Understanding and managing uncertainty and variability for wastewater monitoring beyond the pandemic: Lessons learned from the United Kingdom National COVID-19 Surveillance Programmes

Wade, Matthew J.; Jacomo, Anna Lo; Armenise, Elena; Brown, Mathew; Bunce, Joshua T.; Cameron, Graeme; Fang, Zhou; Farkas, Kata; Gilpin, Deidre; Graham, David W.; Grimsley, Jasmine M. S.; Hart, Alwyn; Hoffmann, Till; Jackson, Katherine; Jones, Davey L.; Lilley, Chris; McGrath, John W.; McKinley, Jennifer; McSparron, Cormac; Nejad, Behnam Firoozi; Morvan, Mario; Quintela-Baluja, Marcos; Roberts, A. M. I.; Singer, Andrew C.; Souque, Célia; Speight, Vanessa; Sweetapple, Chris; Watts, Glenn; Weightman, Andrew J.; Kasprzyk-Hordern, Barbara

doi:10.1002/essoar.10507606.2

Cited by 25 publications

(24 citation statements)

References 66 publications

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“…The lead-lag relationship between wastewater concentrations of SARS-CoV-2 RNA and case rates has not remained constant during the pandemic and more research is needed to understand the drivers of this variance (Wade et al 2021). In England, the quantitative polymerase chain reaction qPCR) data are generated on average within 36 hours of sample collection, while in South Africa the time varies depending on the testing sites and location from labs, ranging between 2 to 4 days.…”

Section: Data Collection Analysis Sharing and Usementioning

confidence: 99%

Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 – case studies from South Africa, the Netherlands, Turkey and England

Tlhagale

Liphadzi

Bhagwan

et al. 2022

Journal of Water and Health

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The COVID-19 pandemic has resulted in over 340 million infection cases (as of 21 January 2022) and more than 5.57 million deaths globally. In reaction, science, technology and innovation communities across the globe have organised themselves to contribute to national responses to COVID-19 disease. A significant contribution has been from the establishment of wastewater-based epidemiological (WBE) surveillance interventions and programmes for monitoring the spread of COVID-19 in at least 55 countries. Here, we examine and share experiences and lessons learnt in establishing such surveillance programmes. We use case studies to highlight testing methods and logistics considerations associated in scaling the implementing of such programmes in South Africa, the Netherlands, Turkey and England. The four countries were selected to represent different regions of the world and the perspective based on the considerable progress made in establishing and implementing their national WBE programmes. The selected countries also represent different climatic zones, economies, and development stages, which influence the implementation of national programmes of this nature and magnitude. In addition, the four countries' programmes offer good experiences and lessons learnt since they are systematic, and cover extensive areas, disseminate knowledge locally and internationally and partnered with authorities (government). The programmes also strengthened working relations and partnerships between and among local and global organisations. This paper shares these experiences and lessons to encourage others in the water and public health sectors on the benefits and value of WBE in tackling SARS-CoV-2 and related future circumstances.

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Section: Data Collection Analysis Sharing and Usementioning

confidence: 99%

Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 – case studies from South Africa, the Netherlands, Turkey and England

Tlhagale

Liphadzi

Bhagwan

et al. 2022

Journal of Water and Health

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“…Wastewater-based surveillance has been widely applied during the COVID-19 pandemic as an unbiased, aggregate and anonymous method of monitoring for population-level infection trends and the spread of variants, 6 but it should not replace clinical testing for infectious diseases. Despite ethical concerns, wastewater-based surveillance of prisons has been used in numerous countries for surveillance of self-administered prescription and recreational drugs.…”

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Wastewater surveillance for rapid identification of infectious diseases in prisons

et al. 2022

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“…Specifically, observing changes in the relative WC ratio may allow for the detection of changes in reported clinical cases that are not linked to actual changes in viral load in the community but are instead linked to shifts in testing rules and regulations, testing strategies, or fundamental changes in the disease vector. It is however important to also consider potential variations and uncertainties present in WWS (Ahmed et al, 2022; Li et al, 2021; Wade et al, 2022), as these will also have an impact on the WC ratio. It is hypothesized that in this study, due to trends observed during the change in testing strategies, is it likely that reported clinical cases may have been underreported in Ottawa and to a lesser extent, Peel, following the modification to the testing strategies applied in these communities.…”

Section: Resultsmentioning

confidence: 99%

Wastewater to clinical case (WC) ratio of COVID-19 identifies insufficient clinical testing, onset of new variants of concern and population immunity in urban communities

D’Aoust¹,

Tian²,

Towhid³

et al. 2022

Preprint

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Clinical testing has been the cornerstone of public health monitoring and infection control efforts in communities throughout the COVID-19 pandemic. With the extant and anticipated reduction of clinical testing as the disease moves into an endemic state, SARS-CoV-2 wastewater surveillance (WWS) is likely to have greater value as an important diagnostic tool to inform public health. As the widespread adoption of WWS is relatively new at the scale employed for COVID-19, interpretation of data, including the relationship to clinical cases, has yet to be standardized. An in-depth analysis of the metrics derived from WWS is required for public health units/agencies to interpret and utilize WWS-acquired data effectively and efficiently. In this study, the SARS-CoV-2 wastewater signal to clinical cases (WC) ratio was investigated across seven different cities in Canada over periods ranging from 8 to 21 months. Significant increases in the WC ratio occurred when clinical testing eligibility was modified to appointment-only testing, identifying a period of insufficient clinical testing in these communities. The WC ratio decreased significantly during the emergence of the Alpha variant of concern (VOC) in a relatively non-immunized community’s wastewater (40-60% allelic proportion), while a more muted decrease in the WC ratio signaled the emergence of the Delta VOC in a relatively well-immunized community’s wastewater (40-60% allelic proportion). Finally, a rapid and significant decrease in the WC ratio signaled the emergence of the Omicron VOC, likely because of the variant’s greater effectiveness at evading immunity, leading to a significant number of new reported clinical cases, even when vaccine-induced community immunity was high. The WC ratio, used as an additional monitoring metric, complements clinical case counts and wastewater signals as individual metrics in its ability to identify important epidemiological occurrences, adding value to WWS as a diagnostic technology during the COVID-19 pandemic and likely for future pandemics.

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Understanding and managing uncertainty and variability for wastewater monitoring beyond the pandemic: Lessons learned from the United Kingdom National COVID-19 Surveillance Programmes

Cited by 25 publications

References 66 publications

Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 – case studies from South Africa, the Netherlands, Turkey and England

Establishment of local wastewater-based surveillance programmes in response to the spread and infection of COVID-19 – case studies from South Africa, the Netherlands, Turkey and England

Wastewater surveillance for rapid identification of infectious diseases in prisons

Wastewater to clinical case (WC) ratio of COVID-19 identifies insufficient clinical testing, onset of new variants of concern and population immunity in urban communities

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