Examining the Correlation and Lead Time Between Reported COVID-19 Cases and SARS-CoV-2 RNA Concentrations in Wastewater Influent Catchment Areas in Fulton County, Georgia Open Access
Cavallo, Matthew (Spring 2022)
Abstract
INTRODUCTION: Wastewater-based surveillance quickly gained popularity during the COVID-19 pandemic as an effective and non-invasive surveillance system for understanding COVID-19 burden within a wastewater facility catchment area. The ability to detect SARS-CoV-2 RNA from cases that are not reported, or asymptomatic cases, provides a unique advantage over traditional diagnostic testing. OBJECTIVE: The objective of this analysis was to examine how SARS-CoV-2 RNA concentrations in wastewater correlate with reported COVID-19 cases. The time with which rising SARS-CoV-2 RNA concentrations precede increasing reported COVID-19 cases was also examined. METHODS: Wastewater samples were collected from six influent lines servicing known catchment areas from February 2021-April 2022. Samples (n=257) were processed for viral concentration and RNA extraction, followed by quantitative RT-PCR. Reported COVID-19 case data (n=40,294) were collected from the Georgia Department of Public Health, then geocoded by patient address, to determine weekly number of reported COVID-19 cases for each influent catchment area basin. Linear regression and correlation analysis were conducted to examine the relationship between these variables. RESULTS: SARS-CoV-2 RNA in wastewater and reported COVID-19 cases showed a positive correlation for each of the six influent line catchment areas. The line of best fit for each linear regression was weak, potentially due to a variety of biological and environmental factors. The correlation analysis indicated that SARS-CoV-2 RNA concentrations preceded reported COVID-19 cases by one week for five influent line catchment areas (r ranged from 0.415-0.804), and two weeks for one influent line catchment area (r=0.829). DISCUSSION: The relationship between SARS-CoV-2 RNA concentration in wastewater and reported COVID-19 cases in the catchment areas is complex. Future research will need to take into account the effect of environmental factors, such as wastewater facility flow rate and precipitation levels; biological factors, such as variable viral shedding; and socio-behavioral factors, such as diagnostic testing access. A one-week lead time is an important advantage of wastewater-based surveillance that allows health officials to mobilize resources and prepare for potential case spikes. As COVID-19 incidence decreases and diagnostic testing declines, wastewater-based surveillance will continue to be an important tool for understanding community COVID-19 burden and mitigating potential outbreaks.
Table of Contents
Table of Contents
Literature Review
Introduction 1
Wastewater Surveillance for Viral Pathogens 3
Wastewater Surveillance Applications 5
Fulton County Demographics 9
Research Question 11
Methods
Wastewater Sampling 12
Virus Concentration and RNA Extraction 13
Data Analysis 14
Results
Reported COVID-19 case and SARS-CoV-2 genome copies trends 15
Estimating COVID-19 population prevalence from measured SARS-CoV-2 RNA concentration in wastewater 16
Lead Time Estimation 18
Discussion
Applications 19
Existing Literature 21
Limitations 24
Recommendations 25
Conclusion 29
Appendix 30
References 38
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