of the different variants, so we try to make our results available as quickly as possible because they might influence treatment decisions,” Desmond said.

The DOH estimates the BA.2 subvariant is currently responsible for 40% of new covid infections across the state and 8% of new cases in Kauai County.

Some states have found success publishing regular wastewater reports since the beginning stages of the pandemic, including Missouri, which teamed up with the University of Missouri – Columbia to launch its first testing pilot in June 2020.

The program grew to encompass over 20 treatment plants across the state, a spread made possible by a pre-existing courier system for biological samples, said Missouri health department spokeswoman Lisa Cox in an email.

But Hawaii is not alone in struggling to get its wastewater testing off the ground. In the 18 months since the CDC launched its National Wastewater Surveillance System, Politico reported only about a dozen states have routinely submitted data. Even then, data has been spotty.

California, for example, lists numbers from 23 treatment plants on the NWSS data dashboard for its 39 million people, out of more than 250 publicly run wastewater facilities.

Some states simply lacked the manpower and bandwidth to take on the extra responsibility. Others, including Hawaii, faced concerns over privacy.

During Honolulu’s first partnership with UH in 2020, professor Yan and city officials complained the state was refusing to release nasal swab testing data for the zip codes that feed into wastewater treatment plants.

The DOH, at the time under different leadership, had been refusing to release even basic Covid data to the public on the basis of protecting patient privacy.

But now, the state has taken the lead in promoting the virtues of sewage testing, with plans to extend its mandate beyond the Covid pandemic “into the indefinite future.”

“We’re going to be able, as I mentioned, to look for antibiotic resistance … or if we had a pandemic caused by influenza A,” Desmond said. “We’ll have a wastewater testing system, we’ll have the collection devices, we’ll have the equipment and we’ll have the staff to be able to work on things that come up.”

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