The study included 3,586 patients who had been tested with a multiplex real-time PCR respiratory panel after initially testing negative for SARS-CoV-2. This design choice is important: because the COVID-19 pandemic dominated respiratory diagnostics from 2020 onward, patients negative for the coronavirus were typically then screened with broader panels capable of detecting a wide range of viruses and bacteria simultaneously. Multiplex PCR works by amplifying genetic material from multiple target organisms in a single reaction, allowing laboratories to identify pathogens such as influenza viruses, respiratory syncytial virus, rhinoviruses, adenoviruses, and bacterial species like Streptococcus pneumoniae and Haemophilus influenzae from one sample. The technique has become a cornerstone of modern respiratory surveillance, particularly in settings where clinical symptoms alone cannot distinguish between viral and bacterial causes of infection. In this cohort, 62.4 percent of the patients were children, reflecting the fact that young people bear a disproportionate burden of acute respiratory tract infections and are tested more frequently with these panels.

Overall, at least one pathogen was detected in 52.6 percent of the samples, but the identity of those pathogens was striking. The most frequently detected organism was Streptococcus pneumoniae, found in 36.7 percent of samples, followed by Haemophilus influenzae at 8.2 percent, rhinovirus at 6.1 percent, and human bocavirus and influenza A, each at 2.8 percent. The dominance of bacterial detections, particularly pneumococcus, is notable because multiplex PCR detects genetic material rather than viable organisms, and colonizing bacteria can be present in the airways without causing disease. Nevertheless, the pattern provides a snapshot of what was circulating in the population’s respiratory tracts during the study window. Positivity rates were dramatically higher in children than in adults, at 64.5 percent versus 33.0 percent, a difference that was highly statistically significant. Detection also peaked in autumn and winter, consistent with the well-documented seasonality of respiratory infections in temperate climates, where indoor crowding and lower humidity favor transmission.

The temporal trends across the four years were equally revealing. Overall positivity declined from 57.5 percent in 2021 to 34.8 percent in 2023, and then rebounded sharply to 60.7 percent in 2024. This trajectory mirrors patterns observed globally after the COVID-19 pandemic, when widespread masking, distancing, and lockdowns suppressed transmission of many common respiratory pathogens, only for them to return with unusual intensity once restrictions lifted. The dip in 2023 is particularly interesting because it coincides with the year of the earthquakes, which struck in February and upended daily life across the region. Yet the researchers found that the overall rate of pathogen detection was almost identical before and after the earthquakes, at 52.5 percent versus 52.7 percent. On the surface, the disaster appeared to have left the total burden of detectable respiratory pathogens essentially unchanged.

Beneath that stable overall figure, however, the composition of detected pathogens shifted in ways that initially seemed alarming. In unadjusted comparisons, bacterial positivity rose from 34.2 percent before the earthquakes to 44.9 percent afterward, while viral positivity fell from 31.2 percent to 19.8 percent. This pattern would be consistent with what disaster epidemiologists might predict: displacement into crowded shelters, interruption of routine healthcare, and stress-induced immune suppression could plausibly increase bacterial carriage and transmission, while reduced social mixing in some settings or altered testing patterns might suppress viral detection. When the researchers built multivariable logistic regression models adjusting for age group, sex, season, clinical setting, year of sampling, and PCR platform, the signal persisted in some analyses. Compared with 2021, the adjusted odds of bacterial detection in 2024 were 5.50 times higher, with a 95 percent confidence interval of 3.51 to 8.63, a substantial and statistically robust increase.

But the story took a decisive turn when the team applied sensitivity analyses designed to test the robustness of the earthquake association. When they restricted the post-earthquake period to just the first 12 months after the disaster, the increases in bacterial and pneumococcal detection disappeared. When they restricted the analysis to samples tested only with the Bio-Speedy platform, one of the PCR systems used in the laboratory during the study period, the increases were not reproduced either. These findings matter because they suggest that the apparent post-earthquake bacterial surge may have been an artifact of how the comparison windows were defined or of changes in testing platforms and laboratory workflows over time, rather than a genuine biological effect of the earthquakes. The authors explicitly state that the differences between pre- and post-earthquake periods varied according to the time window and analytic subset examined, and that the data do not support attributing these differences specifically to the earthquakes.

This methodological caution is one of the study’s most valuable contributions. Natural experiments like earthquakes generate enormous public health interest, and observational data from affected regions are often the only evidence available in the chaotic aftermath of disaster. Yet such data are vulnerable to confounding by indication, changes in who gets tested, shifts in laboratory capacity, and the simple passage of time. A patient tested in late 2024 differs from one tested in 2021 not only in earthquake exposure but also in pandemic-era immune history, vaccination status, healthcare access, and the diagnostic technology applied to their sample. By showing that a seemingly compelling association dissolved under alternative analytic choices, the study offers a template for how respiratory surveillance data should be interrogated before dramatic conclusions are drawn about disaster-driven outbreaks.

The findings also carry practical implications for laboratories and public health agencies. Multiplex PCR panels are powerful tools, but their results depend on the specific platform, the panel composition, and the clinical context in which testing is ordered. The fact that restricting the analysis to a single PCR platform changed the results underscores how technical factors can shape epidemiological signals. The authors argue that multiplex PCR-based surveillance may be valuable for monitoring respiratory pathogen dynamics during periods of epidemiological disruption, precisely because such periods are when conventional assumptions about seasonality and pathogen distribution break down. Continuous, standardized surveillance, they suggest, is the best defense against both missed outbreaks and false alarms.

The research was supported by the Scientific Research Projects Coordination Unit of Mersin University and approved by the university’s Health Sciences Research Ethics Committee, which waived the requirement for informed consent given the retrospective design and use of anonymized routine clinical data. As the region continues to recover from one of the deadliest earthquakes in modern history, the study provides reassurance that the disaster did not produce a measurable, sustained shift in the overall burden of detectable respiratory pathogens, while simultaneously demonstrating how much careful statistical work is required to separate genuine epidemiological change from the noise of a health system in upheaval. For infectious disease watchers, the message is twofold: respiratory pathogens in southern Türkiye followed their own temporal rhythms through pandemic and earthquake alike, and the tools we use to watch them must be scrutinized as rigorously as the pathogens themselves.

Subject of Research: Temporal patterns of respiratory pathogen detection by multiplex PCR in southern Türkiye before and after the 2023 earthquakes

Article Title: Temporal patterns of respiratory pathogen detection in southern Türkiye: a retrospective multiplex PCR study with pre- and post-earthquake comparisons

Article References: Gülbudak, H., Bozok, T., Bekci, A., Ülger, S. T., & Aslan, G. (2026). Temporal patterns of respiratory pathogen detection in southern Türkiye: a retrospective multiplex PCR study with pre- and post-earthquake comparisons. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14638-z

Image Credits: AI Generated

DOI: 10.1186/s12879-026-14638-z

Keywords: respiratory pathogens, multiplex PCR, Streptococcus pneumoniae, earthquakes, Türkiye, epidemiology, respiratory tract infections, post-pandemic, surveillance, BMC Infectious Diseases, bacterial detection, rhinovirus

The study is grounded in two complementary theoretical frameworks. Resource-Based Theory, first advanced by Birger Wernerfelt in 1984, holds that a firm’s competitiveness depends on its ability to access and deploy valuable resources, including financial capital, human capital, and social networks. Institutional Theory, by contrast, explains how external structures, norms, and regulations shape entrepreneurial behaviour and outcomes. By integrating these perspectives, the researchers sought to capture a dual dynamic: women entrepreneurs may lack critical resources, and the institutional environment may simultaneously govern whether those resources can be acquired at all. This recursive relationship, in which institutional barriers restrict resource acquisition and resource scarcity limits the capacity to navigate institutional constraints, sits at the heart of the study’s findings.

To investigate these dynamics empirically, the researchers targeted a population of 11,275 female entrepreneurs registered with the Small Enterprise Development Agency in eThekwini Municipality, spanning industries from personal services and transportation to trade, construction, agriculture, manufacturing, and hospitality. Using Yamane’s formula, they calculated a required sample of 386 respondents and administered closed-ended questionnaires in person, drawing on a five-point Likert scale. Of the 350 questionnaires returned, 349 were deemed usable for analysis, representing a 90.6 percent response rate. The study received ethical approval from the Institutional Research Ethics Committee at Durban University of Technology, and informed consent was obtained from all participants between February and May 2024.

The demographic profile of the sample is itself revealing. Approximately 62 percent of respondents were aged between 21 and 35 years, and 96 percent identified as African Black women. Most respondents, 84.2 percent, had between zero and nine years of entrepreneurial experience, and 60.2 percent reported secondary education as their highest qualification. The researchers note that this concentration is particularly significant in the South African context, where apartheid systematically excluded Black women from economic participation, access to capital, and entrepreneurial opportunities. The challenges identified in the study must therefore be understood not only through the lens of gender but also in relation to race and historical structural inequalities.

Before examining the relationships between variables, the researchers employed Exploratory Factor Analysis using Principal Axis Factoring with Promax rotation to identify latent constructs underpinning women entrepreneurs’ experiences. The suitability of the data was confirmed using the Kaiser-Meyer-Olkin measure of sampling adequacy, which returned a value of 0.913, well above the recommended minimum of 0.60, and Bartlett’s Test of Sphericity, which was statistically significant at χ²(231) = 4134.443, p < 0.001. Four factors with eigenvalues greater than one were retained, collectively accounting for 58.413 percent of the common variance. These dimensions were named Entrepreneurial Constraints, Entrepreneurial Support, Entrepreneurial Participation, and Business Environment and Regulatory Climate. All retained items loaded above the 0.50 threshold, and reliability analysis confirmed internal consistency, with Cronbach’s alpha coefficients ranging from 0.803 to 0.879 across the four constructs.

The descriptive statistics paint a stark picture. Entrepreneurial Constraints recorded the highest composite mean at 4.16 on the five-point scale, indicating that respondents generally agreed they faced substantial barriers. At the item level, lack of capital for business expansion recorded the highest mean at 4.48, followed by lack of skills to grow the business at 4.38 and low profitability limiting the ability to employ additional staff at 4.37. Male domination in certain industries was also strongly perceived as a constraint, with a mean of 4.24. Respondents further agreed that inadequate education, cultural barriers, and family-related interference represented challenges to their entrepreneurial activities, demonstrating that the barriers confronting women entrepreneurs extend well beyond finance into interconnected resource, capability, cultural, and gender-related dimensions.

In sharp contrast, perceptions of entrepreneurial support were overwhelmingly negative. The composite mean for Entrepreneurial Support was just 1.76, falling within the disagreement range. Financial support recorded the lowest item mean at 1.46, indicating strong disagreement that adequate funding was available, while infrastructural support, business training, and business guidance all fell within the disagreement category. Mentorship recorded a comparatively higher mean of 2.64, though respondents remained generally neutral about the adequacy of ideas received from mentors. Perceptions of the Business Environment and Regulatory Climate were similarly unfavourable, with a composite mean of 1.76. Satisfaction with employment legislation recorded the lowest item mean at 1.50, corresponding to strong disagreement, while tax and levy fairness and tax policy satisfaction also fell within the disagreement range.

The regression analysis, however, reveals why these perceptions matter. With Entrepreneurial Participation as the dependent variable, the model was statistically significant at F(3, 345) = 99.160, p < 0.001, and the three predictors collectively explained 46.3 percent of the variance in participation. Entrepreneurial Support emerged as the strongest predictor, with a standardised coefficient of 0.419, indicating that greater financial, infrastructural, training, guidance, and mentorship support was associated with higher entrepreneurial participation. Entrepreneurial Constraints had a negative and statistically significant relationship with participation, with a standardised coefficient of −0.342, meaning that respondents reporting greater constraints tended to report lower participation. Business Environment and Regulatory Climate was positively associated with participation, with a standardised coefficient of 0.299. Notably, the low descriptive means for support and regulatory climate are not contradictory to these positive regression coefficients; they simply indicate that while support and favourable conditions matter for participation, respondents perceive the current levels as inadequate.

Entrepreneurial Participation itself recorded a composite mean of 2.00, indicating relatively low levels of engagement. Participation in women’s business activities arranged by the municipality, having more than two employees, and supplying goods and services within and beyond the municipality all fell within the disagreement range. Business diversification through operating more than one line of business also recorded a relatively low mean of 2.19. However, respondents were comparatively more optimistic about the future, with the expectation of having more branches within five years recording the highest mean at 3.28, falling within the neutral category. This suggests that some women entrepreneurs retain aspirations for expansion despite currently limited levels of participation and business reach.

The findings carry significant implications for policymakers and support interventions. From a Resource-Based Theory perspective, efforts should prioritise enhancing access to financial, human, and social capital through mentorship programmes, skills development workshops, and partnerships with educational institutions. From an Institutional Theory perspective, there is a pressing need to reform regulatory frameworks, simplify tax policies and employment legislation, strengthen support systems, and challenge entrenched gender norms. The researchers argue that without addressing both dimensions simultaneously, interventions are unlikely to produce meaningful or sustainable improvements in female entrepreneurial outcomes. The study also acknowledges limitations, including its cross-sectional design, focus on a single municipality, and reliance on self-reported data, and calls for longitudinal and comparative research to assess the long-term effectiveness of support programmes for women entrepreneurs across different regions.

Subject of Research: Women's entrepreneurship in South Africa

Article Title: Women’s voice in the South African entrepreneurial ecosystem: implications for support interventions

Article References: Mkhwanazi, S. J., & Utete, R. (2026). Women’s voice in the South African entrepreneurial ecosystem: implications for support interventions. Frontiers in Sustainable Cities, 8, Article 1977451. https://doi.org/10.3389/frsc.2026.1977451

Image Credits: AI Generated

DOI: 10.3389/frsc.2026.1977451

Keywords: women entrepreneurship, South Africa, Durban, eThekwini Municipality, SMEs, Resource-Based Theory, Institutional Theory, entrepreneurial support, entrepreneurial constraints, regulatory climate, post-pandemic, Frontiers in Sustainable Cities

The sector’s centrality is not accidental. Construction and facilities management sit squarely within SDG 9, the goal of industry, innovation, and infrastructure, and the editorial highlights how transformative technologies such as artificial intelligence and the Internet of Things are reshaping the sector’s efficiency and sustainability profile. Recent studies have affirmed measurable gains from these technologies, from energy optimization in smart buildings to predictive maintenance in infrastructure networks, yet the editors caution that much remains to be uncovered about their comprehensive potential and limitations. Digitalization, paired with adherence to ISO standards, is emerging as a leading practice for the future of facilities management, and the editorial calls for further research to test the full scope of these strategies against broader sustainability goals.

The five publications span an unusually wide technical territory. They include bioenergy projects converting cellulosic urban waste feedstock into sustainable aviation fuel, gender equality in smart sustainable cities, modular integrated construction as a development strategy, stakeholder dynamics in sustainable waste management, energy-driven circular design in the built environment, decision-making in the adaptive reuse of industrial buildings as hotels, electric vehicle consumer behavior and purchase intentions, and the adoption of biomimicry in the United Arab Emirates construction industry. The collection comprises one Policy and Practice Review, one Literature Review, and three Original Research Articles, offering conceptual, empirical, and review contributions to the field.

Among the original research articles, Maelissa and colleagues tackle a persistent gap in road infrastructure delivery: the systematic incorporation of social value. Although project social value is increasingly recognized as crucial to sustainable road infrastructure aligned with the UN SDGs, few comprehensive models guide its integration. The team proposes a conceptual model grounded in stakeholder and sustainability theories, identifying five key factors—community engagement, government involvement, sustainability practices, organizational performance, and design—represented by 38 indicators. The model emphasizes the interactions among these factors to produce social outcomes, merging the social and technical dimensions of sustainability while offering practical guidance for policymakers and practitioners in infrastructure planning and delivery.

The Policy and Practice Review by Munonye introduces the Smart Circular City, a framework that brings together technology, the circular economy, and urban metabolism to improve how materials and energy flow through historic buildings. By reusing resources and considering the entire lifecycle of structures, cities can extend building lifespans, reduce waste, and lower carbon emissions while fostering culturally rich urban areas. Digital tools such as digital twins and real-time monitoring systems help turn historic buildings into vital parts of sustainable urban systems, optimizing their use while preserving cultural values. Strategies like adaptive reuse and energy retrofitting aim to balance conservation with environmental performance, though the review notes that governance faces challenges from disconnected policies and economic limitations. Successful European cities demonstrate that combining policy coordination, cross-sector collaboration, and community engagement is crucial for advancing circular initiatives, and future strategies recommend embedding cultural value in digital assessments and encouraging circular retrofitting.

A second original research article, by Kyambade and colleagues, examines health and sanitation projects in Uganda, where poor governance, inconsistent service delivery, and aging infrastructure often cause projects to fail after their initial phases, hindering progress toward SDG 3 and SDG 6. The study reveals that responsible leadership improves sustainability performance directly and enhances project resilience, which in turn positively impacts sustainability. Resilience partly mediates the connection between responsible leadership and sustainability performance, indicating that effective leadership boosts sustainability both directly and through improved adaptability. By linking responsible leadership, resilience, and sustainability performance in one framework, the study strengthens relational leadership theory and provides valuable insights for sustaining health and sanitation projects in developing countries.

The third original research article, by Gajanayake and colleagues, turns to India’s urban housing sector, where circular economy strategies are not being adopted as quickly as other sustainability concepts like energy efficiency and green buildings, particularly in the Global South. Although the circular economy aligns with the SDGs, it is not explicitly mentioned in the SDG framework. Drawing on data from a focus group of construction practitioners in India, the findings show that practitioners focus on resource efficiency, low-carbon materials, clean energy, green building performance, and waste management. While primarily linked to environmental benefits, these efforts also connect to health, job creation, urban resilience, and partnerships. The study reveals an overlap between circular economy and green building ideas, with limited focus on advanced circular strategies, suggesting the industry needs a more comprehensive approach to sustainability supported by clear policies, professional skill development, stakeholder collaboration, and technological innovation.

The Literature Review by Malifete and colleagues examines green financing in South Africa’s construction industry, where effective use faces several operational barriers. The authors surveyed 44 professionals from public and private sectors, analyzing their perceptions of challenges and opportunities. Key barriers included a lack of knowledge about green products, inadequate sustainability training, and high costs of green materials. The main enabling factors are long-term investment planning, increased awareness of green financing, development of green financial products, and better collaboration among stakeholders. The team proposes a framework outlining the barriers and enabling conditions that affect organizations’ readiness to engage with green financing, adding evidence from South Africa and offering practical ideas for enhancing skills and partnerships to support sustainable construction.

Collectively, the five publications highlight the breadth and significance of current research at the intersection of construction, sustainability, and urban resilience. The editors emphasize that the findings offer fresh perspectives for research, policy, and practice, and they hope the collection will inspire new ideas in a field where the stakes are rising. As Lok and colleagues argue, focusing on construction in the post-pandemic period can help build the systems, practices, and structures that make cities better able to withstand future crises, testifying to the essential role that smart technologies and innovation play in advancing the UN SDGs within the built environment.

Subject of Research: Construction and facilities management research maps how the built environment can advance UN Sustainable Development Goals and urban resilience after the pandemic.

Article Title: Editorial: Role of construction in achieving UN Sustainable Development Goals to urban resilience in the post-pandemic context

Article References: Lok, K. L., Chen, C., & Smith, A. J. (2026). Editorial: Role of construction in achieving UN Sustainable Development Goals to urban resilience in the post-pandemic context. Frontiers in Sustainable Cities, 8, Article 2002041. https://doi.org/10.3389/frsc.2026.2002041

Image Credits: AI Generated

DOI: 10.3389/frsc.2026.2002041

Keywords: construction, UN Sustainable Development Goals, urban resilience, circular economy, green financing, smart cities, post-pandemic, sustainable infrastructure, Editorial, Role, achieving, Sustainable

One of the distinguishing features of this research is its long-term scope, spanning both the acute pandemic phase and the post-pandemic transition period. Most wastewater surveillance studies published to date have focused on relatively short windows, often limited to pandemic waves of SARS-CoV-2, which restricts the ability to draw conclusions about how viral circulation behaves under more ordinary epidemiological conditions. By continuing collection through the period when public health interventions were lifted and society returned to pre-pandemic patterns of contact, the researchers were able to observe the re-establishment of seasonal respiratory virus dynamics that had been dramatically suppressed during 2020 and much of 2021. This before-and-after contrast is scientifically precious because it documents, in a single location with consistent methodology, how the near-total interruption of transmission for viruses such as influenza and respiratory syncytial virus was followed by unusual out-of-season resurgences and subsequently by a gradual return to typical winter seasonality.

The concept of a middle-size city is relevant to the broader applicability of wastewater surveillance. Much of the foundational work in this field has been conducted in large metropolitan areas, where sewersheds serve millions of people and dilution effects are substantial but signal magnitude is high. Smaller cities present a different set of conditions: the contributing population is smaller, which can make signals more sensitive to localized outbreaks but also more variable, and the sewer network characteristics, industrial discharges, and demographic composition differ from those of megacities. Demonstrating that a standardized analytical pipeline can produce interpretable, reproducible data in a middle-size urban setting strengthens the case for deploying such systems across heterogeneous municipalities, which is precisely what many national and regional surveillance programs in Europe now aim to do under frameworks supported by the European Commission and coordinated through initiatives involving public health institutes across member states.

Methodologically, long-term wastewater studies of respiratory viruses must contend with several persistent analytical challenges. Viral RNA in sewage degrades over time depending on temperature, pH, and the presence of nucleases, so normalization strategies are needed to distinguish true changes in viral shedding from artifacts introduced by variable wastewater flow, rainfall dilution, or sample processing efficiency. Common approaches include normalizing to fecal indicators such as human adenovirus or pepper mild mottle virus, or to physicochemical parameters like ammonium concentration and flow volume. Recovery controls, typically spiked surrogate viruses, allow laboratories to estimate extraction efficiency for each sample. The choice of concentration method, whether electronegative membrane filtration, ultrafiltration, or polyethylene glycol precipitation, influences sensitivity for different viruses. Studies that maintain the same protocol over years, as this one did, gain an important advantage: temporal comparisons become more reliable because methodological noise is held constant, allowing genuine epidemiological trends to stand out more clearly.

The multipathogen panel typical of such studies generally includes SARS-CoV-2, influenza A and B viruses, respiratory syncytial virus, and often additional targets such as human metapneumovirus, parainfluenza viruses, seasonal coronaviruses, rhinoviruses, and adenoviruses. Quantitative reverse transcription PCR remains the workhorse detection technology because it provides absolute or relative quantification with well-characterized performance. Multiplexing several assays in a single reaction conserves sample volume and reduces cost, which matters when hundreds of samples are processed over multi-year campaigns. The resulting time series can be analyzed for peak timing, peak height, epidemic onset, and the lead time between wastewater signal and clinical indicators such as hospital admissions or sentinel physician reports. Across many studies, wastewater signals for influenza and RSV have tended to lead or coincide with clinical peaks by roughly one to two weeks, a window that can be operationally meaningful for hospital preparedness, staffing decisions, and the timing of public health communications.

The pandemic-to-post-pandemic transition also offers a natural experiment in viral interference and immune landscape dynamics. During the period of intense SARS-CoV-2 circulation and non-pharmaceutical interventions, the near-disappearance of influenza and RSV created a substantial immunity debt, particularly among children born during those years who had never encountered RSV. When restrictions eased, many countries in the Northern Hemisphere, including Spain, experienced an out-of-season RSV wave in the summer of 2021 and an unusually early and intense influenza and RSV season in late 2022. A wastewater time series that spans these events provides an independent record of how quickly viral circulation rebounded and how the relative timing of different pathogens shifted, information that is difficult to reconstruct from clinical data alone because testing practices for non-COVID respiratory viruses were themselves disrupted during the pandemic.

Another dimension of long-term wastewater data is its potential to capture the emergence and replacement of SARS-CoV-2 variants. Variant-specific assays or sequencing of wastewater samples can reveal the rise of Alpha, Delta, Omicron, and subsequent lineages weeks before genomic surveillance of clinical samples detects the same shifts, simply because wastewater aggregates infections across the whole community without the sampling biases introduced by who gets tested. Even when the primary focus of a study is quantitative viral load rather than lineage tracking, the overall SARS-CoV-2 signal reflects the cumulative effect of variant-driven changes in transmissibility, immune evasion, and shedding kinetics. The post-pandemic period, characterized by the evolution of Omicron sublineages and the transition of COVID-19 toward an endemic, wave-like pattern, is particularly interesting in this respect, as wastewater data can help define whether SARS-CoV-2 settles into winter seasonality similar to influenza or retains a distinct periodicity.

From a public health operations standpoint, the value of a multi-year dataset lies in establishing baselines. A single season of data cannot tell decision-makers whether a given viral load measurement represents a normal winter peak or an anomalous surge. After several years of consistent monitoring, thresholds can be defined empirically, for example as multiples of the median off-season concentration, and these thresholds can trigger predefined responses such as enhanced clinical testing, hospital surge planning, or targeted vaccination campaigns. The European Union’s recommendation in 2023 that member states extend wastewater surveillance beyond SARS-CoV-2 to include other pathogens of concern reflects exactly this logic: sustained, standardized monitoring is what converts raw measurements into actionable intelligence. Studies conducted in individual cities, with fully documented protocols and openly reported concentrations, provide the calibration points that such larger programs depend upon.

It is also worth noting the complementary relationship between wastewater surveillance and clinical sentinel systems. Clinical data provide information that wastewater cannot: which individuals are infected, their age distribution, vaccination status, symptom severity, and the identification of specific strains through patient sampling. Wastewater data, conversely, provide population-level coverage without dependence on healthcare-seeking behavior or testing policy, and they are available even when clinical laboratories scale back routine respiratory panels during off-seasons. Integrating the two streams, for instance by correlating wastewater concentrations with hospitalization rates or by using wastewater to trigger more intensive clinical sampling, generally yields better situational awareness than either source alone. The Spanish middle-size city dataset, by covering both pandemic and post-pandemic phases, illustrates how this integration can be evaluated across very different epidemiological regimes, from emergency-driven mass testing to routine seasonal monitoring.

Finally, the scientific community’s interest in studies of this kind reflects a broader shift in how infectious disease surveillance is conceptualized. Rather than reacting to outbreaks after they become clinically visible, public health authorities increasingly seek leading indicators drawn from environmental monitoring, genomic sequencing, and digital data sources. Wastewater surveillance occupies a central place in this vision because it is relatively inexpensive per capita, technologically accessible to regional laboratories, and demonstrably effective across a growing list of pathogens, including not only respiratory viruses but also enteroviruses, hepatitis A, mpox, and antimicrobial resistance genes. Long-term, single-site studies with consistent methodology, such as the one conducted in this Spanish city, serve as the empirical backbone for this transition, demonstrating that the signals are stable, interpretable, and reproducible over years rather than weeks, and that the infrastructure built during the COVID-19 emergency can be repurposed into durable, routine surveillance capacity capable of informing responses to future epidemic threats.

Subject of Research: Pandemic and post-pandemic dynamics of respiratory viruses in a Spanish middle-size city using a long-term wastewater surveillance

Article Title: Pandemic and post-pandemic dynamics of respiratory viruses in a Spanish middle-size city using a long-term wastewater surveillance

Article References: Casado-Martín, L., Hernández, M., Pérez-Alonso, D., Yeramian, N., Alves-Elois, M., Dorighello-Cadamuro, R., Fongaro, G., Eiros, J. M., & Rodríguez-Lázaro, D. (2026). Pandemic and post-pandemic dynamics of respiratory viruses in a Spanish middle-size city using a long-term wastewater surveillance. npj Viruses. https://doi.org/10.1038/s44298-026-00232-2

Image Credits: AI Generated

DOI: 10.1038/s44298-026-00232-2

Keywords: Pandemic, post-pandemic, dynamics, respiratory, viruses, Spanish, middle-size, city, long-term, wastewater, surveillance, scientific research