Wastewater based epidemiology – the future in monitoring of community health?

Researchers at Universities worldwide are exploring the use of wastewater based epidemiology for coronavirus surveillance in communities. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ribonucleic acid (RNA) has been detected by numerous researchers in feces of both symptomatic and asymptomatic patients. Additional reports confirm the survival of the virus outside of the body for few hours to days, depending on the wastewater temperature, and its detection in municipal wastewater treatment plants. Community wide monitoring could help in detecting decreasing or increasing trend of the disease in particular region, which could better inform policies.

Wastewater based epidemiology (WBE), although relatively new paradigm, is considered a complementary approach for current disease surveillance systems and an early warning system for disease outbreaks. The concept is primarily based upon the extraction, detection and then subsequent analysis and interpretation of chemical and/or biological compounds and has been used to assess illicit drug use, antibiotic resistance prevalence and infectious diseases occurrence. The basic premise of WBE is that community wastewater represents an unbiased snapshot of the population’s health and lifestyle habits.

Many groups are currently trying to correlate the SARS-CoV-2 RNA detection in wastewater to number of cases in particular community. Back-calculating from the amount of viral RNA in wastewater to actual cases poses a lot of challenges, mostly due the uncertainty about multiple factors, such as the percentage of asymptomatic cases in population, magnitude of virus shedding, virus survival in the collection system, wastewater flow rates.

Despite the multiple challenges, researchers are exchanging ideas and collaborating to help in coronavirus surveillance. Once fully developed, WBE might become routine tool in public health protection.