Testing and case identification are key strategies in controlling the COVID-19 pandemic. Contact tracing and isolation are only possible if cases have been identified. The effectiveness of testing should be assessed, but a single comprehensive metric is not available to assess testing effectiveness, and no timely estimates of case detection rate are available globally, making inter-country comparisons difficult. The purpose of this paper was to propose a single, comprehensive metric, called the COVID-19 Testing Index (CovTI) scaled from 0 to 100, derived from epidemiological indicators of testing, and to identify factors associated with this outcome. The index was based on case-fatality rate, test positivity rate, active cases, and an estimate of the detection rate. It used parsimonious modeling to estimate the true total number of COVID-19 cases based on deaths, testing, health system capacity, and government transparency. Publicly reported data from 165 countries and territories that had reported at least 100 confirmed cases by June 3, 2020 were included in the index. Estimates of detection rates aligned satisfactorily with previous estimates in literature (R²= 0.44). As of June 3, 2020, the states with the highest CovTI included Hong Kong (93.7), Australia (93.5), Iceland (91.8), Cambodia (91.3), New Zealand (90.6), Vietnam (90.2), and Taiwan (89.9). Bivariate analyses showed the mean CovTI in countries with open public testing policies (66.9, 95% CI 61.0–72.8) was significantly higher than in countries with no testing policy (29.7, 95% CI 17.6–41.9) (p<0.0001). A multiple linear regression model assessed the association of independent grouping variables with CovTI. Open public testing and extensive contact tracing were shown to significantly increase CovTI, after adjusting for extrinsic factors, including geographic isolation and centralized forms of government. The correlation of testing and contact tracing policies with improved outcomes demonstrates the validity of this model to assess testing effectiveness and also suggests these policies were effective at improving health outcomes. This tool can be combined with other databases to identify other factors or may be useful as a standalone tool to help inform policymakers.

The combination of a low dose of coagulant with a ballast, also known as “flock and sink,” has been proposed as a lake restoration and cyanobacteria bloom management strategy. The effectiveness of this technique using aluminum sulfate (alum) as a coagulant and a local soil (LS) from Thailand as a ballast in eutrophic water dominated by positively buoyant Microcystis colonies collected from a tropical lake was investigated by measuring changes in chlorophyll-a (chl-a), pH, and zeta potential. Cell integrity was also evaluated using scanning electron microscopy. Results showed that alum alone could reduce chl-a (up to 60% to 83%) at doses (higher than 3 to 6 mg Al/L) dependent on the initial pH (7.6 to 8.2) and initial chl-a concentration (138 to 615 µg/L) of the lake water but resulted in morphological changes to cellular structure and generally required a dose that reduced pH to <7. LS ballast alone was able to reduce chl-a concentrations (up to 26% at highest dose of 400 mg/L) and caused no significant changes to pH or zeta potential. Combining a low dose of alum (2 mg Al/L) with some amount of LS ballast (50 to 400 mg/L) created an interaction effect that resulted in 81 to 88% reduction in chl-a without changes to zeta potential or morphological changes to cellular structure. Flock and sink may serve a niche role in lake restoration when positively buoyant cyanobacteria are present in the water column during time of treatment. This research showed that an 800% increase in ballast dose resulted in about an 8% reduction in chl-a when combined with 2 mg Al/L of alum. Therefore, it is recommended that ballast dose should be determined by considering its phosphorus sorption capacity and the potentially releasable phosphorus in the lake sediment in order to realize long-term reductions in sediment nutrient release.

The threat of anthropogenic eutrophication and harmful algal blooms in lakes requires the development of innovative stormwater best management practices (BMPs) to reduce the external loading of phosphorus (P). This paper presents the findings of a 5-year study of a full-scale P removal structure constructed in Minnesota, USA with spent lime drinking water treatment residual (DWTR), a by-product of water softening at a local water treatment plant. Influent and effluent water samples were collected by auto-samplers during 43 storm events during the growing season. Samples were analyzed for P constituents, heavy metals, total suspended solids (TSS), and pH. Toxicity of the effluent was assessed using Ceriodaphnia dubia. Flow-weighted removal effectiveness was calculated for each storm event. Overall, the spent lime DWTR reduced total P loading by 70.9%, dissolved reactive P by 78.5%, dissolved P by 74.7%, and TSS by 58.5%. A significant reduction in heavy metals was also observed. Toxicity tests indicated the aquatic toxicity of the effluent treated with spent lime DWTR was not different from untreated stormwater. This study provided long-term real-world data that demonstrated that a full-scale P removal structure with spent lime DWTR significantly reduced P and other pollutants in stormwater discharging to an urban lake. Therefore, spent lime DWTR, which is currently treated as a waste product, is a promising filter material for stormwater treatment.

Drinking water treatment residuals (DWTRs) generated during drinking water treatment have been proposed for use in lake restoration as a solid-phase sorbent to inactivate phosphorus (P) in lake sediment. However, treatments that minimize leaching of nitrogen (N) and optimize P sorption capacity may be necessary prior to use. This study assessed seven different treatment methods, including washing and heat treatments at different temperatures and with and without oxygen limitation, among two DWTRs from Thailand. Results showed that oxygen-limited heat treatment at 600 °C substantially reduced N leaching (<0.2 mg/kg TKN) while also improving P sorption capacity (increase of 18–32% compared to untreated DWTR) to a maximum of 45.7 mg P/kg. Washing with deionized water reduced N leaching if a sufficient volume was used but did not improve P sorption. Heating at 200 °C with or without the presence of oxygen did not improve N leaching or P sorption. Regression of P sorption parameters from a two-surface Langmuir isotherm against physio-chemical properties indicated that oxalate-extractable (i.e., amorphous) aluminum and iron were significantly associated with total P sorption capacity (R² = 0.94), but micropores and oxalate-extractable P modulated the P sorption from high-affinity to low-affinity mechanisms. In conclusion, this study confirmed the importance of amorphous aluminum in DWTRs for inactivating P, and the results suggest that high-temperature treatment under oxygen-limited conditions may be the most reliable way to optimize DWTRs for environmental remediation applications.