Wastewater and surface monitoring to detect COVID-19 in elementary school settings: The Safer at School Early Alert project

Published in medRxiv, 2021

Recommended citation: Fielding-Miller RK, Karthikeyan S, Gaines T, Garfein RS, Salido RA, Cantu V, Kohn L, Wijaya FC, Flores M, Omaleki V, Majnoonian A, Martin NK, Austin D, Laurent LC, Gonzalez-Zuniga P, Nguyen M, Vo AV, Le TT, Duong D, Hassani A, Tweeten S, Jepsen K, Henson B, Hakim A, Birmingham A, Mark AM, Nasamran CA, Rosenthal SB, Moshiri N, Fisch KM, Humphrey G, Farmer S, Tubb H, Valles T, Morris J, Kang J, Khaleghi B, Young C, Akel AD, Eilert S, Eno J, Curewitz K, Rosing T, Knight R (2021). "Wastewater and surface monitoring to detect COVID-19 in elementary school settings: The Safer at School Early Alert project". medRxiv. doi:10.1101/2021.10.19.21265226

Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children’s educational and social-emotional wellbeing. While wastewater monitoring has been implemented to mitigate outbreak risk in universities and residential settings, its effectiveness in community K-12 sites is unknown. We implemented a wastewater and surface monitoring system to detect SARS-CoV-2 in nine elementary schools in San Diego County. Ninety-three percent of identified cases were associated with either a positive wastewater or surface sample; 67% were associated with a positive wastewater sample, and 40% were associated with a positive surface sample. The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Passive environmental surveillance can complement approaches that require individual consent, particularly in communities with limited access and/or high rates of testing hesitancy.