Understanding treatment of pain during COVID pandemic – a wastewater-based epidemiology approach

In the last decade, Wastewater-Based Epidemiology (WBE) has been growing in popularity because, compared to conventional epidemiology approaches, it provides a more comprehensive, non-invasive, near real-time, and cost-effective measure of a community’s health and lifestyle, while respecting the privacy of individuals. WBE relies on the principle that human markers (such as pharmaceuticals and illicit drugs) are excreted by individuals, unchanged or as a mixture of metabolites, into urban sewer networks. Influent wastewaters can be considered as a pool of markers that can be linked to the population and this approach uses the total amount of target compounds (and their metabolites) in influent wastewater samples to back-calculate the consumption/exposure rates of a community which contributes to that wastewater catchment.
This presentation focusses on the utilisation of WBE as an epidemiology tool aimed at understanding changes to treatment of pain during COVID pandemics in South West England. Four towns and cities in South West England were monitored over 1 year, between April 2020 and April 2021, to verify trends in consumption of pain treatment pharmaceuticals such as anti-inflammatory compounds and analgesics. Two samples per week were collected from four wastewater treatment plants (WWTPs) using flow and time proportional samples.
Samples were prepared using solid phase extraction followed by analysis with ultra-performance liquid chromatography coupled with triple quadrupole tandem mass spectrometry. Daily pain pharma loads excreted by studied communities were calculated after taking wastewater flows, and metabolism correction factors into account. Normalisation to the population size that contributed to the wastewater catchment allowed comparisons among different-sized communities. The results were then triangulated with Covid-19 infectious/deaths data available for the region.
Data triangulation (wastewater pharmaceuticals’ levels, Sars-CoV-2 prevalence, prescription data in primary and secondary care, and vaccination status) revealed statistically significant changes in consumption of pain medication in the region during peak periods of Covid-19 cases. This is likely due to higher usage of pain medicines to reduce/prevent symptoms of Covid-19 and the side effects of the vaccine. This study shows that monitoring of pharmaceuticals can be used as a proxy of community health.