Ohio Coronavirus Wastewater Monitoring Network: Implementation of Statewide Monitoring for Protecting Public Health

CONTEXT

Prior to the COVID-19 pandemic, wastewater influent monitoring for tracking disease burden in sewered communities was not performed in Ohio, and this field was only on the periphery of the state academic research community.

PROGRAM

Because of the urgency of the pandemic and extensive state-level support for this new technology to detect levels of community infection to aid in public health response, the Ohio Water Resources Center established relationships and support of various stakeholders. This enabled Ohio to develop a statewide wastewater SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) monitoring network in 2 months starting in July 2020.

IMPLEMENTATION

The current Ohio Coronavirus Wastewater Monitoring Network (OCWMN) monitors more than 70 unique locations twice per week, and publicly available data are updated weekly on the public dashboard.

EVALUATION

This article describes the process and decisions that were made during network initiation, the network progression, and data applications, which can inform ongoing and future pandemic response and wastewater monitoring.

DISCUSSION

Overall, the OCWMN established wastewater monitoring infrastructure and provided a useful tool for public health professionals responding to the pandemic.

Evaluation of intra- and inter-lab variability in quantifying SARS-CoV-2 in a state-wide wastewater monitoring network

In December 2019, SARS-CoV-2, the virus that causes coronavirus disease 2019, was first reported and subsequently triggered a global pandemic. Wastewater monitoring, a strategy for quantifying viral gene concentrations from wastewater influents within a community, has served as an early warning and management tool for the spread of SARS-CoV-2 in a community. Ohio built a collaborative statewide wastewater monitoring network that is supported by eight labs (university, government, and commercial laboratories) with unique sample processing workflows. Consequently, we sought to characterize the variability in wastewater monitoring results for network labs. Across seven trials between October 2020 and November 2021, eight participating labs successfully quantified two SARS-CoV-2 RNA targets and human fecal indicator virus targets in wastewater sample aliquots with reproducible results, although recovery efficiencies of spiked surrogates ranged from 3 to 75%. When SARS-CoV-2 gene fragment concentrations were adjusted for recovery efficiency and flow, the proportion of variance between laboratories was minimized, serving as the best model to account for between-lab variance. Another adjustment factor (alone and in different combinations with the above factors) considered to account for sample and measurement variability includes fecal marker normalization. Genetic quantification variability can be attributed to many factors, including the methods, individual samples, and water quality parameters. In addition, statistically significant correlations were observed between SARS-CoV-2 RNA and COVID-19 case numbers, supporting the notion that wastewater surveillance continues to serve as an effective monitoring tool. This study serves as a real-time example of multi-laboratory collaboration for public health preparedness for infectious diseases.

Wastewater surveillance of SARS-CoV-2 in dormitories as a part of comprehensive university campus COVID-19 monitoring

Wastewater-based epidemiology is an effective tool for monitoring infectious disease spread or illicit drug use within communities. At the Ohio State University, we conducted a SARS-CoV-2 wastewater surveillance program in the 2020-2021 academic year and compared results with the university-required weekly COVID-19 saliva testing to monitor COVID-19 infection prevalence in the on-campus residential communities. The objectives of the study were to rapidly track trends in the wastewater SARS-CoV-2 gene concentrations, analyze the relationship between case numbers and wastewater signals when adjusted using human fecal viral indicator concentrations (PMMoV, crAssphage) in wastewater, and investigate the relationship of the SARS-CoV-2 gene concentrations with wastewater parameters. SARS-CoV-2 nucleocapsid and envelope (N1, N2, and E) gene concentrations, determined with reverse transcription droplet digital PCR, were used to track SARS-CoV-2 viral loads in dormitory wastewater once a week at 6 sampling sites across the campus during the fall semester in 2020. During the following spring semester, research was focused on SARS-CoV2 N2 gene concentrations at 5 sites sampled twice a week. Spearman correlations both with and without adjusting using human fecal viral indicators showed a significant correlation (p < 0.05) between human COVID-19 positive case counts and wastewater SARS-CoV-2 gene concentrations. Spearman correlations showed significant relationships between N1 gene concentrations and both TSS and turbidity, and between E gene concentrations and both pH and turbidity. These results suggest that wastewater signal increases with the census of infected individuals, in which the majority are asymptomatic, with a statistically significant (p-value <0.05) temporal correlation. The study design can be utilized as a platform for rapid trend tracking of SARS-CoV-2 variants and other diseases circulating in various communities.

Thinking Outside the Treatment Plant: UV for Water Distribution System Disinfection

This work critically evaluates the current paradigm of water distribution system management and juxtaposes that with the potential benefits of employing UV irradiation, which we hope will catalyze a judicial re-evaluation of the current practices in water distribution system management and spur critical research and a new way of thinking about secondary disinfection across the extent of distribution systems. Given the recent advances in UV technology and the efficacy of UV disinfection against all pathogen classes, we now see UV applications for disinfection in many aspects of consumers lives: in water coolers, dishwashers, coffee makers, and disinfection of personal items like gym bags, water bottles, and toothbrushes. Public and regulatory concern over water quality and pathogens, especially the recent interest in building plumbing, calls out for new approaches to disinfection and distribution system management. We envision a new model for secondary disinfection in water distribution systems utilizing emerging germicidal UV LED-based disinfection. UV irradiation in water treatment can achieve high levels of disinfection of all pathogens and minimize or eliminate the formation of regulated disinfection byproducts. So why is UV not considered as a secondary disinfectant for distribution systems? In this Account, we lay out the logic as to the benefits and practicality of adding distributed UV treatment to assist in protection of distribution systems and protect water quality for human exposure. The possible locations of UV irradiation in distribution systems are envisioned, potentially including UV booster stations along the distribution network, UV in storage tanks or their inlet/outlets, LEDs distributed along pipe walls, small point of use/entry treatment systems for buildings/homes/taps, or submersible swimming or rolling UV LED drones to reach problem pipes and provide a "shock" treatment or provide sterilization after main breaks or repairs. The benefits of UV applications in water also include high effectiveness against chlorine-resistant protozoa, no added disinfection byproducts, and compatibility of adding of UV to existing secondary disinfection strategies for enhanced protection. Potential challenges and research needs are described, such as use of UV-compatible pipe materials, implementation of sensors to monitor distributed LEDs, management of waste heat from the rear surface of the LED, and understanding the potential for regrowth of opportunistic microorganisms. Another notable challenge is the relatively stagnant regulatory environment in some countries to develop frameworks for evaluation and acceptance of UV technology in distribution systems that require a chemical secondary disinfectant. Rapid advances in UV LED research has propelled the growth of this field, but needs still remain, including understanding behavior of biofilms in pipes under UV irradiation, including any beneficial effects that may be lost, the potential for fouling of LED emission surfaces and monitoring points, and provision of a distributed power network to run the LEDs. Regulators may want specific monitoring approaches and advances in real-time monitoring of microbial viability, and engineers may need to develop new approaches to overall management.

Microbial aerosol liberation from soiled textiles isolated during routine residuals handling in a modern health care setting

BACKGROUND

A wide variety of specialty textiles are used in health care settings for bedding, clothing, and privacy. The ability of textiles to host or otherwise sequester microbes has been well documented; however, their reciprocal potential for liberating airborne bacteria remains poorly characterized. In response, a multi-season survey of bacterial bioaerosols was conducted in the origin and terminus of residual paths which are specifically designed to isolate soiled hospital textiles as they are moved to laundering. This survey used conventional optical particle counting which incorporated multi-channel fluorescence in conjunction with molecular phylogenetic analyses to characterize the bioaerosols liberated during soiled textile storage--immediately before and after the occupation of a modern hospital. Although outfitted with a HEPA filtration system, the number of airborne particles presenting fluorescing optical signatures consistent with airborne bacteria and fungi significantly increased in textile holding rooms soon after the hospital's commissioning, even though these isolated residual areas rarely host personnel. The bioaerosol liberated during textile storage was characterized using Illumina MiSeq sequencing of bacterial 16S ribosomal ribonucleic acid (rRNA) genes. Gene copies recovered by quantitative PCR from aerosol collected in co-located impingers were consistent with fluorescence gated optical particle counting.

RESULTS

The relative abundance patterns of proximal bacterial bioaerosol were such that the air in the origin and terminus of textile storage rooms could not be differentiated once the hospital began processing soiled linens. Genes from microbes typically associating with human skin, feces, and hair--Staphylococcus, Propionibacteria, Corynebacteria, Lactobacillus, and Streptococcus spp.--dominated the aerosol abundance profiles in textile holding rooms, which were generally far less diverse than communities recovered from surfaces in patient rooms.

CONCLUSIONS

These results suggest that aerosol partitioning from the routine handling of soiled textiles can contribute to airborne exposures in the health care environment.