Integrating wastewater analysis and targeted clinical testing for early disease outbreak detection and an enhanced public health response

Abstract

The COVID-19 pandemic provided an unprecedented opportunity to assess the value of wastewater based epidemiology (WBE) as a tool to complement clinical testing in efforts to monitor and mitigate disease outbreaks. This study presents a retrospective assessment of a WBE approach that integrated WBE from congregate living facilities with high-frequency, rapid-turnaround clinical testing within a university setting. By focusing on communal living spaces, such as dormitories, this approach made it possible to rapidly identify and counter the spread of SARS-CoV-2 as well as to monitor the efficacy of campus-focused public health measures throughout the pandemic. Beginning in 2020, the University of Denver (DU) implemented a campus-wide, dual-prong COVID-19 response that combined WBE with frequent high-sensitivity testing (FHST) of individuals by RT-qPCR. Wastewater monitoring at the building level was employed in an effort to facilitate the early detection of SARS-CoV-2 spread and thereby make it possible to more confidently and precisely allocate limited clinical testing resources to identify and isolate infected individuals. This data-driven approach to WBE-informed targeting of FHST resources contributed to markedly and consistently lower SARS-CoV-2 positivity rates on campus compared to the surrounding metropolitan area. Analyses of data from multiple dormitories, and spanning several early-stage disease outbreaks, have highlighted the potential of WBE to optimize limited clinical resources for detecting, containing, and resolving the spread of communicable diseases. The information gained from DU's COVID-19 response can help to guide the development of future public health strategies in other communities confronting similar challenges.