Wastewater surveillance provides 10-days forecasting of COVID-19 hospitalizations superior to cases and test positivity: A prediction study

Background

The public health response to COVID-19 has shifted to reducing deaths and hospitalizations to prevent overwhelming health systems. The amount of SARS-CoV-2 RNA fragments in wastewater are known to correlate with clinical data including cases and hospital admissions for COVID-19. We developed and tested a predictive model for incident COVID-19 hospital admissions in New York State using wastewater data.

Methods

Using county-level COVID-19 hospital admissions and wastewater surveillance covering 13.8 million people across 56 counties, we fit a generalized linear mixed model predicting new hospital admissions from wastewater concentrations of SARS-CoV-2 RNA from April 29, 2020 to June 30, 2022. We included covariates such as COVID-19 vaccine coverage in the county, comorbidities, demographic variables, and holiday gatherings.

Findings

Wastewater concentrations of SARS-CoV-2 RNA correlated with new hospital admissions per 100,000 up to ten days prior to admission. Models that included wastewater had higher predictive power than models that included clinical cases only, increasing the accuracy of the model by 15%. Predicted hospital admissions correlated highly with observed admissions (r = 0.77) with an average difference of 0.013 hospitalizations per 100,000 (95% CI = [0.002, 0.025]).

Interpretation

Using wastewater to predict future hospital admissions from COVID-19 is accurate and effective with superior results to using case data alone. The lead time of ten days could alert the public to take precautions and improve resource allocation for seasonal surges.

Establishing a Statewide Wastewater Surveillance System in Response to the COVID-19 Pandemic: A Reliable Model for Continuous and Emerging Public Health Threats

CONTEXT

The COVID-19 pandemic sparked efforts across the globe to implement wastewater surveillance for SARS-CoV-2.

PROGRAM

New York State (NYS) established the NYS Wastewater Surveillance Network to estimate the levels of COVID-19 community risk and to provide an early indication of SARS-CoV-2 transmission trends. The network is designed to provide a better understanding of public health burdens and to assist health departments to respond effectively to public health threats.

IMPLEMENTATION

Wastewater surveillance across NYS increased from sporadic and geographically spare in 2020 to routine and widespread in 2022, reaching all 62 counties in the state and covering 74% of New Yorkers. The network team focused on engaging local health departments and wastewater treatment plants to provide wastewater samples, which are then analyzed through a network-affiliated laboratory. Both participating local health departments and wastewater treatment plants receive weekly memos on current SARS-CoV-2 trends and levels. The data are also made publicly available at the state dashboard.

EVALUATION

Using standard indicators to evaluate infectious disease surveillance systems, the NYS Wastewater Surveillance Network was assessed for accuracy, timeliness, and completeness during the first year of operations. We observed 96.5% sensitivity of wastewater to identify substantial/high COVID-19 transmission and 99% specificity to identify low COVID-19 transmission. In total, 80% of results were reported within 1 day of sample collection and were published on the public dashboard within 2 days of sample collection. Among participating wastewater treatment plants, 32.5% provided weekly samples with zero missing data, 31% missed 1 or 2 weeks, and 36.5% missed 3 or more weeks.

DISCUSSION

The NYS Wastewater Surveillance Network continues to be a key component of the state and local health departments' pandemic response. The network fosters prompt public health actions through real-time data, enhancing the preparedness capability for both existing and emerging public health threats.

The MEDLINE update on closed-circuit television

An alternative format for presentation of the MEDLINE Update is presented. Utilization of a statewide closed-circuit television network is time-saving and cost-effective for the audience. Differences in and audience response to this alternative programming are described.

The partial molar volumes of anesthetics in lipid bilayers

The excess volumes of mixing of benzyl alcohol, halothane, and methoxyflurane in water and in suspensions of several lipid bilayers have been determined at 25 degrees C using a novel excess volume dilatometer. The excess volumes of mixing in water were all found to be negative, whereas in lipid suspensions they were all more positive than those in water alone. From known partition coefficients the partial molar volumes of these three solutes in the lipid bilayers were calculated. These values were all close to the molar volumes of the pure anesthetics, as was a value determined for halothane in olive oil. Halothane was studied in dipalmitoylphosphatidylcholine below its phase transition, and was found to exhibit a much larger excess volume than in any other system we studied. The potency of these three anesthetics was determined in tadpoles. It was calculated that at equi-anesthetic doses these three agents caused an expansion in egg lecithin/cholesterol (2:1) bilayers of 0.21 +/- 0.015%. This result is consistent with the hypothesis that general anesthetics act by expanding membranes.

Quantitative hemodynamic effects of heart rate in aortic regurgitation

The hemodynamic effect of varying heart rate was studied in eight patients with aortic regurgitation. At the subjects' resting sinus rhythm and at a higher heart rate induced with right atrial pacing, left ventricular and aortic pressures and Fick cardiac outputs (FCO) were measured, and left ventricular biplane angiocardiograms were performed. Left ventricular volumes and left ventricular minute flow (LVMF) were determined from the angiograms. Regurgitant flow was quantitated by subtracting the FCO from LVMF. Increased heart rate produced highly significant reductions in the left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic volume, and stroke volume. End-diastolic circumferential stress (EDCS) and end-diastolic load (EDL) were abnormally high at resting sinus rhythm and were markedly decreased with increased heart rate. FCO increased, but no significant changes were observed in either the LVMF or the regurgitant flow per minute.

Bradycardia in aortic regurgitation may cause pulmonary congestion secondary to high LVEDP and may accelerate left ventricular dilatation secondary to markedly elevated EDCS and EDL. The possible benefits of preventing bradycardia in aortic regurgitation by chronic demand pacing is currently being tested.