Nasal Swabs or Wastewater Swabs? Comparing the Costs of Two Approaches for SARS-CoV-2 Surveillance in Atlanta Public Schools Open Access

Damani, Shazneen (Spring 2023)

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In the spring of 2020, approximately 55 million school-aged children in the United States were confined to their homes (Bureau, n.d.). Since then, it had been estimated that more than 13.9 million children under 18 years of age have been infected with SARS-CoV-2 (Michaud & Dietz, 2023). Wastewater-based epidemiology (WBE), is a surveillance approach that has gained attention in recent months and has been utilized at colleges and universities to monitor the prevalence and spread of SARS-CoV-2 across campuses (Harris-Lovett et al., 2021). However, there are limited studies that have examined the application and effectiveness of WBE in K-12 public schools. Our study conducted a pilot study to examine two surveillance approaches and their implementation costs over a span of two years. The goal of the study was to collect data on the costs of rapid antigen diagnostic testing in Atlanta Public Schools and compare them to wastewater-based surveillance testing. This study utilized an activity-based cost (ABC) analysis and sensitivity analysis to compare the costs associated with each of the two surveillance approaches. Major findings of the study indicated the cost of implementing rapid antigen diagnostic testing in Atlanta Public School was 69 times higher than the cost of wastewater surveillance testing.

Table of Contents

Chapter 1. Literature review 1

1.1 Introduction and background on the SARS-CoV-2 Pandemic and the impact of the SARS-CoV-2 pandemic on children's health, well-being, and livelihoods in the U.S. 1

1.2 Percentage of Georgia children infected with SARS-CoV-2 since March 2020 2

Figure 1 3

Figure 2 4

1.3 Highlight the importance of understanding the spread of SARS-CoV-2 in learning communities, specifically in public schools. 4

1.4 Current problem of SARS-CoV-2 spread in public schools and relevance in understanding the costs associated with monitoring and preventing transmission in these communities. 6

1.5 Existing studies on the costs of COVID diagnostic testing in schools and the financial impacts. 8

1.6 Wastewater-based monitoring initiatives that have been utilized to examine the spread of SARS-CoV-2 in universities and other settings. 8

1.7 Lack of studies that have examined the relationship between costs associated with conducting wastewater epidemiology in public schools compared to diagnostic testing. 10

1.8 Summarize the current problem of SARS-CoV-2 spread in public schools and the significance of the study in understanding the costs associated with monitoring and preventing transmission in these communities. 11

Chapter 2. Introduction, Research Objectives, and Rationale 11

Chapter 3. Methods 13

3.1 Study Design and Sample Selection 13

Figure 3 14

Table 1 15

Figure 4a 15

Figure 4b 16

3.2 Data Collection-17

3.2.1 Wastewater Monitoring Costs 17

Figure 5 18

Figure 6 18

Table 2 21

Table 3 21

3.2.2 Diagnostic Testing Costs 22

3.2.3 Classification of surveillance costs 22

Table 4a 23

Table 4b 24

3.3 Data Analysis: 24

3.4 Mathematical ABC and sensitivity Analysis Model and Model Structure 24

3.4.1 Activity Based Cost Analysis Model and Model Structure 25

Table 6 27

Table 7 29

3.4.2.Sensitivity Analysis Model and Model Structure 30

Table 8 31

Table 9 31

Chapter 4 Results 32

4.1 ABC Model results 33

Figure 7 33

Figure 8 34

Figure 9 35

Table 11 36

Figure 10 36

Figure 11 38

Figure 12 39

Figure 14 41

Table 12 41

Figure 15 43

Figure 16 43

Figure 17 44

Figure 18 45

Table 13 46

4.2 Sensitivity Analysis 46

Figure 19 47

Figure 20 47

Chapter 5 Discussion and Recommendations 8

5.1 Overall comparison of results ABC 50

5.1.2 Overall comparison of results Sensitivity Analysis 51

5.2 Strengths of Wastewater Testing 51

5.3 Strengths of Diagnostic Surveillance 52

5.4 Limitations of these Surveillance Approaches 53

5.4.1 Wastewater Monitoring 53

5.4.2 Diagnostic Testing 54

5.5 Strengths of this study 54

5.6 Additional considerations 54

5.7 Limitations 55

Chapter 6 Conclusion 56

References 58

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