Wastewater Analysis of SARS CoV-2 in Tribal Communities

摘要 新冠肺炎大流行的迅速爆发让世界各地的许多人没有做好检测、治疗和计划 冠状病毒发病率和死亡率。部落国家就是如此，它们的主权地位使它们能够迅速和 预防性措施，如封锁和关闭边境，但其文化有助于增加 独特的风险因素。其中包括测试差异、潜在的健康因素和社区基础设施。 然而，临床检测并不能反映阳性病例的范围，而且如果没有这一集体努力， 项目，部落可能不会被包括在基于废水的流行病学(WBE)分析中，该分析已获得 由于其在社区传染性之前生成数据的能力而受到广泛关注。在这个项目中，我们将 表明WBE是一种非侵入性的、文化上合适的生物监测策略，可以采用 由部落社区实施，为他们提供实用但技术先进的健康 监控工具。建立在部落协商和以社区为基础的参与的严格方法基础上 研究、评估废水和社区基础设施，并培训部落废水操作员 和WBE上的卫生管理员，我们将成立WBE部落协调中心。部落将被招募 通过亚利桑那州国家部落水和废水操作员培训计划的部落间委员会 网络。我们将使用已建立的RT-qPCR来测量美国保留地废水中的冠状病毒 技术和一种新的蛋白质定量方法，我们将对病毒RNA提取物进行测序，以评估SARS- 部落社区中的CoV-2变种。部落社区新冠肺炎升高的风险因素将 通过整合地理空间分析进行量化。针对众多环境风险的框架- 我们的团队已经开发出传播病原体，为将变异性和 部落环境的不确定性和来自部落的定性信息，以便适当地确定我们的建模范围 努力。模拟结果将有助于有效地将资源用于监测和公共卫生干预 通过确定最有可能在其他社区检测到SARS-CoV-2的特定采样位置 和科学上的限制。将最大限度地利用来自RADx数据协调中心的信息 将部落社区与非部落社区进行比较。通过冠状病毒大流行和 此外，部落将更好地了解他们使用WBE衡量社区健康的能力，从而 保护社区健康，并为未来的应用和研究翻译建设能力。

ABSTRACT The rapid onset of the COVID-19 pandemic left many across the world unprepared to test, treat, and plan for coronavirus morbidity and mortality. This was true for Tribal nations, whose sovereign status enabled swift and preventative measures such as lock-downs and border closures, yet whose culture contributed to additional unique risk factors. Among those are testing disparities, underlying health factors, and community infrastructure. However, clinical testing doesn’t capture the extent of positive cases, and without the collective efforts of this project, Tribes will likely not be included in wastewater-based epidemiology (WBE) analysis, which has garnered wide-spread interest due to its ability to generate data in advance of community infectivity. In this project, we will show that WBE is a non-invasive, culturally appropriate biomonitoring strategy that can be adopted and implemented by Tribal communities to empower them with a practical, yet technologically advanced health surveillance tool. Building upon a rigorous methodology of Tribal consultation and community-based participatory research, assessment of wastewater and community infrastructure, and training of Tribal wastewater operators and health administrators on WBE, we will form the WBE Tribal Coordination Center. Tribes will be recruited through the InterTribal Council of Arizona’s National Tribal Water and Wastewater Operator Training Program network. We will measure coronavirus in wastewater across U.S. reservations using established RT-qPCR techniques and a novel protein quantification method, and we will sequence viral RNA extracts to assess SARS- CoV-2 variants in Tribal communities. Risk factors contributing to elevated COVID-19 in Tribal communities will be quantified with integration of geospatial analysis. Frameworks for risks from numerous environmentally- transmitted pathogens have been developed by our team, setting a foundation to incorporate variability and uncertainty for Tribal settings with qualitative information from Tribes in order to appropriately scope our modeling efforts. Simulation results will help to target resources efficiently for monitoring and public health interventions by identifying specific sampling locations where it is most likely to detect SARS-CoV-2 given other community and scientific constraints. Information from the RADx Data Coordination Center will be used to the fullest extent to compare Tribal communities with their non-Tribal counterparts. Through the coronavirus pandemic and beyond, Tribes will be better informed of their ability to use WBE to measure community health, thereby protecting community health and building capacity for future applications and research translation.