Clinical correlation of SARS-CoV-2 wastewater passive sampling in long-term care facilities and wastewater treatment plants

William Strike; Alexus Rockward; Blazan Mijatovic; Ann Noble; Cullen Olsson; Soroosh Torabi; Mohammad Dehghan Banadaki; Reuben Adatorwovor; James Keck; Scott Berry

doi:10.1016/j.envadv.2025.100635

Clinical correlation of SARS-CoV-2 wastewater passive sampling in long-term care facilities and wastewater treatment plants

William Strike, Alexus Rockward, Blazan Mijatovic, Ann Noble, Cullen Olsson, Soroosh Torabi, Mohammad Dehghan Banadaki, Reuben Adatorwovor, James Keck, Scott Berry

Research output: Contribution to journal › Article › peer-review

Abstract

Wastewater-based epidemiology (WBE) is a promising tool for improving health outcomes through early detection and cost-effective pathogen surveillance. Long-term care facilities (LTCFs) serve and employ vulnerable populations that may particularly benefit from the use of WBE, but financial and technical costs associated with standard sampling methods limit the feasibility of WBE in the LTCF setting. In this work, we used passive sampling to simplify the wastewater analysis process and compared its performance to the standard composite sampling method. Moore swabs and automatic composite samplers were used concurrently to sample wastewater from two LTCFs, and samples were analyzed for SARS-CoV-2 concentration. Passive sampling relies on an unknown volume of wastewater flowing through a cotton material, which complicates back calculations of pathogen concentration. We chose to calculate analyte concentrations based on the squeezed eluent from the cotton swab, which is practical for temporal analysis. Across all samples, passive and composite sampling performed similarly for SARS-CoV-2 detection and mean concentration. However, we observed a sensitivity advantage at low SARS-CoV-2 concentrations (<180 gc/mL) when using passive sampling. Furthermore, SARS-CoV-2 wastewater concentrations obtained via passive sampling correlated with the reported clinical cases, with wastewater concentration leading reported clinical cases by an average of 4 days. Passive and composite sampling were also performed at a wastewater treatment plant (WWTP) to examine the effects of facility type on sampling performance. To our knowledge, this is the first work performing a comparative analysis at both facility- and community-scale locations. Passive sampling yielded significantly higher SARS-CoV-2 and fecal load biomarkers than composite sampling at WWTPs, illustrating an important difference between LTCF samples and WWTP samples.

Original language	English
Article number	100635
Journal	Environmental Advances
Volume	20
DOIs	https://doi.org/10.1016/j.envadv.2025.100635
State	Published - Jul 2025

Bibliographical note

Publisher Copyright:
© 2025

Funding

This work was funded by the National Institutes of Health (NIH) [1U01DA053903-01, P30 ES026529], the Centers for Disease Control and Prevention (CDC) [BAA 75D301-20-R-68024], the National Science Foundation (NSF) [Awards #2154934 and # 2412446], and pilot funding from the UK Center for Clinical and Translational Science.

Funders	Funder number
UMass Center for Clinical and Translational Science, University of Massachusetts Medical School Worcester
U.S. Department of Energy Chinese Academy of Sciences Guangzhou Municipal Science and Technology Project Oak Ridge National Laboratory Extreme Science and Engineering Discovery Environment National Science Foundation National Energy Research Scientific Computing Center National Natural Science Foundation of China	2154934, 2412446
U.S. Department of Energy Chinese Academy of Sciences Guangzhou Municipal Science and Technology Project Oak Ridge National Laboratory Extreme Science and Engineering Discovery Environment National Science Foundation National Energy Research Scientific Computing Center National Natural Science Foundation of China
Centers for Disease Control and Prevention	BAA 75D301-20-R-68024
Centers for Disease Control and Prevention
National Institutes of Health (NIH)	1U01DA053903-01, P30 ES026529
National Institutes of Health (NIH)

Keywords

Clinical correlation
Long-term care facilities
Moore swab
Passive sampling
SARS-CoV-2
Wastewater-based epidemiology (WBE)

ASJC Scopus subject areas

Global and Planetary Change
Environmental Chemistry
Environmental Science (miscellaneous)

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Cite this

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title = "Clinical correlation of SARS-CoV-2 wastewater passive sampling in long-term care facilities and wastewater treatment plants",

abstract = "Wastewater-based epidemiology (WBE) is a promising tool for improving health outcomes through early detection and cost-effective pathogen surveillance. Long-term care facilities (LTCFs) serve and employ vulnerable populations that may particularly benefit from the use of WBE, but financial and technical costs associated with standard sampling methods limit the feasibility of WBE in the LTCF setting. In this work, we used passive sampling to simplify the wastewater analysis process and compared its performance to the standard composite sampling method. Moore swabs and automatic composite samplers were used concurrently to sample wastewater from two LTCFs, and samples were analyzed for SARS-CoV-2 concentration. Passive sampling relies on an unknown volume of wastewater flowing through a cotton material, which complicates back calculations of pathogen concentration. We chose to calculate analyte concentrations based on the squeezed eluent from the cotton swab, which is practical for temporal analysis. Across all samples, passive and composite sampling performed similarly for SARS-CoV-2 detection and mean concentration. However, we observed a sensitivity advantage at low SARS-CoV-2 concentrations (<180 gc/mL) when using passive sampling. Furthermore, SARS-CoV-2 wastewater concentrations obtained via passive sampling correlated with the reported clinical cases, with wastewater concentration leading reported clinical cases by an average of 4 days. Passive and composite sampling were also performed at a wastewater treatment plant (WWTP) to examine the effects of facility type on sampling performance. To our knowledge, this is the first work performing a comparative analysis at both facility- and community-scale locations. Passive sampling yielded significantly higher SARS-CoV-2 and fecal load biomarkers than composite sampling at WWTPs, illustrating an important difference between LTCF samples and WWTP samples.",

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AU - Strike, William

AU - Rockward, Alexus

AU - Mijatovic, Blazan

AU - Noble, Ann

AU - Olsson, Cullen

AU - Torabi, Soroosh

AU - Banadaki, Mohammad Dehghan

AU - Adatorwovor, Reuben

AU - Keck, James

AU - Berry, Scott

PY - 2025/7

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N2 - Wastewater-based epidemiology (WBE) is a promising tool for improving health outcomes through early detection and cost-effective pathogen surveillance. Long-term care facilities (LTCFs) serve and employ vulnerable populations that may particularly benefit from the use of WBE, but financial and technical costs associated with standard sampling methods limit the feasibility of WBE in the LTCF setting. In this work, we used passive sampling to simplify the wastewater analysis process and compared its performance to the standard composite sampling method. Moore swabs and automatic composite samplers were used concurrently to sample wastewater from two LTCFs, and samples were analyzed for SARS-CoV-2 concentration. Passive sampling relies on an unknown volume of wastewater flowing through a cotton material, which complicates back calculations of pathogen concentration. We chose to calculate analyte concentrations based on the squeezed eluent from the cotton swab, which is practical for temporal analysis. Across all samples, passive and composite sampling performed similarly for SARS-CoV-2 detection and mean concentration. However, we observed a sensitivity advantage at low SARS-CoV-2 concentrations (<180 gc/mL) when using passive sampling. Furthermore, SARS-CoV-2 wastewater concentrations obtained via passive sampling correlated with the reported clinical cases, with wastewater concentration leading reported clinical cases by an average of 4 days. Passive and composite sampling were also performed at a wastewater treatment plant (WWTP) to examine the effects of facility type on sampling performance. To our knowledge, this is the first work performing a comparative analysis at both facility- and community-scale locations. Passive sampling yielded significantly higher SARS-CoV-2 and fecal load biomarkers than composite sampling at WWTPs, illustrating an important difference between LTCF samples and WWTP samples.

AB - Wastewater-based epidemiology (WBE) is a promising tool for improving health outcomes through early detection and cost-effective pathogen surveillance. Long-term care facilities (LTCFs) serve and employ vulnerable populations that may particularly benefit from the use of WBE, but financial and technical costs associated with standard sampling methods limit the feasibility of WBE in the LTCF setting. In this work, we used passive sampling to simplify the wastewater analysis process and compared its performance to the standard composite sampling method. Moore swabs and automatic composite samplers were used concurrently to sample wastewater from two LTCFs, and samples were analyzed for SARS-CoV-2 concentration. Passive sampling relies on an unknown volume of wastewater flowing through a cotton material, which complicates back calculations of pathogen concentration. We chose to calculate analyte concentrations based on the squeezed eluent from the cotton swab, which is practical for temporal analysis. Across all samples, passive and composite sampling performed similarly for SARS-CoV-2 detection and mean concentration. However, we observed a sensitivity advantage at low SARS-CoV-2 concentrations (<180 gc/mL) when using passive sampling. Furthermore, SARS-CoV-2 wastewater concentrations obtained via passive sampling correlated with the reported clinical cases, with wastewater concentration leading reported clinical cases by an average of 4 days. Passive and composite sampling were also performed at a wastewater treatment plant (WWTP) to examine the effects of facility type on sampling performance. To our knowledge, this is the first work performing a comparative analysis at both facility- and community-scale locations. Passive sampling yielded significantly higher SARS-CoV-2 and fecal load biomarkers than composite sampling at WWTPs, illustrating an important difference between LTCF samples and WWTP samples.

KW - Clinical correlation

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KW - Passive sampling

KW - SARS-CoV-2

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Clinical correlation of SARS-CoV-2 wastewater passive sampling in long-term care facilities and wastewater treatment plants

Abstract

Bibliographical note

Funding

Keywords

ASJC Scopus subject areas

Access to Document

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