Graph showing level of Covid, flu and RSV in US wastewater systems, by city

http://publichealth.verily.com/

by arikr • 4 years ago

142 199 4 years ago

publichealth.verily.com

arikr• 4 years ago

See also: https://biobot.io/data/

mutagen• 4 years ago

Popped in to share this one, it has COVID data on my area while the Verily site doesn't seem to yet.

I've been using wastewater data to adjust my behavior since official testing and reporting is down and under-reporting cases. Detected COVID goes up, I reduce my exposure and remind my vulnerable loved ones. Detected COVID goes back down, I adjust my behavior accordingly.

UncleOxidant• 4 years ago

There are some seriously long delays and gaps in wastewater reporting, though. They only do it in my local area very 6 weeks or so.

larsiny• 4 years ago

Oddly, this site doesn't report for my local counties that are listed as having submitted data to CDC's NWSS (King and Pierce counties in Washington State).

I wonder if the more "popular" counties are pay-walled or something?

EDIT: According to the site, "County Selection: Counties associated with each location were provided by our sampling partners, and correspond to the primary county served by each sampling location. In the county-level section we highlight a subset of counties which had at least 21 weeks of data and whose sampling locations represented at least 10,000 individuals, as well as the primary counties of our sampling partners in the Biobot Network."

So I'm curious what other factors are excluding the largest (by population) counties in Washington?

cgb223• 4 years ago

Lots of cities missing from this, many exist but lack any data

Not sure how helpful this is when huge swathes of the population aren’t represented here

amalter2• 4 years ago

Wastewater facilities are almost always run by local government. I expect it takes time to get buy in for a project like this. I didn't see if there was a grant to cover the testing, but you at very least need a worker to package up samples and mail them to a lab.

Still, this is tremendously useful where there is coverage, and looks like enough data to make sampling type of conclusions. Hopefully we'll eventually see some kind of network effect.

For example, I'm in the NYC area - and Newark NJ has coverage. There is enough overlap that I expect flu and covid curves (including strains) to be close enough to be interesting.

datameta• 4 years ago

With fewer people commuting to work there's less overlap, but enough new yorkers have family in NJ and vice versa that I suspect suspect Newark should be pretty accurate for NYC +/- 5-15% with a lag time of a week max.

Eric_WVGG• 4 years ago

here's the CDC charts, includes NYC

https://covid.cdc.gov/covid-data-tracker/#wastewater-surveil...

spacefracas• 4 years ago

It's Suspect that adjacent cities have such divergent trends. For example Novato vs San Rafael CA.

Novato: http://publichealth.verily.com/#Novato,%20CA:SARS-CoV-2

San Rafael: http://publichealth.verily.com/#San%20Rafael,%20CA:SARS-CoV-...

meroes2• 4 years ago

I don't find it suspect (well, suspect of what exactly?) as a native to these cities but I may lack perspective. Go one city over all over the Bay Area and you get wild differences. There's a lot of land between north bay cities too. Also, weren't we all just using these divergences a year ago to back up Covid statistics - i.e. Santa Rosa was higher than surrounding cities from my recollection, and that was "expected" one you knew the areas.

mistrial92• 4 years ago

an eighty year old in either place may rarely talk to anyone, while a commuting Dad with kids in pre-school may get involuntarily exposed every single week. There is some truth to geographic locality for disease, but there is also Car Culture in the USA.

jeffbee5• 4 years ago

This is not suspicious at all. San Rafael has a combined sanitary and storm sewer system. In the California rain season their sewer is diluted with rain water. Novato has separate sanitary and storm water systems.

ropeladder2• 4 years ago

Wastewater surveillance is a pretty crazy technology. My neighbor works on projects using it for wildlife tracking, and they can get startling amounts of information about what is going on in a given watershed. What (e.g endangered) animals are present, what animals humans are eating, etc. And all the way down to the viral level, obviously.

jdadj• 4 years ago

I’m confused. How is wastewater from endangered animals ending up in the sewage system? Surely they’re not using toilets…

londons_explore• 4 years ago

There is always a little that drains in... Often these tests are done on river water too.

And PCR tests are super sensitive.

ropeladder2• 4 years ago

Sorry, my comment was a bit misleading: as the other commenter noted, they are doing testing in rivers, etc. When animals defecate/urinate onto the ground, some of it eventually gets carried and aggregated into flowing water.

TaylorAlexander5• 4 years ago

I am continually surprised at how many people don’t wear masks at places like the grocery store even as cases are rising. I got covid over the summer and it was horrible! I lost two weeks of work which was a lot of money to lose, missed multiple dates with my partner I would have really enjoyed and felt totally isolated. Then I felt fatigue and brain fog for months afterwards. Afterwards I got the bivalent vaccine so I do feel more protected now, but there’s still a risk.

Wear a mask and wash your hands folks!

rajup3• 4 years ago

Masks are unlikely to have protected you much unless it’s a tight fitting n95 mask worn around the clock. This topic has been beaten to death on here, not sure why people continue to cling on to masks as anything other than security theater.

aaroninsf2• 4 years ago

Because it's not security theater, as has been demonstrated time and again FFS

It's trivially easy to acquire authentic N95s today.

People just won't wear them, so, we all suffer.

basch6• 4 years ago

The primary mechanism these things are spread by is water droplets in the air expelled from the nose and mouth. A sick person wearing a mask will expel more moisture into the mask, and less into the air.

None of this is binary. It's not sick or not sick. There is a viral load component, where a persons body can fight off a certain amount of virus.

jonahhorowitz2• 4 years ago

I wear a flomask every day when I'm out and about and it works great. You don't need to wear it "around the clock." You just need to wear it when you're inside and there are people around you who might be infected.

uhtred• 4 years ago

Masks are primarily for protecting other people, you cough and sneeze and breathe out infected water droplets into the mask- not other people's faces.

Why do people like you have such anger about mask wearing?

justin66• 4 years ago

worn around the clock

I'm reluctantly curious what your thinking is on that.

deanc• 4 years ago

At this point, I’d tend to agree. However, this is a bit of a broad and inaccurate statement. Wearing masks gave society time to catch up in terms of vaccinations and other measures.

2OEH8eoCRo02• 4 years ago

Protection isn't binary. At society scale these small changes add up.

tmaly• 4 years ago

I think washing hands and not touching your face are something that is very underrated.

gumby• 4 years ago

Yes, though those don't help so much with illnesses transmitted through breathing

fullmoon5• 4 years ago

We Europeans are continually surprised that talking about masks is still a thing.*

Except for 1 or 2 outlier countries masking is over.

* Unless they are familiar with U.S. politics

morsch3• 4 years ago

Small outlier countries like Germany, where I still see masks regularly in various settings, and where FFP2 masks are either still mandatory in public transport or just stopped being mandatory a few days ago. Also mandatory in doctor's offices, hospitals.

howinteresting3• 4 years ago

Indoor masking is quite common in the SF Bay Area.

rconti• 4 years ago

Wait, are you saying Europeans are surprised talking about it is still a thing, because everyone wears them? Or because nobody wears them?

Just got back from Germany yesterday, and while masks are required on most public transport (but not airplanes), you'll see a decent amount of compliance (50%?) but not anywhere else indoors.

Minimal masking in public spaces on public transport, stores, airplanes, etc in my experience in Germany/France/UK. There's absolutely more masking going on here in the Bay Area.

dxhdr2• 4 years ago

I'd rather be sick for 2 weeks than wear a mask every day. Surveying those around me I'd say 98% came to the same conclusion.

Diederich5• 4 years ago

Being sick two weeks is a very clear cost. Less clear are the long-term costs associated with long-covid.

How would you characterize the costs associated with wearing a mask most of the time when in public?

listless• 4 years ago

Same. And I’m just getting over the flu, which was rough. A world where we constantly mask to avoid any illness at all holds 0 interest for me. I’ll take the COVID.

potatochup• 4 years ago

It doesn't have to be that dichotomous though. I don't wear a mask at work (which is well ventilated and people are pretty responsible about staying home when sick) but I do in higher risk situations (E.g. a plane flight)

TaylorAlexander5• 4 years ago

There’s a lot of people in my life that don’t want to get sick. And I don’t want to have to cancel plans with them every time I feel a little fatigue, because 99% of the time that’s just due to weird sleep. But if I wasn’t masked I would be constantly wondering if I was getting sick and if I should cancel plans. My parents are elderly, my partners partner is vulnerable. There’s a lot of people in my life that can’t afford to get sick because they would infect their entire household.

I guess it’s fine if no one you hang out with cares, but that’s not the case for me.

I should also note that I don’t work with other people. I might feel differently if I had to mask at work all the time. I do keep a mask for the 2% of the time at work I interact with others. But the biggest thing is grocery stores. Not masking there you’re just asking to elevate community transmission. You’re increasing the risks for others. I’d love it if the virus was gone, but it just isn’t.

FullStackAda• 4 years ago

Especially considering I can mask all the way in all public spaces, my kid will bring all the viruses from public schools all the same.

meroes2• 4 years ago

Good for you for having the choice. I can't make the choice for my immunocompromised roommate.

spookthesunset2• 4 years ago

There is more to life than a myopic focus on avoiding one specific illness. I’ve got a million other problems in my life to worry about. Catching Covid isn’t anywhere near the top of that list.

This applies to society as a whole as well. The damage caused by our incredibly myopic focus on Covid is far, far greater than the damage actually caused by the virus itself.

ipaddr2• 4 years ago

Wear a mask and stop getting other viral illnesses. We should have been doing this before covid.

diag2• 4 years ago

The things we do to avoid covid also help with avoiding other respiratory infections as well, all of which are pretty terrible to get in case anybody forgot about them.

But saying that covid isn't causing damage is itself highly myopic.

haswell3• 4 years ago

The damage caused by our incredibly myopic focus on Covid is far, far greater than the damage actually caused by the virus itself.

This seems much easier to say if you haven't been impacted by a serious case. I have friends who were similarly unconcerned, and who felt very differently after a month long battle with COVID, and as they continue to struggle with the after effects.

So yes, there's more to life than a myopic focus on avoiding one specific illness, but the actual impact of that statement and a closer look at the actual risk tradeoffs makes things a bit less obvious, and I'm not convinced that most of the behavior people are exhibiting is myopic.

The damage caused by our incredibly myopic focus on Covid is far, far greater than the damage actually caused by the virus itself

This is a statement that needs quite a bit of evidence to back it up. I think it's safe to say that no one knew what the 2nd and 3rd order effects of trying to avoid COVID itself would be, and those effects are indeed significant. But neither can we say that we should have gone back and let the first rounds overwhelm and collapse hospital systems, the impact of which is something we can't even begin to understand right now.

gernb4• 4 years ago

On the one side we have 20 million people dead. What's the counter factual of how many people would be dead if we'd been less myopic

https://ourworldindata.org/grapher/excess-deaths-cumulative-...

orblivion• 4 years ago

Are cases really rising? It looks maybe a little higher than the summer right now, maybe depends on the area. Nothing like the last two autumns, thankfully. We'll see about winter. They keep saying some new variant is going to break through but I don't see it yet.

ABCLAW4• 4 years ago

In my area, cases are rising fairly rapidly and certain hospitals have begun to rescheduling electives on the basis that they're overstressed. This is concerning because winter is just getting started and transmission rates when people are indoors are higher.

That said, I think the seasonal wave we're anticipating is a product of when our winter hits and how hard our winter hits - other areas might have very different experiences overall.

asiachick3• 4 years ago

looks like they were highest ever in the SF Bay area just 1 week after Thanksgiving but they've fallen quickly

https://covid19.sccgov.org/dashboard-wastewater

2OEH8eoCRo02• 4 years ago

I hear you but I'm only going to mask up if required. I've gotten 4 COVID vaccines, caught COVID, and I've never missed a flu vaccine.

kitsunesoba• 4 years ago

I hear you. Having seen family who's suffered from brain fog and greatly reduced stamina ever since getting over covid, I want absolutely nothing to do with it. The fact that it has the potential to so negatively impact my means of earning a living as a developer (my mental faculties) makes it terrifying. If I lose that, I have nothing. It'd be like a carpenter losing dexterity in their hands.

Anything that can reduce my chances of a severe outcome or even coming down with it in the first place is worth it in my book.

gjsman-10005• 4 years ago

Never again. Caught COVID, vaccinated friends also caught COVID, vaccinated individuals are now 58% of hospitalizations, and long term effects of both long COVID and having microplastics embedded in your lungs are both unknown. However, long COVID is just long, but microplastics are forever. I've chosen to be mask-free and anyone who doesn't like that can mask themselves.

rayiner3• 4 years ago

For vaccinated individuals, being sick for two weeks is unusual. When I got covid the first time, before vaccines were available, I was sick less than a week. I had a few weeks of brain fog after that but it cleared up. I got it again last week and I was sick for only a day. Not any worse than any cold I’ve had before. Indeed I’ve had fewer sick days the last couple of years than I did the year my daughter started daycare.

I’m not going to go around wearing a mask all the time to avoid a couple of days of cold symptoms every other year. Getting colds is part of the human condition.

neilv2• 4 years ago

I think an additional benefit of the masks is that they signal something about the person's Covid conscientiousness -- which I suspect affects how likely they are to be a carrier, and how likely they are to be careful about spreading it if they are.

(Though that signal didn't help me in Trader Joe's the other day, when one of the few employees wearing a mask (only surgical), turned out to have a phlegmy cough. In that case, I imagine the logic might've been, "You're obviously sick and probably spreading something, maybe Covid? We don't pay you to stay home. Strap on the least effective mask you can find, which suddenly we believe in, and get out there and superspread among shoppers!" :( )

rajup3• 4 years ago

An additional way to virtue signal is a benefit? Weird world we live in…

xkbarkar• 4 years ago

The only people I see wearing masks are American tourists in the airports ( last 6 weeks Gardemoen, Kastrup , Keflavik, Arlanda )

Duck bill mask clad Germans generally stay in Germany. And they look insane. Like warning signs of nature insane.

Public announcements in Sweden, Norway and Denmark, from epidemiologists and ICU doctors recently is to stay the <f**> home if you are sick. If sick dont go out wearing a mask since it protects no one and, even if immuno compromized, live like you did in 2019 you are not protected wearing a flimsy surgical facemask and you need to socialize and not lock yourself up for the rest of your days.

And once you are not sick anymore, go back to work. Don't bother the currently overloaded hospitals unless something is very wrong, you know when your cold/flu is over.

https://www.svt.se/nyheter/inrikes/overlakaren-restriktioner.... https://www.svt.se/nyheter/lokalt/vasterbotten/smittskyddsla....

Use common sense.

So no , presumably democrat american internet stranger. Dont wear a mask, If sick stay at home. Dont go out, face covered, and think you have saved a life. Mask is pointless.

Hand washing still applies though.

Don't think handwashing has been controversial since dr. Ignaz Semmelweis in 1865 was declared insane and put in an asylum by the medical establishment for suggesting that hand washing prevented doctors from spreading disease between their patients.

quarterdime• 4 years ago

Your suggestion of staying home if sick is one I agree with. Unfortunately I cannot make others do this. In fact, where I live in the USA I come across people who are visibly/audibly ill in my daily life: air travel, public transport, grocery store, and so on. I would prefer if these people stayed home, but can I make them? I can wear a mask, and I do (typically N95 in public places). If others think I look crazy, that is a small price to pay to avoid a few weeks of being sick or infecting someone else. Particularly my vulnerable family members.

TaylorAlexander5• 4 years ago

If the other people around me actually followed that guidance you might have a point… except that covid is transmissible even before you get sick and even when you never do get sick. So people can’t stay home if they don’t know they’re contagious. And again, people don’t follow the guidance either.

I also don’t wear a surgical mask, I wear a KN95 because I’m not a fool.

landemva2• 4 years ago

You got actual covid and recovered, then did you get blood test to check for development of antibodies? Then you later got the shot for what purpose?

amalter2• 4 years ago

Caught a medium severity case of omicron almost exactly a year ago when I was triple vax'd.

Took the bivalent booster about 2 months ago then went on a cruise and directly after to re:invent.

Since then had multiple exposures with people around me getting week long fevers. So far I had something in my system that made me feel "slightly off" - but nothing worse.

Yay antibodies.

I'm a big believer in "more antibodies the better" - but I am also on the side of "COVID amnesty". The pandemic was an immensely scary time for everyone, and got co-opted by politics of all stripes. We need to forgive each other and move on.

I now support everyone's choice - with the standard exceptions (Childhood vaccines, don't go out when sick, respect others).

dmix• 4 years ago

I remember during the tail end of the pandemic someone posted a link to a big spike in wastewater COVID testing in our city's sewers. So I decided to pay close attention to the COVID test rates/hospitalizations for the next 2 months. But I never ended up seeing any correlation. The trendline stayed stagnant, before declining as it did everywhere else.

I know that's a one-off non-scientific example, but it made me wonder if it's occasionally just noise in a small sample set? Certainly useful but maybe not always easy to translate/project into IRL illness rates.

aaroninsf2• 4 years ago

Depending on when/where that was during the pandemic,

unless you were able to find background positivity rates (the best proxy for community infection rates), published test rate data was always noisy and after testing mandates were relaxed became all but literally meaningless,

and there is also an apples/oranges issues trying to correlate hospitalization rates as vaccination and different waves moved through (among other factors).

Getting a clear picture has been devilishly hard...

...and about 100x harder than it needed to be, if we had competent governance involved from the beginning. E.g. OSHA and CDC mandating comprehensive ongoing PCR at scale; schools doing weekly testing regardless of symptoms, with consistent reporting standards, etc ad nausuem.

Sigh.

thehappypm• 4 years ago

It’s been extremely reliable in Boston.

jpollock• 4 years ago

Santa Clara has data for the south bay, and I couldn't find it on the verily page.

https://covid19.sccgov.org/dashboard-wastewater

jefftk• 4 years ago

It's not on the Verily page because Santa Clara's monitoring isn't a Verily project. The page has "Source: Sewer Coronavirus Alert Network (SCAN) project by Stanford University"

adrianmonk• 4 years ago

What is PMMoV normalization?
In addition to the pathogens it tests for, WastewaterSCAN measures an extremely common, harmless plant virus that is consumed when people eat. It is called pepper mild mottle virus (or PMMoV). By measuring the concentration of PMMoV genetic markers per dry weight gram of wastewater solids, WastewaterSCAN can account for how much viral material is recovered from each sample and changes to the “fecal strength” of that sample. For example, heavy rain that drains into a wastewater system can dilute the strength of a particular day’s sample.

OK, that's pretty clever and it sounds useful, so I guess I should turn on that toggle. But then I read further and see this:

Our analysis suggests that both the concentrations of the SARS-CoV-2 genes measured as copies per gram of solid waste and those concentrations normalized by PMMoV are proportional to laboratory confirmed COVID-19 incidence rates in the sewersheds.

How can both things be proportional? Do they actually mean positively correlated?

If raw data is already proportional to lab tests, then it doesn't seem like there's any benefit from normalizing.

epistasis• 4 years ago

Wastewater analysis is a new and very difficult measurement problem. There's continual discussion of how to do the analysis, and no strong consensus in the field.

This is the best part of science: not knowing, but working to discover.

toxik• 4 years ago

The strength will mostly be a constant scale factor, hence proportional to.

hcknwscommenter• 4 years ago

I think a lot is being lost in the translation here. I mean, Verily's analysis is a laboratory *determined* COVID-19 incidence rate in the sewersheds right? How is it any different from the laboratory *confirmed* incidence rate they compare to? As far as proportional, I think you are right. When laboratory confirmed goes up, both Verily concentrations also go up. When laboratory confirmed goes down, both Verily concentrations also go down. I doubt there is a constant scale factor operating here unless the laboratory confirmed is using a similar method of normalization (i.e., they all start with copies per gram dry weight).

mjevans• 4 years ago

The post holiday gathering spike is rather obvious. Not just for COVID but for everything. We really should have test kits, and people should test BEFORE travel. A national level policy of full refunds if tested positive (for any illness / disease) could help prevent the needless spread of illness.

timr7• 4 years ago

The post holiday gathering spike is rather obvious. Not just for COVID but for everything.

Post hoc, ergo propter hoc.

It's not a "holiday gathering spike". It's literally the same respiratory pathogen pattern we've seen for as long as we've bothered to look: in the winter, as we go inside and the air becomes cool and dry, respiratory infections go up. The viruses evolved to work this way, because it's a great survival strategy when your host is a social animal that doesn't/can't live outside in the cold.

It happens in parts of the world where Christmas and Thanksgiving aren't a thing (see Japan and China and Korea right now). It happens on the opposite schedule in the lower half of the planet (even where Christmas and/or Thanksgiving are a thing).

This impulse to blame/scold people for a natural phenomenon is unnerving.

ampersandy• 4 years ago

What about staying inside with cool/dry air causes these infections? Genuinely curious.

gernb4• 4 years ago

in the winter, as we go inside and the air becomes cool and dry, respiratory infections go up.

This winter is the cause the please explain Japan which had it's biggest spikes in summer

TurkishPoptart3• 4 years ago

This impulse to blame/scold people for a natural phenomenon is unnerving.

Yeah, but as far as our governments will share more information on this, this SARS-CoV-2 virus was invented by people in a lab, and it escaped from a lab, due to human error.

chrisco255• 4 years ago

Diseases are inevitable. It's not all that useful to be testing for every random disease that comes up. Testing doesn't help. Lockdowns don't help. Even mRNA treatments don't help. You WILL get Covid. You WILL get the flu. And your immune system will get stronger as you get exposed.

Covid used to be novel. Now it's endemic and mutates multiple times per year. It's looking more and more like Covid will be with us for decades if not forever, just like the flu and the common cold.

droopyEyelids• 4 years ago

Your 'inevitable' comment reminds me of the novice security mindset where something either Secure or it is Not Secure.

In the world of security, you grow up, leave behind the simple binary descriptions, and assess impact of event and threat you're defending against.

This applies to disease safety as well. It's not just 'inevitable' or 'preventable', but there is a difference between getting sick once a year and getting sick every month. Between working in a hospital and working from home. Between being sick by yourself and spreading it to your extended family.

There is a risk assessment to be done, and calculated measures to be taken.

jimjimjim2• 4 years ago

gah! Sure fine whatever. you'll get covid. but how many times? If you test and you discover you currently have covid maybe don't be a raging asshole and give it to your family and friends!

micromacrofoot5• 4 years ago

There seem to be some amount of long-term risks associated with covid that aren't present in influenza though. I hope to continue avoiding covid myself.

ethbr0• 4 years ago

It is worth all of those things... when you have a novel pandemic to blunt.

However, once the disease is characterized, you have effective treatments and protocols for the most sick, and you have decent rates of vaccination and recent infection... needs shift.

The critical factor is {max hospital ICU capacity} + 1 more seriously ill person, and when you're dealing with exponential growth rates and a virgin population, that can be hit pretty easily.

The fact that we didn't (in most parts of the world, for most of the time) is a triumph of modern health policy.

the_cat_kittles• 4 years ago

wastewater seems like such an incredible resource for monitoring so many things. its such a huge statistical sample, for free

jgalt212• 4 years ago

The longer a society wears masks, the sicker everyone will be when they eventually come off. In the formerly overly cautious US Northeast, kids are getting sick left and right this school year. And COVID is the least dangerous bold-faced name they need to worry about.

amilios2• 4 years ago

This is an absolute myth. There is no evidence of "immunity debt", and serious public officials parrotting this nonsense are doing real damage. It's a tempting explanation because it's simple and seems to make intuitive sense, but it's just wrong. The explanation that has much more evidence is that everyone and their dog caught COVID, and COVID has been directly linked to lasting immune system damage, making everyone more susceptible to catching these other viruses.

https://globalnews.ca/news/9272293/immunity-debt-covid-19-mi...

anon_coward_ghk8• 4 years ago

It seems anything that could hurt pfizer or Moderna stock is "misinformation".

"In fact, Furness likens the immune system to a collection of photographs. When people take photos and put them away in an album, the photos don’t fade over time just because they aren’t being looked at regularly."

By that logic I must not need my yearly flu shot because my flu "photo" hasn't faded. Clearly if I wasn't exposed to rsv (and it's most recent variants) my immune system can fight it just as strongly because I have that photo from two years ago.

Also, tetanus vaccines every 10 years, that must be bs.

funstuff0072• 4 years ago

There is no evidence of "immunity debt", and waning immunity are one and the same. So if think one is myth, you believe both are myths.

funstuff0072• 4 years ago

Furness seems to have only a cursory understand of immunity (despite all his credentials). Boosters and yearly flu shots just some simple examples of how the immunological world does not work the way he describes. Too many public health officials are unwilling to admit they made mistakes and gave bad recommendations early in the pandemic. He should correct his errors or step down.

anon_coward_ghk8• 4 years ago

It seems that we are perpetually on the verge of the next big wave, the next scary variant. I am always told by administrators that cases are rising even though I am having trouble finding patients on the floor with covid.

Graph showing level of Covid, flu and RSV in US wastewater systems, by city

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