Tracking COVID-19 in sewers and in patients to help halt the pandemic

ABSTRACT

In this article, experts highlighted their experiences with employing a wastewater-based epidemiological surveillance (WBE) approach to track coronavirus infection levels in local communities in an online symposium. The objective of the Water Research Commission (WRC)-hosted symposium was to share knowledge on the progress that has been made in South Africa in monitoring the spread of COVID-19 using the WBE approach. With insights from collaborating partners, the establishment of South African Collaborative COVID-19 Environmental Surveillance System (SACCESS) has become one of the most significant development to date in terms of WBE surveillance in South Africa. With SACCESS and WBE, advance warnings about outbreaks can be made, such that the data collected using the WBE approach enabled researchers to predict the surge in clinical cases in April in KwaZulu-Natal three weeks before it happened. But risk is still prevalent for the health of wastewater workers or in the reuse of treated effluents, as well as the absence of WBE surveillance in non-sewered communities. With this, research has been made on developing and optimising the methodology for SARS-CoV-2 detection, quantification and monitoring in different types of samples from non-sewered environments. The detection of SARS-CoV-2 RNA in 98% of the wastewater samples collected has demonstrated the proof of concept for using WBE surveillance to track COVID-19. Continued WBE sampling at priority sites will allow for the expansion of pandemic trend monitoring. In terms of the impact on public health decision-making, only the City of Cape Town and the Western Cape Provincial Department of Health have incorporated WBE into their local responses.