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Official websites use. Share sensitive information only on official, secure websites. Elsevier hereby grants permission to make all its COVIDrelated research that is available on the COVID resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. China has controlled the nationwide spread of COVID since April , but it is still facing an enormous threat of disease resurgence originating from infected international travelers. Taking the rapid transmission and the mutation of SARS-CoV-2 into consideration, the current status would be easily jeopardized if sporadic locally-transmitted individuals are not identified at an early stage. Clinical diagnosis is the gold standard for COVID surveillance, but it is hard to screen presymptomatic or asymptomatic cases in those who have not exhibited symptoms. Since presymptomatic or asymptomatic individuals are infectious, it is urgent to establish a surveillance system based on other tools that can profile the entire population. Nonetheless, after the relaxation of containment measures such as restrictions on national and international travel, COVID outbreaks triggered by infected international travelers or even contaminated imported goods Pang et al. The risk of the resurgence of COVID nationwide remains high if any sporadic outbreaks are not controlled at an early stage. China's infectious disease surveillance system was established after the emergence of severe acute respiratory syndrome SARS in This monitoring and early warning of infectious diseases system is based on a case reporting system that covers all levels of healthcare facilities across the country. Confirmed case reports from local hospitals are directly sent to the aforementioned three systems in a timely manner via the internet, whereas for serious and unknown infectious diseases, the clinical diagnosis should be reported within 2 h via telephone or fax Cao et al. However, for COVID, a substantial proportion of infected people barely exhibit symptoms whereas healthy people can be infected by presymptomatic and asymptomatic individuals. Thus, an early warning of COVID outbreaks in communities is limited when merely based on the current symptom-based disease surveillance system. As a result, China has undertaken stringent containment strategies such as quarantines and lockdowns once a few domestic infected individuals have been reported in a community. Based on the evidence of a few daily confirmed cases reported by the National Health Commission of China, these control measures are effective in reducing human—to—human transmission. The rapid transfer from a time of peace to civil defense also challenges the emergency management capability of local governments, because it is difficult to carry out the strict containment measures over a long period of time without making any mistakes. As reported by Zhou et al. Due to the lenient management at the airport, COVID first circulated among the airport cleaning staff and then was introduced to domestic passengers, families, and the local communities, which consequently led to large-scale community transmission and eventually spilled over to nine cities across the country. Hence, local governments are asked to maintain vigilance and improve disease control strategies. Moreover, the identification of the spread of COVID in rural areas is a tricky issue, which was indicated by cases of cluster transmission in rural areas in Fujian Province. As reported by the National Health Commission of China, the disease was introduced to villagers through one returning citizen who may have become infected during quarantine but was not detected for at least ten days. Considering the gap between rural and urban areas in public health facilities as well as the level of clinical diagnosis and treatment Yao et al. Therefore, an effective, timely, and economical alternative for monitoring and early warning system is critical for controlling and preventing the nationwide spread of COVID Therefore, this work aimed to discuss the practical feasibility of establishing a complementary surveillance system for communicable diseases such as COVID in China. The concept of WBE was firstly proposed to estimate the illicit drug consumption in communities Daughton, In , the cocaine consumption in Italy was estimated through WBE for the first time and thus verified its practical feasibility Zuccato et al. Generally, epidemiological investigations based on WBE follow a procedure of pre-investigation, sampling, marker selection, pre-treatment, instrumental analysis, and back-estimation based on modelling. Since the outbreak of the COVID pandemic, the adoption of WBE has been accelerated to monitor the prevalence of highly infectious diseases in communities or even in residential buildings Wong et al. Australia, the Netherlands, the United States, and many other countries are now exploring how to establish an early warning system for public health emergencies based on WBE Hayward, ; Thompson et al. Compared with conventional epidemiological investigation approaches Table 1 , WBE, without individually testing thousands of people, is regarded as a cost-effective and real-time method to monitor the spread of COVID within the corresponding wastewater catchments. Similar to other countries, previous studies of WBE in China were initiated to investigate the illegal consumption of illicit drugs such as cocaine, heroin, and methamphetamine. In , Lai et al. In , Khan et al. Since then, several Chinese research groups have investigated the consumption of illicit drugs, tobacco, nicotine, and PPCPs in various cities across the country. Nonetheless, previous studies focused more on the verification of WBE in supporting epidemiological surveys, whereas a nationwide monitoring system has not yet been established. Based on the initial WBE result, local governments could conduct further clinical testing or quarantine people at COVID hotspots within communities to prevent the transmission of the disease without affecting the normal activity of the entire population of the whole city. To elucidate the feasibility of WBE, we mainly focused on the sewage and drainage system and laboratory testing capabilities in China, which are two prerequisites for WBE implementation. A well-functioning sewage and drainage system, especially the coverage of the drainage systems in communities, is a prerequisite for applying WBE. With the rapid development of urbanization, WWTPs in China receive a large volume of domestic wastewater from cities and towns, which is essential for the implementation of WBE Gao et al. As shown in Fig. According to the National Bureau of Statistics of China, by the end of , the daily capacity of sewage treatment reached to By the end of , the total length of the sewage pipeline in China reached , km. However, as indicated in Fig. The drainage system coverage was relatively high in the eastern part of China such as in Jiangsu and Zhejiang Province, whereas it remained low in the western part such as in Tibet and Qinghai Province. Current status of the wastewater system in mainland China data source: the National Bureau of Statistics of China. The central government launched a promotion program in May to establish more laboratories across the country with a biosafety level higher than Level 2 The National Development and Reform Commission, The analytical abilities for applying WBE at the national level could be sufficient in the near future. Hence, the implementation of WBE would become easier with hundreds of local research centers and laboratories that are equipped with various chemical and biological analysis instruments. Zhao et al. Yang et al. Because the sampling period of these studies were almost at the end of the epidemics, it is impossible to perform back-estimation modelling for the comparison of the WBE results and the clinically confirmed cases. Thus, it is reasonable to conclude that the application of WBE for infectious disease monitoring and early warning systems is technically feasible in China, notably for large and mid-sized cities with well-developed municipal infrastructure. Although WBE has been shown to be a powerful epidemiological investigation approach in the mass surveillance of COVID, there are several limitations and challenges in establishing an alternative disease surveillance system for public health emergencies, such as COVID Currently, there is no consensus regarding the framework of sampling, pre-treatment, analysis, back-calculation, and modelling for the implementation of WBE in COVID surveillance Michael-Kordatou et al. Previous studies in the literature Wang et al. However, this approach not only requires sophisticated instruments but also increases the potential transmission risk for laboratory staff. In other words, the lack of a suitable marker for infectious disease may limit the future application of WBE. These approaches may support the future application of WBE in monitoring emerging communicable diseases in wastewater and could be extremely useful for less-developed countries and regions in monitoring COVID hotspots rapidly and efficiently. Another important factor that should be taken into consideration for the back-estimation modelling of WBE is mass migration in China, especially during national holidays such as the Spring Festival. With the growth of national high-speed railways, it has become convenient to travel across the country in several hours, thus resulting in frequent population migration. Population migration not only allows infectious diseases to circulate rapidly but also leads to difficulty in tracking carriers of the virus. Thus, Liu et al. They also suggested that the viral RNA of SARS-CoV-2 obtained in the samples could be used for genome sequencing to determine its original source, whether from transient or permanent residents in the community, by comparing the previous data of other regions. Wu et al. Furthermore, the drainage pipeline system and its topology may influence the accuracy of WBE results. As a result, domestic wastewater, rainwater, and treated industrial wastewater are discharged together into WWTPs via the same drainage pipeline system, notably in old towns. The complicated composition of sewage in a CSS may cause difficulties in the sample pre-treatment and analysis steps of WBE, whereas the marker concentration may be diluted when relatively clean rainwater flows together with domestic wastewater. Moreover, because the operation, management, and maintenance of the drainage system have not drawn much attention in China, serious problems within the drainage system occur in many cities, such as leakage, overflow, and blockages. The exfiltration and infiltration of drainage networks result from corrosion or structural damage of the pipeline, pipe misconnection and mixed connection, and backwards irrigation from surface water Cao et al. In addition, chemical and biological markers can be retained in pipelines owing to physical deposition and sedimentation. Recent studies Zhao et al. All these issues would result in fluctuations in the marker concentration and finally affect the accuracy of WBE results, which need further systematic studies. In the past two decades, China has experienced two coronavirus-induced epidemics i. To cope with the future challenges in public health emergencies, it is vital to monitor sewage for the emergence of potentially dangerous viruses based on WBE and to establish a corresponding surveillance system that is complementary to the current case reporting system. Rather than launching a national wastewater surveillance program, we think it would be feasible to initiate WBE monitoring in megacities, traffic hub cities, and well-developed coastal cities with a high population density. As demonstrated in Fig. As a result, local and central governments could formulate and adjust containment strategies based on the scientific and reliable estimations from both WBE and clinical results. Because the detection of SARS-CoV-2 in wastewater can be several days prior to the onset of symptoms, WBE profiling both healthy and sick people in communities could provide reliable and accurate data for policy makers to mitigate disease appropriately and effectively. There is no reason to replace clinical testing with WBE, but the advantage of WBE in epidemiological investigation such as early warning is worthy of implementing in China. With the rapid development of the sewage system, it is feasible for China to apply WBE in monitoring the outbreak of infectious disease, especially in the well-developed coastal cities with a high population density. Thus, we recommend that WBE would assist China to cost-effectively control and prevent the spread of infectious disease in communities in the near future. The promotion of WBE applications in China may also provide useful information and experience for many other developing countries with an underperforming sewage system. All authors listed have made a substantial, direct and intellectual contribution to the work, and approved it for publication. The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. As a library, NLM provides access to scientific literature. Sci Total Environ. Find articles by Ying Zhang. Find articles by Kongquan Zhu. Find articles by Weiyi Huang. Find articles by Zhixuan Guo. Find articles by Senhua Jiang. Find articles by Chujun Zheng. Find articles by Yang Yu. All rights reserved. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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How can I buy cocaine online in Zhangjiajie

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How can I buy cocaine online in Zhangjiajie