Safer at school early alert: an observational study of wastewater and surface monitoring to detect COVID-19 in elementary schoolsResearch in context

• Published in: Lancet Regional Health - Americas (Online) Vol. 19; p. 100449
• Main Authors: Rebecca Fielding-Miller, Smruthi Karthikeyan, Tommi Gaines, Richard S. Garfein, Rodolfo A. Salido, Victor J. Cantu, Laura Kohn, Natasha K. Martin, Adriane Wynn, Carrissa Wijaya, Marlene Flores, Vinton Omaleki, Araz Majnoonian, Patricia Gonzalez-Zuniga, Megan Nguyen, Anh V. Vo, Tina Le, Dawn Duong, Ashkan Hassani, Samantha Tweeten, Kristen Jepsen, Benjamin Henson, Abbas Hakim, Amanda Birmingham, Peter De Hoff, Adam M. Mark, Chanond A. Nasamran, Sara Brin Rosenthal, Niema Moshiri, Kathleen M. Fisch, Greg Humphrey, Sawyer Farmer, Helena M. Tubb, Tommy Valles, Justin Morris, Jaeyoung Kang, Behnam Khaleghi, Colin Young, Ameen D. Akel, Sean Eilert, Justin Eno, Ken Curewitz, Louise C. Laurent, Tajana Rosing, Rob Knight, Nathan A. Baer, Tom Barber, Anelizze Castro-Martinez, Marisol Chacón, Willi Cheung, Evelyn S. Crescini, Emily R. Eisner, Lizbeth Franco Vargas, Charlotte Hobbs, Alma L. Lastrella, Elijah S. Lawrence, Nathaniel L. Matteson, Karthik Gangavarapu, Toan T. Ngo, Phoebe Seaver, Elizabeth W. Smoot, Rebecca Tsai, Bing Xia, Stefan Aigner, Catelyn Anderson, Pedro Belda-Ferre, Shashank Sathe, Mark Zeller, Kristian G. Andersen, Gene W. Yeo, Ezra Kurzban
• Format: Journal Article
• Language: English
• Published: Elsevier 01-03-2023
• Subjects: COVID-19 in schools; SARS-CoV-2; Wastewater surveillance
• ISSN: 2667-193X; 2667-193X

Background: Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. Previous research suggests that wastewater monitoring can detect SARS-CoV-2 infections in controlled residential settings with high levels of accuracy. However, its effective accuracy, cost, and feasibility in non-residential community settings is unknown. Methods: The objective of this study was to determine the effectiveness and accuracy of community-based passive wastewater and surface (environmental) surveillance to detect SARS-CoV-2 infection in neighborhood schools compared to weekly diagnostic (PCR) testing. We implemented an environmental surveillance system in nine elementary schools with 1700 regularly present staff and students in southern California. The system was validated from November 2020 to March 2021. Findings: In 447 data collection days across the nine sites 89 individuals tested positive for COVID-19, and SARS-CoV-2 was detected in 374 surface samples and 133 wastewater samples. Ninety-three percent of identified cases were associated with an environmental sample (95% CI: 88%–98%); 67% were associated with a positive wastewater sample (95% CI: 57%–77%), and 40% were associated with a positive surface sample (95% CI: 29%–52%). The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Interpretation: Passive environmental surveillance can detect the presence of COVID-19 cases in non-residential community school settings with a high degree of accuracy. Funding: County of San Diego, Health and Human Services Agency, National Institutes of Health, National Science Foundation, Centers for Disease Control.