Effectiveness of Wastewater-Based Epidemiology as an Early Warning Tool to Detect SARS-CoV-2 (COVID-19)

Abstract

Medical diagnostic tests to detect Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) for individuals in the United States were initially limited to people who were traveling or symptomatic to track disease incidence due to the cost of providing testing for all people in a community on a routine basis. As an alternative to randomly sampling large groups of people to track disease incidence at significant cost, wastewater-based epidemiology (WBE) is a well-established and cost-effective technique to passively measure the prevalence of disease in communities without requiring invasive testing. WBE can also be used as a forecasting tool since the virus is shed in individuals prior to developing symptoms that might otherwise prompt testing. This study applied the WBE approach to understand its effectiveness as a possible forecasting tool by monitoring the SARS-CoV-2 levels in raw wastewater sampled from sewer lift stations at a large public university campus setting including dormitories, academic buildings, and athletic facilities. The WBE analysis was conducted by sampling from building-specific lift stations and enumerating target viral copies using RT-qPCR analysis. The WBE results were compared with the 7-day rolling averages of confirmed infected individuals for the following week after the wastewater sample analysis. In most cases, changes in the WBE outcomes were followed by similar trends in the clinical data. The positive predictive value of the applied WBE approach was 86% for the following week of the sample collection. In contrast, positive correlations between the two data with Spearmen correlation (r s ) ranged from 0.16 to 0.36. A stronger correlation (r s = 0.18 to 0.51) was observed when WBE results were compared with COVID-19 cases identified on the next day of the sampling events. The P value of 0.007 for Dorm A suggests high significance, while moderate significance was observed for the other dormitories (B, C, and D). The outcomes of this investigation demonstrate that WBE can be a valuable tool to track the progression of diseases like COVID-19 seven days before diagnostic cases are confirmed, allowing authorities to take necessary measures in advance and also enable authorities to decide to reopen a facility after a quarantine.