News | July 22, 2022

UB Researchers Find Link Between Medicine In Wastewater, Covid-19 Outbreaks

By Janet Gramza

Diana Aga at the University of Buffalo's Natural Science Complex on Monday, July 11, 2022. (Minh Connors / Buffalo News)

The Covid-19 pandemic showed that wastewater can tell us a lot about public health – and University at Buffalo researchers have found that it can tell us even more.

A UB effort to track Covid-19 by monitoring wastewater has revealed a new early warning sign for Covid-19 outbreaks: the levels of acetaminophen in untreated sewage.

Researchers in UB’s RENEW Institute – short for for Research and Education in eNergy, Environment and Water – already were tracking viral RNA in wastewater as a Covid-19 indicator, a practice that has been widely adopted worldwide for community monitoring of Covid-19.

Then, Diana Aga, a chemistry professor at UB since 2002 who took over as director of the RENEW Institute last year, had the idea to test wastewater for antibiotics and painkillers, as well as viral RNA, to see if their levels might correlate with a spike in Covid-19.

Her team found that acetaminophen – the active ingredient in common, over-the-counter painkillers, including Tylenol – stood out as a predictor for Covid-19 outbreaks. Levels of acetaminophen jumped significantly two and a half weeks before clinical peaks in Covid-19, Aga said – and a week and a half before a rise in viral RNA signaled a coming spike in SARS-CoV-2.

Aga and a team of students also saw increases in prescription anti-viral drugs, which people may have in their medicine cabinets from prior treatments and use if they start experiencing virus symptoms. But the levels were nowhere near those of acetaminophen, Aga said.

“Of all the compounds we looked for, acetaminophen was huge,” she said. “A normal level would be 10 micrograms per liter or less, but we were seeing up to 200 micrograms per liter leading up to a Covid-19 outbreak. Normally, we have to concentrate our samples to test them. This time we had to dilute them, that’s how huge it was.”

The findings have big implications for monitoring of Covid-19 and other viral diseases. The study, published in the journal Environmental Science & Technology Letters, suggests that measuring the concentrations of medicines in wastewater could be a valuable tool for forecasting disease outbreaks.

“A lot of scientists are already monitoring wastewater and surface water for pharmaceuticals and looking for emerging contaminants,” Aga said. “The concept of looking for acetaminophen and correlating it with viral RNA and Covid is what’s new – and I imagine that now people will be doing this because many of them already have the data.”

Aga’s own research has focused for years on analyzing groundwater and wastewater for personal care products and other trace chemical pollutants. Hers is among a couple of UB labs using mass spectrometry to test wastewater samples obtained from county treatment facilities before the water is treated and filtered.

She approached her RENEW colleague Ian Bradley, whose lab has been analyzing wastewater for viral RNA since early in the Covid-19 pandemic.

“I said, ‘Why don’t we split the samples so my students can analyze for pharmaceuticals?' ” she said. The samples come from the Bird Island, City of Tonawanda, Kenmore and Lackawanna water treatment centers, she said.

This potential early detection tool comes at a time when other methods of monitoring Covid-19 cases may be becoming less reliable with the availability of home tests and Covid-19 vaccines.

“A lot of people are being diagnosed using home tests now, and many of those are not being recorded,” Aga said. “Also, there are more asymptomatic cases among people who are vaccinated, and these also may not be counted or reported.

“That’s why it’s important to measure viral RNA to monitor Covid at the community level, and to pursue new methods of early detection, because people are shedding the virus before they show symptoms.”

Aga envisions a future reporting system in which sensors will immediately detect increases in acetaminophen and viral RNA in local wastewater and upload the data electronically to provide early warning of a potential spike in illness.

“If we could do this online, you could monitor it on your cellphone, see that acetaminophen is increasing and implement mandates, like putting on masks again and social distancing, to prevent a total shutdown” that many countries experienced in 2020, Aga said.

UB faculty in the RENEW Institute are working on a variety of other research projects all aimed at providing cleaner, more sustainable and healthier systems for water and energy resources and human and environmental health. Learn more at

Want to know more? Three stories to catch you up:

  • Is Covid-19 anti-viral drug effective for kids? Clinical trial at UB aims to find out
  • Pandemic Lessons: Covid-19 is cooling, but misinformation spread is even harder to stop

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Buffalo Next reporters Jonathan D. Epstein, Jon Harris, Natalie Brophy, Matt Glynn, Janet Gramza and Mike Petro contributed to this roundup.


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Source: University of Buffalo