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

新型冠状病毒株SARS-CoV-2（严重急性呼吸综合征冠状病毒2）的出现现在被视为对人类健康的主要全球威胁。最近的估计预测，全球有1500万人死亡，SARS-CoV-2感染可能导致2.1万亿英镑的经济损失。对这种病原体的有效监测对于估计在人群中传播的感染量以及为控制疾病传播的措施的设计提供信息至关重要。SARS-CoV-2相关疾病（COVID-19）的住院病例数量提供了人口中疾病流行的一些衡量标准，但它没有提供关于轻度感染和无症状携带者的可靠信息。使用随机的“抽查”和热成像摄像机已经被引入来筛查感染，尽管这些实施起来成本很高，而且非常不精确。因此，需要更好的方法来评估SARS-CoV-2在更广泛人群中的患病率。由于SARS-CoV-2在粪便中大量脱落（Xiao et al.，2020，Zhang等人，2020），我们假设废水可以在任何时间点提供疾病发病率的有力指标（Ye等人，2016年），特别是因为大多数英国城市中心只有1或2个污水处理厂，从而在单个样本中提供了数百万人的单一综合信号。因此，NERC紧急项目的目的是：（1）使用废水提供英国人口中SARS-CoV-2发病率的近实时信息;（2）监测英国人口中SARS-CoV-2的上升和随后的下降，并将其与传统疾病报告指标进行比较（例如确诊的SARS-CoV-2住院病例）;（3）确定英国主要城市中心SARS-CoV-2丰度的相似性;（4）示范利用废水综合监测人口中的人类致病病毒;（5）为利益相关者（如国家政府、NHS、HPA、PHE、PHW、HPS、水务公司等）提供关键的科学信息和工具，以便能够应对和适应当前和未来潜在的疾病流行。

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.