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Review
. 2021 Sep 1:202:117438.
doi: 10.1016/j.watres.2021.117438. Epub 2021 Jul 12.

Making waves: Plausible lead time for wastewater based epidemiology as an early warning system for COVID-19

Kyle Bibby  1 , Aaron Bivins  2 , Zhenyu Wu  2 , Devin North  2
Affiliations
Review

Making waves: Plausible lead time for wastewater based epidemiology as an early warning system for COVID-19

Kyle Bibby et al. Water Res. .

Abstract

Wastewater-based epidemiology (WBE) has emerged as a useful tool in the fight to track and contain COVID-19 spread within communities. One of the motives behind COVID-19 WBE efforts is the potential for 'early warning' of either the onset of disease in a new setting or changes in trends in communities where disease is endemic. Many initial reports of the early warning potential of WBE have relied upon retrospective sample analysis, and delays in WBE analysis and reporting should be considered when evaluating the early warning potential of WBE that enable public health action. Our purpose in this manuscript is to establish a framework to critique the potential of WBE to serve as an early warning system, with special attention to the onset of viral shedding and the differential between results reporting for WBE and clinical testing. While many uncertainties remain regarding both COVID-19 clinical presentation and technical factors influencing WBE results, our analysis suggests at most a modest lead time interval ranging from six days for clinical testing to four days for WBE during community-level wastewater surveillance where clinical testing is accessible on-demand with a rapid time to results. This potential lead time for WBE subsequently increases in settings with limited clinical testing capacity or utilization. Care should be taken when reporting 'early detection' of COVID-19 disease trends via WBE to consider underlying causes (e.g., clinical testing lag or delayed result reporting) to avoid misrepresenting WBE potential.

Keywords: COVID-19; Early warning; SARS-CoV-2; Wastewater monitoring; Wastewater-based epidemiology.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Figure 1
Figure 1
Framework to evaluate the temporal advantage of WBE versus clinical testing. The x-axis represents the onset of symptoms relative to the onset of RNA shedding in stool; the y-axis represents the differential in time to results between WBE and clinical testing. Indicated viral shedding areas are from (Hartman et al. 2020; Woolsey et al. 2021; Wölfel et al. 2020). The dashed green box indicates a representative plausible scenario range as discussed in the text.
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