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      Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs

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          Abstract

          Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members.

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          Most cited references51

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          Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups.

          Qualitative research explores complex phenomena encountered by clinicians, health care providers, policy makers and consumers. Although partial checklists are available, no consolidated reporting framework exists for any type of qualitative design. To develop a checklist for explicit and comprehensive reporting of qualitative studies (in depth interviews and focus groups). We performed a comprehensive search in Cochrane and Campbell Protocols, Medline, CINAHL, systematic reviews of qualitative studies, author or reviewer guidelines of major medical journals and reference lists of relevant publications for existing checklists used to assess qualitative studies. Seventy-six items from 22 checklists were compiled into a comprehensive list. All items were grouped into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. Duplicate items and those that were ambiguous, too broadly defined and impractical to assess were removed. Items most frequently included in the checklists related to sampling method, setting for data collection, method of data collection, respondent validation of findings, method of recording data, description of the derivation of themes and inclusion of supporting quotations. We grouped all items into three domains: (i) research team and reflexivity, (ii) study design and (iii) data analysis and reporting. The criteria included in COREQ, a 32-item checklist, can help researchers to report important aspects of the research team, study methods, context of the study, findings, analysis and interpretations.
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            Virological assessment of hospitalized patients with COVID-2019

            Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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              First confirmed detection of SARS-CoV-2 in untreated wastewater in Australia: A proof of concept for the wastewater surveillance of COVID-19 in the community

              Infection with SARS-CoV-2, the etiologic agent of the ongoing COVID-19 pandemic, is accompanied by the shedding of the virus in stool. Therefore, the quantification of SARS-CoV-2 in wastewater affords the ability to monitor the prevalence of infections among the population via wastewater-based epidemiology (WBE). In the current work, SARS-CoV-2 RNA was concentrated from wastewater in a catchment in Australia and viral RNA copies were enumerated using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) resulting in two positive detections within a six day period from the same wastewater treatment plant (WWTP). The estimated RNA copy numbers observed in the wastewater were then used to estimate the number of infected individuals in the catchment via Monte Carlo simulation. Given the uncertainty and variation in the input parameters, the model estimated a median range of 171 to 1090 infected persons in the catchment, which is in reasonable agreement with clinical observations. This work highlights the viability of WBE for monitoring infectious diseases, such as COVID-19, in communities. The work also draws attention to the need for further methodological and molecular assay validation for enveloped viruses in wastewater.
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                Author and article information

                Contributors
                Role: Academic Editor
                Journal
                Int J Environ Res Public Health
                Int J Environ Res Public Health
                ijerph
                International Journal of Environmental Research and Public Health
                MDPI
                1661-7827
                1660-4601
                22 April 2021
                May 2021
                : 18
                : 9
                : 4455
                Affiliations
                [1 ]Berkeley Water Center, University of California Berkeley, 410 O’Brien Hall, Berkeley, CA 94720, USA
                [2 ]Department of Civil and Environmental Engineering, University of California Berkeley, MS 1710, Berkeley, CA 94720, USA; karanelson@ 123456berkeley.edu
                [3 ]Department of Community, Environment & Policy, Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave., Tucson, AZ 85724, USA; pbeamer@ 123456email.arizona.edu
                [4 ]Department of Civil and Environmental Engineering, University of California Davis, 3109 Ghausi Hall, One Shields Ave., Davis, CA 95616, USA; hbischel@ 123456ucdavis.edu
                [5 ]Department of Civil and Environmental Engineering and Earth Sciences, University of Notre Dame, 156 Fitzpatrick Hall, Notre Dame, IN 46556, USA; abivins@ 123456nd.edu
                [6 ]Department of Mathematics and Computer Science, Colorado College, 14 E Cache la Poudre St., Colorado Springs, CO 80903, USA; abruder@ 123456coloradocollege.edu
                [7 ]Department of Civil and Environmental Engineering, University of Massachusetts Amherst, 130 Natural Resources Rd., Amherst, MA 01003, USA; csbutler@ 123456umass.edu
                [8 ]Department of Pharmaceutical Sciences, St. John Fisher College, 3690 East Ave., Rochester, NY 14618, USA; tcamenisch@ 123456sjfc.edu
                [9 ]Department of Civil and Environmental Engineering, 1301 Campus Delivery, Colorado State University, Fort Collins, CO 80526, USA; susan.de_long@ 123456colostate.edu
                [10 ]Department of Pediatrics, University of California San Diego, Biomedical Res. Facility 2, 9500 Gilman Drive, La Jolla, CA 92037, USA; skarthikeyan@ 123456health.ucsd.edu
                [11 ]Department of Public Health, Syracuse University, 430C Barclay, Syracuse, New York, NY 13244, USA; dalarsen@ 123456syr.edu
                [12 ]Department of Environmental Studies and Sciences, Siena College, 515 Loudon Rd., Loudonville, NY 12211, USA; kmeierdiercks@ 123456siena.edu
                [13 ]Department of Civil and Environmental Engineering, University of New Hampshire Durham, 35 Colovos Rd., 236 Gregg Hall, Durham, NH 03824, USA; Paula.Mouser@ 123456unh.edu
                [14 ]Department of Civil and Environmental Engineering, University of Massachusetts Lowell, 1 University Avenue, Lowell, MA 01854, USA; Sheree_Pagsuyoin@ 123456uml.edu
                [15 ]Water and Energy Sustainable Technology Center, University of Arizona, 2959 W Calle Agua Nueva, Tucson, AZ 85745, USA; sprasek@ 123456email.arizona.edu
                [16 ]School of Chemical, Biological, and Environmental Engineering, Oregon State University, 116 Johnson Hall, 105 SW 26th St., Corvallis, OR 97331, USA; tyler.radniecki@ 123456oregonstate.edu
                [17 ]Department of Physiology, Wayne State University, 540 E. Canfield St., Detroit, MI 48201, USA; jeffram@ 123456wayne.edu
                [18 ]Department of Biological Engineering, Utah State University, 4105 Old Main Hill, Logan, UT 84322, USA; keith.roper@ 123456usu.edu
                [19 ]Department of Civil and Environmental Engineering, University of California Davis, 2001 Ghausi Hall, 480 Bainer Hall Drive, Davis, CA 95616, USA; hrsafford@ 123456ucdavis.edu
                [20 ]Department of Environmental Health Science, Tulane University, 1440 Canal St., New Orleans, LA 70112, USA; sshercha@ 123456tulane.edu
                [21 ]Department of Civil and Environmental Engineering, Wayne State University, 5050 Anthony Wayne Drive, Detroit, MI 48202, USA; wshuster@ 123456wayne.edu
                [22 ]Department of Biological Sciences, University of Idaho, 875 Perimeter Dr. MS3051, Moscow, ID 83844, USA; tstalder@ 123456uidaho.edu
                [23 ]Department of Molecular and Biomedical Sciences, University of Maine, 5735 Hitchner Hall, Orono, ME 04473, USA; robert.wheeler1@ 123456maine.edu
                [24 ]Department of Environmental Medicine, University of Rochester, 601 Elmwood Ave., Box EHSC, Rochester, NY 14642, USA; katrina_korfmacher@ 123456urmc.rochester.edu
                Author notes
                Author information
                https://orcid.org/0000-0001-9006-6895
                https://orcid.org/0000-0001-6226-4536
                https://orcid.org/0000-0002-1876-6536
                https://orcid.org/0000-0003-2316-0915
                https://orcid.org/0000-0002-5295-3562
                https://orcid.org/0000-0003-3223-7021
                Article
                ijerph-18-04455
                10.3390/ijerph18094455
                8122720
                33922263
                98a5abd6-c5cd-46f9-a97e-e3aabfb517aa
                © 2021 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( https://creativecommons.org/licenses/by/4.0/).

                History
                : 16 February 2021
                : 17 April 2021
                Categories
                Article

                Public health
                wastewater surveillance,colleges and universities,covid-19,sewage,sars-cov-2
                Public health
                wastewater surveillance, colleges and universities, covid-19, sewage, sars-cov-2

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