Impact of Potential COVID‐19 Treatment on South African Water Sources Already Threatened by Pharmaceutical Pollution

Abstract

After a cluster of human pneumonia cases in Wuhan City (China) on 7 January 2020, a novel coronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified as the causative agent of the disease COVID-19 (World Health Organization 2020). It quickly became a global pandemic and continues to rapidly spread across the world, having infected almost 4 million confirmed cases and caused more than 265 000 deaths at time of publication, far surpassing the total cases of SARS and Middle East respiratory syndrome (MERS). Currently, health officials are relying on behavioral interventions and quarantines to contain the COVID-19 spread until effective treatment can be developed and deployed. Scientists and researchers are actively working on lifting pressure off countries affected by the COVID-19 pandemic. The use of established drugs developed for other diseases (MERS coronavirus, human immunodeficiency virus [HIV], influenza, hepatitis C, Ebola, and malaria) is being investigated to combat the fastmoving COVID-19 spread (Saey 2020). Research has illustrated similarities between COVID-19 and HIV because host convertase, furin, has the potential to cleave the viral envelope glycoproteins of both viruses. This enhances viral fusion with host cell membranes. Furin is highly expressed in human lungs but also in small intestines and liver and might explain the multiple clinical symptoms observed for COVID-19 patients (Coutard et al. 2020). Lopinavir/ritonavir (HIV treatment), chloroquine phosphate (malaria treatment), ribavirin (broadspectrum antiviral), arbidol (influenza virus treatment), and interferon-α (hepatitis treatment) are some of the drugs that have been included in the latest version of the "Guidelines for the Prevention, Diagnosis, and Treatment of Novel Coronavirus-Induced Pneumonia," issued by the National

The COVID-19 pandemic: Impacts on cities and major lessons for urban planning, design, and management

“…For instance, in South Africa, the antiretrovirals (ARVs) used for treatment of HIV have polluted freshwaters due to the failure of wastewater treatment plants to properly remove them from wastewater. Based on this, it is argued that possible use of ARVs for treatment of COVID-19 patients and their release into wastewater may further intensify the pollution problem ( Horn et al, 2020 ). This indicates the importance of taking effective wastewater treatment measures.…”

Agrochemicals in freshwater systems and their potential as endocrine disrupting chemicals: A South African context

“…Complex mixtures of EDCs from different sources (industrial chemicals, agrochemicals, pharmaceuticals) end up in aquatic environments, making it near impossible to pinpoint their origins. The response to the COVID-19 pandemic is likely to contribute additional pharmaceuticals to the aquatic environment ( Horn et al , 2020 ). When environmental matrices are assessed for ED activity, any of the hormone-active chemicals present in environmental extracts can be responsible for the observed activity.…”

Traffic, Drugs, Mental Health, and Disinfectants: Changes in Sewage Sludge Chemical Signatures During a COVID-19 Community Lockdown

“…We detected endocrine disrupting compounds including triclocarban, oxybenzone, and sertraline that can have negative impacts on marine organisms and cycle back to humans via consumption of local seafood (62,63). Much concern has been expressed about the potential ecological impacts of increased pharmaceutical loads in wastewater, particularly in developing areas where wastewater treatment is limited and access to antibiotic and antiviral medications is not controlled by prescriptions (64)(65)(66)(67). Spread of resistance to antibiotic and antiviral medications is also a potential concern (64,67).…”

“…Much concern has been expressed about the potential ecological impacts of increased pharmaceutical loads in wastewater, particularly in developing areas where wastewater treatment is limited and access to antibiotic and antiviral medications is not controlled by prescriptions (64)(65)(66)(67). Spread of resistance to antibiotic and antiviral medications is also a potential concern (64,67).…”