Water & Sanitation Safety Plan Dalam Adaptasi New Normal Pandemi Covid-19

KESEHATAN LINGKUNGAN & MANAGEMEN

RISIKO KESEHATAN DALAM MINIMASI
KEJADIAN COVID-19

Prof. Anwar Mallongi, SKM. MSc.Ph.D

Environmental Health Department

Faculty of Public Health, Hasanuddin University,
Makassar 12 Juni 2020
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100 negara teraman dari Covid-19 berdasarkan
Deep Knowledge Group:
• 1. Swiss 97. Indonesia Masuk Kategory
• 2. Jerman • 9. Selandia Baru Sangat BERISIKO
• 3. Israel • 10. Korea Selatan
• 4. Singapura • 96. Peru
• 5. Jepang • 97. Indonesia
• 6. Austria • 98. Kamboja
• 7. China • 99. Laos
• 100. Bahama
• 8. Australia

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Analysis Risiko Covid-19

• Penilaian risiko kesehatan meliputi analisis komprehensif dari

penularan Mikroba di lingkungan (Identifikasi Bahaya),
• dan tingkat paparan manusia melalui jalur pada padanan (penilaian
paparan), tertentu
• Virulensi mikroba (penilaian dosis-respons),
• Komunitas yang terpapar (karakterisasi risiko)
Tergantung dari Banyak nya orang yg masuk dari saerah terinfeksi

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 Faktor Lingkungan Penularan
Corona Virus -19
• Melalui tetesan cairan (droplets) yang asalnya dari
batuk dan bersin.
• Melakukan kontak dekat dengan carrier atau
pembawa virus misalnya bersalamans dan
menyentuh mulut
• Menyentuh benda atau permukaan yang di atasnya
ada virus. Kemudian, tanpa mencuci tangan
menyentuh mulut, hidung, atau mata
• Kontaminasi tinja, namun penularan ini jarang
terjadi
• Studi baru menemukan, ada potensi penularan
terjadi melalui udara dan Air.
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 • Studi menunjukkan, pasien terinfeksi
Covid-19 berpotensi besar menularkan
virus corona ke banyak orang pada saat
pertama kali mereka merasa tidak sehat.

• Oleh karena itu, Organisasi Kesehatan

Dunia (WHO) khawatir pelonggaran
karantina wilayah (lockdown) akan
mendorong penyebaran virus.

• Peneliti Jerman dan Amerika Serikat (AS)

menunjukkan bahwa orang dengan
gejala ringan dapat menularkan virus
corona hingga 8-9 hari. “Bisa jauh lebih
lama bagi orang yang sakit parah
• Viral loads (peningkatan jumlah virus)
memuncak pada saat kita baru mulai sakit

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 Group Yang Berisiko
Siapa saja bisa tertular dan menularkan
virus corona.
- Laki-laki dan perempuan,
- orang dewasa,
- anak-anak hingga lansia bisa berpotensi
terpapar.
Namun, ada beberapa kelompok yang
cenderung lebih rentan
- mereka penyakit diabetes,
- kanker,
- HIV,
- Penderita Asma dan gangguan pernapasan
lainnya.

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Manajement Risiko agar tidak Tertular Covid 19

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Agar Terhindar COVID-19

1. Rutin cuci tangan

2. gunakan anti septik
3. hindari kontak fisik
4. Tetap dirumah
5. jaga jarak
6. Pakai Masker
7. Pisahkan alat pribadi
8. tdk menyentuh bagian wajah
9. Hindari tempat ramai
10. update informasi dan laporkan diri kalau gejala 8
Langkah selanjutnya
• langkah karantina,
• isolasi pasien,
• serta social distancing harus dilakukan untuk meminimalisir lonjakan
pasien dalam waktu singkat di sebuah negara.
• mitigasi adalah untuk mengurangi dampak epidemi dengan
meratakan kurva (jumlah pasien dan orang meninggal),

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FOKUS Management and Risks Assessment MRA
Chemical Risks Assessment Microbial Risks Assessment

• Components of Risk Assessment • Components of Risk Assessment

• Guidance Documents for HRA • Guidance Documents for HRA
• Risk Characterization • Risk Characterization
• Cancer and Non-Cancer risks • Infection, illness and Death
• Exposure Routes • Exposure Routes
• Health Effects Databases • Health Effects Databases
• Equation • Equation
Ecological Risks Assessment
- Components of Risk Assessment
- Exposure Routes
- Formulation used
- Equation 10
Health Risk Assessment Definition and 4 Steps
• Penilaian risiko kesehatan meliputi
analisis komprehensif Penyebaran
Mikroba pada lingkungan
(Identifikasi Bahaya),
• Tingkat paparan manusia melalui
jalur yang padanan (penilaian
paparan), yakni pernapasan,
ingesti dan skin contack
• Tingkat Virulensi mikroba
(penilaian dosis-respons), misalnya
corona virus
• Perkiraan Besar risiko ; mulai
infection, illness dan Death rate
(karakterisasi risiko)

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 2. MRA/QMRA
• Penilaian Risiko Mikroba Kuantitatif
adalah metodologi yang digunakan
untuk mengatur dan menganalisis
informasi ilmiah dlm memperkirakan
probabilitas dan tingkat keparahan
suatu peristiwa yang merugikan
akibat mikroba.
• Metodologi ini juga dapat
membantu mengidentifikasi tahap-
tahap dalam Pertumbuhan virus ,
penularan, penanganan, dan akibat /
Risiko yg berkontribusi peningkatan
risiko penyakit

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Tools & Data Needs for
Microbial Risk Assessment
• Disease surveillance
• Clinical studies
• Epidemiological studies
• Methods for detection of microbial
• Transport models
• Regrowth and die-off models
• Development of occurrence data bases
• Dose-response models
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 Environmental & Health Effects
• Virulensi mikroba dan faktor
patogenisitas
• Infeksi simtomatik dan simtomatik
Keparahan (durasi, perawatan medis &
rawat inap)
• Mortality
• Status kekebalan tubuh inang
Populasi rentan

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Acute and Chronic Outcome Associated with
Microbial infections
Acute disease Chronic disease

Microorganism Outcomes Outcomes

Campylobacter Diarrhea Gullain-Barre’ syndrome

E. Coli 015H7 Diarrhea Hemolytic uremic syndrome

Helicobacter Gastritis Ulcers and stomach cancer

Salmonella, Diarrhea Reactive arthrititis

Shigella, & Yersinia
Coxsackievirus B Encephalitis, aseptic Diabetes
Meningitis, diarrhea,
respiratory disease

Giardia Diarrhea Failure to thrive, lactose

intolerance, chronic joint pain
Toxoplama Newborn syndrome, Mental retardation, dementia,
hearing and visual loss seizures
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Dose Response Issues

• Human data sets (healthy volunteers)

• Vaccine strains or less virulent organisms
• Low doses often not evaluated
• Doses measured with mainly cultivation methods for bacteria and
viruses (CFU; PFU) for parasites counted under the microscope.
• Response: excretion in the feces, antibody response and sometimes
illness.
• Human subjects concerns for filling in data gaps

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Exposure Assessment
and Risk Characterization

• Exposure and levels of contamination the most important

aspect for providing input to risk characterization.
• Need better monitoring data, better transport models.
• Will need new methods, QPCR, for better assessment of non-
cultivatible but important viruses and bacteria.
• Essential for Good Risk Management Decisions

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Occurrence Analysis for the Exposure Process

• Concentrations

• Frequency

• Spatial and Temporal Variations

• Regrowth and Die-off

• Transport

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New Environmental Microbiological Methods
to Inform Risk Assessment during Exposure

• Alternative Indicators

• Pathogen Monitoring

• Source Tracking

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Criteria to Consider
Several criteria to consider for identifying a candidate Microbial risk
assessment (MRA)
a) Characteristics and importance of the hazard(s) of concern;
b) Magnitude (e.g., presence, prevalence, concentration of hazards) and
severity (e.g., impact on public health) of the risk;
c) Urgency of the situation;
d) Populations of concern;
e) Other factors associated with specific hazards (e.g., water treatment
processes, food processing, cooking, cross contamination);
f) Availability of resources (e.g., time, money, staff).
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 PROBLEM FORMULATION

ANALYSIS
CHARACTERIZATION

of Exposure of Human
Health Effects

RISK CHARACTERIZATION

RISK MANAGEMENT OPTIONS

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 Percentage of Disease Due to
Transmission Route

Animal to Person to
Human Person
?% ?% Aerosols
Drinking ?%
Water ?%
?% ?% ?%

Food
Fomite Recreation

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Factors Important in
Assessing Exposure
• Route of Exposure
• Duration of exposure
• Seconds, hours, minutes
• Number of exposures
• How many times in a day, month, year
• Degree of exposure
• Liters of water ingested
• Liters of air inhaled
• Grams of food ingested

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 How Important is the Environment in Disease
Transmission?

• 80% of all infections are acquired through the environment

• Most other infections are acquired from insect bites and direct
personal contact (e.g. sex, hand shaking, kissing)

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Factors that influence Enteric Virus and Bacteria
Survival in Surface Waters
• Temperature • Longer survival at lower temperatures
• UV Light • Related to amount of sunshine
• Organic Matter • Longer survival in presence of organic
matter
• Seawater vs.
Freshwater • Shorter survival in seawater
• Sediments
• Prolonged survival in sediments; regrowth
of enteric bacteria possible in sediments
• Antagonistic • Certain marine microbes prey on bacteria
Microflora or are antagonistic to virus survival;
survival is reduced in the presence of non- 28
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Factors that influence Enteric Virus and Bacteria
Survival at/near Soil Surface
• Temperature • Longer survival at lower temperatures

• Soil Moisture • Related to amount of sunshine

• Organic Matter • Longer survival in presence of organic

matter
• Rate of Moisture
Loss • The greater the evaporation rate the more
rapid the rate of inactivation

• Antagonistic • Certain microbes prey on bacteria or are

Microflora antagonistic to survival; survival is reduced
in the presence of non-enteric
microorganisms 30
Sources of Foodborne Organisms

• Infected animal

• Cross contamination
• Cutting board to produce (vegetables)

• Irrigation water

• Handling and processing

• Hand to produce
• Wash water
• Ice

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 Transport and fate of enteric viruses
in the marine environment
Aerosolization
by breaking waves
Sewage outfall

Virus association with suspended

solids (acts to prolong virus survival)

Resuspension by rain,
wave action, tides,
dredging, etc.

Accumulation in sediments
(viruses occur in higher concentrations Uptake by crustacea 88
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in sediment than the overlaying water) and bottom feeding fish
Derivation of Beta-Poisson Model (assumptions)

• Same as the exponential model except nonconstant survival and

infection probabilities

• Survival probabilities (k) are given by the beta distribution

• Slope of dose response curve more shallow than exponential

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A farm-to-fork model in MRA
Should consider :
a) How many viable pathogens (or indicators) are present in the source (e.g.,
infected chicken, contaminated carcass) at time zero?
b) How many pathogens are released from the source and/or what is the
prevalence of infection in the source?
c) Over what period are the pathogens released?
1) Continuously
2) Batchwise
d) At what rate are the pathogens released?
1) Counts/unit time (e.g., cfu, pfu, genomes per minutes, seconds, hours, days)

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A farm-to-fork model in MRA
e) What is the form of the release?
1) Fomites
2) Spray equipment
3) Offgases from a fermentor
4) Waste water
5) Animal slaughter

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A farm-to-fork model in MRA
f) To what medium are they released?
1) Food
2) Surface water
3) Soil
4) Air
5) Other surfaces

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Point Estimate

• Single numeric value of risk

• May correspond to best estimate of risk
• May be maximum reasonable exposure

• Use parameter values of exposure and dose response parameters

corresponding to point estimate of interest

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Example: Anthrax
−

• What is the risk of Anthrax attack?  d 1/  

P = 1− 1+ (2 −1)
• Best fit dose-response is Beta-Poisson model  N 50 
Alpha = 0.974 and N50 =62817 (Haas unpublished)
Risk = 1-(1+(dose/62817)*(2^(1/0.974)-1))^-0.974 N50= organisms for 50 %
 infectivity

• If 1 spore of B. antracis is inhaled

Risk = 1-(1+(dose/62817)*(2^(1/0.974)-1))^-0.974
Risk = 1.6 x 10-5
Note: this is the fatality risk

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Thank you

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