By Anneli Cers
Public health microbiologist Joan Rose has spent her career tracking pathogens in water, from Escherichia coli to the COVID-19 virus. The 2016 recipient of the prestigious Stockholm Water Prize took an interest in microbiology early in her undergraduate studies, completed her master’s thesis at the University of Wyoming, and conducted her Ph.D. research at a drinking water plant in Arizona. Now Rose, the Homer Nowlin Chair in Water Research and Professor at Michigan State University, studies waterborne health threats by mapping the world’s waterways.
Her experience in the world of water pollution microbiology with a public health slant has brought Rose to communities where waterborne disease outbreaks have forever altered lives.
“I realized that it wasn’t just about running around and collecting water samples; it was really about a public health issue and protecting water for communities, the children, the elderly, and all of the people at risk,” she said.
Her latest project: leading research on the Michigan State University campus and around the state of Michigan to track the COVID-19 virus in communities by collecting and tracing wastewater samples, so scientists can predict when and where outbreaks are likely to occur.
During Earth Week, Rose was a keynote speaker at the Spring 2021 iSEE Congress, “The Future of Water.” Ahead of her virtual visit with the University of Illinois campus community, she talked in Fall 2020 with Q’s Anneli Cers about mapping waterborne diseases, threats to water security, and addressing water quality through policy.
Q. Did you grow up near water?
I grew up in the Mojave Desert in Southern California, where water was scarce. Although the groundwater is stressed now, we had plenty of groundwater at that time. As a young kid, I did not worry about the quality of the tap water. I was excited to go to a little river, the mountain lakes, or to the ocean with my family. There is an appreciation of water when it’s not around you. I did not think of groundwater as much until I got to Arizona and did my Ph.D. We sampled waters around the state to determine the water quality. I started thinking about whether the water was used for recreation or drinking water, and if it was coming off of our land, from our communities as wastewater, and how all this was impacting our water quality.
Q. How do you track pathogens in water?
It’s not easy, but methods have evolved. The polymerase chain reaction (PCR) uses a kind of molecular tool to study pathogens, but these methods were not around when I started my Ph.D. We used culture techniques and an old-school medium that we knew could specifically or differentially tell us which bacteria were present. For viruses, we had cell cultures. Often we knew a virus was there, but we did not know what kind. In 1985, PCR really started impacting the microbiology world and made things easier. It’s no longer hunting for the needle in the haystack; we now have a magnet, so to speak, with which we can pull that needle out. We can look for any specific organism we want in the water with the new instruments and knowledge around DNA. PCR is basically a DNA copying machine, so we can look very specifically for pathogens like adenovirus, Cryptosporidium, or Giardia.
When the COVID-19 virus showed up in feces and sewage, scientists, including our lab, were able to quickly develop a method to look for that virus in the wastewater. We take the water sample, concentrate it, and sometimes actually use a magnet. We attach an antibody to our target organism with an iron molecule and pull it out of everything else with a magnet. Then, we use these molecular tools to identify the pathogen or even understand the source of the pollution, which could be coming from humans, birds, or cows.
Q. Could you describe the complex process of mapping water diseases in just a few sentences?
We know we cannot sample every single water source every single day to understand the quality, so we strategically select our sampling sites to create a model. A watershed is a whole bunch of river systems that all come down to one spigot. A lot of times we’ll sample at that spigot to try to collect what’s in that watershed, and then we’ll go upstream into that watershed. We try to understand what the land use is. How many wastewater plants are there? How many people are in that watershed? How many cows are in that watershed? Rain is a driver because it carries stuff off of the land and into our rivers, so we try to understand the transport. We try to study where the organisms come from, how fast they move, and where they go. We can determine if they are going to places where they are going to make people sick, like the beach or a drinking water source. We work with modelers, people who understand land use, and people who understand mapping. It’s very much like a puzzle.
Q. What is the most notable or interesting outbreak that you have studied?
The Cryptosporidium outbreak in Milwaukee in 1993 was notable for many reasons. It was one of the largest outbreaks in terms of the number of people who got sick. Several sensitive populations were affected and immunocompromised individuals died. Suddenly people were like, “Wow, people are dying from our tap water!” In the United States, that shouldn’t be happening. Another reason it was so notable is that the Safe Drinking Water Act was being reauthorized by Congress. The outbreak made an impact on the reauthorization because people realized that there are going to be emerging new microbes and contaminants that are going to cause a risk, so it got attention politically, scientifically, and in the public health arena.
One of the outbreaks that affected me more was a smaller outbreak associated with E. coli in a little town in Canada. I went to that community about five years after the outbreak and met people who were affected. Some had lost a child because of the contaminated tap water. People still had reactive arthritis, which can be a chronic condition from some infections. People weren’t affected for a short amount of time; this changed their lives for the long haul. It meant that we have to protect our drinking water and reduce those kinds of events.
Q. Why aren’t people more aware of waterborne diseases?
Luckily, waterborne disease outbreaks are rare in the United States. When we mapped outbreaks over 50 years, we found that the same community rarely experienced two outbreaks. Once you have an outbreak, the infrastructure gets upgraded and a lot of attention is paid to the treatment conditions at the utility. We made a lot of changes to improve our drinking water after the Cryptosporidium outbreaks, and the new rules were implemented as part of the Safe Drinking Water Act.
A lot of things have to happen for an outbreak to occur. A pathogen has to hit a water plant, enter your well water, or enter the groundwater. It has to get through the treatment. Some water is quite susceptible because sometimes there’s no treatment. Then, the outbreak has to be recognized. We believe that there are little outbreaks occurring, but they are not recognized because they’re not big enough. The attack rate is the percentage of people in a community who actually get sick. Generally, the attack rate has to be above 20 percent to be recognized as an outbreak; 20 percent of the population is a lot. If the contamination is lower than that, and there are people getting sick, it’s just not recognized.
Q. What is the biggest threat to water security? What kind of risk does climate change pose?
I think the biggest threat in terms of climate change is the change in precipitation patterns, the intensity of rainfall events, and increased flooding. Analyses around the world reveal that a high percentage of outbreaks and dramatic disease events occur during these flood events because fecal pollution is spread by the floods. I think that this is a threat that overlays what we do on the land. We’ve got more people, we’ve got more animals, and we’ve got an aging infrastructure. So if we don’t take care of the increased fecal pollution and aging infrastructure, the climate is going to exacerbate these issues.
Q. What do policy solutions for these threats look like at different levels of government?
At the state level, I think that solutions include investments under the Clean Water Act, source-tracking methods, fixing impaired waterways, and looking at long-term solutions for treatment and infrastructure. As we build pipes or wastewater plants, we should be thinking that these should last 50 years. Our clean water is going to be an asset and a driver of economic growth because people love to live around clean water. It drives economies in terms of tourism, fisheries, food, agriculture, and the manufacturing industry. At the federal level, we need to look at new emerging areas, such as plumbing systems in buildings. The few distribution system rules and federal programs that exist are not mandatory and are not cohesive to look at water quality in these buildings.
Our pipes are kind of out of sight, out of mind, and we don’t think about them until something breaks. We really need a water infrastructure program that invests. We can’t afford it if we ask the local ratepayer to pay for all of the upgrades for our water systems. The federal government and the state government need to partner with the local communities so that our taxes are actually going toward upgrading our infrastructure. This is going to protect our ambient waters, our lakes, our groundwaters, and the water that we drink.
Q. Many people are currently affected by COVID-19. What might a pandemic caused by a waterborne pathogen look like?
We have seen it already to a certain extent with cholera. Cholera came over to the Americas in 1991 and spread to almost every country in South America. That was a big wakeup call because they did not have good wastewater treatment. We did not see it in North America because we have wastewater and drinking water treatment, which is a barrier to the spread of waterborne diseases. Cholera and Salmonella, the cause of typhoid, are still globally significant, but we know how to interrupt waterborne diseases for the most part. Cryptosporidium in emerging regions of the world, however, was so resistant to one of the most important barriers that we used, which was disinfection with chlorination, that we had to adjust to this new pathogen. We have seen these waterborne diseases spread around the world in a very short amount of time. A new genotype for norovirus, for example, can spread through food, people, water, and sewage. The main thing about these outbreaks in water is how many people are exposed at one time. Once the water is contaminated, you can have hundreds and thousands of people exposed at a single period of time from their drinking water; that’s why it’s so dramatic. It’s more like a plane crash than what we are seeing right now with the pandemic.
Q. Do we take water for granted? What are we risking by ignoring these issues?
Yes, I do think we take water for granted. I think most people don’t know where their water comes from because they just turn on the tap. They don’t know what’s groundwater, surface water, and they don’t know how it’s treated. And they certainly don’t know where their water goes when they flush their toilet. In some ways, that’s kudos to the water profession for making it so seamless that we don’t ever have to think about it. On the other side of that, the community gets upset if the city starts to raise water rates. It can be expensive, especially for poor income areas where they have to spend a high percentage of their income on water, which is a necessity. Globally there’s been a declaration that water is a human right. In the United States we say that water is a human right, but you have to pay to access it. So how do we make sure that is reasonable and that, financially, we are doing the right thing for our communities as we install infrastructure?
Q. Where do you feel you’ve made the most impact, either through a specific project or overall?
I have never been my own lab. I work in collaboration, so I think I have had an impact on other fields by bringing microbiology into hydrology and working in the field. There’s been an impact in developing, monitoring, and appreciating data. I’ve been a big supporter of monitoring, and not just compliance, where the law says you have to monitor for E. coli on a beach. I think that we need water diagnostics. When we find the pollution, how do we fix it? If we have water diagnostics, we can spend our dollars more wisely. And we’ve been able to create a global network where we can share knowledge. I think my impact has been in those areas.
Q. In 2016 you received the Stockholm Water Prize for your leadership in research on microbial threats to human health in water and translation of scientific findings to policy makers. What did that mean to you and to your work?
I was stunned! The recognition that the prize gave to our field of water quality and public health allows us to have a platform where we have more people calling and asking us to speak about this topic. It opens doors so that you meet more individuals who are working globally at the interfaces between disciplines. It’s really humbling to be awarded something like that. You don’t really think it’s something that’s going to happen in your career. It was an amazing week.
Q. What’s next for you?
We are looking at taking everything we have learned and making it accessible on a global basis using the internet. We finished an online book about waterborne pathogens. We are creating a platform where we can share information so that people can make use of all of this knowledge that we have accumulated over the last 20 years, through both peer-reviewed publications and tools where you can access the actual data.
With COVID-19, I think that there is going to be even more attention to wastewater infrastructure and our ability to help with decisions about opening schools, the sports season, and the protection of nursing homes. I really think that the monitoring of wastewater systems is going to help us with this type of pandemic. As a vaccine becomes widely available, we will be able to support how this vaccine is administered, its uptake, and its protection of our communities by monitoring wastewater. Rather than having to sample each individual person, you can get a picture of the whole community with water samples. My public health colleagues are working so hard right now to fight this pandemic. It’s just unbelievable.
About the Author …
Anneli Cers is from Chicago, Ill. She studies Natural Resources & Environmental Sciences with a minor in Environmental Law & Economics. She plans to pursue a J.D. in environmental law.
This interview is her first assignment for Q Magazine.