Subsewershed SARS-CoV-2 Wastewater Surveillance and COVID-19 Epidemiology Using Building-Specific Occupancy and Case Data

Abstract

To evaluate the use of wastewater-based surveillance and epidemiology to monitor and predict SARS-CoV-2 virus trends, over the 2020–2021 academic year we collected wastewater samples twice weekly from 17 manholes across Virginia Tech’s main campus. We used data from external door swipe card readers and student isolation/quarantine status to estimate building-specific occupancy and COVID-19 case counts at a daily resolution. After analyzing 673 wastewater samples using reverse transcription quantitative polymerase chain reaction (RT-qPCR), we reanalyzed 329 samples from isolation and nonisolation dormitories and the campus sewage outflow using reverse transcription digital droplet polymerase chain reaction (RT-ddPCR). Population-adjusted viral copy means from isolation dormitory wastewater were 48% and 66% higher than unadjusted viral copy means for N and E genes (1846/100 mL to 2733/100 mL/100 people and 2312/100 mL to 3828/100 mL/100 people, respectively; n = 46). Prespecified analyses with random-effects Poisson regression and dormitory/cluster-robust standard errors showed that the detection of N and E genes were associated with increases of 85% and 99% in the likelihood of COVID-19 cases 8 days later (incident–rate ratio (IRR) = 1.845, p = 0.013 and IRR = 1.994, p = 0.007, respectively; n = 215), and one-log increases in swipe card normalized viral copies (copies/100 mL/100 people) for N and E were associated with increases of 21% and 27% in the likelihood of observing COVID-19 cases 8 days following sample collection (IRR = 1.206, p < 0.001, n = 211 for N ; IRR = 1.265, p < 0.001, n = 211 for E ). One-log increases in swipe normalized copies were also associated with 40% and 43% increases in the likelihood of observing COVID-19 cases 5 days after sample collection (IRR = 1.403, p = 0.002, n = 212 for N ; IRR = 1.426, p < 0.001, n = 212 for E ). Our findings highlight the use of building-specific occupancy data and add to the evidence for the potential of wastewater-based epidemiology to predict COVID-19 trends at subsewershed scales.

Building-Level Detection Threshold of SARS-CoV-2 in Wastewater

“…Surge testing can measure positive predictive power but not negative predictive power, specificity, nor sensitivity. Other studies may have obtained data to query the detection threshold ( 16 – 21 ) but did not report the analysis. One campus program reported ~10% sensitivity for detecting one or two sporadic cases in a residence hall ( 22 ).…”

Highly Multiplexed Reverse-Transcription Loop-Mediated Isothermal Amplification and Nanopore Sequencing (LAMPore) for Wastewater-Based Surveillance

“…WBS has shown promise as a strategy to inform interventions aimed at suppressing community disease transmission. , For example, in response to the COVID-19 pandemic, WBS was rapidly implemented across the globe to detect SARS-CoV-2 viral RNA in wastewater and to provide an early warning of the spread of COVID-19 within a community. ,− Ideally, WBS can be applied to relate loads of viral RNA in wastewater to fecal shedding of SARS-CoV-2 by infected members of the population. Encouragingly, in many cases, SARS-CoV-2 viral RNA loads in wastewater samples have been found to correlate with clinical COVID-19 cases in the community …”

“…Encouragingly, in many cases, SARS-CoV-2 viral RNA loads in wastewater samples have been found to correlate with clinical COVID-19 cases in the community. 14 Reverse-transcription polymerase chain reaction (RT-PCR)based assays (e.g., RT-quantitative PCR, RT-digital droplet PCR) are now widely accepted as the gold standard approach for sensitive detection of SARS-CoV-2 viral RNA. 15−18 Unfortunately, there were numerous PCR capacity shortages at the outset of large-scale testing (e.g., following the declaration of a global pandemic) since PCR requires centralized facilities and highly trained personnel.…”

Wastewater-based epidemiology for comprehensive communitywide exposome surveillance: A gradient of metals exposure

“…Wastewater has been used to monitor toxicants including illicit drugs (Banta-Green et al, 2016;Choi et al, 2019;Croft et al, 2020), tobacco metabolites (Choi et al, 2019), and biological agents as weapons (Sinclair et al, 2008). Wastewater surveillance has also been used successfully to monitor disease health threats across geographic scales from buildings and neighborhoods to entire cities (Cohen et al, 2022;Holm et al, 2022;Mercier et al, 2022; National Academies of Sciences, Engineering, and Medicine, 2023; Weidhaas et al, 2021).…”

“…Wastewater has been used to monitor toxicants including illicit drugs (Banta-Green et al, 2016; Choi et al, 2019; Croft et al, 2020), tobacco metabolites (Choi et al, 2019), and biological agents as weapons (Sinclair et al, 2008). Wastewater surveillance has also been used successfully to monitor disease health threats across geographic scales from buildings and neighborhoods to entire cities (Cohen et al, 2022; Holm et al, 2022; Mercier et al, 2022; National Academies of Sciences, Engineering, and Medicine, 2023; Weidhaas et al, 2021). Exposure to toxic metals as one of the key environmental contaminants has been attracting public health attention as exposure can be related to contamination across air, water, and soil as well as associated with individual factors (Barcelos et al, 2020; Menke et al, 2016; Nadal et al, 2011).…”