Wastewater-Based Epidemiology: Wastewater Surveillance for Pandemic Preparedness

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Wastewater surveillance (WWS) has been applied for several decades as an aggregated, anonymous, and non-invasive measurement of community disease. Since the onset of the coronavirus disease in 2019 (COVID-19), WWS of the severe acute respiratory syndrome-2 virus (SARS-CoV-2), virus responsible for COVID-19, has emerged and expanded to over 57 countries. The expansion of CoV-2 WWS has been paralleled with an accelerated advancement in our understanding of the uses and benefits of WWS; with WWS demonstrating the potential to identify early detection of outbreaks, resurgences and next waves of disease in both small and large populations. The G7 Pandemic Preparedness Partnership recently highlighted the need for "a responsive diagnostics sector [.] producing accurate and rapid diagnostic tests at scale to detect new cases early". As such, WWS is positioned as a promising technology for not only pandemic preparedness in Canada but also for other countries. To translate the promise of WWS into an applied responsive diagnostic tool for pandemic preparedness, it is critical to continue to develop our understanding and interpretation of WWS measurements. In particular, the World Health Organization, the US Centers for Disease Control and Prevention, the Public Health Agency of Canada, academic researchers and others have identified the need to further understand and minimize variability and uncertainty associated with WWS measurements. The proposed research program aims to advance our understanding of the fate and transport of disease gene targets in sewers and to develop data normalization strategies to improve the accuracy and reliability of WWS for disease estimation. The scientific approach of the proposed research program is to perform controlled, laboratory-scale experiments to isolate the persistence or degradation associated with CoV-2 RNA during sewer transport and sewer flushing events, including heavy rainfall and snow melt events. The laboratory-scale experiments will be complimented by specific full-scale sewer system testing to translate the new knowledge attained at laboratory-scale to full-scale systems. Successively, the research program will apply normalization strategies to determine the potential of these strategies to minimize the variability induced by sewer transport and flushing events and to ultimately improve the precision and accuracy in the reporting and interpretation of CoV-2 WWS measurements. The research program will address CoV-2 gene target measurements with the findings being transferrable to important disease targets of future pandemics. The proposed research program will evolve the current perspective of wastewater from a source of waste to a proxy of community health and will advance the development of a rapid diagnostic technology for public health protection and pandemic preparedness in Canada and internationally.