Making waves: Wastewater surveillance of SARS-CoV-2 in an endemic future

Fuqing Wu; Wei Lin Lee; Hongjie Chen; Xiaoqiong Gu; Franciscus Chandra; Federica Armas; Amy Xiao; Mats Leifels; Steven F Rhode; Stefan Wuertz; Janelle Thompson; Eric J Alm

doi:10.1016/j.watres.2022.118535

Making waves: Wastewater surveillance of SARS-CoV-2 in an endemic future

Water Res. 2022 Jul 1:219:118535. doi: 10.1016/j.watres.2022.118535. Epub 2022 May 3.

Authors

Affiliations

¹ Center for Infectious Disease, Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas School of Public Health, Houston, TX, USA. Electronic address: fuqing.wu@uth.tmc.edu.
² Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore.
³ Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA.
⁴ Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore.
⁵ Massachusetts Water Resources Authority, Boston, MA USA.
⁶ Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; School of Civil and Environmental Engineering, Nanyang Technological University, Singapore.
⁷ Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Singapore Centre for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore; Asian School of the Environment, Nanyang Technological University, Singapore.
⁸ Antimicrobial Resistance Interdisciplinary Research Group, Singapore-MIT Alliance for Research and Technology, Singapore; Campus for Research Excellence and Technological Enterprise (CREATE), Singapore; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA, USA; Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, MA, USA; Broad Institute of MIT and Harvard, Cambridge, MA, USA. Electronic address: ejalm@mit.edu.

Abstract

Wastewater-based surveillance (WBS) has been widely used as a public health tool to monitor the emergence and spread of SARS-CoV-2 infections in populations during the COVID-19 pandemic. Coincident with the global vaccination efforts, the world is also enduring new waves of SARS-CoV-2 variants. Reinfections and vaccine breakthroughs suggest an endemic future where SARS-CoV-2 continues to persist in the general population. In this treatise, we aim to explore the future roles of wastewater surveillance. Practically, WBS serves as a relatively affordable and non-invasive tool for mass surveillance of SARS-CoV-2 infection while minimizing privacy concerns, attributes that make it extremely suited for its long-term usage. In an endemic future, the utility of WBS will include 1) monitoring the trend of viral loads of targets in wastewater for quantitative estimate of changes in disease incidence; 2) sampling upstream for pinpointing infections in neighborhoods and at the building level; 3) integrating wastewater and clinical surveillance for cost-efficient population surveillance; and 4) genome sequencing wastewater samples to track circulating and emerging variants in the population. We further discuss the challenges and future developments of WBS to reduce inconsistencies in wastewater data worldwide, improve its epidemiological inference, and advance viral tracking and discovery as a preparation for the next viral pandemic.

Keywords: COVID-19; Cost-effective; Endemic; Epidemiology; SARS-CoV-2; Wastewater surveillance.

MeSH terms

COVID-19* / epidemiology
Humans
Pandemics
RNA, Viral
SARS-CoV-2*
Wastewater
Wastewater-Based Epidemiological Monitoring

Substances

RNA, Viral
Waste Water

Supplementary concepts

SARS-CoV-2 variants