Strengthening COVID-19 prevention strategies via wastewater surveillance in a Northern Plains Tribe

Despite the abundance of clinical and epidemiologic data collected during this pandemic, relatively little focus has been paid to the examination of infectious agents through bulk wastewater detection and epidemiological data that is particularly well-suited for disease surveillance in remote, frontier settings such as the CRST Reservation. The goal of this application is to develop and implement a 15-community wastewater testing program for viral contaminants, including SARS-CoV-2, to better understand the utility of wastewater testing and COVID-19 or other viral outbreaks in this remote, low-resourced, and relatively low-density Tribal community. We will use our highly collaborative, multidisciplinary team of Native investigators to develop and implement, and evaluate the effectiveness of a viral wastewater sequencing testing program in a very rural and remote Northern Plains Lakota Reservation. Therefore, we propose to leverage our 20-year, long-running partnership with CRST to address the following Specific Aims: 1. Use a highly participatory approach to design, garner approval for, and implement a wastewater testing system in a large Tribal reservation community. This community surveillance approach will screen for viral isolates, including SARS-CoV-2, in coordination with CRST's preexisting COVID-19 surveillance system; and 2. Deploy qualitative methods to examine 16 key Tribal stakeholders' and Tribal members' attitudes towards this new community wastewater testing approach and, ultimately, how this new environmental testing effort affects Tribal members socially, ethically, and behaviorally; and 3. Seek to codify this new resource into the Tribe's public health emergency response program, thereby enhancing the Tribe's capacity for future viral and other likely epidemic and pandemic outbreaks.