Sars-Cov-2 Wastewater Surveillance for Public Health Action: Connecting Perspectives From Wastewater Researchers and Public Health Officials During a Global Pandemic

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COVID-19, wastewater surveillance


Wastewater surveillance for SARS-CoV-2 has garnered extensive public attention during the COVID-19 pandemic as a proposed complement to existing disease surveillance systems. Over the past year, environmental microbiology and engineering researchers have advanced methods for detection and quantification of SARS-CoV-2 viral RNA in untreated sewage and demonstrated that the trends in wastewater are correlated with trends in cases reported days to weeks later depending on the location. At the start of the pandemic, the virus was also detected in wastewater in locations prior to known cases. Despite the promise of wastewater surveillance, for these measurements to translate into useful public health tools, it is necessary to bridge the barriers between researchers and the public health responders who will ultimately use the data. Here we describe the key uses, barriers, and applicability of SARS-CoV-2 wastewater surveillance for supporting public health decisions and actions. This perspective was formed from a multidisciplinary group of environmental microbiology, engineering, wastewater, and public health experts, as well as from opinions shared during three focus group discussions with officials from ten state and local public health agencies. The key barriers to use of wastewater surveillance data identified were: (1) As a new data source, most public health agencies are not yet comfortable interpreting wastewater data; (2) Public health agencies want to see SARS-CoV-2 wastewater data in their own communities to gain confidence in its utility; (3) New institutional knowledge and increased capacity is likely needed to sustain wastewater surveillance systems; and (4) The ethics of wastewater surveillance data collection, sharing, and use are not yet established. Overall, while wastewater surveillance to assess community infections is not a new idea, by addressing these barriers, the COVID-19 pandemic may be the initiating event that turns this emerging public health tool into a sustainable nationwide surveillance system.