SARS-CoV-2 wastewater surveillance data can predict hospitalizations and ICU admissions

Aikaterini Galani; Reza Aalizadeh; Marios Kostakis; Athina Markou; Nikiforos Alygizakis; Theodore Lytras; Panagiotis G Adamopoulos; Jordan Peccia; David C Thompson; Aikaterini Kontou; Apostolos Karagiannidis; Evi S Lianidou; Margaritis Avgeris; Dimitrios Paraskevis; Sotirios Tsiodras; Andreas Scorilas; Vasilis Vasiliou; Meletios-Athanasios Dimopoulos; Nikolaos S Thomaidis

doi:10.1016/j.scitotenv.2021.150151

SARS-CoV-2 wastewater surveillance data can predict hospitalizations and ICU admissions

Sci Total Environ. 2022 Jan 15:804:150151. doi: 10.1016/j.scitotenv.2021.150151. Epub 2021 Sep 7.

Authors

Aikaterini Galani¹, Reza Aalizadeh¹, Marios Kostakis¹, Athina Markou¹, Nikiforos Alygizakis¹, Theodore Lytras², Panagiotis G Adamopoulos³, Jordan Peccia⁴, David C Thompson⁵, Aikaterini Kontou¹, Apostolos Karagiannidis¹, Evi S Lianidou¹, Margaritis Avgeris⁶, Dimitrios Paraskevis⁷, Sotirios Tsiodras⁸, Andreas Scorilas³, Vasilis Vasiliou⁹, Meletios-Athanasios Dimopoulos¹⁰, Nikolaos S Thomaidis¹¹

Affiliations

¹ Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, University Campus, Zografou, 15771, Athens, Greece.
² School of Medicine, European University Cyprus, Cyprus.
³ Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece.
⁴ Department of Chemical and Environmental Engineering, School of Engineering and Applied Science, Yale University, New Haven, CT, USA.
⁵ Department of Clinical Pharmacy, School of Pharmacy and Pharmaceutical Sciences, University of Colorado Skaggs, Aurora, CO, USA; Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT 06510, USA.
⁶ Department of Biochemistry and Molecular Biology, Faculty of Biology, National and Kapodistrian University of Athens, Athens, Greece; Laboratory of Clinical Biochemistry - Molecular Diagnostics, Second Department of Pediatrics, "P. & A. Kyriakou" Children's Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.
⁷ Department of Hygiene Epidemiology and Medical Statistics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
⁸ Fourth Department of Internal Medicine, School of Medicine, University General Hospital Attikon, National and Kapodistrian University of Athens, Greece.
⁹ Department of Environmental Health Sciences, Yale School of Public Health, Yale University, New Haven, CT 06510, USA.
¹⁰ Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Greece.
¹¹ Laboratory of Analytical Chemistry, Department of Chemistry, National and Kapodistrian University of Athens, University Campus, Zografou, 15771, Athens, Greece. Electronic address: ntho@chem.uoa.gr.

Abstract

We measured SARS-CoV-2 RNA load in raw wastewater in Attica, Greece, by RT-qPCR for the environmental surveillance of COVID-19 for 6 months. The lag between RNA load and pandemic indicators (COVID-19 hospital and intensive care unit (ICU) admissions) was calculated using a grid search. Our results showed that RNA load in raw wastewater is a leading indicator of positive COVID-19 cases, new hospitalization and admission into ICUs by 5, 8 and 9 days, respectively. Modelling techniques based on distributed/fixed lag modelling, linear regression and artificial neural networks were utilized to build relationships between SARS-CoV-2 RNA load in wastewater and pandemic health indicators. SARS-CoV-2 mutation analysis in wastewater during the third pandemic wave revealed that the alpha-variant was dominant. Our results demonstrate that clinical and environmental surveillance data can be combined to create robust models to study the on-going COVID-19 infection dynamics and provide an early warning for increased hospital admissions.

Keywords: COVID-19; Hospital admission rates; ICU admission rates; Method validation; RT-qPCR; Wastewater-based epidemiology.

MeSH terms

COVID-19*
Hospitalization
Humans
Intensive Care Units
RNA, Viral
SARS-CoV-2*
Wastewater
Wastewater-Based Epidemiological Monitoring

Substances

RNA, Viral
Waste Water

Grants and funding

UL1 TR001863/TR/NCATS NIH HHS/United States