Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Fielding-Miller, Rebecca; Karthikeyan, Smruthi; Gaines, Tommi; Garfein, Richard S.; Salido, Rodolfo A.; Cantu, Victor; Kohn, Laura; Martin, Natasha K.; Wynn, Adriane; Wijaya, Carrissa; Flores, Marlene; Omaleki, Vinton; Majnoonian, Araz; González‐Zúñiga, Patricia; Nguyen, Megan; Vo, Anh Van; Le, Tina; Duong, Dawn; Hassani, Ashkan; Tweeten, Samantha; Jepsen, Kristen; Henson, Benjamin; Birmingham, Amanda; Hoff, Peter De; Mark, Adam; Nasamran, Chanond A; Rosenthal, Sara Brin; Moshiri, Niema; Fisch, Kathleen M.; Humphrey, Greg; Farmer, Sawyer; Tubb, Helena M.; Valles, Tommy; Morris, Justin; Kang, Jaeyoung; Khaleghi, Behnam; Young, Colin; Akel, Ameen; Eilert, Sean; Eno, Justin; Curewitz, Ken; Laurent, Louise C.; Rosing, Tajana; Knight, Rob; Baer, Nathan A; Barber, Tom; Castro-Martínez, Anelizze; Chacón, Marisol; Cheung, Willi; Crescini, Evelyn S; Eisner, Emily; Vargas, Lizbeth Franco; Hakim, Abbas; Hobbs, Charlotte A.; Lastrella, Alma L; Lawrence, Elijah S; Matteson, Nathaniel L.; Gangavarapu, Karthik; Ngo, Toan T; Seaver, Phoebe; Smoot, Elizabeth W; Tsai, Rebecca; Xia, Bing; Aigner, Stefan; Anderson, Catelyn; Belda-Ferre, Pedro; Sathe, Shashank; Zeller, Mark; Andersen, Kristian G.; Yeo, G; Kurzban, Ezra

doi:10.1016/j.lana.2023.100449

Cited by 14 publications

(13 citation statements)

References 23 publications

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“…School wastewater was positive at three of the six schools studied peaking at 2.7 × 10 6 gene copies per litre in one school, while at the WWTP, it was not detectable at any point in the study. This study validates for another respiratory pathogen that building level WBS provides more spatial granularity than WWTP level [73 ▪ ]. Wastewater surveillance has also been shown to be useful for notifying building occupants following a positive wastewater sample.…”

Section: New Insights From Hospital Healthcare Facility and Healthcar...supporting

confidence: 67%

“…Wastewater surveillance has also been shown to be useful for notifying building occupants following a positive wastewater sample. In schools and other settings, this notification was significantly associated with increased diagnostic testing uptake [73 ▪ ,74]. As hospitals are also areas for enhanced respiratory transmission, this suggests that wastewater could be one approach to proactively monitor vulnerable communities and elicit behaviour change better during periods of enhanced risk.…”

Section: New Insights From Hospital Healthcare Facility and Healthcar...mentioning

confidence: 99%

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Wastewater-based epidemiology for surveillance of infectious diseases in healthcare settings

Hassard

Fernández

Castro-Gutiérrez

2023

Current Opinion in Infectious Diseases

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Purpose of review Wastewater-based surveillance (WBS) (epidemiology) using near-source sampling (NSS) in large buildings, hospitals and care homes is reviewed covering three main areas: state-of-the-art WBS, benefits/opportunities NSS has for hospital infection control systems and new insights from hospital wastewater surveillance and policy implications. Recent findings Wastewater provides aggregate, anonymous sources of data where the spatial resolution can be linked to populations being served. In hospitals, clear links established between wastewater RNA-fragments signal to nosocomial COVID-19 cases/outbreaks. Detecting other targets from hospital wastewater such as antimicrobial resistance markers is considered a substantial opportunity for this technology. Other clinically relevant infections, that is influenza and monkeypox, can be perceived, and sub-variant resolution to target public health response in near real time to benefit hospital infection control. WBS can reduce hospitals’ clinical testing requirements, as diagnostic costs are aggregated into fewer samples while still detecting single cases. Summary WBS using NSS can inform infectious disease monitoring earlier, faster and cheaper than conventional monitoring. Routine sampling using wastewater provides a platform for risk-based sampling and enables smarter allocation of resources. Finally, hospital wastewater can be used for the benefit of the wastewater surveillance field as a promising source to monitor emerging threats and resolve longstanding questions on faecal shedding. Hospital monitoring in low-income settings is considered a priority for future research.

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Section: New Insights From Hospital Healthcare Facility and Healthcar...supporting

confidence: 67%

Section: New Insights From Hospital Healthcare Facility and Healthcar...mentioning

confidence: 99%

Wastewater-based epidemiology for surveillance of infectious diseases in healthcare settings

Hassard

Fernández

Castro-Gutiérrez

2023

Current Opinion in Infectious Diseases

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“…SASEA is based in San Diego County, a large, urban county in southern California. 17 Study sites consisted of elementary, middle schools, and child care centers, which were eligible if they were located in a census tract with high levels of social vulnerability according to the California Healthy Places Index 18 and in ZIP codes with COVID-19 infection rates in the top quintile as of August 2020. Eight public schools, one charter school and one private school serving elementary and middle school students and three childcare sites serving children ages 0 to 5 years participated in the project.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative and qualitative data for the present study were obtained from a community survey and focus group discussions (FGDs), respectively, that were conducted through the Safer at School Early Alert (SASEA) project. SASEA is based in San Diego County, a large, urban county in southern California 17 . Study sites consisted of elementary, middle schools, and child care centers, which were eligible if they were located in a census tract with high levels of social vulnerability according to the California Healthy Places Index 18 and in ZIP codes with COVID‐19 infection rates in the top quintile as of August 2020.…”

Section: Methodsmentioning

confidence: 99%

Challenges of COVID‐19 Case Investigation and Contact Tracing in School Settings: An Initial Investigation

Majnoonian

et al. 2023

Journal of School Health

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Background Case investigation and contact tracing (CI/CT) are important public health tools to interrupt COVID‐19 transmission. Our study aims to understand how parents and school staff perceive COVID‐19 CI/CT. Methods Using a mixed methods approach, we distributed a community survey and conducted 15 focus group discussions (FGDs) in English and Spanish between December 2020 and March 2021 with 20 parents and 22 staff from schools in San Diego County ZIP Codes with COVID‐19 rates in the top quintile as of August 2020. Results One in 4 survey respondents reported that they would be reluctant to participate in CI/CT. FGDs revealed themes of mistrust in government authorities, overburdened institutions, unfamiliarity with CI/CT, and uncertainty about its reliability. School community members emphasized that parents trust schools to be involved in CI/CT efforts, but schools are overwhelmed with this added responsibility. Conclusions Investing in schools as community hubs is necessary so they can become important partners in prevention and mitigation in public health.

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“…Expanding spatial granularity of WBE surveillance can improve the accuracy and actionability of routine wastewater monitoring. Several prior studies focused on sampling sites upstream of the WWTP, such as lift stations, schools, universities, and hospitals (Castro-Gutierrez et al, 2022; Fielding-Miller et al, 2023; Gibas et al, 2021; Haak et al, 2022; Holm et al, 2022; Scott et al, 2021; Spurbeck et al, 2021). The WBE program for the City of Houston has routinely made use of sub-sewershed measurements (hou-wastewater epi.org/, 2023).…”

Section: Introductionmentioning

confidence: 99%

Online trend estimation and detection of trend deviations in sub-sewershed time series of SARS-CoV-2 RNA measured in wastewater

Ensor,

Schedler,

Sun

et al. 2023

Preprint

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Wastewater surveillance has proven a key public health tool to understand a wide range of community health diseases and has proven to be especially critical to health departments throughout the SARS CoV-2 pandemic. The size of the population served by a wastewater treatment plant (WWTP) may limit the targeted insight about community disease dynamics. To investigate this concern, samples of wastewater were obtained at lift stations upstream of WWTPs within the sewer network. First, an online, semi-automatic time series model is fitted to the weekly measurements of WWTP samples to estimate the viral trend for the community and compared to the time series observations from the lift stations. Second, deviations from the WWTP trend are identified using an Exponentially Weighted Moving Average (EWMA) control chart. The analysis reveals that the lift stations display slightly different dynamics than the larger WWTP, highlighting the more granular insight gleaned from sampling sites which represent smaller populations. Discussion focuses on the use of our methods to support rapid public health decision-making based on additional, targeted samples in times of concern.

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Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Cited by 14 publications

References 23 publications

Wastewater-based epidemiology for surveillance of infectious diseases in healthcare settings

Wastewater-based epidemiology for surveillance of infectious diseases in healthcare settings

Challenges of COVID‐19 Case Investigation and Contact Tracing in School Settings: An Initial Investigation

Online trend estimation and detection of trend deviations in sub-sewershed time series of SARS-CoV-2 RNA measured in wastewater

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