Wastewater Assessment for Coronavirus in Kentucky: Implementing Enhanced Surveillance Technology

Developing next generation technology to simplify wastewater RNA extraction and quantification makes wastewater surveillance feasible and scalable in facilities and rural communities. Wastewater testing for SARS-CoV-2 in rural communities using field-friendly technology provides important information to local authorities and citizens about the spread and trend of SARS-CoV-2 infection in their communities. This project accomplished two aims: 1) Develop next generation wastewater assessment technology, and 2) Implement and evaluate the next generation wastewater assay. Aim 1 adapted technology termed exclusion-based sample preparation (ESP) to simplify and improve RNA extraction from wastewater. ESP was paired with loop-mediated isothermal amplification (LAMP) technology for RNA detection to create a sensitive, robust, and field-friendly platform for testing wastewater for SARS-CoV-2 RNA. The next generation assay was compared with established techniques on metrics of sensitivity, specificity, and usability (e.g., assay time, number of assay steps). Aim 2 first validated the next generation assay in the field at congregate living facilities in a side-by-side comparison with conventional wastewater surveillance. Next, building on existing relationships in Eastern Kentucky, a purposive group of wastewater treatment plant operators, watershed watch citizen scientists, and school science teachers were recruited and trained to test wastewater in their communities and schools using the field-friendly next generation wastewater assay. Field results were validated in the lab. A robust mixed methods evaluation using the RE-AIM framework assessed community perceptions of feasibility, acceptability, and utility of wastewater surveillance for SARS-CoV-2 and identified community measures taken in response to test results.