EWS-C19 scope and objectives

Building an Early Warning System for community-wide infectious disease spread: SARS-CoV-2 tracking in Africa via environment fingerprinting


Urban water contains a complex mixture of substances including human specific excretion products resulting from exposure to various stressors (e.g. infectious agents, toxicants) and disease (e.g. proteins, genes). EWS-C19 postulates that measurement of human derived city metabolism excretion products, continuously pooled by sewerage derived from different communities, can provide quantitative, anonymous and objective evidence of community-wide exposure to the SARS-CoV-2 virus and resulting effects in real-time. Over the last 15 years we have developed this cutting-edge Wastewater-Based Epidemiology (WBE) approach of extracting epidemiological information from urban water to estimate drug use or AMR trends and we are best placed to deliver EWS-C19. 

EWS-C19 considers the crisis of a healthcare system due to Covid19 pandemics (South Africa and Nigeria) as its main objective. Sars-Cov2 has had an unprecedented impact on humanity globally. It disabled, within weeks, functioning of whole countries and exposed global vulnerability to this natural disaster as well as exposed acute inability to rapidly identify, contain and manage the virus due to lack of enabling EWS focussed on rapid identification of SARS-Cov2 hotspots and response. 

As testing is limited, there is no understanding of true spread of the virus in communities of Lagos and Cape Town. Nigeria with over 200 million people had only been able to test about 70,000 people as of June 2nd, due to the cost of testing. This study will bridge that gap as the onset of infection in a community can be tracked in real-time even if the residents in such community have not been tested to know their Covid status.


EWS-C19 will provide grounds to revolutionise Covid-19 surveillance as urban water is considered as a diagnostic medium for the health status of a city. Such a tool will be critical to understand the near real-time spatiotemporal changes in Covid-19 infection levels both at the community scale and across UK cities to potentially help underpin critical decisions regarding ‘lockdown’ restriction periods.

There is a limited number of conventional tests that can realistically be performed per day. As a result true understanding of the prevalence of the virus is not possible. Furthermore, Covid testing drains resources at the cost of other diseases such as TB, South Africa’s biggest killer, malnutrition and greater mortality from other non-Covid related illnesses. 

Instead of locking down a vast proportion of communities and paralysing the economic activities, the hotspot can be isolated and movement restricted within the space until the spread of infection is eliminated.

This project will focus on tracking infection rates of SARS-Cov2 within tested communities. However, it will be transferrable to other diseases. By producing an EWS that can detect public health threats, this project will provide South Africa and Nigeria with the tools to improve their citizens’ public health and welfare. It will increase resilience of cities through the adoption of the EWS. This in turn will have an impact on the economic development of South Africa and Nigeria as public health threats that are addressed at an early stage are less likely to cause expensive damage.