Looking Forward: The Role of Academic Researchers in Building Sustainable Wastewater Surveillance Programs

Abstract

Background: In just over 2 years, tracking the COVID-19 pandemic through wastewater surveillance advanced from early reports of successful SARS-CoV-2 RNA detection in untreated wastewater to implementation of programs in at least 60 countries. Early wastewater monitoring efforts primarily originated in research laboratories and are now transitioning into more formal surveillance programs run in commercial and public health laboratories. A major challenge in this progression has been to simultaneously optimize methods and build scientific consensus while implementing surveillance programs, particularly during the rapidly changing landscape of the pandemic. Translating wastewater surveillance results for effective use by public health agencies also remains a key objective for the field. Objectives: We examined the evolution of wastewater surveillance to identify model collaborations and effective partnerships that have created rapid and sustained success. We propose needed areas of research and key roles academic researchers can play in the framework of wastewater surveillance to aid in the transition from early monitoring efforts to more formalized programs within the public health system. Discussion: Although wastewater surveillance has rapidly developed as a useful public health tool for tracking COVID-19, there remain technical challenges and open scientific questions that academic researchers are equipped to address. This includes validating methodology and backfilling important knowledge gaps, such as fate and transport of surveillance targets and epidemiological links to wastewater concentrations. Our experience in initiating and implementing wastewater surveillance programs in the United States has allowed us to reflect on key barriers and draw useful lessons on how to promote synergy between different areas of expertise. As wastewater surveillance programs are formalized, the working relationships developed between academic researchers, commercial and public health laboratories, and data users should promote knowledge co-development. We believe active involvement of academic researchers will contribute to building robust surveillance programs that will ultimately provide new insights into population health. https://doi.org/10.1289/EHP11519

Problems of Centralized Depuration Systems

“…The cost of such a control system, for example, with adequate sensors, would be negligible compared to the amount of money already spent in this sector on the construction of conventional treatment plants, the pipes to carry wastewater to these points, and the construction of pumping stations, not to mention their maintenance [38].…”

Tackling covid-19 variants

“…Wastewater data are not individual level data and cannot be stratified by age group, ethnic group, or many other variables, and it is not immediately clear what they can be realistically linked to. To interpret wastewater data appropriately and meaningfully, they must be validated against infection and disease data to establish how changes in signals in wastewater could be linked to the circulation of pathogens 2728…”

Identifying trends in SARS-CoV-2 RNA in wastewater to infer changing COVID-19 incidence: Effect of sampling frequency

“…However, there is still uncertainty about how to appropriately interpret WBE data and use it to aid public health decision-making [18][19][20]. Accurately interpreting SARS-CoV-2 RNA concentrations as increasing, decreasing, or plateauing is important for guiding pandemic response efforts.…”

“…When analyzing time-series data for trends, a large number of observations provides greater statistical power [24], and high frequency (e.g., daily) data has previously been identified as ideal for WBE to most accurately identify trends [25]. However, daily sampling and processing of wastewater can be challenging to implement [18,20], and many facilities across the United States only collect samples once per week [26,27]. Previous studies found that sampling wastewater at least twice per week is needed to detect correlations between wastewater SARS-CoV-2 RNA concentrations and incident clinical cases [6,28,29], but these studies collected data over a limited duration of time (at most six months) or did not include daily data in the analysis.…”