Disease Detectives Use Wastewater Testing to Monitor COVID Infection Trends

 Throughout the COVID-19 pandemic, researchers from the University of Kentucky’s College of Medicine and College of Engineering have joined forces to track the virus’ presence in the community using wastewater testing.

In addition to providing local disease surveillance, the collaboration across disciplines has generated $4.7 million in external federal funding to support two research projects involving the detection of SARS-CoV-2 in wastewater.

Led by Assistant Professor of Family and Community Medicine James Keck, M.D., and Associate Professor of Mechanical Engineering Scott Berry, Ph.D., the two projects are aimed at exploring wastewater testing’s impact on COVID-19 public health measures and advancing testing technology. 

Wastewater surveillance provides an alternative strategy for SARS-CoV-2 detection in communities by evaluating samples of wastewater for the presence of viral biomarkers like RNA. Wastewater includes water from household and building use that can contain human fecal waste, which can be tested for SARS-CoV-2 RNA.

The practice has seen limited use in the past as a public health surveillance tool, but the COVID-19 pandemic has brought newfound interest in the approach due to its ability to monitor infection trends without extensive clinical testing, says Keck.

“The investment in advancing wastewater testing is a reflection of the usefulness of this tool to give a comprehensive picture of the spread of infection, especially in rural communities with limited access to clinical testing,” Keck said.

The team’s first project, supported by an 18-month $1.3 million grant from the Centers for Disease Control and Prevention, is focused on testing wastewater for the early detection of COVID-19 in nursing homes.

The team has been testing wastewater daily at six nursing homes in the Lexington and Louisville areas using an automated sampling device in facility sewers. If a sample tests positive for SARS-CoV-2, facilities are notified and can then take additional measures to prevent infection spread including facility-wide clinical testing.

Keck says results will help inform public health officials about how testing can be used as another measure to control the spread of disease in congregate living settings, including long-term care facilities.

“Since wastewater testing can show the first signs of an outbreak in a community prior to detection in clinical samples, the early notice could help prevent COVID-19 infections and deaths in this vulnerable population,” Keck said.

The second project, supported by a $3.4 million grant from the National Institutes of Health, is aimed at advancing the testing technology so that samples can be processed and analyzed on-site.

During conventional wastewater testing, samples must be sent to a lab after they are collected so they can go through a complicated series of steps needed to extract the RNA before a polymerase chain reaction (PCR) test can be done.

Berry invented a new technology called exclusion-based sample preparation (ESP), which uses special beads to extract the RNA to make the process faster and more efficient.

“ESP can provide a fast and simple method to manipulate RNA and has the potential to improve testing sensitivity and help to create a low-cost way to expand testing in rural areas or developing countries,” said Berry. “RNA also degrades over time, so the faster samples can be tested, the more accurate the results.”

With the help of engineering students, Berry and his team created a mobile lab to take wastewater testing to rural Kentucky. Equipped with ESP and loop-mediated isothermal amplification (LAMP), the “Disease Detective” van has the capability to both process and analyze samples in the field.

Beginning this summer, the van will head to rural communities in Kentucky where Berry’s team will train people to test wastewater at treatment plants, schools and streams.

In the meantime, Berry's lab is processing weekly samples from wastewater treatment plants across eight counties in Kentucky. Results are being used by local health officials to evaluate response measures that were taken due to the spread of infection. The hope is that the ESP technology will eventually allow the wastewater treatment plant operators to do the testing themselves, Berry says.

In addition to the training, the team partners with UK’s College of Education on another project that will utilize the mobile lab to teach local students about wastewater testing and get them excited about science, technology, engineering and mathematics (STEM).

It’s just another way the project has connected researchers from different disciplines who otherwise may never have worked together, says Keck.

“Basic science researchers and engineers are working with public health officials to have real impact in communities across Kentucky,” said Keck. “These projects utilize expertise and resources across many disciplines, bringing UK’s mission as a land grant institution into service.”

Research reported in this publication was supported in part by the Centers for Disease Control and Prevention under Award Number 75D30120C09531 and the National Institute on Drug Abuse of the National Institutes of Health under Award number 1U01DA05390301. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Centers for Disease Control and Prevention and the National Institutes of Health.