key: cord-1040632-g40wqm61 authors: Corchis-Scott, R.; Geng, Q.; Seth, R.; Ray, R.; Beg, M.; Biswas, N.; Charron, L.; Drouillard, K. G.; D'Souza, R.; Heath, D. D.; Houser, C.; Lawal, F.; McGinlay, J.; Menard, S. L.; Porter, L. A.; Rawlings, D.; Tong, Y.; Scholl, M. L.; Siu, K. W. M.; Weisener, C. G.; Wilhelm, S. W.; McKay, R. M. L. title: Averting an outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a university residence hall through wastewater surveillance date: 2021-06-25 journal: nan DOI: 10.1101/2021.06.23.21259176 sha: f6b61ae8caf238763a8cdddb3855de068f6a4812 doc_id: 1040632 cord_uid: g40wqm61 A wastewater surveillance program targeting a university residence hall was implemented during the spring semester 2021 as a proactive measure to avoid an outbreak of COVID-19 on campus. Over a period of 7 weeks from early February through late March 2021, wastewater originating from the residence hall was collected as grab samples 3 times per week. During this time, there was no detection of SARS-CoV-2 by RT-qPCR in the residence hall wastewater stream. Aiming to obtain a sample more representative of the residence hall community, a decision was made to use passive samplers beginning in late March onwards. Adopting a Moore Swab approach, SARS-CoV-2 was detected in wastewater samples on just two days after passive samplers were activated. These samples were also positive for the B.1.1.7 (Alpha) Variant of Concern (VOC) by RT-qPCR. The positive result triggered a public health case finding response including a mobile testing unit deployed to the residence hall the following day with testing of nearly 200 students and staff, which identified two laboratory-confirmed cases of B.1.1.7 variant COVID-19. These individuals were re-located to a separate quarantine facility averting an outbreak on campus. Aggregating wastewater and clinical data, the campus wastewater surveillance program has yielded the first estimates of fecal shedding rates of the B.1.1.7 VOC of SARS-CoV-2 in individuals from a non-clinical setting. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) and their receipt in the laboratory was no longer than 30 min. Sample processing: For grab samples of raw wastewater, a particle-associated fraction was CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 25, 2021. ; https://doi.org/10.1101/2021.06.23.21259176 doi: medRxiv preprint 9 SW Ontario and quantified by RT-Droplet Digital PCR was used to generate standard curves 158 (D'Aoust et al., 2021b). No template controls yielded no amplification, and we report a limit of 159 detection of 5 gene copies of N1 per reaction (≥95% probability of detection). Estimating fecal shedding rates: The approach described as part of the WBE program at the between the approaches has been reported, groups report within-day variability in terms of 207 detection of SARS-CoV-2 using the grab sample approach, a concern that is magnified when 208 dealing with a congregate living facility housing a small population such as a university 209 residence hall. This concern was reflected by the variability in the concentration of PMMoV At the time of the campus surveillance program, there was mounting concern globally 247 over the emergence of SARS-CoV-2 VOCs. In North America, concern was focused largely on 248 the B.1.1.7 VOC which was reported to be more transmissible than the wild-type Wuhan strain Because infected students were relocated to quarantine facilities that did not contribute to the 306 study's sewershed, infections associated with the dormitories were considered incident 307 infections. Aggregating data from all dorms yielded a mean SARS-CoV-2 shedding rate of 6.84 308 ± 0.77 log10 gene copies/g-feces based on the N1 gene (Schmitz et al., 2021). The case study presented here based on the experience of implementing WBE at the 310 University of Windsor likewise offered a unique opportunity to estimate fecal shedding rates 311 attributed to a defined community, but with a signal easier to interpret compared with similar 312 studies elsewhere. In this case, there was but a single occupied residence hall, having no 313 detection of SARS-CoV-2 in wastewater over 7 weeks leading up to the initial detection, which 314 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 25, 2021. ; https://doi.org/10.1101/2021.06.23.21259176 doi: medRxiv preprint triggered clinical testing of the building occupants. Two individuals tested positive for COVID-315 19 with both individuals relocated to a quarantine facility on campus less than two days after the 316 wastewater data were reported to campus administration. Analysis of wastewater was positive 317 for the B.1.1.7 VOC. Limiting our analysis to just the 4-day period encompassing the initial 318 detection of SARS-CoV-2 in the residence hall wastewater, through to the clinical testing and 319 quarantine of the two individuals who tested positive (Fig. 2) , we report fecal shedding rates 320 progressing in their intensity and ranging across 3-orders of magnitude from 3.93 log10 gc/g-321 feces to 5.99 log10 gc/g-feces based on the N1 gene target. These rates are lower than those 322 reported from the Arizona study and must be interpreted with some caution, given the is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 25, 2021. ; https://doi.org/10.1101/2021.06.23.21259176 doi: medRxiv preprint Unfortunately, as sampling resumed following a holiday weekend and SARS-CoV-2 was 337 once again detected in the residence hall wastewater, data interpretation was complicated due to 338 the return of the students who had previously been quarantined. Thus, while a new infection was 339 most likely responsible for the reemergent SARS-CoV-2 signal in wastewater detected in early 340 April, that individual was removed to quarantine the following day and the 60% decline in signal 341 that followed was attributed to reduced rates of shedding by the students deemed no longer to be CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted June 25, 2021. ; https://doi.org/10.1101/2021.06.23.21259176 doi: medRxiv preprint University-coordinated testing clinic on campus which attracted 65 student residents for testing, 383 all of whom tested negative. We subsequently learned that the two residents who were initially 384 quarantined had been approved to return to the residence hall after 10 days had elapsed, as they 385 were deemed no longer infectious. This information combined with the knowledge that all 386 student residents who chose to be tested following the re-emergence of SARS-CoV-2 in 387 residence hall wastewater were negative suggests that convalescent shedding of SARS-CoV-2 388 was likely responsible for the virus persisting in the wastewater stream through mid-April. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted June 25, 2021. ; https://doi.org/10.1101/2021.06.23.21259176 doi: medRxiv preprint How sewage could reveal true scale of coronavirus outbreak The potential of wastewater-based 621 epidemiology as surveillance and early warning of infectious disease outbreaks Coronavirus-2 RNA in sewage and correlation with reported COVID-19 prevalence in the early 626 stage of the epidemic in the Netherlands Show 630 us the data: Global COVID-19 wastewater monitoring efforts, equity, and gaps the author/funder, who has granted medRxiv a license to display the preprint in perpetuity Ontario Agency for Health Protection and Promotion (Public Health Ontario). 2021a. Enhanced 638 epidemiological summary: COVID-19 variants of concern in Ontario Ontario Agency for Health Protection and Promotion (Public Health Ontario) CoV-2 (COVID-19 virus) Variant of Concern (VoC) surveillance The proportion of SARS-CoV-2 infections that are asymptomatic Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics Moore swab performs equal to composite and 657 outperforms grab sampling for SARS-CoV-2 monitoring in wastewater High-resolution within-sewer SARS-665 CoV-2 surveillance facilitates informed intervention The characterization of feces and urine: a 669 review of the literature to inform advanced treatment technology Estimation of wastewater discharges by means of OpenStreetMap 673 data Targeted wastewater 676 surveillance of SARS-CoV-2 on a University Campus for COVID-19 outbreak detection and 677 mitigation Moore swab": a classic environmental 680 surveillance tool involving filtration of flowing surface water and sewage water to recover 681 typhoidal Salmonella bacteria Wastewater surveillance can have a second act in 684 COVID-19 vaccine distribution Providing a safe, in-person, 688 residential college experience during the COVID-19 pandemic COVID-19: updates for Canada's universities the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted Detection of SARS-CoV-2 in 704 different types of clinical specimens WE-SPARK Health Institute, 2021. COVID screening platform County Health Unit, 2021. Local COVID-19 data Virological assessment of hospitalized patients 715 with COVID-2019 World Health Organization, 2020. Pneumonia of unknown cause -China COVID-19 Coronavirus pandemic CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted SARS-CoV-2 titers in wastewater are higher than expected from clinically 726 confirmed cases Prolonged presence of SARS-CoV-2 viral 730 RNA in faecal samples Characteristics of pediatric SARS-CoV-2 infection and 734 potential evidence for persistent fecal viral shedding Proportion of asymptomatic infection among COVID-19 positive persons and their 738 transmission potential: A systematic review and meta-analysis Comparative study on virus shedding patterns in nasopharyngeal and fecal specimens of 742 COVID-19 patients Viral dynamics in asymptomatic 745 patients with COVID-19 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted June 25, 2021.