ABSTRACT
The rapid development of scientific communication approaches for environmental surveillance data with online information dashboards has been done in the absence of a global organizing body during the coronavirus disease 2019 pandemic. We aim to make a case for standardization of dashboards presenting SARS-CoV-2 wastewater data. The list of dashboards was compiled as of March 31, 2022. The 127 dashboards reviewed represented 27 countries using a range of line/bar graphs, maps, and tables with symbol presentation. We identified 96 separate units of measure for the wastewater SARS-CoV-2 data. There was also inconsistency in using linear or log scale. Twenty-five percent of dashboards presented SARS-CoV-2 variant monitoring. Only 30% (38/125) of dashboards provided downloadable source data. There is great opportunity to improve scientific communication though the adoption of uniform data presentation conventions or standards for this field.
ABSTRACT
Study objectiveTo garner a framework for combining community wastewater surveillance with state clinical surveillance that influence confirmation of SARS-CoV-2 variants within the community, and recommend how the flow of such research evidence could be expanded and employed for public health response. Design, setting, and participantsThis work involved analyzing wastewater samples collected weekly from 17 geographically resolved locations in Louisville/Jefferson County, Kentucky from February 10 to November 29, 2021. Genomic surveillance and RT-qPCR platforms were used as screening to identify SARS-CoV-2 in wastewater, and state clinical surveillance was used for confirmation. Main resultsThe results demonstrate increased epidemiological value of combining community wastewater genomic surveillance and RT-qPCR with conventional case auditing methods. The spatial scale and temporal frequency of wastewater sampling provides promising sensitivity and specificity to be useful to gain public health screening insights about community emergence, seeding, and spread. ConclusionsBetter national surveillance systems are needed for future pathogens and variants, and wastewater-based genomic surveillance represents opportune coupling. This paper presents current evidence that complementary wastewater and clinical testing is enhanced cost-effectively when linked; making a strong case for a joint public health framework. The findings suggest significant potential for rapid progress to be made in extending this work to consider pathogens of interest as a whole within wastewater, which could be examined in either a targeted fashion as we currently do with SARS-CoV-2 or in terms of a global monitoring of all pathogens found, and developing evidence based public health practice to best support community health. Thumbnail BoxO_ST_ABSWhat is already known on this subject?C_ST_ABSThe primary approach for the genomic surveillance of SARS-CoV-2 relies on the sequencing of clinical COVID-19 samples. Variants of SARS-CoV-2 can also be tracked in community wastewater. What this study adds?We propose that, for comprehensive community surveillance, the first line of community pathogen screening should involve geographically-resolved wastewater samples collected at a regular frequency and employ both Next Generation Sequencing (NGS) and RT-qPCR. These results could then be compared with state clinical surveillance. This framework is a more comprehensive and cost-effective approach for surveillance in practice to catch community emergence, seeding, and spread. Policy implicationsOur results present a framework that could support the implementation of better surveillance policies directed to solve future community pathogen and variant detection. We anticipate this work can help public health officials implement rational community sampling schemes and develop sensible coordination with other clinical surveillance. The utility of this for COVID-19 extends to many other infectious disease models and other public health hazards such as toxic exposures.
ABSTRACT
The majority of sewer systems in the United States and other countries, are operated by public utilities. In the absence of any regulation, public perception of monitoring wastewater for population health biomarkers is an important consideration for a public utility commission when allocating resources for this purpose. In August 2021, we conducted a survey as part of an ongoing COVID-19 community prevalence study in Louisville/Jefferson County, KY. The survey comprised of seven questions about awareness of and privacy concerns and was sent to 32,000 households randomly distributed within the county. A total of 1,220 sampled adults participated in the probability sample, and 981 were used in analysis. A total of 2,444 adults additionally responded in the convenience sample, and 1,751 were used in analysis. The samples were weighted to produce estimates representative of all adults in the county. Public awareness of tracking COVID-19 virus in the sewers was low. Opinions about how data from this activity are shared strongly supported public disclosure of monitoring results. Responses showed more support for measuring the largest areas (>30,000 to 50,000 households) typically representing population levels found in a community or regional wastewater treatment plant. Those who had a history of COVID-19 infection were more likely to support highly localized monitoring. Understanding wastewater surveillance strategies and thresholds of privacy concerns requires in-depth, comprehensive analysis of public opinion for continued success and efficacy of public health monitoring. Graphic for Table of Contents (TOC)/Abstract Art O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=44 SRC="FIGDIR/small/21264954v1_ufig1.gif" ALT="Figure 1"> View larger version (25K): org.highwire.dtl.DTLVardef@8774aforg.highwire.dtl.DTLVardef@fdbeaborg.highwire.dtl.DTLVardef@f0fc3forg.highwire.dtl.DTLVardef@14097dd_HPS_FORMAT_FIGEXP M_FIG C_FIG
ABSTRACT
In this communication, we report on the genomic surveillance of SARS-CoV-2 using wastewater samples in Jefferson County, KY. In February 2021, we analyzed seven wastewater samples for SARS-CoV-2 genomic surveillance. Variants observed in smaller catchment areas, such as neighborhood manhole locations, were not necessarily consistent when compared to associated variant results in downstream treatment plants, suggesting catchment size or population could impact the ability to detect diversity.
ABSTRACT
BackgroundWastewater monitoring for virus infections within communities can complement conventional clinical surveillance. Currently, most SARS-CoV-2 testing is performed during clinical encounters with symptomatic individuals, and therefore likely underrepresents actual population prevalence. Randomized testing on a regular basis to estimate population-level infection rates is prohibitively costly and is hampered by a range of barriers associated with participation in clinical research. In comparison, community-level fecal monitoring can be performed through wastewater surveillance and can effectively surveil communities with less temporal lag than other surveillance methods. However, epidemiologically-defined protocols for wastewater sample site selection are lacking. MethodsHerein we describe methods for developing a geographically-resolved population-level wastewater sampling approach in Jefferson County, Kentucky which may have general applicability for cities throughout the United States. This approach was developed by the selection of sampling locations along sewer lines transporting raw wastewater from geographically and demographically distinct areas that correspond with locations where random testing of residents occurs. ConclusionsDevelopment of this protocol for population-level sampling for SARS-CoV-2 prevalence in wastewater can be utilized to inform consistent wastewater monitoring among cities for up-to-date and geographically-resolved information on COVID-19 prevalence within communities. This information could substantially supplement public health surveillance of COVID-19 and thus serve to better guide targeted mitigation strategies throughout the United States.
