The dynamic relationship between COVID-19 cases and SARS-CoV-2 wastewater concentrations across time and space: Considerations for model training data sets

Schill, Rebecca; Nelson, Kara L.; Harris-Lovett, Sasha; Kantor, Rose

doi:10.1016/j.scitotenv.2023.162069

Cited by 24 publications

(21 citation statements)

References 54 publications

(78 reference statements)

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“…Others have looked for, and found, changes in the relationship between caseload and wastewater signals that correlate with pandemic milestones ,, but to our knowledge this is the first time statistical approaches have been used to detect such changes independent of knowledge of changes in the aforementioned factors. Boehm et al reported a statistically significant change in the relationship between SARS-CoV-2 RNA in wastewater settled solids and cases in California after May 1, 2022 at the onset of the BA.2/BA.5 surge and coincident with the widespread availability of at-home COVID-19 antigen tests .…”

Section: Resultsmentioning

confidence: 99%

“…In the fall of 2020, increases in the ratio of SARS-CoV-2 to caseloads were observed, but these were not evaluated statistically. Schill et al 38 used data from five WWTPs in California collected over 18 months to compute a smoothened log(case)-to-log(copy) ratio and observed changes in ratio (both increases and decreases) that coincided with the peak caseloads during variant waves. Like us, they found a reduced fit of regression models as the pandemic progressed.…”

Section: ■ Results and Discussionmentioning

confidence: 99%

“…Poor correlations also could reflect that these are more rural communities which are often under-tested/under-reported, or that a single infected person will have a larger impact if the population is small. Others have reported weaker correlations for WWTPs with smaller catchment areas, ,,, and attributed this to various factors including that smaller systems are inherently more noisy (because one infected individual has more impact) or are less able to perform regular sampling. Further, correlations generally increased for increasing sewershed facility service area and flow rate (Figure ).…”

Section: Resultsmentioning

confidence: 99%

“…The relationship between clinical cases and levels of circulating virus has been seen to shift over time as a pandemic progresses. , Factors such as vaccination, naturally acquired immunity, testing format/access, social distancing, and the rise and fall of variants can all impact the relationship. The complex interactions between these factors make understanding and predicting changes in the relationship between cases and wastewater signal difficult, if not impossible.…”

Section: Resultsmentioning

confidence: 99%

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View of an Evolving Pandemic: Changes in the Relationship Between Clinical Cases and Levels of SARS-CoV-2 RNA in Colorado Wastewater

Ghanbari,

Huang,

Luc

et al. 2024

ACS EST Water

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The utility and interpretation of SARS-CoV-2 wastewater monitoring data as a predictor of community health can be confounded by variables such as wastewater system complexity, viral variants, and human behavior, including vaccination status and use of at-home tests. Here, we explored the relationship between the COVID caseload and SARS-CoV-2 concentration in wastewater for 23 locations over a 22-month period as the pandemic evolved. Spearman’s rank analysis showed strong correlations (ρ > 0.7) for most facilities, independent of normalization. While correlations remained strong throughout the pandemic, application of change point analysis (CPA) identified shifts in the relationship between reported clinical cases and the wastewater signal over time. These shifts did not generally coincide with known pandemic milestones, suggesting the involvement of multiple interacting or unknown variables. Models accounting for these shifts in the pandemic phase showed significantly improved predictions of reported caseloads. Additionally, the existence of change points highlights the increased reliability of wastewater data over clinical data when changes in the ratio of cases to wastewater concentrations are due to changes in human immunity and behaviors. In future pandemics, public health professionals will ideally be aware that the case-to-copy ratio can change unpredictably as pandemics evolve, and CPA can support public health decision-making.

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Section: Resultsmentioning

confidence: 99%

Section: ■ Results and Discussionmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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View of an Evolving Pandemic: Changes in the Relationship Between Clinical Cases and Levels of SARS-CoV-2 RNA in Colorado Wastewater

Ghanbari,

Huang,

Luc

et al. 2024

ACS EST Water

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“…7 Several studies have illustrated a positive correlation of viral concentration in WW with the number of SARS-CoV-2 cases, and many settings have established WBE to approximate the disease burden of COVID-19 in communities. 8–10 This development has been especially useful while health systems were overwhelmed, and documented examples of public health actions based on WW data are now emerging. 11–13…”

Section: Introductionmentioning

confidence: 99%

Stakeholder Interviews to Inform Best Practice for Public Facing COVID-19 Wastewater Dashboards

Morales,

Rhodes,

O’Reilly

2024

Preprint

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BackgroundWW-based epidemiology is the detection of pathogens from wastewater, typically sewage systems. Its use gained popularity during the COVID-19 pandemic as a rapid and non-invasive way to assess infection prevalence in a population. Public facing dashboards for SARS-CoV-2 were developed in response to the discovery that RNA biomarkers were being shed in faeces before symptoms. However, there is not a standard template or guidance for countries to follow. The aim of this research is to reflect on how currently available dashboards evolved during the pandemic and identify suitable content and rationale from these experiences.Methods and ResultsInterviews were carried out with implementers and users of dashboards for SARS-CoV-2 WW data across Europe and North America. The interviews addressed commonalities and inconsistencies in displaying epidemiological data of SARS-CoV-2, clinical parameters of COVID-19, data on variants, and data transparency. The thematic analysis identified WW dashboard elements that can facilitate standardization, or at least interoperability. These elements emphasise communication among developers under the same organization, open access for identified stakeholders, and data summarized with a time-intensive graphic analysis through normalizing at least by population. Simultaneous communication of clinical surveillance is recommended. More research is needed on flow and faecal indicators for normalization of WW data, and on the analysis and representation of variants.DiscussionWW dashboard development between 2020-2023 provided a ‘real-time’ iterative process of data representation, and several recommendations have been identified. Communication of data through dashboards has the potential to support early warning systems for infectious diseases.

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Leveraging wastewater surveillance to actively monitor Covid‐19 community dynamics in rural areas with reduced reliance on clinical testing

Jarvie,

Nguyen,

Southwell

et al. 2024

Applied Research

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The prevalence of COVID‐19 in the community has become more difficult to gauge utilizing clinical testing due to a decrease in reported test results stemming from the availability of at‐home test kits and a reduction in the number of cases seeking medical treatment. The purpose of this study was to examine the trend of diminishing correlation between reported clinical cases of COVID‐19 and wastewater‐based surveillance epidemiological data as home testing became available in the Eastern Upper Peninsula of Michigan. Wastewater grab samples were collected weekly from 16 regional locations from June 2021‐December 2022. Samples were analyzed for SARS‐CoV‐2 N1 and N2 viral particles using reverse transcriptase digital droplet polymerase chain reaction (RT ddPCR). N1 and N2 gene copies were correlated with clinical cases. The t‐test was used to determine correlation deterioration point. Clinical cases post‐deterioration were calculated for high‐correlated pre‐deterioration locations using linear regression. Correlation between the wastewater‐based surveillance of SARS‐CoV‐2 and reported clinical cases deteriorated after February 1, 2022. This corresponds with the timeframe in which commercially available at‐home test kits became available in the United States. The increase in at‐home testing for SARS‐CoV‐2 likely contributed to the decrease in reported clinical positive tests in early 2022, providing an unrealistic picture of the presence of Covid‐19 in the community. As measures to reduce exposure such as personal masking, clinical testing, social isolating, and quarantining continue to decline, wastewater surveillance for the presence of SARS‐CoV‐2 may be the best method for public health professionals to remain aware of virus dynamics in localized regions. Time‐series modeling adds another layer of information when clinical data is unobtainable or underreported.This article is protected by copyright. All rights reserved.

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The dynamic relationship between COVID-19 cases and SARS-CoV-2 wastewater concentrations across time and space: Considerations for model training data sets

Cited by 24 publications

References 54 publications

View of an Evolving Pandemic: Changes in the Relationship Between Clinical Cases and Levels of SARS-CoV-2 RNA in Colorado Wastewater

View of an Evolving Pandemic: Changes in the Relationship Between Clinical Cases and Levels of SARS-CoV-2 RNA in Colorado Wastewater

Stakeholder Interviews to Inform Best Practice for Public Facing COVID-19 Wastewater Dashboards

Leveraging wastewater surveillance to actively monitor Covid‐19 community dynamics in rural areas with reduced reliance on clinical testing

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