. 2023 Feb 20:19:100449.

doi: 10.1016/j.lana.2023.100449. eCollection 2023 Mar.

Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Rebecca Fielding-Miller¹, Smruthi Karthikeyan², Tommi Gaines¹, Richard S Garfein³, Rodolfo A Salido⁴, Victor J Cantu⁴, Laura Kohn⁵, Natasha K Martin¹, Adriane Wynn¹, Carrissa Wijaya³, Marlene Flores³, Vinton Omaleki³, Araz Majnoonian^{3

6}, Patricia Gonzalez-Zuniga³, Megan Nguyen^{3

7}, Anh V Vo^{3

7}, Tina Le³, Dawn Duong³, Ashkan Hassani³, Samantha Tweeten⁸, Kristen Jepsen⁹, Benjamin Henson⁹, Abbas Hakim¹⁰, Amanda Birmingham¹¹, Peter De Hoff², Adam M Mark¹¹, Chanond A Nasamran¹¹, Sara Brin Rosenthal¹¹, Niema Moshiri¹², Kathleen M Fisch^{10

11}, Greg Humphrey², Sawyer Farmer², Helena M Tubb², Tommy Valles², Justin Morris^{12

13}, Jaeyoung Kang¹⁴, Behnam Khaleghi¹², Colin Young¹², Ameen D Akel¹⁵, Sean Eilert¹⁵, Justin Eno¹⁵, Ken Curewitz¹⁵, Louise C Laurent⁶, Tajana Rosing¹², Rob Knight^{2

4}; SEARCH

Collaborators, Affiliations

Affiliations

¹ Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
² Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
³ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁴ Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁵ Kohn Education Consulting, San Diego, CA, USA.
⁶ University of California San Diego and San Diego State University Joint Doctoral Program in Public Health, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁷ Johns Hopkins University Bloomberg School of Public Health, International Health Social and Behavioral Interventions, 615 N Wolfe St, Baltimore, MD 21205, USA.
⁸ County of San Diego, Health and Human Services Agency, 1600 Pacific Highway, San Diego, CA, 92101, USA.
⁹ Institute for Genomic Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹⁰ Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹¹ Center for Computational Biology & Bioinformatics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹² Department of Computer Science & Engineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹³ Department of Electrical and Computer Engineering, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
¹⁴ Department of Electrical and Computer Engineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹⁵ Micron Technology, Inc., 7220 Trade Street, San Diego, CA 92121, USA.

PMID: 36844610
PMCID: PMC9939935
DOI: 10.1016/j.lana.2023.100449

Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Rebecca Fielding-Miller et al. Lancet Reg Health Am. 2023.

. 2023 Feb 20:19:100449.

doi: 10.1016/j.lana.2023.100449. eCollection 2023 Mar.

Authors

Affiliations

¹ Division of Infectious Disease and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
² Department of Pediatrics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
³ Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁴ Department of Bioengineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁵ Kohn Education Consulting, San Diego, CA, USA.
⁶ University of California San Diego and San Diego State University Joint Doctoral Program in Public Health, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
⁷ Johns Hopkins University Bloomberg School of Public Health, International Health Social and Behavioral Interventions, 615 N Wolfe St, Baltimore, MD 21205, USA.
⁸ County of San Diego, Health and Human Services Agency, 1600 Pacific Highway, San Diego, CA, 92101, USA.
⁹ Institute for Genomic Medicine, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹⁰ Department of Obstetrics Gynecology and Reproductive Sciences, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹¹ Center for Computational Biology & Bioinformatics, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹² Department of Computer Science & Engineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹³ Department of Electrical and Computer Engineering, San Diego State University, 5500 Campanile Drive, San Diego, CA, 92182, USA.
¹⁴ Department of Electrical and Computer Engineering, University of California San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
¹⁵ Micron Technology, Inc., 7220 Trade Street, San Diego, CA 92121, USA.

PMID: 36844610
PMCID: PMC9939935
DOI: 10.1016/j.lana.2023.100449

Abstract

Background: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown.

Methods: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 to March 2021.

Findings: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88%-98%); 67% were associated with a positive wastewater sample (95% CI: 57%-77%), and 40% were associated with a positive surface sample (95% CI: 29%-52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples.

Interpretation: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy.

Funding: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.

Keywords: COVID-19 in schools; SARS-CoV-2; Wastewater surveillance.

PubMed Disclaimer

Conflict of interest statement

Authors declare they have no competing interests.

Figures

**Fig. 1**
Safer at School Early Alert (SASEA) system.

**Fig. 2**
Wastewater and surface sampling and 95% confidence interval across full 12-week pilot period, and with consent at 70% or above (weeks 9–12).

**Fig. 3**
Individual diagnostic testing consent over time by site (gray) and total across all nine sites (red) throughout 12-week pilot phase.

**Fig. 4**
**SARS-CoV-2 genomic surveillance.** A. SARS-CoV-2 variant prevalence in the wastewater sequences: The relative proportions of each variant were calculated using Freyja v.1.3.11 ‘Other’ contains all lineages not designated as VoC/Variants of Interest (VoI). B. Genomic sequencing of clinical and environmental samples: Maximum likelihood (ML) phylogenetic tree for the clinical and environmental (wastewater and surface) samples which had an average SARS-CoV-2 virus genome coverage of 95% or above constructed using IQtree.

See this image and copyright information in PMC

Update of

Wastewater and surface monitoring to detect COVID-19 in elementary school settings: The Safer at School Early Alert project.
Fielding-Miller R, Karthikeyan S, Gaines T, Garfein RS, Salido RA, Cantu VJ, Kohn L, Martin NK, Wynn A, Wijaya C, Flores M, Omaleki V, Majnoonian A, Gonzalez-Zuniga P, Nguyen M, Vo AV, Le T, Duong D, Hassani A, Tweeten S, Jepsen K, Henson B, Hakim A, Birmingham A, De Hoff P, Mark AM, Nasamran CA, Rosenthal SB, Moshiri N, Fisch KM, Humphrey G, Farmer S, Tubb HM, Valles T, Morris J, Kang J, Khaleghi B, Young C, Akel AD, Eilert S, Eno J, Curewitz K, Laurent LC, Rosing T, Knight R. Fielding-Miller R, et al. medRxiv [Preprint]. 2023 Jan 25:2021.10.19.21265226. doi: 10.1101/2021.10.19.21265226. medRxiv. 2023. Update in: Lancet Reg Health Am. 2023 Feb 20;19:100449. doi: 10.1016/j.lana.2023.100449. PMID: 34704096 Free PMC article. Updated. Preprint.

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Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Collaborators

Affiliations

Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schools

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

Update of

References

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous