Bacteria and the Bagmati

Why Bagmati’s wastewater is both an opportunity or perhaps the largest biological threat of our times, named duly by the WHO as one of the top ten global public health threats.

By: Adarsh Man Sherchan (Principal Investigator: Bagmati Biome Project), Sophiya Gyanwali, Bilim Prajapati and Amar Khatri. (Research Assistants: Bagmati Biome Project)

A looming concern is rising among the scientific community worldwide. Its origin is biological; it circulates and regenerates in the environment and grows in amplified strength due to unregulated human behavior. Clinicians already know the bane of its existence all too well; COVID-19 will pale by comparison if we haven’t already learned a lesson to curb its threat on time. It is duly called Anti-microbial Resistance and the motherload of its threat is deposited in our rivers. For Kathmandu, that resource being the Bagmati river.

As research scientists who have studied infectious diseases, wildlife, and the environment in a single paradigm (also known as One Health) for the past decade (more), there is not a single element of surprise over how Covid-19 has come about, yet here we are again, reminding populations of a threat larger that looms on the horizon, able to change global economics and keep our existential momentum to a standstill, resulting in an unprecedented loss of animal and human life. AMR is a phenomenon where bacteria, viruses, fungi, or parasites: microbes, in general, develop resistance against antimicrobial agents. Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites change over time and no longer respond to medicines making infections harder to treat and increasing the risk of disease spread, severe illness, and death.?These may be antivirals, antifungals, antibiotics, or antiparasitic agents as by nature and design they are supposed to work. These drugs then interact with bacteria in the water, which can evolve resistance within these environments, which in turn can transfer to human-associated bacteria, meaning that antibiotics are less likely to work.

Scientists are calling for new safety thresholds for antibiotics in sewage to be tightened to help to fight the spread of resistant bacteria, as the latest research shows present measures are not safe

The WHO has namely declared AMR as one of the top 10 global public health threats facing humanity. The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stay, the need for more expensive medicines and financial challenges for those impacted. The cost of AMR to the economy is significant. In addition to death and disability, prolonged illness results in longer hospital stays, the need for more expensive medicines, and financial challenges for those impacted. Without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk. Furthermore, without effective antimicrobials, the success of modern medicine in treating infections, including during major surgery and cancer chemotherapy, would be at increased risk.

So where does the Bagmati fit into this jigsaw?

The Bagmati has been plagued with decades of ignorance resulting from sewer waste, industrial effluent, and community-level solid waste mismanagement. The motherload of all antibiotic use in the form of fecal and sewer waste ultimately lands up in the rivers with large consortium studies (lead by York University in 72 rivers worldwide) showing increased AMR loads in rivers particularly in Bangladesh, Pakistan, Kenya and Ghana. The Mekong, Seine, Chao Praya all affected with large antibiotic load. The Bagmati is already spewing with AMR load brought about by overconsumed antimicrobials for human or animal health, antibiotics in particular that undergo little to no wastewater treatment. Moreover, of the 5 projected Waste Water Treatment Plants (WWTPs) supposed to be functional in Kathmandu, only Guheshwori WWTP according to an ADB report handles the majority waste load of 4 million-plus people. Anyone who understands Antimicrobial Resistance (AMR) knows all too well the threat of Multidrug Resistance in a clinical setting. Every day, the scale is tipping incrementally towards resistance and lowered susceptibility. In the pharmaceutical world, the economic and research investments for antibiotics research and discovery since the mid-1990s have paled in comparison to the earlier half of the century owing to lower market returns for the heavy investments put for drug discovery. AMR is predicted to become the leading cause of mortalities by 2050, with multidrug resistance already causing over 700,000 deaths worldwide.

The WHO duly states, "The main drivers of antimicrobial resistance include the misuse and overuse of antimicrobials; lack of access to clean water, sanitation and hygiene (WASH) for both humans and animals; poor infection and disease prevention and control in health-care facilities and farms;??poor access to quality, affordable medicines, vaccines and diagnostics; lack of awareness and knowledge; and lack of enforcement of legislation.". Such a predicament is the exact one the Nepali people find themselves in surrounded around the Bagmati.

What can we do?

As far as Bagmati cleanups are concerned, often it is campaigning with banners and posters below the Thapathali bridge with feel-good social media tags and a lot of self patting on the back. Sure, solid waste management is a grave issue in its own rights but keeping the focus on the larger picture, AMR derived from wastewater sourced primarily from sewer waste is Kathmandu's largest future health threat by 2050. Pilot studies around understanding the antibiotic load on our rivers accompanied by environmental metrics such as chemical offload, Biological Oxygen Demand (BOD), Dissolved Oxygen will be a significant way moving forward. COVID-19 has sprouted a large mushroom of molecular setups in the country, now is the right time to use multidisciplinary sciences as such microbiology, molecular tools, and bioinformatics aligned with sampling principles from environmental engineers and WWTP design modifications to use gene segments such as the 16S RNA, bioinformatics databases and DNA based tools to understand the true load of unprocessed and post WWTP processed wastewater to intervene the best decisional strategy of Antibiotic-Resistant Gene (ARG) reduction, the true proponent of the AMR phenomena.

The private sector needs to help fund some of this R&D baseline study as wastewater remediation is a great opportunity for economic welfare in the form of compost and/or localized bio-energy resources but more so because the Bagmati is the artery of our collective health in the valley. Bagmati cleanups can no longer be about the feel-good pick trash for a day phenomena, it needs to vein deeper into research and findings for which the medical, environmental, and general community at large must be ready to put on a strong fight to tackle. Just like how COVID-19 has taught us, AMR is not going to explode overnight, but it will gradually and incrementally increase in impact, for now, it is simply a sleeping tiger that hasn't roared in its full furor.