Swasti | Surveillance Playbook

What is a playbook?
A playbook includes "process workflows, standard operating procedures, and cultural values that shape a consistant response-the play." it borrows some aristotelian elements of the play -

Plot - The arrangement of events or incidents on the stage. The plot is composed of "clearly defined problems for characters to solve."

Character - The agents of the plot. the people

Theme - The reason for the play. The purpose

PLOT: PROBLEM STATEMENT

No One is safe till EveryOne is safe

Without a robust surveillance system, public health response is largely reactive and not preventive and proactive. This leads to inefficient clogged supply chains at its least and lives lost at its worse. The public health infrastructure while in continued development, has gaps in the access of healthcare, health financing and overall health infrastructure. One such gap is observed in public health surveillance. Most of the systems established in public health surveillance are associated with data and information collected from several healthcare records and surveys. However, there are several other avenues which still remain unexplored in the country. As a result, we have limited resources in the public health surveillance system. There are typically 2 pronged issues :

A hurdle in the comprehension of what an environmental surveillance system can and cannot do.

A lack of identification of the diverse players involved for environmental surveillance systems to be meaningful in design and impactful in delivery / outcome

There is a lack of evidence-based decision-making platforms or tools in the public health surveillance system at the city and state level, which may facilitate better control measures of disease spread in the case of outbreaks. As a result, public health response remains pigeonholed and dependent on theoretical predictive indices without an agile component that can help localized response.

Wastewater Surveillance under Precision Pandemic Surveillance Initiative is aimed to support the local municipal administration to understand the trends of COVID infections within the community. It can be utilised as an Early Warning System that indicates an outbreak by detecting sentinel from the wastewater

We have learnt that

1. A functional / impactful Early Warning System NOT ONLY solves for the science but ALSO for the communication
2. It demonstrates how the data can be presented and shared to
- Help administrative decision making
- Generate proof points for Public Health Communication
- Inform risk metrics at community, city and district levels depending on the sewage systems.
3. Environmental surveillance findings needs to be part of a sense making platform where other sources of data are used to make a comprehensive finding report. It is one marker among many - but one of the most agile and cost efficient ones
4. Diverse set of stakeholders are absolutely essential for Early Warning Systems to be functional

PURPOSE AND OBJECTIVE

The COVID-19 Wastewater Surveillance Playbook is a guiding document to help organizations to set up and implement the wastewater surveillance system for SARS-CoV-2 virus detection in partnership with local government and other partners.

The playbook outlines the detailed steps required to initiate and conduct wastewater surveillance in any given city. In this playbook you will find

Wastewater surveillance and monitoring system as an effective public health surveillance tool to detect and rack the trends of SARS-CoV-2 in the community

Set of activities conducted for the wastewater surveillance

Checklists, Tips & Tricks, Standard Operating Procedures and Further Reading Links

The playbook divides the entire process into 3 Acts and 4 scenes, which are as follows:

Act.1 Scene 1:
PLANNING

Act.1 Scene 2: SET UP

Act 2:
IMPLEMENTATION

Act 3: EVALUATION

People

Who are the people?

Solve for the science

Scientists

Molecular Biologists
Genome Experts
Ecological Experts
Water & Sanitation Experts

Strategic Communication

Communication Specialists

Inform national, state and sub- provincial policy making

Public Policy

Enable the environment. Take scaled action

Govt Administrators

City Administrators
Public Health
Stats
Water & Sewage and Pollution boards

Support effective understanding and communication

Data Scientists
Data Visualisers

Inform / validate case loads
Inform on clinical presentations

Clinicians

Role Matrix

Role Title	Anchoring Organization / Institution	Local Government (LG)
Coordination	Orientation and capacity building of partners; Regular updates on insights.	Designation of officials as Point of Contact (PoC) for better communication and coordination with the team.
Insights to action	Create and develop better data visualization and interpretation platforms from the obtained data and information to help local governments in faster decision-making and actions on disease control.	Integration of Early Warning System and environmental surveillance with other surveillance tools for better evidence based decision making
Communication	Create and develop communication tools to avoid misinterpretation and misleads from the data and dashboard.	Set up and include the initiative members in regular dialogues for updates and insights from the initiative
Learning	Create and develop learning platforms on environmental surveillance hosting and organizing through webinars, seminars and workshops.	Create suitable conditions and climate for the Precision Health platform to be used for other infectious diseases and use cases in multiple domains.
Sustenance and flexibility	Create advocacy channels for the platform in the city which can be utilized by other sectoral works.	Linking the platform with other departments to support intersectoral initiatives.
Research	Create advocacy channels for the platform in the city which can be utilized by other sectoral works.	Support research works in the field of environmental surveillance through inviting global researchers.