Regressing SARS-CoV-2 sewage measurements onto COVID-19 burden in the population: a proof-of-concept for quantitative environmental surveillance

Abstract

SARS-CoV-2 is an RNA virus, a member of the coronavirus family of respiratory viruses that includes SARS-CoV-1 and MERS. COVID-19, the clinical syndrome caused by SARS-CoV-2, has evolved into a global pandemic with more than 2,900,000 people infected. It has had an acute and dramatic impact on health care systems, economies, and societies of affected countries within these few months. Widespread testing and tracing efforts are employed in many countries in order to contain and mitigate this pandemic. Recent data has indicated that fecal shedding of SARS-CoV-2 is common, and that the virus can be detected in wastewater. This indicates that wastewater monitoring is a potentially efficient tool for epidemiological surveillance of SARS-CoV-2 infection in large populations at relevant scales. Collecting raw sewage data, representing specific districts, and crosslinking this data with the number of infected people from each location, will enable us to derive and provide quantitative surveillance tools. In particular, this will provide important means to (i) estimate the extent of outbreaks and their spatial distributions, based primarily on in-sewer measurements (ii) manage the early-warning system quantitatively and efficiently (and similarly, verify disease elimination). Here we report the development of a virus concentration method using PEG or alum, providing an important a tool for detection of SARS-CoV-2 RNA in sewage and relating it to the local populations and geographic information. This will provide a proof of concept for the use of sewage associated virus data as a reliable epidemiological tool.

Wastewater surveillance for population-wide Covid-19: The present and future

“…Sewage monitoring had already been established as a tool to detect existing threats from pathogens, particularly for polio virus (Anis et al, 2013;Berchenko et al, 2017;Brouwer et al, 2018;WHO, 2003). And within a few short months after the emergence of Covid-19, the first pilot studies began to appear for WBE's possible use as a tool for tracking Covid-19 (e.g., Ahmed et al, 2020;Bar Or et al, 2020;La Rosa et al, 2020;Medema et al, 2020;Nemudryi et al, 2020;Randazzo et al, 2020aRandazzo et al, , 2020bWu et al, 2020b;Wurtzer et al, 2020). However, much more research will be required for its full development.…”

“…Addressing each of these points would be required for calibrating any WBE monitoring method so that data could be related to actual per capita infection rates. A number of different means have been proposed, the inverse regression of qPCR cycle thresholds with known infection rates being one example (Bar Or et al, 2020). Only if calibration could be achieved, would WBE then be able to reliably estimate the total number of infected people at any given time.…”

“…This approach is analogous to conventional diagnostic urinalysis performed en masse but instead targets sewage (Daughton, 2020a;Sims and Kasprzyk-Hordern, 2020). Designed to quantify the community-wide usage of a wide expanse of chemicals (originally illicit drugs), this methodology (Wastewater-Based Epidemiology -WBE) is now beginning to be applied to Covid-19 (see: Ahmed et al, 2020;Bar Or et al, 2020;La Rosa et al, 2020;Medema et al, 2020;Nemudryi et al, 2020;Randazzo et al, 2020aRandazzo et al, , 2020bWu et al, 2020b;Wurtzer et al, 2020). However, the numbers of research projects and pilot studies currently planned or in progress globally far exceed these and are rapidly growing.…”

The role of wastewater treatment plants as tools for SARS-CoV-2 early detection and removal

“…In the case of SARS-CoV-2, considering that the virus was found both in stool samples and wastewater as previously described, several authors have proposed to use WBE as a tool to monitor the pandemic [ 41 , [76] , [77] , [78] , [79] , [80] , [86] , [87] , [88] , [89] , [90] , [91] , [92] , [93] , [94] , [95] , [96] , [97] , [98] , [99] , [100] ]. Thus, Medema et al [ 38 ] reported that sewage surveillance could be a sensitive tool to monitor SARS-CoV-2 circulation in the population since it could be detected prior to symptoms being reported in the local population.…”

City-level SARS-CoV-2 sewage surveillance

“…10.19.20215244 doi: medRxiv preprint NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. 8 School of Public Health, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 9 KANDO, Environment Services Ltd, Tsor St 8, Kokhav Ya'ir Tzur Yigal, Israel. 10 Unit of Environmental Engineering, Ben-Gurion University of the Negev, Beer-Sheva,…”