Water & Wastewater Asia March/April 2022

FOCUS
More recently, wastewater-based
epidemiology has been used to map
community opioid exposure in the US.
Researchers 2 conducted a pilot study of
wastewater opioid monitoring in a North
Carolina municipality for five months in
2018. The 24-hour aggregate samples were
collected from 10 residential manholes
throughout the pilot, and opioid metabolites
were measured and quantified using liquid
chromatography-mass spectrometry/mass
spectrometry (LC-MS/MS).
The data were used to map opioid use in
particular communities, highlighting opioids
that were most prevalent and in which areas.
Public health officials identified pharmacies
as critical access points for outreach and
prevention efforts because they fill opioid
prescriptions and are the primary distributors
of naloxone, a medication used to reduce the
effects of opioids. Researchers stated the
maps can “provide an evidentiary basis for
the deployment of pharmacy-centred public
health responses.”
WASTEWATER TESTING FOR SARS-
COV-2
A recent study 3 indicated the Omicron variant
may be 105% more transmissible than the
Delta variant, and by January 2022, the
number of reported cases per day had more
than doubled in the US compared to January
2021 4 .
While some jurisdictions had already
abandoned individual testing and reporting,
many remaining jurisdictions have now
followed suit, as limitations in available or
anticipated resources have made it difficult
for individual testing to keep pace with
the spike in cases caused by the Omicron
variant. In doing so, they have acknowledged
it is no longer feasible to use centralised
clinical testing to determine the true number
of infections in a community or state at any
given time.
Wastewater testing is emerging as the best
tool to provide an accurate picture of total
The CDC relies on
LuminUltra’s existing
network of physical
and mobile laboratories
across the US to ensure
samples are collected
and tested
COVID-19 cases and variant cases in a
community at this point in the pandemic.
Pooled samples from a population, whether it
is an entire city or an individual collection on
individuals, while preserving the anonymity of
those contributing to the wastewater sample.
CDC NATIONAL WASTEWATER
SURVEILLANCE SYSTEM
In September 2020, the US Centers for
Disease Control and Prevention (CDC)
launched the National Wastewater
Surveillance System (NWSS) 5 . This is the
first national wastewater testing programme
in the US, and its purpose is to measure the
levels of SARS-CoV-2 in wastewater and
track infection trends, both symptomatic and
asymptomatic, at the community level.
The system coordinates wastewater
surveillance programmes implemented
by state, territorial and tribal health
departments, to collect localised data that
can then be analysed to determine local or
national trends. Health departments use
this information to adjust their pandemic
response as necessary.
The CDC has been developing the NWSS by
focusing on four areas: “1) offering technical
assistance to implementing jurisdictions; 2)
creating a data portal for centralised data
submission and standardised data analysis
visualisation; 3) coordinating communities of
practice to share best practices among health
departments, public health laboratories,
and utilities; and 4) building epidemiology
and laboratory capacity for wastewater
surveillance at health departments.”
Last December, with the transmission of the
Omicron variant becoming more widespread,
the CDC announced it was partnering with
LuminUltra Technologies to gate data from
up to 500 wastewater treatment plants
across the country until March 2022 to test
for SARS-CoV-2 in wastewater. The testing
will identify not just the presence of the virus
but also the genetic mutations associated
with the Delta and Omicron variants.
LuminUltra has worked in the wastewater
industry for over 26 years and has been at
the forefront of SARS-CoV-2 wastewater
testing throughout the pandemic, creating
the world’s first rapid on-site SARS-CoV-2
testing solution. The company was also one
of the first in the country to use innovative
technologies to identify individual variants of
the virus.
The CDC relies on LuminUltra’s
existing network of physical and mobile
laboratories across the US to ensure
samples are collected and tested from
each participating utility twice per week.
LuminUltra tests the samples and uploads
data to a CDC platform for analysis. The
CDC reviews the data, and “to facilitate
robust analysis, data comparability, and
appropriate interpretation, the NWSS
data platform receives SARS-CoV-2 RNA
measurements and quality control data,
performs automated data quality checks,
adjusts SARS-CoV-2 concentrations for
wastewater composition and method
performance and performs regression
analyses from serial measurements to
classify SARS-CoV-2 wastewater trends.”
WATER & WASTEWATER ASIA | MARCH/APRIL 2022 37