Wastewater Surveillance for SARS-CoV-2 in an Atlanta, Georgia Jail: A study of the feasibility of wastewater monitoring and correlation of building wastewater and individual testing results

Abstract

Background Wastewater-based surveillance (WBS) on an institutional level was implemented during the COVID-19 pandemic, including carceral facilities. In this study of a mega-jail, we examined the relationship between COVID-19 diagnostic test results from jail residents and the PCR signal for SARS-CoV-2 detection in weekly samples of jail wastewater over a 28-week period. Methods This study in a Georgia Jail (average population ~2,700) was conducted October 2021-May 2022. Weekly on-site wastewater samples were collected (Moore Swabs) and tested for SARS-CoV-2 RNA using RTqPCR. The source of wastewater was identified using a tracer dye. The jail offered residents rapid antigen testing at entry. We conducted periodic mass screenings via RT-PCR of nasal swabs. We aggregated individual test data, calculated the Spearman correlation coefficient, and performed logistic regression to examine the relationship between the strength of the SARS-CoV-2 PCR signal (Ct value) in wastewater and the proportion of the jail population that tested positive for COVID-19. Results Overall, 3770 individual nasal specimens were collected; 3.4% were COVID-positive. Weekly diagnostic test positivity ranged from 0%-29.5%. Dye tests demonstrated that a single wastewater collection point was sufficiently representative of the jails aggregate viral load. Twenty-five wastewater samples were collected. RT-qPCR Ct values for wastewater samples with SARS-CoV-2 RNA ranged from 28.1-39.9. A strong inverse correlation was observed between diagnostic test positivity and Ct value (r= -0.67, p < 0.01). Conclusion WBS was shown to be an effective strategy for surveilling COVID-19 in a large jail. Strong partnerships with the jail administration are essential to the success of WBS surveillance.

Surveillance via wastewater monitoring and nasal self-collection of specimens (The SWANSS Study): A CFIR-informed qualitative study with key carceral and healthcare stakeholders

“…Opt-out nasal swab screening by laboratory-based PCR was conducted from October 2021-May 2022 on a weekly basis, in randomly chosen housing units, averaging 300 tests per week. Results of the project indicated the correlation between community viral load found in wastewater and percent positive test results, which supported the use of WBS as a reliable proxy measurement of prevalence within the jail population [14].…”

“…SARS-CoV-2 testing at FCJ was performed by the medical vendor contracted to provide jail medical services, and third-party partners. The jail's medical team began opt-out rapid antigen testing for COVID-19 during the intake process in 2021 [14]. Additional SARS-CoV-2 testing was provided by the Georgia Department of Health (GDPH) using an outside contracted company, which also supplemented the vaccination efforts by the medical staff.…”

“…WBS data can also be used in tandem with clinical testing data provided by Polymerase Chain Reaction (PCR) and antigen testing; it can hasten the response to an outbreak and guide public health decision making [10]. We have previously demonstrated that WBS combined with NST is convenient and accurate, and acceptable among residents of FCJ [12][13][14]. The rst objective of the SWANSS (Surveillance via Wastewater monitoring And Nasal Self-Collection of Specimens) study was to nd a correlation between WBS and NST in a carceral setting [14].…”

“…We have previously demonstrated that WBS combined with NST is convenient and accurate, and acceptable among residents of FCJ [12][13][14]. The rst objective of the SWANSS (Surveillance via Wastewater monitoring And Nasal Self-Collection of Specimens) study was to nd a correlation between WBS and NST in a carceral setting [14]. The second objective was to understand the barriers and facilitators to implementing WBS coupled with low-cost ($10-25 per test), high throughput individual NST for SARS-CoV-2 through stakeholder engagement at FCJ.…”

“…The second objective was to understand the barriers and facilitators to implementing WBS coupled with low-cost ($10-25 per test), high throughput individual NST for SARS-CoV-2 through stakeholder engagement at FCJ. Data from this study were used to understand if and how these approaches could be scaled and sustained in other U.S. carceral settings for COVID-19 and other emerging and important pathogens [14].…”