The devil is in the details: emerging insights on the relevance of wastewater surveillance for SARS-CoV-2 to public health

Abstract

The severe health consequences and global spread of the COVID-19 pandemic have necessitated the rapid development of surveillance programs to inform public health responses. Efforts to support surveillance capacity have included an unprecedented global research response into the use of genetic signals of SARS-CoV-2 in wastewater following the initial demonstration of the virus' detectability in wastewater in early 2020. The confirmation of fecal shedding of SARS-CoV-2 from asymptomatic, infected and recovering individuals further supports the potential for wastewater analysis to augment public health conventional surveillance techniques based on clinical testing of symptomatic individuals. We have reviewed possible capabilities projected for wastewater surveillance to support pandemic management, including independent, objective and cost-effective data generation that complements and addresses attendant limitations of clinical surveillance, early detection (i.e., prior to clinical reporting) of infection, estimation of disease prevalence, tracking of trends as possible indicators of success or failure of public health measures (mask mandates, lockdowns, vaccination, etc.), informing and engaging the public about pandemic trends, an application within sewer networks to identify infection hotspots, monitoring for presence or changes in infections from institutions (e.g., long-term care facilities, prisons, educational institutions and vulnerable industrial plants) and tracking of appearance/progression of viral variants of concern.

Editorial: SARS-CoV-2 in water

“…In further support of research translation, we include an excellent review prepared by Hrudey & Conant (2022) drawing on their experience with the Canadian Water Network (CWN) Wastewater Coalition. Hrudey & Conant (2022) argue that appropriate interpretation of wastewater data for public health decision-makers requires an understanding of the importance of different knowns and unknowns.…”

Review of concerned SARS-CoV-2 variants like Alpha (B.1.1.7), Beta (B.1.351), Gamma (P.1), Delta (B.1.617.2), and Omicron (B.1.1.529), as well as novel methods for reducing and inactivating SARS-CoV-2 mutants in wastewater treatment facilities

“…In response to reports that the disease is more infectious and may be immune evading, flights were banned, and more measures were taken to control its spread in various regions of the world ( Chen et al 2021 , Gu et al 2021 ). Besides community-based monitoring of SARS-CoV-2 mutations, wastewater surveillance has been demonstrated to be a proper supplemental strategy ( Hrudey et al 2021 , Lee et al 2021 ). An epidemiological study retrospectively on routine surveillance data revealed that Omicron viruses might increase the risk of reinfection following primary infection ( Ferré et al 2022 ).…”

VirPool: Model-Based Estimation of SARS-CoV-2 Variant Proportions in Wastewater Samples

“…Wastewater monitoring can help to address biases in analysis of clinical samples that are due to differences in test availability and willingness to undergo a clinical test. Moreover, increases in wastewater viral RNA levels can precede the results of clinical testing by several days or even longer when clinical testing is not readily available (Bibby et al, 2021;Hrudey and Conant, 2022), and thus wastewater analysis can provide early 1 warning signals of worsening epidemic situation or emergence of new variants of the virus in a particular area.…”

“…Long-term studies have shown that the composition of viral RNA fragments in wastewater reflects qualitatively and quantitatively the breakdown of virus lineages circulating in the population of the catchment (Agrawal et al, 2022; Amman et al, 2022). Wastewater-based epidemiology (WBE) has recently emerged as a cost effective and scalable alternative to sequencing individual sample patients (Safford et al, 2022; Hrudey and Conant, 2022). Various PCR-based techniques can be used to estimate concentration of virus particles in wastewater to ascertain epidemiological trends.…”