Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology

Wastewater Assessment for Coronavirus in Kentucky - Implementing Enhanced SurveillanceTechnologySurveillance for SARS-CoV-2 is hindered by the availability of testing, particularly in remote and ruralareas. Screening of wastewater for SARS-CoV-2 viral biomarkers offers a viable alternative to individualtesting and it can identify communities and facilities that are at risk of becoming hotspots.Wastewatersurveillance overcomes several limitations of clinical surveillance, such as the need for robust healthcareand laboratory infrastructure and the lack of representative and comprehensive testing withincommunities. Conventional wastewater surveillance takes samples from sewer systems or wastewatertreatment facilities and uses a series of extraction steps prior to advanced PCR technology to quantitatethe viral biomarker (RNA). This approach is time and resource-intensive, which limits its wide-scaleapplication. Developing next generation technology to simplify wastewater RNA extraction andquantitation will make it feasible to use more broadly at facilities and in rural communities. The limitedclinical testing for COVID-19 in rural Southeastern Kentucky hampers disease surveillance and preventsinformed public action to mitigate and contain the spread of disease. Wastewater testing for SARS-CoV-2 in these communities using field-friendly technology will provide important information to localauthorities and citizens about the spread and trend of SARS-CoV-2 infection in their communities. Ourproject will accomplish two aims: 1) Develop next generation wastewater assessment technology and 2)Implement and evaluate the next generation wastewater assay. For Aim 1 we adapt technology inventedby our team termed exclusion-based sample preparation (ESP) to simplify and improve RNA extractionfrom wastewater. We will pair ESP with loop-mediated isothermal amplification (LAMP) technology forRNA detection to create a sensitive, robust, and field-friendly platform for testing wastewater for SARS-CoV-2 RNA. We will compare the next generation assay with established techniques on metrics ofsensitivity, specificity, and usability (e.g., assay time, number of assay steps). For Aim 2 we will firstvalidate the next generation assay in the field at congregate living facilities in a side-by-side comparisonwith conventional wastewater surveillance. Next, building on existing relationships in AppalachianKentucky, we will recruit and train a purposive group of wastewater treatment plant operators, watershedwatch citizen scientists, and school science teachers to test wastewater in their communities and schoolsusing the field-friendly next generation wastewater assay. Field results will be validated in the lab. Arobust mixed methods evaluation using the RE-AIM framework will assess community perceptions offeasibility, acceptability, and utility of wastewater surveillance for SARS-CoV-2 and identify communitymeasures taken in response to test results.