photo by: Philip Heying/Journal-World File

The City of Lawrence Wastewater Treatment Facility at 1400 E. Eighth St. is pictured in this file photo from March 13, 2009.

The information that public health officials rely on to gauge community transmission of the coronavirus is shifting, in part because of the increased prevalence of self-testing that goes unreported to local health departments.

Officials with Lawrence-Douglas County Public Health told the Journal-World recently that the specific data points they monitor to understand the virus’ spread have changed during different phases of the pandemic.

Veronica White, preparedness and epidemiology coordinator for Lawrence-Douglas County Public Health, said the current phase is the spread of the newest subvariant of the virus, known as BA.2 or “stealth omicron.”

“This newest variant is the most infectious, and the concentrations of COVID around the country have just been exploding with this newest variant,” White told the Journal-World last week.

Douglas County has seen a recent uptick in COVID transmission that coincides with that national trend, having returned last week to the “yellow” zone of the health department’s color-coded community transmission scale for the first time since early March.

That upward trend may also have something to do with the tens of thousands of University of Kansas basketball fans who filled downtown Lawrence across three weekends earlier this month celebrating the team’s national championship run. White said those mass gatherings certainly had the potential to be COVID-19 super-spreader events, but the increase in unreported self-tests makes it hard to tell.

That doesn’t make at-home tests a bad thing, health officials note, even if that means there’s a less accurate case count. Sonia Jordan, the health department’s director of informatics, told the Journal-World the tests were an important tool even though they weren’t included in public data. Earlier in the pandemic COVID testing was scarce and unavailable outside of clinical testing sites.

“If you think of it from the perspective of trying to prevent the spread of disease and allowing an individual to make an informed decision, at-home tests are, on the whole, a good thing,” Jordan said. “Yes, they probably do mess with our numbers a little bit, and our numbers we release are probably lower than the numbers in reality. But if having an at-home test allows somebody to take a test when they’re not feeling well and make a choice about whether they’re going to go to a KU game or go to church that day or go to work that day, that’s ultimately better.”

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That’s where influent wastewater data has come into play. KU’s School of Engineering has been conducting research into such data since March of 2020, in partnership with the Kansas Department of Health and Environment. Lawrence is one of a number of communities in Kansas that have been subjects of the study; the project has been testing Lawrence’s wastewater weekly. For a while, that included both of the city’s wastewater treatment plants, but now it is taking place only at the Kansas River Wastewater Treatment Plant, the city’s main facility.

Justin Hutchison, an assistant professor and researcher in KU’s engineering school, told the Journal-World Monday that the study’s weekly sampling does allow for the data to provide helpful comparisons when there’s a jump in COVID transmission in the community, something that has remained true since the start of the study.

Comparing the wastewater sample from the week KU won the national basketball championship to the sample the week after, Hutchison said, researchers found an order of magnitude jump — or in other words, the community’s baseline low-end COVID concentration multiplied by the power of 10. That elevated level of COVID concentration in the city’s wastewater continued to appear in more recent samples taken on April 19, he said.

The only difficulty is that wastewater numbers aren’t very easily translated to pinpointing exactly how many COVID cases there are at any given time. Hutchison said that’s mainly because as new variants appear, the amount of virus an individual sheds varies.

But that study will end soon. It’ll wrap up at the end of June, and now Hutchison said conversations among the research team involved with the project have revolved around whether their work will continue beyond then.

Regardless, Hutchison said he thinks the study has shown the potential of influent wastewater data as a tool for public health departments that perhaps wasn’t as widespread prior to the pandemic, which could be helpful in studying other viruses beyond COVID.

“We’ve been measuring diseases in wastewater for many, many years, even before the pandemic,” Hutchison said. “Not necessarily in the context of an epidemiological wastewater (study), but things we measure in wastewater. Bringing that toolbox to bear in this community assessment, I think, is one of the coolest things about this effort, that it seems to be gaining a little bit more acceptance as part of that toolbox.

“I don’t think we’ll go to pot (without the wastewater study),” Hutchison added. “… It’s the same thing with clinical testing. We’re transitioning out of reporting clinical testing. I think people are coming to realize that COVID is going to be with us for a while. Whether it’s a seasonal thing, how long we’ll have to deal with it, if it will be like the flu and be around forever — those are some interesting questions.”

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Though the end of the wastewater study is on the horizon, the health department is prepared to move forward. Jordan said that public health officials statewide were looking to shift toward an “endemic state of operations.” That means looking beyond just the concentration of COVID cases in a community to understand the severity of spread there.

For Douglas County, that means using COVID hospitalizations and deaths as the guideposts moving forward.

“I think as we continue to move into this endemic state, I think things like hospitalizations and deaths are going to become the more important metrics,” Jordan said. “And those have always been important; we’ve always been looking what we can do to try to protect our health care system.”

Jordan said those statistics remain relatively stable here, which is a good sign for where things stand now. Plus, she said that from a local public health perspective, not knowing exactly how many COVID cases there are at one time but having relatively few of them in the hospital is preferable to knowing that number but having 50 people who urgently need care in the emergency room for COVID symptoms.

Another part of that shift relies on reminding community members of the mitigation strategies they already know — like wearing a mask or getting a booster shot — that can help them make living with COVID manageable. One of the newest developments on that front is the fourth dose of the COVID vaccine authorized by the Food and Drug Administration at the end of March for people 50 and older. The health department’s more recent message has been geared toward trying to encourage that group to get the additional shot.

“It’s a really interesting time period that we’re in,” Jordan said. “We have, as a society and as a country, been talking about what ‘endemic’ looks like, and this is the first time that we get to see how it happens.”

Reducing how often data updates are shared with the community is also part of that process; the health department recently decreased the frequency of its community COVID statistics updates from three days per week to two. That’s also a reflection of how much time it takes staff members to put together all that work into something the general public can follow, Jordan said.

The health department does plan to continue to update its familiar yellow graph tracking the 14-day moving average of new COVID-19 cases in the county; Jordan said they recognize that many community members rely on that resource, in particular, as a valuable tool to guide their decision-making.

And in general, Jordan said the current state of things is shaped by how much more information and resources people have for understanding and treating COVID now than what was available early on.

“We’ve gone from a place of not really having any tools in our pocket to having a variety across the different levels, from individual to system, that are allowing us to move into this more endemic state,” Jordan added.