Using Wastewater Based Epidemiology to Fight COVID-19

As of December 2020, COVID-19 has infected over 72 million people globally, causing over 1.6 million deaths, with numbers expected to rise through the early months of 2021. Even with vaccination efforts launching globally, COVID-19’s highly infectious and often asymptomatic nature has led the scientific community to prioritize strategies for reliable tracking of community spread. Non-diagnostic testing such as wastewater based epidemiology is being widely considered as a method to help track COVID-19 incidence within communities.(1)

What is Wastewater Based Epidemiology (WBE)?

Wastewater based epidemiology, or WBE, is a method of testing wastewater for the genetic material of pathogens which can be used as a biomarker for disease spread. WBE’s utility in disease surveillance has already been proven in the fight against poliovirus.(2) Like SARSCoV-2, most infections caused by poliovirus are mild or even asymptomatic, but result in the excretion of significant amounts of viral RNA. Sewage surveillance could potentially be used as an early warning system to help determine the extent of an outbreak more accurately and quickly than clinical evaluations that rely on testing symptomatic individuals.

How has WBE been used to monitor COVID-19?

The COVID-19 causative pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is shed in fecal matter and occasionally urine. Viral RNA remains detectable in wastewater for days to weeks, so monitoring wastewater is a viable option for tracking the spread of COVID-19 in communities. (3) WBE has already been used to monitor the prevalence of COVID-19 in countries like Japan (4), India (5), Turkey (6), and the US (7). WBE could be a useful tool for the public health officials for individual institutions and their greater communities. The University of Arizona used WBE and clinical testing to detect and isolate three infected individuals within a dormitory which prevented further spread (8). In a similar use case, the state of South Carolina predicted the number of infected individuals by studying samples from three sewersheds (9).

WBE is accessible and cost effective. 

Wastewater monitoring can help determine the appropriate response measures at all levels, including potentially determining the geographic priority of vaccine deployments in order to thwart emerging outbreaks. In addition, compared to mass individual testing, WBE is a more cost-effective way to monitor transmission dynamics because sewage influent effectively pools samples from an entire community.(10) Furthermore, its effectiveness is unaffected by patient access or willingness to participate, making it particularly useful in places where individual testing is either delayed, unavailable, or carries stigma.(11)

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References
  1. Ahmed W, et al., Surveillance of SARS-CoV-2 RNA in wastewater: Methods optimisation and quality control are crucial for generating reliable public health information, Curr Opin Environ Sci Health. 2020;17:82-93.
  2. Asghar H, et al., Environmental surveillance for polioviruses in the global polio eradication initiative. J Infect Dis. 2014;210:S294–S303.
  3. Betancourt, W.Q., and Shulman, L.M. 2017. Polioviruses and other Enteroviruses. In: J.B. Rose and B. Jiménez-Cisneros, (eds) Global Water Pathogen Project. http://www.waterpathogens.org (J.S Meschke, and R. Girones (eds) Part 3 Viruses) http://www.waterpathogens.org/book/polioviruses-and-other-enteroviruses Michigan 
  4. Hata A, et al., Detection of SARS-CoV-2 in wastewater in Japan by multiple molecular assays-implication for wastewater-based epidemiology (WBE). medRxiv. 2020.06.09.20126417.
  5. Arora S, et al., Sewage surveillance for the presence of SARS-CoV-2 genome as a useful wastewater based epidemiology (WBE) tracking tool in India. medRxiv. 2020.06.18.20135277.
  6. Kocamemi BA, et al., Routine SARS-CoV-2 wastewater surveillance results in Turkey to follow Covid-19 outbreak. medRxiv. 2020.12.21.20248586.
  7. Larsen, D.A., et al., Tracking COVID-19 with wastewater. Nat Biotechnol. 2020;38:1151–1153.
  8. Betancourt WW, et al., Wastewater-based Epidemiology for Averting COVID-19 Outbreaks on The University of Arizona Campus. medRxiv. 2020.11.13.20231340.
  9. McMahan CS, et al., COVID-19 Wastewater Epidemiology: A Model to Estimate Infected Populations. medRxiv. 2020.11.05.20226738. 
  10. Hart OE, et al., Computational analysis of SARS-CoV-2/COVID-19 surveillance by wastewater-based epidemiology locally and globally: feasibility, economy, opportunities and challenges. Sci Total Environ. 2020;730:138875.
  11. Rowe, AK, et al., Caution is required when using health facility-based data to evaluate the health impact of malaria control efforts in Africa. Malar J. 2009;8:209.

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