How to set up sewage surveillance for SARS-CoV-2 virus as an early detection system for corona infections

KWR has demonstrated that sewage surveillance can be a predictive tool in monitoring the circulation of SARS-CoV-2 (the virus responsible for Covid-19) in communities (Medema et al., 2020). Via the stools of infected people, the virus enters the sewers. Since 6 February, KWR has been measuring the concentration of RNA from SARS-CoV2 (the causative agent of COVID-19) in sewage water in various cities. By comparing the data of the sewage water with the reported number of hospital admissions, we see a correlation: the higher the concentration of RNA of the virus in the sewage water, the higher the number of hospital admissions. The graph also shows that a decrease in sewage water corresponds with a decrease in hospital admissions.

The concentration of genetic particles in the sewer (red), the number of reported infections at the City Health Service (blue) and the number of hospital admissions (grey) in Amsterdam. The measurement results are from water samples taken on Wednesday, 22 July

Based on Gert Jan Medema’s research, several countries are considering sewage monitoring as an early warning system. Firstly, because there are indications that we can detect the virus in the sewage water sooner rather than patients reporting sick. Secondly, because not everyone who is infected actually feels sick and is tested. Thirdly, because there seems to be a correlation between the concentrations of RNA measured in sewage water and the level of infection among the population.

This approach is not limited to wastewater treatment plants as the same analytical procedure, and surveillance can be extended to sewered communities, non-sewered communities and all other human wastes streams such as sludge collection facilities or septic tanks.

Sewage surveillance is a scientifically grounded and economically efficient screening method next to individual clinical testing. This approach provides highly relevant and trustworthy information about changes both in the degree and location of contamination.

What we offer

KWR can assist you with analysis, validation, quality control, sampling programmes and development of actual early warning and monitoring systems.

1. Sampling strategy: Design sampling plan (locations and frequency) for optimal information on virus spread.
2. Samples analysis: Process and test samples.
3. Analysis capacity: Set up programs to develop analysis capacity and to support quality control.
4. Data processing: Set upreporting system for tracking and visualisation (online platform).
5. Advanced modelling: Combine data with other datasets and pandemic models to monitor effects of interventions. Create early warning platform and reports (online data).
6. Advanced approach advising: Identify sub-catchment sampling and modelling approaches. Co-create user interfaces for different stakeholders.
7. Risk-based assessment methodology for virus outbreaks: Develop virus monitoring methodology based on best practice.

This early warning and monitoring method provides timely information that can be pivotal in decision making (relaxing or strengthening policies). With the ultimate goals to better manage an existing outbreak and make society, community and workplace resilient to a new outbreak.

Contact Frederic Béen, Gerard van den Berg or Jan Vreeburg to discover what we can offer you.

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