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Campus Collaborations As a Model for Transforming SARS-CoV-2 Wastewater Surveillance Research into Public Health Action

Cite this: Environ. Sci. Technol. 2021, 55, 19, 12770–12772
Publication Date (Web):September 17, 2021
https://doi.org/10.1021/acs.est.1c03351

Copyright © 2021 American Chemical Society. This publication is available under these Terms of Use.

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Introduction

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Wastewater monitoring is a promising tool for COVID-19 public health surveillance. Environmental scientists and engineers have played critical roles in developing wastewater monitoring systems to inform public health decision making in Europe and elsewhere. (1) In the United States (U.S.), the Centers for Disease Control (CDC) is establishing a national wastewater surveillance system, and several states and municipalities have implemented this approach. (2,3) Many colleges and universities have developed their own separate wastewater monitoring systems to inform their institution’s decision making process. These systems complement larger community or regional efforts by providing data specific to their student population, enabling targeted public health action on campus.
Yet wastewater surveillance has not fully realized its promise for informing public health decision making. In addition to technical challenges, there are gaps in understanding how best to design a wastewater surveillance system that is both effective and feasible to implement. There are also uncertainties about how best to communicate, interpret, and use this new data. Lessons learned from collaborations between researchers and data users in small-scale wastewater surveillance systems at colleges offer insight into how to address these challenges at larger scales.
Many wastewater surveillance researchers based at academic institutions worked with campus stakeholders to apply this developing technology to their college’s pandemic response efforts in real time. We recently assessed the wastewater monitoring programs of 25 colleges and universities across the U.S. (4) The vast majority (22) of these programs were initiated by researchers in science, technology, engineering, and mathematics (STEM) fields who brought their expertise to bear on their institutions’ public health responses. In nearly every case, these scientists reported that collaborating with public health decision-makers, risk managers, facilities staff, community leaders, communications professionals, and students was essential to translating research into action. These efforts suggest that key questions for developing wastewater surveillance systems to inform public health decision making include the following:
(1)

Who needs to know what in order to integrate wastewater monitoring data into public health decisions?

(2)

What are the social, cultural, and institutional contexts of the wastewater monitoring effort that may influence follow-up actions?

(3)

How can scientists support interpretation and communication of results to facilitate appropriate responses?

Insights from early experiences with campus wastewater monitoring suggest that proactively addressing these considerations is critical to any effective wastewater monitoring effort.

Understanding End Uses

Public health decision makers need to understand both the potential and limitations of wastewater monitoring based on the physical sewage infrastructure, sampling constraints, and resources available. Scientists can help create a shared understanding of what is feasible to inform design of an effective system (e.g., location and frequency of sampling). From our research, we learned that colleges had various “end uses” for the resulting data including
  • Identifying dorms with infected students as an early warning to target clinical testing, contact tracing, and isolation/quarantine to quell emergent outbreaks.

  • Addressing community concerns that student neighborhoods will have higher rates of infection, putting residents at risk.

  • Cost-effectively monitoring resident student populations over the long-term to guide campus-wide clinical surveillance testing.

Most college efforts we studied found that their understanding of how wastewater monitoring could support decision making evolved over time. Ongoing multistakeholder dialogue was essential to inform adaptation of the wastewater monitoring strategy and ultimate uses of the data. This suggests that development of public wastewater surveillance systems should incorporate input from end users—including public health departments, city officials, municipal wastewater treatment plant staff, school leaders, private companies, and diverse community members—about how wastewater information could affect their decisions in order to appropriately sample the wastewater at locations and frequencies that will provide the most actionable data.

Social, Cultural, and Institutional Context

Many scientists we interviewed were surprised by how significantly social factors shaped their colleges’ wastewater monitoring systems. Partnering with colleagues in the social sciences, student life, and administration helped shed light on social, cultural, or institutional factors that affected how wastewater results would be perceived and acted upon. For example:
  • Public institutions were less able than private institutions to compel students to be tested if their dormitory wastewater yielded evidence of SARS-CoV-2.

  • Universities with cultural, ethnic, or interest-themed dormitories resisted sharing dorm-level data out of concern for stigmatizing those residences’ populations.

  • Student life staff could identify dorms with a history of risky social behavior that should be prioritized for wastewater sampling.

  • Wastewater monitoring was more logistically complicated when many students lived off-campus.

These experiences suggest that communities with varied demographic, political, mobility, and geographic characteristics may use wastewater surveillance information differently. Therefore, awareness of social factors is essential to designing a system that is appropriate to each unique situation. Partnering with social scientists who can assess the community’s characteristics, attitudes and values may help design a successful strategy for collecting, sharing, and using wastewater-derived data.

Interpretation and Communication of results

Contextual factors may also affect the communication of wastewater monitoring results. Many scientists we interviewed were challenged by the complex dynamics of communicating wastewater results to decision makers and the college community. As with other scientific fields where decisions are made under significant scientific uncertainty, efforts to share results of wastewater monitoring for SARS-CoV-2 can benefit from applying risk communication principles like having a trusted messenger, the notion of “leading with what you know,” and connecting with what matters to your audience. (5) In the case of colleges, this often required ongoing consultation with student representatives to inform effective strategies. For example, one university publicized initial results widely on campus to encourage social distancing, but found the “ick factor” of discussing sewage impacted the students’ willingness to participate in clinical surveillance testing. As one involved researcher said, “No one wanted to be found to be the person pooping virus that was caught by sewage testing.”
Decision makers often demand certainty, but wastewater monitoring for SARS-CoV-2 is characterized by highly variable data, with sources of uncertainty related to sample collection, laboratory analysis, dynamic fecal shedding of the virus, movement of individuals in and out of the area contributing the wastewater, and other factors. Many scientists reported struggling to explain to college administrators why SARS-CoV-2 was detected in a dormitory’s wastewater but follow-up testing of residents failed to identify any positive cases. Developing a strong multidisciplinary team that includes scientists, wastewater sample collection staff, public health decision-makers, and community members creates opportunities for colearning about data interpretation, drivers of uncertainty, and effective communication strategies. At the level of community or larger scale wastewater surveillance systems, colleges’ experiences suggest engaging local stakeholders in developing data dashboards, communication tools, and information dissemination strategies.

Discussion

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Wastewater monitoring has provided an opportunity for STEM researchers to leverage their expertise to make a significant contribution to campus health during the COVID-19 pandemic. Many of the scientists we interviewed felt gratified by doing something tangible to help their community address this crisis. The ongoing engagement with a broad set of stakeholders who could collaborate on understanding the end uses for data, the institution’s unique social context, and the complexities of communicating uncertain data was key to progress in college wastewater monitoring efforts.
These experiences on college campuses suggest that engaging local health departments, municipalities, community leaders and others in the design, reporting, and plans for data use may help wastewater monitoring become a trusted source of public health information in communities. Collaborating with diverse stakeholders can inform the constraints and potential for wastewater data to inform public health action in a particular community. For example, some communities may object to wastewater surveillance based on fear of stigmatizing of their members and neighborhoods. Others may value fine-scale sampling that can enable early warning and public health action at a local level. Depending on the circumstances, a public “town hall,” an ongoing Community Advisory Board, or formalized multistakeholder partnership may be appropriate for obtaining this input. Researchers involved in wastewater surveillance are in a unique position to incorporate place-specific community characteristics in the design of systems at all scales.

Author Information

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  • Corresponding Author
  • Authors
    • Sasha Harris-Lovett - Berkeley Water Center, University of California Berkeley, 410 O’Brien Hall, Berkeley, California 94720, United States
    • Kara L. Nelson - Department of Civil and Environmental Engineering, University of California Berkeley, MS 1710, Berkeley, California 94720, United StatesOrcidhttps://orcid.org/0000-0001-8899-2662
  • Author Contributions

    K.S.K and S.H.L. contributed equally. The manuscript was written through contributions of all authors. All authors have given approval to the final version of the manuscript.

  • Funding

    This research was funded by the National Institute of Environmental Health Sciences, grant P30 ES001247 (to K.S.K.), and by the Catena Foundation (to K.L.N. and S.H.L.).

  • Notes
    The authors declare no competing financial interest.

References

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This article references 5 other publications.

  1. 1
    European Commission. Tracking COVID-19 Employing Waste Waters: A Reliable Indicator for Supporting the Prevention and Management of the Pandemic. 2021.
  2. 2
    CDC. National Wastewater Surveillance System https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/wastewater-surveillance.html (accessed 2021/3/2).
  3. 3
    Aparna, K.; Hu Xindi, C.; Marisa, H. Developing a Flexible National Wastewater Surveillance System for COVID-19 and Beyond. Environ. Health Perspect. 2021 129 (4), 045002.  DOI: 10.1289/EHP8572 .
  4. 4
    Harris-Lovett, S.; Nelson, K. L.; Beamer, P.; Bischel, H. N.; Bivins, A.; Bruder, A.; Butler, C.; Camenisch, T. D.; De Long, S. K.; Karthikeyan, S.; Larsen, D. A.; Meierdiercks, K.; Mouser, P. J.; Pagsuyoin, S.; Prasek, S. M.; Radniecki, T. S.; Ram, J. L.; Roper, D. K.; Safford, H.; Sherchan, S. P.; Shuster, W.; Stalder, T.; Wheeler, R. T.; Korfmacher, K. S. Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs. Int. J. Environ. Res. Public Health 2021, 18 (9), 4455,  DOI: 10.3390/ijerph18094455
  5. 5
    Corner, A.; Shaw, C.; Clarke, J. Principles for Effective Communication and Public Engagement on Climate Change: A Handbook for IPCC Authos; Climate Outreach: Oxford, 2018.

Cited By

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This article is cited by 3 publications.

  1. Haorui Cao, Kang Mao, Fang Ran, Pengqi Xu, Yirong Zhao, Xiangyan Zhang, Hourong Zhou, Zhugen Yang, Hua Zhang, Guibin Jiang. Paper Device Combining CRISPR/Cas12a and Reverse-Transcription Loop-Mediated Isothermal Amplification for SARS-CoV-2 Detection in Wastewater. Environmental Science & Technology 2022, 56 (18) , 13245-13253. https://doi.org/10.1021/acs.est.2c04727
  2. Xiaoqing Xu, Yu Deng, Jiahui Ding, Xiawan Zheng, Shuxian Li, Lei Liu, Ho-kwong Chui, Leo L.M. Poon, Tong Zhang. Real-time allelic assays of SARS-CoV-2 variants to enhance sewage surveillance. Water Research 2022, 220 , 118686. https://doi.org/10.1016/j.watres.2022.118686
  3. Katrina Smith Korfmacher, Sasha Harris-Lovett. Invited Perspective: Implementation of Wastewater-Based Surveillance Requires Collaboration, Integration, and Community Engagement. Environmental Health Perspectives 2022, 130 (5) https://doi.org/10.1289/EHP11191
  • Abstract

  • References

    ARTICLE SECTIONS
    Jump To

    This article references 5 other publications.

    1. 1
      European Commission. Tracking COVID-19 Employing Waste Waters: A Reliable Indicator for Supporting the Prevention and Management of the Pandemic. 2021.
    2. 2
      CDC. National Wastewater Surveillance System https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/wastewater-surveillance.html (accessed 2021/3/2).
    3. 3
      Aparna, K.; Hu Xindi, C.; Marisa, H. Developing a Flexible National Wastewater Surveillance System for COVID-19 and Beyond. Environ. Health Perspect. 2021 129 (4), 045002.  DOI: 10.1289/EHP8572 .
    4. 4
      Harris-Lovett, S.; Nelson, K. L.; Beamer, P.; Bischel, H. N.; Bivins, A.; Bruder, A.; Butler, C.; Camenisch, T. D.; De Long, S. K.; Karthikeyan, S.; Larsen, D. A.; Meierdiercks, K.; Mouser, P. J.; Pagsuyoin, S.; Prasek, S. M.; Radniecki, T. S.; Ram, J. L.; Roper, D. K.; Safford, H.; Sherchan, S. P.; Shuster, W.; Stalder, T.; Wheeler, R. T.; Korfmacher, K. S. Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs. Int. J. Environ. Res. Public Health 2021, 18 (9), 4455,  DOI: 10.3390/ijerph18094455
    5. 5
      Corner, A.; Shaw, C.; Clarke, J. Principles for Effective Communication and Public Engagement on Climate Change: A Handbook for IPCC Authos; Climate Outreach: Oxford, 2018.

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