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. 2024 Jan 10;4(1):e0001803.
doi: 10.1371/journal.pgph.0001803. eCollection 2024.

Precision public health in schools enabled by wastewater surveillance: A case study of COVID-19 in an Upstate New York middle-high school campus during the 2021-2022 academic year

Haley Kappus-Kron  1   2 , Dana Ahmad Chatila  3 , Ainsley Mabel MacLachlan  3 , Nicole Pulido  3 , Nan Yang  3 , David A Larsen  3
Affiliations

Precision public health in schools enabled by wastewater surveillance: A case study of COVID-19 in an Upstate New York middle-high school campus during the 2021-2022 academic year

Haley Kappus-Kron et al. PLOS Glob Public Health. .

Abstract

Wastewater surveillance provides a cost-effective and non-invasive way to gain an understanding of infectious disease transmission including for COVID-19. We analyzed wastewater samples from one school site in Jefferson County, New York during the 2021-2022 school year. We tested for SARS-CoV-2 RNA once weekly and compared those results with the clinical COVID-19 cases in the school. The amount of SARS-CoV-2 RNA correlated with the number of incident COVID-19 cases, with the best correlation being one day lead time between the wastewater sample and the number of COVID-19 cases. The sensitivity and positive predictive value of wastewater surveillance to correctly identify any COVID-19 cases up to 7 days after a wastewater sample collection ranged from 82-100% and 59-78% respectively, depending upon the amount of SARS-CoV-2 RNA in the sample. The specificity and negative predictive value of wastewater surveillance to correctly identify when the school was without a case of COVID-19 ranged from 67-78% and 70-80%, respectively, depending upon the amount of SARS-CoV-2 RNA in the sample. The lead time observed in this study suggests that transmission might occur within a school before SARS-CoV-2 is identified in wastewater. However, wastewater surveillance should still be considered as a potential means of understanding school-level COVID-19 trends and is a way to enable precision public health approaches tailored to the epidemiologic situation in an individual school.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Weekly aggregated incident clinical case counts relative to wastewater testing during the 2021–22 academic year.
The wastewater intensity is the log-transformed amount of SARS-CoV-2 in wastewater divided by the log-transformed amount of crAssphage in wastewater.
Fig 2
Fig 2. Characteristics of wastewater samples collected during 2021–2022 academic year.
Not detected means no SARS-CoV-2 RNA was found by PCR. Detected,
Fig 3
Fig 3. Correlation between clinical case 7-day roiling average and different wastewater metrics at TICSD.
Intensity is defined as the log-transformed gene copies of SARS-CoV-2 divided by the log-transformed gene copies of crAssphage.
Fig 4
Fig 4
Sensitivity (A) to identify a COVID-19 case using wastewater surveillance at TICSD, specificity (B) the ability to identify the school building without a COVID-19 case using wastewater surveillance, positive predictive value (C) of a positive wastewater surveillance result to indicate a COVID-19 case among those at the school, and negative predictive value (D) of a negative wastewater surveillance result to indicate no COVID-19 cases among faculty, staff, and students at TICSD.
Fig 5
Fig 5. Comparison of SARS-CoV-2 intensity in wastewater at different catchment sites in Jefferson County.
See this image and copyright information in PMC

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