Covid 19: Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology

Surveillance for SARS-CoV-2 is hindered by the availability of testing, particularly in remote and rural areas. Screening of wastewater for SARS-CoV-2 viral biomarkers offers a viable alternative to individual testing, as it enables identification of communities and facilities that are at risk of becoming hotspots. Wastewater surveillance overcomes several limitations of clinical surveillance, such as the need for robust healthcare and laboratory infrastructure and the lack of representative and comprehensive testing within communities. Conventional wastewater surveillance takes samples from sewer systems or wastewater treatment facilities and uses a series of extraction steps prior to advanced PCR technology to quantitate the viral biomarker (RNA). This approach is time and resource-intensive, which limits its wide-scale application. Developing next generation technology to simplify wastewater RNA extraction will make it feasible to use in rural communities. The limited clinical testing for COVID-19 in many rural communities, including those in Southeastern Kentucky, hampers disease surveillance and prevents informed public action to mitigate and contain the spread of disease. Wastewater testing for SARS-CoV-2 in these rural communities using field-friendly technology will provide important information to local authorities citizens about the spread and trend of SARS-CoV-2 infection in their communities. Our proposal will accomplish the following aims: 1. Use Exclusion-based Sample Preparation (ESP) technology to improve wastewater RNA detection and simplify field testing. We hypothesize that using ESP in combination with Loop-mediated isothermal amplification (LAMP) technology for RNA detection will create a sensitive, robust, and field-friendly platform for testing wastewater for SARS-CoV-2 RNA. We will build and validate this next generation platform against existing conventional wastewater testing protocols. 2. Implement and evaluate wastewater testing for SARS-CoV-2 in rural Kentucky. We hypothesize that the technology developed in Aim 1 will allow rural communities to effectively test for SARS-CoV-2 in their wastewater, and that the data generated by these tests will be useful for local decision makers. Using a community-engaged, participatory science approach we will take our mobile labs to rural communities to train people to test wastewater at treatment plants, schools, and from streams. We will validate the field testing results in our lab and evaluate the utility and acceptability of the technology from the perspective of our community collaborators.