Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, IN 46556, USA.
Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, IN 46556, USA.
Water Res. 2021 Sep 1;202:117438. doi: 10.1016/j.watres.2021.117438. Epub 2021 Jul 12.
Wastewater-based epidemiology (WBE) has emerged as a useful tool in the fight to track and contain COVID-19 spread within communities. One of the motives behind COVID-19 WBE efforts is the potential for 'early warning' of either the onset of disease in a new setting or changes in trends in communities where disease is endemic. Many initial reports of the early warning potential of WBE have relied upon retrospective sample analysis, and delays in WBE analysis and reporting should be considered when evaluating the early warning potential of WBE that enable public health action. Our purpose in this manuscript is to establish a framework to critique the potential of WBE to serve as an early warning system, with special attention to the onset of viral shedding and the differential between results reporting for WBE and clinical testing. While many uncertainties remain regarding both COVID-19 clinical presentation and technical factors influencing WBE results, our analysis suggests at most a modest lead time interval ranging from six days for clinical testing to four days for WBE during community-level wastewater surveillance where clinical testing is accessible on-demand with a rapid time to results. This potential lead time for WBE subsequently increases in settings with limited clinical testing capacity or utilization. Care should be taken when reporting 'early detection' of COVID-19 disease trends via WBE to consider underlying causes (e.g., clinical testing lag or delayed result reporting) to avoid misrepresenting WBE potential.
基于污水的流行病学（WBE）已成为追踪和控制社区内 COVID-19 传播的有用工具。COVID-19 WBE 工作的动机之一是在新环境中疾病发作或地方性疾病社区中疾病趋势变化的“预警”潜力。许多关于 WBE 早期预警潜力的初步报告都依赖于回顾性样本分析，在评估 WBE 的早期预警潜力以采取公共卫生行动时，应考虑 WBE 分析和报告的延迟。我们在本文中的目的是建立一个框架来评估 WBE 作为预警系统的潜力，特别关注病毒脱落的开始以及 WBE 和临床检测结果报告之间的差异。虽然 COVID-19 的临床表现和影响 WBE 结果的技术因素仍然存在许多不确定性，但我们的分析表明，在社区级污水监测中，临床检测可按需随时进行且结果报告时间较快的情况下，WBE 的预警时间最长为六天，而临床检测为四天。在临床检测能力或利用率有限的情况下，WBE 的潜在预警时间会增加。通过 WBE 报告 COVID-19 疾病趋势的“早期检测”时，应考虑潜在原因（例如，临床检测滞后或结果报告延迟），以避免对 WBE 的潜力产生误解。
