Journal
ENVIRONMENTAL HEALTH PERSPECTIVES
Volume 130, Issue 6, Pages -Publisher
US DEPT HEALTH HUMAN SCIENCES PUBLIC HEALTH SCIENCE
DOI: 10.1289/EHP10289
Keywords
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Funding
- National Science Foundation Rapid Response Research grant [2027679]
- David and Lucille Packard Foundation
- PacificSource Health Plans
- Oregon State University Foundation
- Clean Water Services
- Clean Water Services Coronavirus Aid, Relief, and Economic Security Act through the Washington County Cities and Special District Assistance program
- Directorate For Engineering
- Div Of Chem, Bioeng, Env, & Transp Sys [2027679] Funding Source: National Science Foundation
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Wastewater SARS-CoV-2 concentrations can provide better estimations for SARS-CoV-2 community prevalence than reported cases of COVID-19. Wastewater-based epidemiology methods can identify neighborhood-level COVID-19 hotspots and SARS-CoV-2 variants.
BACKGROUND: Positive correlations have been reported between wastewater SARS-CoV-2 concentrations and a community's burden of infection, disease or both. However, previous studies mostly compared wastewater to clinical case counts or nonrepresentative convenience samples, limiting their quantitative potential. OBJECTIVES: This study examined whether wastewater SARS-CoV-2 concentrations could provide better estimations for SARS-CoV-2 community prevalence than reported cases of COVID-19. In addition, this study tested whether wastewater-based epidemiology methods could identify neighborhood-level COVID-19 hotspots and SARS-CoV-2 variants. METHODS: Community SARS-CoV-2 prevalence was estimated from eight randomized door-to-door nasal swab sampling events in six Oregon communities of disparate size, location, and demography over a 10-month period. Simultaneously, wastewater SARS-CoV-2 concentrations were quantified at each community's wastewater treatment plant and from 22 Newport, Oregon, neighborhoods. SARS-CoV-2 RNA was sequenced from all positive wastewater and nasal swab samples. Clinically reported case counts were obtained from the Oregon Health Authority. RESULTS: Estimated community SARS-CoV-2 prevalence ranged from 8 to 1,687/10,000 persons. Community wastewater SARS-CoV-2 concentrations ranged from 2.9 to 5.1 log(10) gene copies per liter. Wastewater SARS-CoV-2 concentrations were more highly correlated (Pearson's r=0.96; R-2 =0.91) with community prevalence than were clinically reported cases of COVID-19 (Pearson's r =0.85; R-2 =0.73). Monte Carlo simulations indicated that wastewater SARS-CoV-2 concentrations were significantly better than clinically reported cases at estimating prevalence (p< 0.05). In addition, wastewater analyses determined neighborhood-level COVID-19 hot spots and identified SARS-CoV-2 variants (B.1 and B.1.399) at the neighborhood and city scales. DISCUSSION: The greater reliability of wastewater SARS-CoV-2 concentrations over clinically reported case counts was likely due to systematic biases that affect reported case counts, including variations in access to testing and underreporting of asymptomatic cases. With these advantages, combined with scalability and low costs, wastewater-based epidemiology can be a key component in public health surveillance of COVID-19 and other communicable infections.
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