Sewershed surveillance of COVID-19 in the City of Toronto

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Molecular methods have increasingly been employed for detection of pathogens from infectious diseases. They offer the ability to be sensitive, rapid, and quantitative analytical tools. Recent data on the current COVID-19 pandemic confirms that the Coronavirus can be shed in the stools of patients and that SARS-CoV2 (the causative agent of COVID-19) positive stool samples can present days before individuals even show clinical symptoms. Sewershed surveillance is a novel and alternative strategy for tracking pathogens and chemicals of interest that have been shed into the sewer system by human populations. Over the past several months, there has been growing global interest in using sewershed surveillance to investigate the circulation of genetic indicators of SARS-CoV-2. The goal of our partnership with Pani Energy is to initiate sewershed surveillance of SARS-CoV2 in the City of Toronto. Potential outcomes of a sewershed surveillance program in the City of Toronto include early detection of new COVID-19 outbreaks, tracking changes in COVID-19 infection trends (e.g., impacts of social and medical interventions), tracking COVID-19 prevalence in communities (e.g., identifying 'hotspots' of infection), and assessing risk to utility workers and those exposed to raw sewage. This project will have significant short- and long-term public health and economic benefits. The project will have an immediate impact on the City of Toronto's ability to track COVID-19 at a broad scale without burdening the healthcare system. Over the course of the project and beyond, the information generated will support public health officials making strategic decisions on medical and social interventions to stop the spread of COVID-19 and safely reopen the Toronto economy.