Mitigating the rapid global spread of Covid-19 requires real-time data on community infection prevalence in order to guide targeted intervention measures on regional, national and global scales. Individual diagnostic testing is of paramount importance for short- and long-term management of the pandemic, but limits on capacity (both of kits and trained workers) mean that healthcare settings are prioritised over the community. Here we propose a novel supplemental low-resource approach for broad community-wide surveillance of SARS-CoV-2 infection prevalence. We aim for a real-time Covid-19 risk prediction platform for community-wide diagnostics via wastewater-based epidemiology (Figure 1). Disease markers present in domestic wastewater can reveal the health status of contributing population, and we propose that this includes the infection prevalence by SARS-CoV-2. Real-time spatiotemporal estimation of this novel coronavirus in urban water across several sites in South Africa (Cape Town) and Nigeria (Lagos) will provide a broad picture of community infection prevalence, even for asymptomatic cases, as well as the level of acquired immunity, thus identifying hotspots for priority testing, contact-tracing and quarantine and will provide more accurate projections of the spread of the virus and the infection fatality rate. As communities contribute directly to wastewater, we will be able to estimate true infection rate at the community level, including also asymptomatic and pre-symptomatic people. The virus loading levels will be used to establish status and time trends. This would enable rapid identification of hot spots for management via targeted intervention measures and potentially support important decisions regarding entry into and exit from 'lockdown' periods as well as focussed screening of selected communities.

We are proposing an innovative solution to current problems with rapidly identifying and responding to deteriorating public health and environmental conditions in fast developing urban environments in LMIC countries, aiming to manage risks to public and environmental health relating to urbanisation, population growth, lack of infrastructure and the overarching challenge of climate change. We will establish a cutting-edge, interdisciplinary research capability, based on engineering and digital technology approaches, for real-time community-wide diagnostics and tuneable multi-hazard public health early warning system (EWS) with the ultimate goal of strengthening communities' resilience. We will do this through a focus on water from urban dwellings, which reflects the health status of a population and surrounding environment as it pools the endo- & exogenous products of that population. Real-time measurement of these specific hazard biomarkers in urban water from different communities allows for rapid evaluation of public health status, prediction of future crises, and thus enables mitigation strategies to be developed for either rapid or slow onset hazards, even before they manifest themselves with characteristic endpoints (e.g. mortality in the event of pandemics). Thus morbidity and mortality can be reduced and resilience and sustainability within the surveyed urban system significantly increased. In this cutting-edge project we will develop innovative tools for public health diagnostics and undertake a scoping study in the city of Stellenbosch to understand the requirements for the development and implementation of a multi-hazard EWS in South Africa and beyond. ReNEW tackles all four strategic objectives set by the Department for International Development (UK Aid, 2015) and it focuses on "strengthening resilience and response to crises: (...) science and technology spend on global public health risks such as antimicrobial resistance, and support for efforts to mitigate and adapt to climate change". The UK is committed to "tackling the great global challenges - from the root causes of mass migration and disease, to the threat of terrorism and global climate change - all of which also directly threaten British interests". ReNEW will address this through engineering novel integrated sensors for on-site monitoring and use of big data for modelling markers within the urban water system as part of an EWS. We will focus on infectious disease. 21st century has already seen the epidemic of SARS (2003), H1N1 (2009), Ebola (2014) and recently Zika virus (2015). The recent O'Neill report (2016) commissioned by the UK government urges that "by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug resistant infections. Most of the direct impact will fall on LMIC countries". This highlights global vulnerability to infectious diseases and shared global responsibility for surveillance and disease control. Easy to operate and cost effective EWSs are urgently needed to provide timely response and to tackle key public health issues in communities that need it most, and to reduce disease spread globally. Urban water profiling can provide such a response in real-time and, if linked with a timely response system, it could reduce burden on public health in LMIC and ultimately worldwide.

The aim of the WASTE FEW ULL project is to develop and test internationally applicable methods of identifying inefficiencies in a city-region's food-energy-water nexus. We will undertake this through an international network of industry/civic society-led Urban Living Labs (ULL) in four urban regions - UK (Bristol), Netherlands (Rotterdam), South Africa (Western Cape) and Brazil (Campinas). Partners in Norway and the USA will provide economic valuations of potential impact, and impact-led public education, outreach and dissemination. Waste occurs across food, energy and water systems; at the interface of these systems, waste increases significantly the over-consumption of our limited resources (FAO, 2017): food (e.g. energy lost in food storage), energy (e.g. used to clean water) and water (e.g. nutrients lost in sewage). Resource scarcity is not only a matter of efficiency, but of access, distribution and equality (Exner et al, 2013). Each urban context has different pressures and opportunities (Ravetz, 2000). The focus of the WASTE FEW ULL project is therefore not so much on the specific downstream challenges, but on upstream processes by which cities can identify, test and scale viable and feasible solutions that reduce the most pressing inefficiencies in each context.