An opinion on Wastewater-Based Epidemiological Monitoring (WBEM) with Clinical Diagnostic Test (CDT) for detecting high-prevalence areas of community COVID-19 Infections

Abstract

Wastewater-Based Epidemiological Monitoring (WBEM) is an efficient surveillance tool during the COVID-19 pandemic as it meets all requirements of a complete monitoring system including early warning, tracking the current trend, prevalence of the disease, detection of genetic diversity as well asthe up-surging SARS-CoV-2 new variants with mutations from the wastewater samples. Subsequently, Clinical Diagnostic Test is widely acknowledged as the global gold standard method for disease monitoring, despite several drawbacks such as high diagnosis cost, reporting bias, and the difficulty of tracking asymptomatic patients (silent spreaders of the COVID-19 infection who manifest nosymptoms of the disease). In this current reviewand opinion-based study, we first propose a combined approach) for detecting COVID-19 infection in communities using wastewater and clinical sample testing, which may be feasible and effective as an emerging public health tool for the long-term nationwide surveillance system. The viral concentrations in wastewater samples can be used as indicatorsto monitor ongoing SARS-CoV-2 trends, predict asymptomatic carriers, and detect COVID-19 hotspot areas, while clinical sampleshelp in detecting mostlysymptomaticindividuals for isolating positive cases in communities and validate WBEM protocol for mass vaccination including booster doses for COVID-19.

Keywords: Booster doses; Clinical Diagnostic Test; Genetic diversity; Mass vaccination; New variants and mutations; SARS-CoV-2; Wastewater-Based Epidemiological Monitoring.

Graphical abstract

Figure 1

COVID-19 patients’ clinical diagnostic tests include general clinical signs and symptoms, imaging findings, and laboratory markers (38). In vitro, diagnostic, and clinical laboratory tests include molecular techniques e.g., viral antigen detection, antibody tests; nucleic acid amplification tests (NAAT); real-time polymerase chain reaction test (RT-PCR); next-generation sequencing (NGS); cell culture; enzyme-linked immunosorbent assay (ELISA); and traditional clinical tests: neutrophil-lymphocyte ratio (NLR); c-reactive protein test (CRP); erythrocyte sedimentation rate test (ESR,); IL-6/interleukin-6; lactate dehydrogenase test (LDH); aspartate aminotransferase test (AST); alanine aminotransferase test (ALT);imaging method: computed tomography (CT); ultrasound sonography (USG), X-ray.

Figure 2

Overview of WBEM procedure. Wastewater sample collection and processing, viral RNA concentration, nucleic acid/RNA extraction from the concentrated samples, interpretation of RT-PCR results, and monitoring the trend of disease outbreak compared with CDT and Whole Genome Sequencing (WGS) for new variants and mutations.