When case reporting becomes untenable: Can sewer networks tell us where COVID-19 transmission occurs?

• Type of Material: Article
• Authors: Yuke Wang, Emory University; Pengbo Liu, Emory University; Jamie VanTassell, Emory University; Stephen P Hilton, Emory University; Lizheng Guo, Emory University; Orlando Sablon, Emory University; Marlene Wolfe, Emory University; Lorenzo Freeman, City of Atlanta Department of Watershed Management; Wayne Rose, City of Atlanta Department of Watershed Management; Carl Holt, City of Atlanta Department of Watershed Management; Mikita Browning, City of Atlanta Department of Watershed Management; Michael Bryan, Georgia Department of Public Health; Lance Waller, Emory University; Peter Teunis, Emory University; Christine Moe, Emory University
• Language: English
• Date: 2022-12-23
• Publisher: PERGAMON-ELSEVIER SCIENCE LTD
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Author(s)
• Final Published Version (URL): http://dx.doi.org/10.1016/j.watres.2022.119516
• Title of Journal or Parent Work: WATER RESEARCH
• Volume: 229
• Keywords: Hotspot; Sampling design; Adaptive sampling; Physical Sciences; SURVEILLANCE; Science & Technology; Engineering, Environmental; COVID-19; Water Resources; Environmental Sciences & Ecology; Technology; Community level; Engineering; Wastewater surveillance; Environmental Sciences; Life Sciences & Biomedicine
• Research Categories: Biology, Biostatistics; Health Sciences, Public Health

Abstract

Monitoring SARS-CoV-2 in wastewater is a valuable approach to track COVID-19 transmission. Designing wastewater surveillance (WWS) with representative sampling sites and quantifiable results requires knowledge of the sewerage system and virus fate and transport. We developed a multi-level WWS system to track COVID-19 in Atlanta using an adaptive nested sampling strategy. From March 2021 to April 2022, 868 wastewater samples were collected from influent lines to wastewater treatment facilities and upstream community manholes. Variations in SARS-CoV-2 concentrations in influent line samples preceded similar variations in numbers of reported COVID-19 cases in the corresponding catchment areas. Community sites under nested sampling represented mutually-exclusive catchment areas. Community sites with high SARS-CoV-2 detection rates in wastewater covered high COVID-19 incidence areas, and adaptive sampling enabled identification and tracing of COVID-19 hotspots. This study demonstrates how a well-designed WWS provides actionable information including early warning of surges in cases and identification of disease hotspots.