WasteWater-

Based
Epidemiology
& COVID-19

M I C H A E L A U S T I N

P H 6 3 4 , S P R I N G
2 0 2 1 , D R . L O P E Z
WasteWater-Based Epidemiology (WBE) & COVID-19
• Epidemic surveillance relies heavily on clinical testing
• RT-PCR of nasopharyngeal swabs to detect RNA signal is the standard procedure to confirm cases

• Serology tests to obtain antibody titers indicating past and present infections

• Challenges with conventional surveillance testing:

• Presence of both Asymptomatic and Presymptomatic Transmission (as high as 50%)1

• Testing relies mostly on identifying Symptomatic cases (after a long incubation period)

• Delay in Turn-Around Time of Results for each individual test

• Testing bottlenecks identified early in the pandemic:

• Limited reagents, staffing, PPE, & coordination within the existing healthcare infrastructure

• Must be followed-up w/ contact tracing for the isolation of cases and quarantine of contacts

• Potential for false positives and false negatives

• Must rely heavily on the disease prevalence to determine the likelihood of disease based on testing

• Wastewater-Based Epidemiology
• Cheaper and potentially more efficient means of tracking infectious agents in communities

• Ethical considerations given that not relying on individual clinical testing

• Can target specific communities

WasteWater-Based Epidemiology (WBE) & COVID-19
• SARS-CoV-2 not the only recent Zoonotic disease outbreak
• Ebola (2000)

• SARS-CoV (2003)

• H1N1 (2009)- the second since Spanish flu outbreak in 1918

• MERS-CoV (2012)

• Zika (2015)

• Nipah (2018)

• WBE successful early applications:

• Tracking illicit drug usage and lifestyle factors

• Detection of a subclinical (silent) Polio outbreak in Israel (2013-14) 2

• WBE applications during COVID-19:

• Early warning System for college campuses

• Tracking and for prediction of COVID-19 by Public Health authorities

• Community Dashboards
Hamouda, et al. (2021)3
Hamouda, et al. (2021)3
Hamouda, et al. (2021)3
Kantor at el. (2021)4
Buschman, UCSD NewsRoom5
Karthikeyan et al.6
Karthikeyan et al.6
 References
• 1. Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 Transmission From People Without COVID-19 Symptoms. JAMA
Network Open. 2021;4(1):e2035057-e2035057. doi:10.1001/jamanetworkopen.2020.35057

• 2. Brouwer AF, Eisenberg JNS, Pomeroy CD, et al. Epidemiology of the silent polio outbreak in Rahat, Israel, based on modeling of
environmental surveillance data. Proceedings of the National Academy of Sciences. 2018;115(45):E10625-E10633.
doi:10.1073/pnas.1808798115

• 3. Hamouda M, Mustafa F, Maraqa M, Rizvi T, Aly Hassan A. Wastewater surveillance for SARS-CoV-2: Lessons learnt from recent
studies to define future applications. Sci Total Environ. 2021;759:143493-143493. doi:10.1016/j.scitotenv.2020.143493

• 4. Kantor RS, Nelson KL, Greenwald HD, Kennedy LC. Challenges in Measuring the Recovery of SARS-CoV-2 from Wastewater.
Environmental Science & Technology. 2021/03/16 2021;55(6):3514-3519. doi:10.1021/acs.est.0c08210

• 5. Buschman H. Sewage-Handling Robots Help Predict COVID-19 Outbreaks in San Diego. UCSD Newsroom March 03, 2021.
https://health.ucsd.edu/news/releases/Pages/2021-03-03-seewage-handling-robots-help-predict-covid-19-outbreaks-in-san-diego.aspx

• 6. Karthikeyan S, Ronquillo N, Belda-Ferre P, et al. High-Throughput Wastewater SARS-CoV-2 Detection Enables Forecasting of
Community Infection Dynamics in San Diego County. mSystems. 2021;6(2):e00045-21. doi:10.1128/mSystems.00045-21