Wastewater-Based Epidemiology of SARS-CoV-2 in Tertiary Care Hospitals: Advancing Wastewater Science and Providing an Early-Warning System for Hospital Transmission and Outbreaks

Wastewater (WW)-based epidemiology (WBE) is an emerging science that seeks to understand the health of a population through sewage analysis. Early in the course of the pandemic, several groups demonstrated that monitoring for SARS-CoV-2 RNA in the community could predict future COVID-19 cases, hospitalizations and deaths. Our group proposes to focus this technology on hospitals in order to both refine WBE infectious disease science and to develop an "early-warning" system for future outbreaks. Hospitals hold great promise to advance WBE science by precisely identifying and tracking SARS-CoV-2; 1. Hospital WW from both in-building and municipal access points can be assessed minutes after release from patients/staff dramatically reducing the potential for signal degradation. 2. Near- precise accounting for all cases (regardless of symptoms) is possible in hospitals including the ability to relate individual patient-level data to symptom onset and potential exposure timing. 3. Hospital populations are well defined with respect to the daily number of patients (with relevant co-morbidities) and staff ensuring accurate denominators for bench marking. Accordingly, hospital-sewer pipes contain invaluable information that can be used to hone WW-science. Early data from our group demonstrates that WW-SARS-CoV-2 RNA from hospitals correlates with total active COVID-19 hospitalized cases - and yet is still able to identify changes associated with new hospital-associated infections and unit specific outbreaks. With this proposal we seek funding to study hospital-based WW monitoring across three tertiary care facilities (>2100 beds) enabling; 1. Validating WW SARS-CoV-2-RNA tracking as a model for passive infection monitoring in hospitals, 2. Developing and implementing real-time testing and reporting measures to enable outbreak avoidance, and, 3. Developing expertise in multi-level facility monitoring to identify, contain and mitigate SARS-CoV-2 spread.