To help fill the needs, University of Louisville faculty members joined forces with Louisville nonprofit earlier this year to learn the most critical needs, then pack and deliver a 40-foot shipping container with those supplies to health care workers and researchers in Malawi.

The project originated with Rochelle Holm, a UofL associate professor with the who is conducting wastewater-based epidemiology in the city of Blantyre, Malawi, and Bethany Hodge, director of the in the UofL School of Medicine. When Hodge traveled to the country in 2023 to explore learning and service opportunities for UofL medical students in the Distinction in Global Health track, she took note of specific needs in the Malawi hospitals she visited.

“Whenever I am walking through a clinical site overseas or seeing other kinds of work going on, I am mentally taking inventory of all the things the doctors, nurses and staff are saying would facilitate their work,” said Hodge, who also is a board member of SOS, which recovers and redistributes surplus medical supplies that otherwise would go into landfills. “There were enough things on their lists that I knew SOS had in their warehouse that I wanted to connect the two entities once I got home to see if the SOS program could be part of filling the needs.”

Holm is permanently based in Malawi, where her research involves regular sampling of wastewater from two hospitals as well as community pit latrines to monitor infectious disease trends and outbreaks. The work requires supplies that are , specifically consumable items such as pipettes, personal protective equipment and laboratory analysis supplies. Holm also asked her research and hospital collaborators about their most critical needs.

Hodge relayed the hospitals’ and Holm’s needs to SOS, which assembled the items and organized a shipment that included durable medical equipment, surgical and consumable medical supplies for area hospitals, along with the research supplies for Holm’s work.

The materials, valued at $380,077, were packed in the container and departed Louisville in late May. The shipment arrived in Malawi on Sep. 20.

“The supplies we received from SOS are difficult to obtain in country, so this shipment is extremely valuable,” Holm said. “It will allow us to continue testing for pathogens circulating in the community with less concern about running out of materials for our research, as well as assisting the sampling sites with meeting critical supply needs to support health care delivery.”

The Malawi University of Science and Technology, which collaborates with Holm on the wastewater research, and its hospital partners received a portion of the shipment.

“As a university, we really appreciate the donation from SOS, which has come at the right time when the university is strengthening its outreach aspect,” said Petros Chigwechokha, head of Malawi University’s Department of Biological Sciences. “The donation will be extended to the university’s key partners, Queen Elizabeth Central Hospital and Thyolo District Hospital, where they will fill a big gap in equipment and consumables and ultimately strengthen health delivery services.”

Another segment of the shipment went to a heath care facility in southern Malawi supported by Bridge Kids International, a Louisville-based group that works locally and abroad to connect children to their African heritage culture and build relationships between Africans and African Americans.

The five-year funding renewal represents a 62% increase over the previous funding cycle for the UofL center, one of just across the U.S. conducting research into the health effects of chemicals and compounds found at hazardous waste disposal sites known as Superfund sites.

UofL was named one of five new superfund research centers in 2017. Since that time, UofL researchers in the center conducted research into the health effects of volatile organic compounds (VOCs), gases emitted by combustion and from liquid and solid chemicals, found at the Lee’s Lane Superfund Site in southwest Louisville.

“This funding ensures that UofL researchers will continue and accelerate the important work to reduce the effects of these toxins on the health of residents in Jefferson County, our state and our country,” said Lori Stewart Gonzalez, interim president of UofL. “The significant increase in funding shows just how successful our center has been in advancing this knowledge under the leadership of Dr. Sanjay Srivastava.”

The Superfund program, created in 1980, is part of a federal government effort to clean up land contaminated by hazardous waste and identified by the U.S. Environmental Protection Agency as a potential risk to human health or the environment. The program was started in part due to the discovery of a waste site near Louisville in Bullitt County known as the “Valley of the Drums,” which contained thousands of steel drums and contamination from 140 different chemicals.

Superfund Research Centers conduct multidisciplinary research in the detection and investigation of the health effects of specific chemicals and compounds and train young investigators in this area of research. The research at the UofL center is focused on understanding how exposure to VOCs contributes to heart disease, inflammation and liver disease, collectively called cardiometabolic disease.

During its first five-year cycle, the UofL Superfund Research Center engaged in three key project areas where they:

• Developed two portable devices to detect airborne volatile organic compounds in neighborhoods and homes
• Assessed effects of VOCs and other toxins on cardiovascular and immune health in human participants
• Conducted lab studies of health effects of VOCs including acrolein, benzene, xylene, vinyl chloride and trichloroethylene

UofL researchers developed two types of technology to detect and monitor VOCs in the environment. First, collaborating with investigators at Washington University in St. Louis, they designed and built a portable device to monitor and measure VOCs inside and outside of homes to compare indoor and outdoor exposure levels.

Second, chemists and chemical engineers at UofL developed a small “lab on a chip” that can be used in a wearable device to monitor an individual’s exposure in various environments, capturing VOCs for analysis in the lab.

Field studies with both technologies will begin in January 2023.

To study health effects of VOC exposure, UofL researchers enrolled about 700 individuals living in south and west Louisville in a human study program to assess exposure and health changes over time. The initial results of this study indicated that low-level exposure to VOCs could increase blood pressure and damage blood vessels and impair their repair. These effects are important markers for heart disease.

Although planned follow-up studies for the human study were delayed by the pandemic, laboratory and animal studies confirmed these effects.

“This research is revealing and decoding the factors that affect our health outcomes,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “By better understanding these factors, such as VOC exposure, we can develop new interventions that help people here in Louisville and around the world live lives that are not just longer, but healthier and more resilient.”

Next studies expand area, add wastewater monitoring and address mitigation

Over the next five years, center researchers will apply the tools and data from the initial phase to expand the studies. They will broaden the human study to include 1,200 participants across Jefferson County, begin monitoring wastewater for VOCs and launch research to develop VOC mitigation methods.

The broader human health study will enable researchers to compare health changes and exposure levels in different parts of the metro area. Participants will be reassessed periodically over several years for changes in their health and to determine whether the toxins have greater impact on older or younger individuals and those with existing health conditions.

The team will begin monitoring wastewater in Jefferson County for the presence of both VOCs and metabolites shed by individuals, indicating exposure to VOCs. It also may reveal sources of VOC contamination.

“We will measure the metabolites of VOCs in the urine of the participants and in the wastewater, so we will have the environmental exposures and personal exposures. Then we will look at all the health outcomes and see the associations,” said Sanjay Srivastava, professor of medicine and director of the center. “We hope to gain better knowledge of how these chemicals exert toxicity and at what levels the toxicity occurs, as well as how exposures may exacerbate other conditions.”

Technology to monitor wastewater for VOCs and metabolites is an outgrowth of methods developed during the pandemic to detect COVID-19 and its variants in wastewater.

Center investigators also will launch remediation research. They will collaborate with researchers at Yale University who are developing methods to break down VOCs using heat to reduce or eliminate VOCs at hazardous waste sites or in a home or business.

In conjunction with the , UofL researchers also are investigating whether increasing the tree canopy will decrease levels of VOCs and other toxins and improve the health of residents in the area.

“Our work is unique in that it focuses on the effects of these toxins on heart disease,” said Aruni Bhatnagar, director of the Christina Lee Brown Envirome Institute. “Most people have heard of cancer-causing chemicals, but we are finding that these chemicals also lead to heart disease, the leading cause of death in the world.”

UofL detected the variant, a Brazilian strain known as P.1, early in April in a wastewater sample from western Jefferson County. Once researchers received the results, they alerted the Louisville Metro Department of Health and Wellness as well as the state, which confirmed a positive case in the same zip codes with different testing methods a week later.

“The ability to detect viruses early, such as in this case, gives officials more time to take precautions and contain their spread,” said Aruni Bhatnagar, professor of medicine and director of , which leads the wastewater research. “With pandemics, every second counts. In as little as one week, the virus can spread significantly, and then it becomes much harder to contain. This work gives us more time and an opportunity for targeted testing.”

UofL researchers began testing wastewater last year as part of the , a groundbreaking partnership to track COVID-19 in Louisville Metro.

The Louisville/Jefferson County Metropolitan Sewer District has sent weekly samples from 12 sites representing multiple neighborhoods and five wastewater treatment facilities that aggregate the entire county.

Those samples are taken to the , where pharmacology and toxicology assistant professor Josh Fuqua and his team process the samples and isolate viral RNA, and to the UofL Genomics and Bioinformatics Core facilities, where computer science and engineering professor Eric Rouchka analyzes the virus sequences to detect variants.

UofL recently announced the expansion of this work, backed by an . That expansion goes one step further than previous work — from identifying whether disease exists in a neighborhood to estimating how prevalent it is there.

Bhatnagar said understanding that connection could “revolutionize the way we track and contain pandemics, and not just COVID-19.”

Rather than rely solely on direct testing, such as with nasal swabs, wastewater testing can give health departments another tool to gauge the severity of community infection and to identify areas where the infection is prevalent. The tool also is faster, more efficient and less invasive.

“This is cutting-edge work – and the fact that it’s being done right here in Louisville – right here at UofL – places us at the forefront of public health innovation,” said Louisville Mayor Greg Fischer. “It shows we’re doing the work to keep our city and cities around the world safe.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with 91% of Jefferson County residents in a recent poll saying they would like to be vaccinated.

“This is one more example of how UofL has led the charge in finding new and innovative ways to detect, contain and fight COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Developing these new, more efficient tools for tracking pandemics, such as wastewater monitoring, is a big step in advancing health for our community and beyond.”

The Co-Immunity Project needs 2,000 residents to undergo random testing for COVID-19 infection and antibodies the week of May 17-23 as part of this ongoing research. To learn more, , call 833-313-0502 or email covidsupport@louisville.edu.

UofL researchers already are testing wastewater to determine whether coronavirus infection exists in different neighborhoods around Jefferson County. This new work goes one step further, with the goal of estimating how many people within those neighborhoods are infected. If virus levels are high in the wastewater, it may be a signal of widespread infection in the community.

“This could revolutionize the way we track and contain pandemics, and not just COVID-19,” said Aruni Bhatnagar, professor of medicine. “It gives us an invaluable tool that could offer a clearer view of where and how the virus spreads.”

Researchers at UofL’s , where Bhatnagar is director, began testing wastewater last year as part of the Co-Immunity Project, a groundbreaking partnership with the to track COVID-19 in Metro Louisville.

As part of that effort, the from 12 sites representing multiple neighborhoods and five water quality treatment centers that aggregate the entire county to the UofL Center for Predictive Medicine for virus analysis.

In this new work, MSD and other community partners will continue collecting wastewater samples over the next six months. After analysis, UofL will also send the results to the CDC’s National Wastewater Surveillance System, which will help inform efforts across the U.S.

As with previous rounds of COVID-19 testing conducted through the Co-Immunity Project, researchers will recruit participants by sending letters to selected households across Jefferson County. They hope to continue to enroll a few thousand people every month and will compare their COVID-19 infection and antibody results with wastewater samples from the same area, with the goal of finding how they correlate.

“The aim of the project is to figure out whether we can estimate how many people in a given area are infected by simply testing the community wastewater,” said Ted Smith, associate professor of medicine and a lead on the wastewater epidemiology project. “Additionally, this is a passive and comparatively low-cost way to monitor community infection and has the additional benefit of being inclusive of all communities in our city and is a promising step to ensuring public health equity.”

Since the beginning of the pandemic, the Co-Immunity Project has conducted ongoing testing and surveys to better understand the spread of the coronavirus and COVID-19. In the past year, UofL researchers have tested more than 12,000 people for COVID-19 infection and antibodies, beginning with frontline health care workers. They also have worked to gauge how local citizens feel about COVID-19 vaccines, with in a recent poll saying they would like to be vaccinated.

“This is critically important work in our fight against COVID-19,” said Kevin Gardner, UofL’s executive vice president for research and innovation. “Our hope is that by working with the CDC, we can develop these new, more efficient tools for tracking pandemics and take a big step in advancing health for all of our community.”

Last year, U.S. Senator Mitch McConnell (R-KY), then-Senate majority leader, negotiated and championed five historic and completely bipartisan COVID-19 rescue packages. In addition to supporting workers and propping up the economy, these relief bills also allocated for COVID-19 testing. McConnell personally called then-U.S. Secretary of Health and Human Services Alex Azar to request that the CDC direct a portion of that funding to UofL’s Co-Immunity Project.

“Our country has responded to this terrible pandemic with innovation and discovery and Kentucky continues to play a major role in beating this virus. I’d like to congratulate Dr. Bhatnagar and UofL’s entire Co-Immunity Project on their groundbreaking study,” McConnell said in a statement. “After hearing about their work, I took this project to the highest levels of the federal government to help accelerate their research with additional federal funding. As UPS and other Louisville employers are sending safe and effective vaccinations around the country, I’m proud top researchers right here at UofL are pushing the boundaries of knowledge in detection and prevention.”