Making waves: Wastewater surveillance of SARS-CoV-2 for population-based health management

Abstract

Worldwide, clinical data remain the gold standard for disease surveillance and tracking. However, such data are limited due to factors such as reporting bias and inability to track asymptomatic disease carriers. Disease agents are excreted in the urine and feces of infected individuals regardless of disease symptom severity. Wastewater surveillance-that is, monitoring disease via human effluent-represents a valuable complement to clinical approaches. Because wastewater is relatively inexpensive and easy to collect and can be monitored at different levels of population aggregation as needed, wastewater surveillance can offer a real-time, cost-effective view of a community's health that is independent of biases associated with case-reporting. For SARS-CoV-2 and other disease-causing agents we envision an aggregate wastewatermonitoring system at the level of a wastewater treatment plant and exploratory or confirmatory monitoring of the sewerage system at the neighborhood scale to identify or confirm clusters of infection or assess impact of control measures where transmission has been established. Implementation will require constructing a framework with collaborating government agencies, public or private utilities, and civil society organizations for appropriate use of data collected from wastewater, identification of an appropriate scale of sample collection and aggregation to balance privacy concerns and risk of stigmatization with public health preservation, and consideration of the social implications of wastewater surveillance.

Surveillance of SARS-CoV-2 RNA in wastewater: Methods optimization and quality control are crucial for generating reliable public health information

“…The sensitive detection of SARS-CoV-2 RNA in wastewater, and thereby the presence of infections within a community depends on both the wastewater sampling and the molecular-based methods employed, which remain diverse and unstandardized, and often lack important information needed by public health units to interpret and apply the information [ 19 , 20 , 21 ]. To date, little has been documented on the performance of concentration, extraction, and detection methods for SARS-CoV-2 in wastewater [ 22 ].…”

SARS-CoV-2 in environmental perspective: Occurrence, persistence, surveillance, inactivation and challenges

“…Enteric virus transmission to the community with wastewater streams is now a major point of focus and concern [12] , [70] even though SARS-CoV-2 transmission via the faecal-oral route is still unclear with the limited information [19] , [44] , [86] , [87] . The possibility of community transmissibility spread cannot be ignored based on the previous experience [5] , [18] , [12] , [81] , [88] .…”

Coronavirus 2 (SARS-CoV-2) in water environments: Current status, challenges and research opportunities

“…Both upstream sampling (i.e., at sewerage maintenance holes) and downstream sampling (i.e., at the WWTP) approach can be used; however, upstream sampling is more appropriate due to variability in downstream samples. A GIS-based sewerage map and flow rates would aid in the selection of upstream sampling locations [ 71 ]. Quantification of SARS-CoV-2 RNA in settled solids in WWTPs may also be used as a reliable and sensitive target for WBE [ 72 ].…”