Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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2 Wastewater Surveillance for COVID-19
2 Wastewater Surveillance for COVID-19
Pages 21-44
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From page 22... ...
In other words, could wastewater data be a leading indicator of the traditional surveillance data time series and provide an early warning of clinical trends? If so, could they help direct more timely public health decisions?
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From page 23... ...
. FIGURE 2-1 Example dashboards that have presented SARS-CoV-2 wastewater data without other surveillance data from the Sewer Coronavirus Alert Network (SCAN)
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From page 25... ...
Data in published reports and on dashboards have demonstrated the value of understanding SARS-CoV-2 wastewater data trends in both high and low–infection prevalence settings. In high-prevalence scenarios, quantitative wastewater results identify increasing, plateauing, or declining trends in community infection prevalence.
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From page 26... ...
The different conclusions regarding lead times reported between studies could stem from numerous factors, including ● the phase of the pandemic, with different phases having different testing availability and potentially changing viral shedding characteristics associated with different variants and shifting natural and vaccine-induced immunities (Wu et al., 2022b) ; ● different amounts of time required for sample transport, analysis, and data reporting; ● different wastewater sampling frequencies; ● the sewershed structure and population; and ● the specifics of the conventional surveillance data to which the wastewater data are compared (e.g., date of specimen collection, date of symptom onset, and date of data reporting)
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From page 27... ...
For accurate assessments of wastewater lead times, it is important to compare the reporting date of both clinical case counts and wastewater concentrations for public health officials. Whereas the results of wastewater surveillance data leading clinical case data are mixed, wastewater data trends have consistently led hospitalization and death data trends regardless of the phase of the pandemic or the location of the study (D'Aoust et al., 2021; Galani et al., 2022; Peccia et al., 2020)
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From page 28... ...
. The value of wastewater surveillance data as a leading indicator of conventional surveillance data can be enhanced at times when there are significant testing delays and case/hospitalization/death number reporting delays and when wastewater data do not have a significant reporting delay.
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From page 29... ...
The COVID-19 case data are typically aggregated for the entire county on public health dashboards. Wastewater data from the two communities, which are analyzed with the same methods in the same laboratory, have provided higher spatial resolution compared to the aggregated county case data.
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From page 30... ...
In this case, the community-scale wastewater data provide higher spatial resolution than that provided by aggregated county surveillance data and have identified differences in trends and burdens between the two communities. NOTE: PMMoV = pepper mild mottle virus.
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From page 31... ...
Wastewater variant tracking has been used to complement clinical testing for early detection and understanding of the spread of known and emerging variants. Improved understanding of shifts in virus epidemiology can be useful for predicting the risk of a new surge, directing resource allocation and prioritization, and refining public health messaging (Kirby et al., 2021)
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From page 33... ...
. In this case, the quantitative PCR assay had been rapidly developed and implemented to capture the introduction of the Omicron variant to the PREPUBLICATION COPY
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From page 34... ...
(2022) demonstrated that variants of concern could be identified in wastewater via high-resolution genome sequencing up to 2 weeks prior to their detection in clinical samples.4 USE IN INFORMING PUBLIC HEALTH ACTIONS In this section, the committee discusses the usefulness of wastewater surveillance data to inform public health decision making and to enhance public awareness of COVID-19 disease transmission, thereby informing public health–related actions.
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From page 36... ...
. Using wastewater data combined with other surveillance data, the City of Tempe, Arizona canceled public special events and meetings on March 19, 2020, and the mayor issued an order for the temporary closure of dining, fitness, and recreation venues.
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From page 37... ...
. The City of Davis, California, used wastewater surveillance data to determine where to send geotargeted public health communications (e.g., door hangers, texts, phone calls, emails)
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From page 38... ...
Informing Clinical Resource Allocations A different example of wastewater data use was in the allocation of clinical resources. For example: In central Oklahoma, physicians used the breakdown of the Omicron and Delta variants in the wastewater to decide where to allocate monoclonal antibody therapies (Haley Reeves, University of Oklahoma, personal communication, 2022)
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From page 39... ...
COVID Data Tracker has had more than 1 million views, and its public wastewater data have been downloaded more than 50,600 times between February 2, 2022, and July 13, 2022 (Rachel West, CDC, personal communication, 2022)
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From page 41... ...
Early information and anecdotal accounts suggest that mentions of wastewater data by public health officials likely increase public awareness. For example, in the summer of 2020, Oklahoma wastewater surveillance indicated high levels of SARS-CoV-2 RNA in in Anadarko, Oklahoma.
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From page 42... ...
Although this undoubtedly increased public knowledge on the topic, little is known about how media attention has affected public understanding, perception, and use of wastewater data or how wastewater surveillance has attracted readers compared to other COVID-19 surveillance reporting. With respect to public awareness and perception of wastewater surveillance for SARSCoV-2, a study of Louisville, Kentucky, residents in August 2021 found that 43 percent were aware that SARS-CoV-2 could be detected in their sewer system; 49 percent said they did not know if that was possible (Holm et al., 2022a)
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From page 43... ...
Clinical testing was the priority at health laboratories, and most of the environmental microbiology academic and research laboratories were initially closed for the pandemic response. CDC's biosafety recommendations for laboratory requirements to process wastewater samples created further hurdles as many environmental laboratories now had to meet biosafety Level 2 or higher.
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From page 44... ...
Although wastewater surveillance is not currently being used as a standalone method to reliably estimate the number of community infections, SARS-CoV-2 wastewater data have correlated with case data and other conventional public health surveillance data. Depending on a number of factors, including wastewater sampling frequency, the time required for sample transport and analysis, and the time required for data reporting, wastewater SARS-CoV-2 viral trends have the potential to be reported more quickly or along a more consistent time frame than conventional disease surveillance reporting.
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