The country is heading into a COVID-19 winter without fully deploying widespread testing of sewage for traces of coronavirus, a Newsy investigation has found.
Wastewater surveillance is one of the few proven tools able to track community spread of the disease, with the potential to help monitor immunity rates from new vaccines.
"It is frustrating," said David Larsen, an associate professor of public health at Syracuse University's Falk College. "We're going to see a huge amount of sadness over the next few months. And it's not too late to scale up wastewater surveillance at this time to help us with that."
Early on, scientists realized infected people shed the virus in stool.
The federal government began a big effort for analyzing the concentration of the virus in community wastewater.
"It's something I think from a national level we need to pursue," Assistant Secretary for Health ADM Dr. Brett Giroir said during a July webinar.
Months later, the government has left it to state and local authorities to launch their own programs.
For some, that's been a challenge.
Newsy learned New York State, for example, suspended its sewage surveillance pilot after a month in part because of an equipment shortage.
As a result, testing stopped in four places including Albany and Erie County, home of Buffalo.The University of Buffalo helped lead the project.
"UB is in the process of acquiring enough materials to continue the monitoring effort moving forward," university spokesman Cory Nealon said in an emailed statement.
As with PPE, there is a global shortage of supplies needed to test sewage for COVID.
Other places are struggling with how to pay for sewage analysis, with coronavirus aid from Washington running dry.
"The biggest factor, the limiting factor, is finances," Larsen said.
The result is a patchwork of places examining wastewater across the country, mainly big cities and college campuses.
"It's not really a unified strategy, unfortunately," said Colleen Naughton, an assistant professor of civil and environmental engineering at the University of California Merced.
She and her team plot testing sites on a map.
"When you zoom out of course the bubbles are big, so it looks like all U.S. is covered," Naughton said. "But when you zoom in you see it's a bit more spread out."
Three states, Iowa, Rhode Island and South Dakota, don't have any surveillance sites at all, she said.
Biobot Analytics looks for COVID in wastewater for about 200 cities and counties but has the capacity to do much more, said company president and cofounder Newsha Ghaeli.
"We're at the beginning, let's say that," Ghaeli said. "There hasn't really been a strong coming together yet around a specific approach or even standards."
The CDC is still putting together a national wastewater surveillance system, building out a database not available to the public yet.
"It is, I think, valuable for the public to see that data and take action as a deciding factor for what activities and what risks am I going to take?" Naughton said.