Making waves: Wastewater-based epidemiology for COVID-19 – approaches and challenges for surveillance and prediction

Abstract

Highlights Presence of SARS-CoV-2 in feces and wastewater constitutes a paradigm shift in surveillance. WBE has potential as a surveillance and predictive tool during the COVID-19 pandemic. Validated protocols for concentration and quantification of SARS-CoV-2 and other markers are needed.

Wastewater-based epidemiology as a useful tool to track SARS-CoV-2 and support public health policies at municipal level in Brazil

“…Our findings highlight the use of WBE approach as an early warning system for the emergence of new COVID-19 cases enabling faster prevention and public health actions by the State, as emphasized recently ( Farkas et al., 2020 ; Medema et al., 2020 ; Polo et al., 2020 ; Randazzo et al., 2020 ; Thompson et al., 2020 ). The success of the intervention carried out in the Boa Esperança community, resulted in the inclusion of SARS-CoV-2 sewage data as a complementary indicator to other traditionally health indicators used, such as growth rates of new cases and hospitalizations, mortality rate, number of available hospital beds and bed occupancy rate.…”

“…Detection of SARS-CoV-2 in faeces and early shedding demonstrated by virus detection in faeces ( He et al., 2020 ) resulted in use of an environmental approach called wastewater-based epidemiology (WBE) as an additional tool to support COVID-19 prevention and control actions in several regions ( Farkas et al., 2020 ; Hart and Halden, 2020 ; Mao et al., 2020 ; Thompson et al., 2020 ). According to Polo et al. (2020) , WBE consists on the assumption that any stable substance that is excreted by humans and in wastewater can be used to back-calculate the original concentration excreted by the serviced population.…”

“…(2020) , WBE consists on the assumption that any stable substance that is excreted by humans and in wastewater can be used to back-calculate the original concentration excreted by the serviced population. The same concept can be used for analysis of pathogens circulation in sanitary sewers in a given population, when excreted in the faeces/urine of infected people ( Mao et al., 2020 ; Polo et al., 2020 ). Such an approach is a useful tool especially where resources for clinical diagnosis are limited and when reporting systems are unavailable or inefficient ( Kitajima et al., 2020 ; Hart and Halden, 2020 ; Thompson et al., 2020 ).…”

Catching a resurgence: Increase in SARS-CoV-2 viral RNA identified in wastewater 48 h before COVID-19 clinical tests and 96 h before hospitalizations

“…Previous WBE work identified several possible normalization biomarkers in wastewater such as 5-Hydroxyindoleacetic acid ( Chen et al, 2014 ), caffeine and cotinine ( Rico et al, 2017 ). However, due to the higher incidence of SARS-CoV-2 viral particles in feces as compared to urine ( Collivignarelli et al, 2020 ; Jeong et al, 2020 ; Lodder and de Roda Husman, 2020 ; Zhurakivska et al, 2020 ), other biomarkers present in wastewater solids, such as pepper mild mottle virus (PMMoV) ( Jafferali et al, 2020 ; Kitajima et al, 2018 ; Rosario et al, 2009 ; Symonds et al, 2014 ) and crAssphage ( Crank et al, 2020 ; Polo et al, 2020 ) saw are being utilized for the normalization of SARS-CoV-2. Some recent studies have demonstrated that biomarker normalized SARS-CoV-2 viral signal may in fact track be capable of tracking the incidence of COVID-19 infections in the community ( Gerrity et al, 2021 ; Kitamura et al, 2021 ) more effectively than non-biomarker-normalized viral signal ( Jafferali et al, 2020 ; Wu et al, 2020 ), even if accounting for corrections due to flow or solids mass flux ( D'Aoust et al, 2021 ).…”

Technical framework for wastewater-based epidemiology of SARS-CoV-2 based on relative quantification via qPCR

“…Furthermore, in order to estimate the infection rate in a community, it is necessary to accurately measure the community population, i.e. the population normalization for the data [32]. This is a challenging task for areas with high population mobility.…”