Coupling freedom from disease principles and early warning from wastewater surveillance to improve health security

Abstract

Infectious disease surveillance is vitally important to maintaining health security, but these efforts are challenged by the pace at which new pathogens emerge. Wastewater surveillance can rapidly obtain population-level estimates of disease transmission, and we leverage freedom from disease principles to make use of nondetection of SARS-CoV-2 in wastewater to estimate the probability that a community is free from SARS-CoV-2 transmission. From wastewater surveillance of 24 treatment plants across upstate New York from May through December of 2020, trends in the intensity of SARS-CoV-2 in wastewater correlate with trends in COVID-19 incidence and test positivity (⍴ > 0.5), with the greatest correlation observed for active cases and a 3-day lead time between wastewater sample date and clinical test date. No COVID-19 cases were reported 35% of the time the week of a nondetection of SARS-CoV-2 in wastewater. Compared to the United States Centers for Disease Control and Prevention levels of transmission risk, transmission risk was low (no community spared) 50% of the time following nondetection, and transmission risk was moderate or lower (low community spread) 92% of the time following nondetection. Wastewater surveillance can demonstrate the geographic extent of the transmission of emerging pathogens, confirming that transmission risk is either absent or low and alerting of an increase in transmission. If a statewide wastewater surveillance platform had been in place prior to the onset of the COVID-19 pandemic, policymakers would have been able to complement the representative nature of wastewater samples to individual testing, likely resulting in more precise public health interventions and policies.

Retrospective Analysis of Wastewater-Based Epidemiology of SARS-CoV-2 in Residences on a Large College Campus: Relationships between Wastewater Outcomes and COVID-19 Cases across Two Semesters with Different COVID-19 Mitigation Policies

“…A lower sensitivity (35%) was reported in a previous study from Larsen et al. in New York . This sensitivity from Larsen et al of 35% was described as a good performance benchmark, when compared to the performance of other surveillance efforts, such as individual-based community testing .…”

“…A lower sensitivity (35%) was reported in a previous study from Larsen et al in New York. 66 This sensitivity from Larsen et al of 35% was described as a good performance benchmark, when compared to the performance of other surveillance efforts, such as individual-based community testing. 66 While the predictive results in our study are strong, there is a limitation that prevented us from improving our results to levels, such as those observed at the University of Arizona.…”

Assessment of a mass balance equation for estimating community-level prevalence of COVID-19 using wastewater-based epidemiology in a mid-sized city

“…Stronger correlations with the COVID-19 case incidence have been reported from multiple other studies with correlations above 0.90 38,46,51,52 . A previous study from Larsen et al showed a significant association (R-Square = 0.55) with the test positivity rate with a sampling frequency of at least twice per week 53 . We believe that the strength of the linear associations in our study would have been higher with an increase in our sampling frequency.…”

“…The correction factor is a potential limitation in their study because COVID-19 community testing is dynamic, and any fluctuations in testing frequency during the pandemic would lead to the need for different clinical case multipliers. Numerous studies have used an estimated prevalence from the test positive rate, either from small community-level random sampling or from broader community testing efforts [34][35][36][37]51,53,60 . Specifically, Layton et al were able to conduct small-scale community seroprevalence testing for comparison to their wastewater-derived prevalence estimates 36 .…”

Evaluating the impact of sample storage, handling, and technical ability on the decay and recovery of SARS-CoV-2 in wastewater

“…Quantifying concentrations of pathogens of interest in wastewater provides a pooled assessment of disease prevalence in a community in real time, complementing clinical case counts [1]. This approach has been employed globally throughout the ongoing SARS-CoV-2 pandemic to monitor patterns in viral load and to aid in public health decisions [2][3][4] as concentrations of SARS-CoV-2 in wastewater have been shown to be highly correlative with and predictive of clinical patterns in disease occurrence [5][6][7][8]. Despite these benefits, quantification of pathogens of interest in wastewater can be difficult.…”