Wastewater-Based Epidemiology of SARS-CoV-2 in Tertiary Care Hospitals: Advancing Wastewater Science and Providing an Early-Warning System for Hospital Transmission and Outbreaks
Wastewater (WW)-based epidemiology (WBE) is an emerging science that seeks to understand the health of a population through sewage analysis. Early in the course of the pandemic, several groups demonstrated that monitoring for SARS-CoV-2 RNA in the community could predict future COVID‑19 cases, hospitalizations and deaths. Our group proposes to focus this technology on hospitals in order to both refine WBE infectious disease science and to develop an “early-warning” system for future outbreaks. Hospitals hold great promise to advance WBE science by precisely identifying and tracking SARS-CoV-2; 1. Hospital WW from both in-building and municipal access points can be assessed minutes after release from patients/staff dramatically reducing the potential for signal degradation. 2. Near- precise accounting for all cases (regardless of symptoms) is possible in hospitals including the ability to relate individual patient-level data to symptom onset and potential exposure timing. 3. Hospital populations are well defined with respect to the daily number of patients (with relevant co-morbidities) and staff ensuring accurate denominators for bench marking. Accordingly, hospital-sewer pipes contain invaluable information that can be used to hone WW-science. Early data from our group demonstrates that WW-SARS-CoV-2 RNA from hospitals correlates with total active COVID‑19 hospitalized cases – and yet is still able to identify changes associated with new hospital-associated infections and unit specific outbreaks. With this proposal we seek funding to study hospital-based WW monitoring across three tertiary care facilities (>2100 beds) enabling; 1. Validating WW SARS-CoV-2-RNA tracking as a model for passive infection monitoring in hospitals, 2. Developing and implementing real-time testing and reporting measures to enable outbreak avoidance, and, 3. Developing expertise in multi-level facility monitoring to identify, contain and mitigate SARS-CoV-2 spread.