From left: Timothy Erickson and Peter Chai

Where others see wastewater, Peter Chai, MD, and his collaborators see an opportunity to help governments and communities tackle the COVID-19 crisis. Over the last year, Chai, an emergency medicine/toxicology physician at the Brigham, has been collaborating with experts at Massachusetts Institute of Technology and a small startup company called BioBot Analytics. The team is developing a technology and a plan for sampling sewage, which can contain rich information about human health, viruses, bacteria and products from medicines that are excreted in urine and stool. The team has been sampling sewage to study opioid use across communities, but now is pivoting to focus on another national crisis: the spread of COVID-19.

“We’ve been working to map opioids, but we’re entering uncharted area as we turn our attention to COVID-19,” said Chai. “Our hope is to figure out which communities are seeing a rise or fall in the virus and understand if mass closings may help to influence this. This could give us a clearer picture of where we need to do testing and where more or less social distancing measures may be needed.”

Chai and Erickson have been collaborating with BioBot Analytics, directed by Mariana Matus and Newsha Ghaeli (pictured in Cambridge)

Chai and his Brigham emergency medicine/toxicology colleague, Timothy Erickson, MD, have been collaborating with BioBot Analytics, which has developed a water-sampling device that can attach to residential manholes in urban areas and take multiple samples over time. Those samples are then analyzed by the laboratory of Eric Alm, PhD, at MIT, a research team with specialized expertise in the microbes found in sewage. Chai and Erickson then advise on the public health implications of the results.

“As clinicians, our role is to help the rest of the team understand the public health impact of the findings and how they might change the way we think about testing,” said Chai.

The team has been collecting samples in North Carolina and Boston over the last several months as part of their project to analyze opioid use. Those samples may provide important clues about the presence or absence of SARS-CoV-2 — the virus that causes COVID-19 — over time in the lead up to the current crisis.

Interestingly, sewage sampling to understand epidemics has a long history. In one of the most famous examples, John Snow, MD, considered one of the founders of epidemiology, used wastewater systems to trace the source of a cholera outbreak in 1854. Chai and collaborators hope to build on that legacy and provide critical information to illuminate the community spread of COVID-19.