Abstract
Accurate estimates of COVID-19 burden of infections in communities can inform public health strategy for the current pandemic. Wastewater based epidemiology (WBE) leverages sewer infrastructure to provide insights on rates of infection by measuring viral concentrations in wastewater. By accessing the sewer network at various junctures, important insights regarding COVID-19 disease activity can be gained. The analysis of sewage at the wastewater treatment plant level enables population-level surveillance of disease trends and virus mutations. At the neighborhood level, WBE can be used to describe trends in infection rates in the community thereby facilitating local efforts at targeted disease mitigation. Finally, at the building level, WBE can suggest the presence of infections and prompt individual testing. In this critical review, we describe the types of data that can be obtained through varying levels of WBE analysis, concrete plans for implementation, and public health actions that can be taken based on WBE surveillance data of infectious diseases, using recent and successful applications of WBE during the COVID-19 pandemic for illustration.
Highlights
Epidemiological surveillance is centered on monitoring the incidence of infection or disease
We review key considerations surrounding the decision to implement public health wastewater surveillance and operational factors associated with the use of wastewater-based epidemiology for the current pandemic and future infectious diseases
The nearby City of Tempe had partnered with a local university to test wastewater for COVID-19, and the program included sampling at points which isolated contributions of different neighborhoods to the city’s overall sewage [62]
Summary
Epidemiological surveillance is centered on monitoring the incidence of infection or disease. Wastewater surveillance has been implemented in many communities across the United States, Europe and globally, as a community risk assessment tool to monitor population-level spread of COVID-19 and detect clusters of infections [13, 14] This strategy has been employed in hotspots of infections, including schools, universities, correctional settings, and nursing homes as an early warning system and supplement to in-person testing and clinical case reporting [15]. In this manuscript, we review key considerations surrounding the decision to implement public health wastewater surveillance and operational factors associated with the use of wastewater-based epidemiology for the current pandemic and future infectious diseases. Building (Upstream) Qualitative presence or absence of Quarantine of building occupants Mass disease on site Outbreak indicator testing of building occupants
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