Scientist Shares How Wastewater Surveillance Program Empowers Public Health Decision-Making

Kerkorian School of Medicine professor Edwin Oh is far from an Ivory Tower researcher.

He’s the kind of scientist who leads the decidedly unglamorous wastewater surveillance program at UNLV, an associate professor who carefully examines sewage samples for the COVID-19 virus, a researcher who gets a manhole opened in the middle of the street and then uses a pole with a bottle attached to the end of it to scoop up sewage which, from the smell of excrement alone, nearly activates the human gag reflex.

Our waste contains an abundance of information about our biology and the infectious conditions that threaten our health. As a result, such samples have let him know, before cases were reported by the Southern Nevada Health District, that Omicron, BA.1, was the dominant strain of the virus circulating in Southern Nevada in December. He also learned early on from sampling that its subvariant, BA.2, is now responsible for up to 70 percent of the circulating virus locally.

“What is surprising right now — a real head-scratcher, but good for Las Vegas —is that we’re not seeing anything like what is happening in other parts of the world, where the number of cases really increased because of BA.2 , which has shown to be highly transmissible,” Oh said. “It could be that the number of cases hasn’t surged here because of protection that has come from a combination of a decent number of those who are vaccinated and those who have developed antibodies as a result of earlier infections. We’ll know more in two or three weeks.”

On March 30, the health district reported 690 new cases over a seven-day period, which Oh called “one of the lowest case counts in the last year…It’s quite remarkable. The number is incredibly lower than we’ve seen with other highly transmissible variants.”

Nabih Ghani, a biology major, and UNLV professor Edwin Oh collect wastewater samples for testing. Ghani is an undergraduate research assistant in Oh’s lab.

Energized by Oh’s wastewater research work, four Las Vegas institutions – UNLV, the Southern Nevada Water Authority, the Southern Nevada Health District, and the Desert Research Institute – have collaborated on a public wastewater surveillance dashboard to track emerging cases of COVID-19. That means the public will learn how COVID-19 will affect the community far more quickly, making support for public health mitigation measures that can help slow the spread of the virus much more likely.

Oh said wastewater surveillance has been used for decades to monitor viral diseases, including polio, but its unglamorous nature has probably kept its usage down. Fortunately, 30 UNLV undergraduate and graduate science majors, along with medical students and postdoctoral fellows, and other researchers, understand the importance of Oh’s work and are supporting his program both in the laboratory and at wastewater sites throughout the community.

Multiple awards

Reporting equally to both the Kirk Kerkorian School of Medicine at UNLV and the Nevada Institute of Personalized Medicine at the UNLV College of Sciences, Oh has been honored this year with the Barrick Distinguished Scholar Award and with the UNLV office of community’s Community-Based Engagement Research Award, which involved collaboration with the Southern Nevada Water Authority, Southern Nevada Health District and Clark County School District. Last year he was presented with the 2021 Outstanding Faculty Mentor Award from the UNLV office of undergraduate research.

While his frequent interaction with a media hungry for news about a virus that has already taken the lives of nearly 1 million Americans gives the public a good sense of his commitment to tracing and identifying the coronavirus in Southern Nevada – Oh has worked seven days a week for the last two years – far less is known about how he got to this place and time.

An International Education

The youngest of three children, Oh was born in Singapore, an island in Southeast Asia that is smaller than the state of Rhode Island. Run by a democratically-elected parliament, the nation, which he tries to visit once a year to see family, has largely been transformed, he noted, “from a fishing village in the 1940s to a landscape of architecture today.” Though his parents had little formal education, they set their eyes on a future that did not involve working in mangroves or a fishing village. Their dream became a reality when Oh’s father got a job as a typist in Singapore’s foreign affairs division.

During Oh’s first 17 years of life, his father’s job would take the family to live in Indonesia, England, the Soviet Union, France, Italy, Finland, New Zealand, Singapore, and the Philippines. “I grew up learning how to make friends quickly and how to, unfortunately, learn to move on quickly, too,” Oh said. “My earliest memories of my childhood are when we were stationed in England. During this time, around the early 1980s, I would always walk around with a cricket bat. This was my entertainment as a toddler.”

Now married and the father of a 2-year-old, Oh grew up attending international schools in countries where his father worked – the schools that catered to the children of government officials doing overseas work. Raised to speak a range of languages ​​that included Mandarin and English, he said he also learned the native languages ​​in the countries where he lived “well enough to get by. I can’t say, though, that I remember them all now.” During his first years in school, he says science and math were disciplines that were introduced early. The first inkling of his love for math and technology was seen during elementary school in New Zealand. “I was exposed to algebra and I absolutely loved playing with numbers. I often had a calculator with me and I would work with exponentials and square numbers because I enjoyed the thrill of knowing the outcome of a combination of numbers as I typed it into the calculator. I was also introduced in New Zealand to the Commodore 128 personal computer at a friend’s house…and from there on I was hooked on computers.”

While in high school in the Philippines, his interest in studying something more powerful than a computer – the human brain – grew. Reading about the University of Michigan’s program in neuroscience, he applied and was accepted. In 1995, he began college at the age of 17, focusing much of his research on the APOE gene now considered to be a major risk factor in Alzheimer’s. After graduating in 1998 with a bachelor’s degree in cellular and molecular biology with high honors, he returned to Singapore to serve three years in the conscription army.

Because of his time in the military, where he was a lieutenant in a tactical unit of his brigade, Oh may be the only scientist now tracing and identifying COVID-19 in an American community who’s also adept at firing — the M16, the rifle that can discharge up to 950 rounds per minute; the GPMG, the world’s deadliest machine gun; and the MILAN anti-tank missile, a shoulder-fired weapon that can knock out an armored vehicle nearly two miles away. “I embraced the core values ​​that I was taught (in the army) and to this day, I still think about how I can apply leadership by example, fighting spirit, and care for soldiers to what we do in the lab.”

Stem cell research

After his military service, the army veteran returned in 2002 to the University of Michigan, where his work revolved around stem cells as he completed his Ph.D. in neuroscience. After training as a postdoctoral fellow at Johns Hopkins University, he became an assistant professor in the department of neurology at Duke University, There, he said, “we were using genomics to help diagnose many rare neurological conditions. We developed the sequencing tools to interrogate the human genome and identified mutations that were more likely to cause disease. When I interviewed at UNLV, I wanted to bring my knowledge of genetics to the School of Medicine and the Nevada Institute of Personalized Medicine and build a new program in neurogenetics.”

In 2017, Oh began his research work at UNLV, where he says “the general interest of my lab is to develop genomic tools to interrogate human diseases. I am also extremely interested in using next-generation methods to identify and characterize pathogens that cause disease.”

Two years ago, when the COVID-19 pandemic exploded in the US, the coronavirus became the center of Oh’s attention. “The COVID-19 pandemic…was exacerbated by the inability to track the infections in a timely manner,” he said. “Testing of humans revealed new public health challenges due to the lack of test kits and perhaps equally important, the lack of symptoms in up to 70 percent of infected communities. This was a time to think really hard about how to devise the best tools for a solution. As a result, my lab collaborated with environmental engineers, public health experts, molecular biologists, clinicians, and business partners to develop a wastewater monitoring program. We are now at a point where we can use wastewater to identify a new pathogen and a variant as it enters in the community; we can also use wastewater to indicate whether opioid consumption in a community is leading to the highest level of drug overdose deaths; and…we are now realizing a future where wastewater can indicate whether a community is at a higher risk for cancer or Alzheimer’s disease.”

The Southern Nevada community, Oh said, must decide on how far to go with what can be learned from wastewater. “The most important aspect of our work moving forward is to ensure that the community is involved with the decision-making components of what we should and should not do with our science. We are at a place in our discipline where we can tell you if a stomach flu bug is circulating in a building or in a school.” Oh also points out that you can tell how much red meat, for example, is consumed in an area. While finding a stomach bug could quickly trigger interventions such as deep cleaning of classrooms and areas before more teachers or children show up sick over time, something the public would no doubt support, he wonders how the public would feel about public health officials suggesting that far less red meat should be sold in Las Vegas because there’s evidence the consumption of red meat causes more risk of heart attacks and cancer.

Calling attention to the fact that the state of North Dakota has introduced legislation relating to prohibiting the testing of wastewater for genetic material or evidence of disease, Oh said the success of many public health programs is dependent “on how transparent we can be with sharing the data we collect. I think this is why we developed the empower.unlv.edu website with the goal of providing data to the communities that we serve. I believe that such information can truly empower decision-making for interventions at the public health and community medicine level. However, we should not turn this science into a Big Brother program.”

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