Wastewater surveillance of pharmaceuticals during the COVID-19 pandemic in Mexico City and the Mezquital Valley: A comprehensive environmental risk assessment

This study tracked five pharmaceutically active compounds (PhACs) in Mexico City's sewage, namely, famotidine, indomethacin, dexamethasone, azithromycin, and ivermectin, which were used to treat COVID-19. The monitoring campaign was carried out over 30 months (May 2020 to November 2022), covering the five COVID-19 waves in Mexico. In the Central Emitter, the main sewage outflow, famotidine displayed levels of 132.57 ± 28.16 ng L−1 (range from < LOQ to 189.1 ng L−1), followed by indomethacin (average 672.46 ± 116.4 ng L−1, range from 516.7 to 945.2 ng L−1), dexamethasone (average 610.4 ± 225.7 ng L−1, range from 233.4 to 1044.5 ng L−1), azithromycin (average 4436.2 ± 903.6 ng L−1, range from 2873.7 to 5819.6 ng L−1), and ivermectin (average 3413.3 ± 1244.6 ng L−1, range from 1219.8 to 4622.4 ng L−1). The concentrations of dexamethasone, azithromycin and ivermectin were higher in sewage from a temporary COVID-19 care unit, by a factor of 3.48, 3.52 and 2.55, respectively, compared with those found in municipal wastewater. In the effluent of the Atotonilco Wastewater Treatment Plant (AWWTP), which treats near 60 % of the Mexico City's sewage, famotidine was absent, while concentrations of indomethacin, dexamethasone, azithromycin and ivermectin were 78.2 %, 76.7 %, 74.4 %, and 88.1 % lower than those in the influent, respectively. The occurrence of PhACs in treated and untreated wastewater resulted in medium to high environmental risk since Mexico City's wastewater is reused for irrigation in the Mezquital Valley. There, PhACs were found in irrigation canals at lower levels than those observed in Mexico City throughout the monitoring. On the other hand, famotidine, indomethacin, and dexamethasone were not found in surface water resulting from the infiltration of wastewater through soil in Mezquital Valley, while azithromycin and ivermectin sporadically appeared in surface water samples collected through 2021. Using an optimized risk assessment based on a semi-probabilistic approach, the PhACs were prioritized as ivermectin > azithromycin > dexamethasone > famotidine > indomethacin. [Display omitted] •COVID-19 drugs tracked in Mexico City's sewage throughout the pandemic.•High levels of dexamethasone, azithromycin and ivermectin found through the survey.•Azithromycin and ivermectin levels in sewage fit with COVID-19 five waves in Mexico City.•Mexico City exported COVID-19 drugs to Mezquital Valley through sewage during the pandemic.•Ivermectin, dexamethasone a