There's Polio in New York City's wastewater. How concerned should we be?

On today's episode of the 5 Things podcast:

The recent discovery of Polio in New York City's wastewater got one listener curious. Amy from Arizona left a voice mail for the team at 5 Things asking how Polio was found? Were they looking for it or something else? So we did a little digging and spoke to two experts on the matter. We wanted to know how a disease like that has been eliminated in the United States can show up again? Should we be worried? And what can we do to protect ourselves?

Our guests today are Chris McKenna, is a veteran reporter with The Times Herald Record a newspaper that covers the northwest suburbs of New York City and Cornell University's Dr. Jay Varma specializes in epidemiology and public health.

They answer our questions and give us more insight into the discovery.

To follow James Brown on Twitter, click here.

To follow Chris McKenna on Twitter, click here.

To follow Dr. Jay Varman on Twitter, click here.

To read Chris McKenna'a articles click here, here, here and here.

To read a USA TODAY article on Polio in the wastewater, click here.

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Hit play on the player above to hear the podcast and follow along with the transcript below. This transcript was automatically generated, and then edited for clarity in its current form. There may be some differences between the audio and the text.

James Brown: Hello and welcome to 5 Things. I'm James Brown. It's Sunday, August 21, 2022.

Every week, we take a question, an idea or a concept and go deep. If there's something you'd like us to look into, you could always email me at jabrown@usatoday.com, or find me everywhere on social media at @jamesbrowntv. Or you could do what Amy did. She's a listener who runs a small business in Arizona. After some recent news caught her attention, she called (585) 484-0339 and left me a voicemail.

Amy: I have been hearing a lot in news reports, actually, ever since COVID reared its head, about different cities and counties testing wastewater to look for presence of disease or incidence of disease. I noticed recently there was an article about polio being detected in wastewater in New York and I was curious how the wastewater process works. You know, were they looking for polio? Do they have an ability to just sort of test for a wide range of diseases? Did it just pop up and, surprise, polio?

I was just curious at how the process works, how many different areas are using this technology, and if the results are comparable from region to region to give us a better idea of what's going on in public health.

James Brown: I thought it was a great idea so I reached out to an epidemiologist, Cornell University's Dr. Jay Varma. He's worked on infectious diseases all around the world.

Dr. Jay Varma: From a public health perspective, we are absolutely very concerned about this because we, in the public health community, we want to fight the diseases that are new, the ones that are emerging, things like COVID or monkeypox. We don't want to be dealing with things that we've actually succeeded in getting rid of here in the United States and any time you're doing that, you're not fighting the new threats that you face.

James Brown: But first, I turn to Chris McKenna. He's based about an hour north of New York City. That's where polio was found. He's a veteran reporter for the Times Herald-Record, and he's been following the resurgence of polio closely. One man has been paralyzed from polio, but as McKenna tells me, it's likely that other people have it and may get it, and some will not know it.

Chris McKenna: We've had a whole sequence of stories about this since around the middle of July when, out of the blue, there was an announcement that a resident of Rockland County had been diagnosed with polio and had been at least partially paralyzed. This was shocking news because, of course, most people routinely are vaccinated against polio when they're infants or young children. So polio has been all but eradicated in this country for years and to hear of somebody being paralyzed by polio is very surprising and very troubling.

So since then, what we've learned is that not only has this one person had a confirmed case of polio, but polio has been circulating since at least May, and they determine this through testing the wastewater. When you hear tips that there's polio in the water, that may sound a little like tales from the 1940s and 1950s before there was a polio vaccine and people worried about catching polio by swimming in a body of water that the virus was present in.

What is meant here by polio in the water is polio in the wastewater. Somebody who's infected with polio excretes that, and through testing of sewage coming into wastewater treatment plants, scientists are able to discover traces of polio and other diseases.

It just so happens that in New York, a network of wastewater plants has been growing over the last two years as a way of monitoring COVID levels. In the same way that people infected with polio excrete the virus, people who are infected with COVID do so as well. So the state has been using this as a way to monitor, not just the presence of COVID because COVID is ubiquitous, but to monitor the rise and fall of cases as a way of warning communities that an outbreak might be coming. The first sign of that might be rising levels of COVID in the wastewater.

So they had already established the surveillance network and once this case in Rockland County, the single case, confirmed case of polio was discovered, they went back to retroactively test samples they had already taken and have been gradually, through this detective work, been tracing where it was circulating and how early it began circulating. The most recent discovery they made was that it's now in New York City, or it was in July. I'm not sure they've tested any samples yet from August to know whether it's still present.

But the main point here is that a single person who has been paralyzed by polio signifies a much greater spread because most people who are infected with polio show no symptoms, almost 75% of people with polio have no symptoms. So for one person to become paralyzed, and that's one in 200 roughly polio cases, it means that there's a much larger group of people who are infecting and who can share polio.

That's what the wastewater test has confirmed that this one person in Rockland County, who had a case so severe that he was paralyzed by it, is representative of a much larger group of unvaccinated people who caught polio in two upstate counties, Orange and Rockland, and in New York City.

James Brown: This person who was paralyzed, what do we know about them? Any sense of who they are?

Chris McKenna: The health departments, both at the county and state level, have released only limited, very limited information about that case, largely for reasons of patient confidentiality. They wouldn't even confirm his gender. It's been widely reported that it's a man, but officially, all that health departments will say is it was a young adult resident of Rockland County.

So we don't know much more about the way in which this person might have caught polio or his interactions that might have exposed other people who are unvaccinated. We don't have much information about his situation or, for that matter, about how he's doing now. It's possible that you can initially have some paralysis that is not permanent.

James Brown: Are there other cases in the area that you're aware of?

Chris McKenna: So far, no.

James Brown: Thankfully.

Chris McKenna: That is fortunate. Again, paralysis is rare for polio. It's, obviously, the most alarming and the most well-known outcome of polio because of what a feared disease it once was before the vaccine was discovered in the 1950s, but most people are asymptomatic. There are people who might have muscle aches or fever that might be attributed to the flu for somebody who has that. It's possible there are people who've had milder symptoms that were never diagnosed as being polio. The only paralytic polio case so far in New York was this one person whose case was announced on July 21st.

James Brown: Is there any reason to believe that there is a lower level of vaccination in your area? As I understand it, this kind of vaccination is required in order to go to public schools, or at least most public schools.

Chris McKenna: There is a lower polio vaccination level in Orange and Rockland Counties than there is generally statewide, roughly 80% of two-year-olds statewide, excluding New York City, which keeps its own data, 80% of two year olds in that area outside New York City have gotten the three recommended polio shots by age two. In Orange and Rockland Counties, it's roughly 60% so it's lower than average.

We looked at school vaccination data, polio and several other vaccines are required for a student to even set foot in school and in New York, in 2019, they eliminated religious exemptions from those requirements. So unless except for a minuscule share of children who might have medical exemptions, they have some medical condition that precludes their getting vaccinated, they're supposed to be up-to-date on their vaccines when they enter school, or they're not supposed to be admitted.

What we discovered through the state data on vaccination rates by school, most schools are complying. They're at or near a hundred percent compliance with polio vaccinations. There are some schools that are in the 90% range, and there's a small number that are outliers that have very low or relatively low vaccination rates.

What was unclear from our reporting on this was whether that meant that schools were admitting unvaccinated students, or they were sloppy in their record-keeping. They weren't necessarily collecting vaccination records from parents before their kids entered school. They might be lenient to give them time, for bureaucratic reasons, allowing them more time to submit those records. So it's hard to say based on that, what proportion of students are being allowed to go to school unvaccinated. It was clear from the data that most schools are adhering to that.

James Brown: Where do we go from here?

Chris McKenna: The wastewater testing continues. Every treatment plant that's participating in this surveillance network in the state is testing at least once a week. So the labs that analyze these wastewater samples will continue doing so, not just for COVID now, but for polio, at least in the area where the state is concerned that polio might be circulating and they'll continue doing so, I gather, until they're confident that it's ceased to be circulating. I don't know how long it would take for them to make that judgment, how many weeks, how many months would have to pass without any positive polio tests for them to declare that this outbreak, if you want to call it that, has passed.

Medical providers have been advised to be on the lookout for people who have symptoms that might otherwise have been attributed to something more commonplace and to determine whether they might be polio. In the New York City and the counties that have been affected by this so far, there's strong outreach to people who have, for whatever reason, have not gotten vaccinated, allowed their children's shots to lapse or haven't been quick enough in starting their shots, it's supposed to start at two months, encouraging them to do so. And there have been county-run vaccination clinics, polio vaccination clinics, where people have been showing up to get their shots in response to the publicity about this polio case.

James Brown: For a broader view on polio and the current state of public health, we turned to Cornell University's Dr. Jay Varma, an expert on prevention and control of diseases. He's the kind of guy I want to talk to for hours. He's led responses to viruses and diseases and epidemics in China, Southeast Asia, Africa and the United States. Most recently, he was an advisor to former New York City mayor Bill De Blasio during the height of the COVID-19 pandemic. I asked him how something like polio ends up in wastewater.

Dr. Jay Varma: One of the ways in which you can track disease in a population is actually by measuring what people put out of their bodies. So everybody poops, there's a kid's books even written about that, and it turns out that your body excretes bugs, pathogens that your body has.

Now with COVID, it's not because your stomach gets infected, although that is possible and has been documented to happen, it's more that you kind of swallow stuff, your respiratory secretions, and then it comes out into your stool and then you can measure it in what we call wastewater, the sewage that you collect.

Polio is a little bit different virus. You know, polio is not something that travels through the air and infects your nose and throat the way COVID does. It's actually transmitted by people spreading it on their hands or drinking contaminated water in some way. It's what we call fecal-oral. Kind of like the same way you can get food poisoning, that's the same way that polio can be transmitted.

Actually, the whole basis for actually using the sewage, what we call wastewater, to monitor COVID was actually built on the infrastructure that a lot of people at CDC and other places developed for monitoring polio in other countries. Then it was brought back here into the US to use now with COVID and now, again, unfortunately, with polio in New York.

James Brown: I was under the impression, until truly this story, that polio was eradicated.

Dr. Jay Varma: Yes.

James Brown: It's obviously not.

Dr. Jay Varma: Correct. Yeah. Just for your listeners out there we, in public health, use these words very specifically. So when we talk about the word eradicated, we mean it doesn't even exist anywhere on the face of the earth, not in a human, not in an animal, not in the environment. There's only one human disease, smallpox, that we consider ever eradicated.

Now there's been a massive amount of initiative, investment, US government, Gates Foundation, Rotary Club, World Health Organization, all sorts of partners around the world, to try to do the same thing with polio, to actually eradicate it. But that effort has been close to successful. Like there have been many times where the world has thought it was close to it, and then this virus has a way of sort of coming back and haunting you.

The only places right now where there's what we call wild polio virus circulating have often been in Pakistan and Afghanistan, but now because of under immunization and some other factors that we can talk about, it's now making a comeback. So there's no real sign that it's going to be eradicated, unfortunately, any time in the next few years.

James Brown: How about we get to some nuts bolts of exactly what it is? It's spread by fecal tissue or fecal matter, but what exactly is it?

Dr. Jay Varma: Polio is a virus. Just like COVID, and the flu and other things like that, it can't live outside of the human body or outside of an animal body. It needs to kind of be part of some living organism to survive and so this is a virus that he's been around in human history for a very long time.

Now, normally when people get it, you can get it the same way you get a lot of infections. You either drink or eat something that's been contaminated, or more often, it's spread from person to person with small little microscopic droplets on your hand that you then pass to another person's hand, who then touches their food or touches their face in some way, and it enters your body that way.

James Brown: For those who might be hesitant to vaccinate someone for it, are there any poor outcomes with this kind of vaccination?

Dr. Jay Varma: You know, polio vaccine is probably one of the greatest, other than smallpox, which most people are not going to remember because the last human case of smallpox was in 1979, polio is a disease that is probably one of the greatest success stories of the 20th century. One of the reasons that's such a success story is that the vaccine is incredibly safe.

Now there are two types of vaccines and that actually what's makes this story a little complicated. The original polio vaccine, the one that people kind of learn about in their history books and stuff, was one developed by Jonas Salk and was an oral vaccine so you actually swallowed it. The reason you swallowed it, it was kind of a weakened form of the virus and it was kind of training your gut, like your stomach and your intestines, to basically block the infection from ever entering your body, again, because it's spread by dirty hands or dirty product somewhere. So if you build your gut immunity, you can block it.

But what was found over time was that one of the downsides of that, because it was a weakened form of the vaccine, is in some people who had like kind of a weak immune system, the virus could kind of mutate and then become more dangerous again.

That's when a second form of vaccine was developed, which was an injection, a shot, what we call the inactivated polio vaccine. That's the one that we use here in the United States because it is very effective at blocking people from getting any of the severe complications from polio, like paralysis. People can also get something called meningitis, where they get swelling in the fluid around the vein. And that injectable vaccine is incredibly safe and incredibly effective at blocking it. That's why the single most important thing is to make sure that anybody you know, particularly if they're young children, are up-to-date on their vaccination, particularly for polio.

James Brown: Is access an issue?

Dr. Jay Varma: No, it's not. You know, polio vaccine is something that the US has, again, in the United States has what we called eliminated. In other words, like it could get reintroduced from the outside, but there have been no cases of polio that have occurred in the US. There's only been one other one in the past 20 years and that was somebody who was infected overseas.

So this case that's been detected in New York is incredibly worrisome and it really comes from basically two things that have happened. You know, one is people missing vaccine appointments because of the pandemic. You know, as we know, a lot of parents were concerned about having their kids go to a doctor's office because they were worried that maybe they'll get COVID. So, as a result of that, both kids here in the US, as well as millions and millions of kids globally, have fallen behind on their regular scheduled vaccines because they miss some of those doctors' appointments.

The second reason we're seeing this problem is that rising anti-vaccine sentiment. You know, this is something that's always existed before. It's increased when you have the internet because one of the things the internet is really good at is spreading wrong information. It's much better at spreading wrong information in some ways than it is spreading the correct information. Then with COVID we saw a lot of people opposed to COVID vaccines also sowing doubt about all vaccines.

So that combination of it kind of an anti-vaccine movement plus kids missing their vaccines due to the pandemic has brought us to the situation where the US now has to fight a disease that we thought we were done with decades ago.

James Brown: Stepping back a bit and considering that this now rare disease has come back, I think a lot of people listening to this will wonder how concerned should we be?

Dr. Jay Varma: Well, I think the single most important message to everybody out there is you've got to get up-to-date on your vaccines, especially your kids. The vaccine is incredibly safe and effective and that's the thing we need to be concerned about. I think from a public health perspective, we are absolutely very concerned about this because we, in the public health community, we want to fight the diseases that are new, the ones that are emerging, things like COVID or monkeypox. We don't want to be dealing with things that we've actually succeeded in getting rid of here in the United States and any time you're doing that, you're not fighting the new threats that you face.

So that's why it is so important for parents, especially, to make sure their kids get into the doctor and I don't mean walk, I mean, run to the doctor to get vaccinated. Because the last thing you want is your kid to end up requiring braces on their legs for the rest of their life because they got a disease that is so easily preventable.

James Brown: Any famous last words?

Dr. Jay Varma: Well, I mean, I just think the most important thing I would encourage people to do out there is the other thing you can do is call your elected official. You know, public health is under threat and the only way public health officials deal with it, think of it as a really important issue, is to go out there and to know that the voters care about this as well. So I always try to put a plug in there for ask your elected official, what are you doing to strengthen public health? Because if you want to be safe from diseases like polio, we need our elected officials to take it seriously, too.

James Brown: When you say that public health is under threat, what do you mean, specifically?

Dr. Jay Varma: Yeah. You know, there's a lot of people that have become disillusioned with what public health does mostly because they don't really know on a day-to-day basis what your government public health agencies are doing.

What they're doing is they're tracking diseases like this and making sure that schools and other places enforce requirements on vaccines. If government doesn't put the right funding and give the right staffing to your public health agency, then diseases come back and these are not diseases you can fight on your own. It's like fighting a foreign army. You can't rely on yourself, you pay government to pay for a military. You pay government to defend you against crime because you yourself can't just hire enough security guards to keep yourself safe, unless you're super rich, I guess, maybe.

So the same thing is true with public health. We need to think of public health the same way we think of public safety. Just like people want to make sure that their community is safe from gun violence and other threats, we also need our government officials to make sure that public health agencies have the right resources they can to protect us from diseases like this.

James Brown: If you like the show, write us a review on Apple podcast or wherever you're listening and do me a favor. Share it with a friend.

Thanks to listener Amy from Arizona for inspiring this episode. What do you think of this show? If you have any ideas, comments or questions, you can always email me at jabrown@usatoday.com. Text me or leave me a voicemail at (585) 484-0339 or send me a message on Twitter at @jamesbrowntv. I love hearing from you.

Thanks to Chris McKenna and Dr. Jay Varma for joining me. You can find links to Chris's work in USA Today's stories on the resurgence of polio in America in the description. Thanks to Alexis Gustin for her production assistance. Taylor Wilson will be back tomorrow morning with 5 Things you need to know for Monday and from all of us at USA Today, thanks for listening. I'm James Brown and, as always, be well.

This article originally appeared on USA TODAY: Does the discovery of Polio in NYC's wastewater mean Polio is back in the U.S.?