Four Models of Wastewater-Based Monitoring for SARS-CoV-2 Complementing Individual Screening in Jail Settings

Abstract

Objectives. To describe 4 unique models of operationalizing wastewater-based surveillance (WBS) for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in jails of graduated sizes and different architectural designs. Methods. We summarize how jails of Cook County, Illinois (average daily population [ADP] 6000); Fulton County, Georgia (ADP 3000); Middlesex County, Massachusetts (ADP 875); and Washington, DC (ADP 1600) initiated WBS between 2020 and 2023. Results. Positive signals for SARS-CoV-2 via WBS can herald a new onset of infections in previously uninfected jail housing units. Challenges implementing WBS included political will and realized value, funding, understanding the building architecture, and the need for details in the findings. Conclusions. WBS has been effective for detecting outbreaks of SARS-CoV-2 in different sized jails, those with both dorm- and cell-based architectural design. Public Health Implications. Given its effectiveness in monitoring SARS-CoV-2, WBS provides a model for population-based surveillance in carceral facilities for future infectious disease outbreaks. (Am J Public Health. 2024;114(11):1232-1241. https://doi.org/10.2105/AJPH.2024.307785).

FIGURE 1—

Moore Swab: A 4″ × 4″ Gauze Square, Tied Together With Fishing Line, Which Is Suspended in Wastewater for 24 Hours Source. Saber et al.

FIGURE 2—

Aerial Photographs, With Locations of Housing Units and Manhole Points, of Jails in (a) Cook County, IL; (b) Fulton County, GA; (c) Middlesex County, MA; and (d) Washington, DC: 2020–2024 Note. Cook County Jail provided residential housing across 16 buildings. Each had its own wastewater-based sampling site. Specific locations are not shared because of security concerns. Proxy/representative site at Fulton County Jail represents sampling site that pools wastewater from the majority of housing sites in the jail.

FIGURE 3—

Comparison of Wastewater and Diagnostic Results With Population Percentage: Fulton County Jail, GA, 2021–2022 Source. Saber et al. Note. Average cycle threshold refers to the number of cycles needed to detect a florescent signal in a real-time polymerase chain reaction test as a result of detection of amplified nucleic acid (RNA or DNA). It is inversely proportional to the amount of RNA in the initial sample. With increasing percentages of negative tests (fewer people infected, less RNA) the cycle threshold increases as more cycles are required to amplify it to detectable levels.