Use of wastewater analysis to evaluate the incidence of coronavirus (SARS-CoV-2) in the UK population

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The emergence of the novel coronavirus strain SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is now viewed as a major global threat to human health. Recent estimates predict the deaths of 15 million people worldwide and that SARS-CoV-2 infections are likely to result in an economic loss £2.1 trillion GDP. Effective monitoring of this pathogen is vital to estimate the amount of infection circulating in the human population, and to inform the design of measures for controlling the spread of disease. The number of hospitalization cases from SARS-CoV-2 related diseases (COVID-19) provides some measure of disease prevalence in the population, it provides no reliable information on mild infections and asymptomatic carriers. The use of random 'spot checks' and thermal imaging cameras have been introduced to screen for infections, though these are costly to implement and very imprecise. Consequently, better methods are needed to evaluate SARS-CoV-2 prevalence in the wider population. As SARS-CoV-2 is shed in faeces in high amounts (Xiao et al., 2020, Zhang et al., 2020), we hypothesize that wastewater can provide a powerful indicator of disease incidence at any point in time (Ye et al., 2016), particularly as most UK urban centres are served by only 1 or 2 wastewater treatment works, thereby providing a single integrated signal of millions of people in a single sample. The aim of this NERC Urgency project is therefore to: (1) use wastewater to provide near real-time information on the incidence of SARS-CoV-2 within the UK population; (2) monitor the rise and subsequent decline of SARS-CoV-2 in the UK population, and to compare this to conventional disease reporting metrics (e.g. confirmed SARS-CoV-2 hospitalization cases); (3) identify similarities in the abundance of SARS-CoV-2 in the major urban centres of the UK; (4) demonstrate the use of wastewater for the integrated surveillance of human pathogenic viruses within the human population; (5) provide stakeholders (e.g. national government, NHS, HPA, PHE, PHW, HPS, water companies etc) with critical scientific information and tools to be able to respond and adapt to current and potential future disease epidemics.