See below for the title, list of authors, acknowledgement of funding, and references cited in our recent poster at the Water Environment Federation conference in Atlanta, GA, August 12 & 13, 2024.
Title: Monitoring SARS CoV-2 markers to support wastewater-based epidemiology to inform public health actions (Wayne State University and Detroit MI)
PI: Jeffrey Ram
According to scientists worldwide, markers of SARS-CoV-2, the virus that causes COVID-19, shows up in sewage long before symptoms and tests of individuals reveal outbreaks of the disease in the community. Working in concert with vaccination campaigns, testing, and public health good practices like social distancing and “masking up”, early warning signals from wastewater from various sewersheds in Detroit will be used to warn of new outbreaks or, when the signals fall to a low level, to give residents and local agencies guidance on reducing mitigation strategies, when appropriate. The project in Detroit focuses on congregate facilities (dormitories, correctional facilities, nursing homes) and relatively small sewersheds and uses digital droplet PCR (ddPCR) for sensitive detection of SARS-CoV-2 in community sewersheds. A sewershed represents the whole of an area estimated to drain into a certain pipe or sewer node. All monitoring-sampling locations were determined and prioritized in collaboration with DHD and LimnoTech. This selection process led to twenty sites in the City of Detroit and includes: Wayne State dormitories, Detroit Medical Center sewersheds, 12 congregate living facilities (nursing home, correctional facility), and 2 communities drained by small-sewersheds and otherwise zipcode-identified locations in Detroit. This project provides prompt reporting of results (48 hours). As vaccination and seasonal changes decrease the level of COVID-19 in the community, weekly wastewater monitoring results for SARS-CoV-2 and its variants, when present, have proven useful for detecting when a new outbreak is beginning. With the addition of variant sequencing we are also able to identify if new variants are causing the new outbreaks. When data indicate the circulation of the virus at any given location(s), we have the network-liaison infrastructure in place with the DHD and the Wayne State University Administration to develop an appropriate public health response. Title: Monitoring SARS CoV-2 markers to support wastewater-based epidemiology to inform public health actions (Wayne State University and Detroit MI)
PI: Jeffrey Ram
According to scientists worldwide, markers of SARS-CoV-2, the virus that causes COVID-19, shows up in sewage long before symptoms and tests of individuals reveal outbreaks of the disease in the community. Working in concert with vaccination campaigns, testing, and public health good practices like social distancing and “masking up”, early warning signals from wastewater from various sewersheds in Detroit will be used to warn of new outbreaks or, when the signals fall to a low level, to give residents and local agencies guidance on reducing mitigation strategies, when appropriate. The project in Detroit focuses on congregate facilities (dormitories, correctional facilities, nursing homes) and relatively small sewersheds and uses digital droplet PCR (ddPCR) for sensitive detection of SARS-CoV-2 in community sewersheds. A sewershed represents the whole of an area estimated to drain into a certain pipe or sewer node. All monitoring-sampling locations were determined and prioritized in collaboration with DHD and LimnoTech. This selection process led to twenty sites in the City of Detroit and includes: Wayne State dormitories, Detroit Medical Center sewersheds, 12 congregate living facilities (nursing home, correctional facility), and 2 communities drained by small-sewersheds and otherwise zipcode-identified locations in Detroit. This project provides prompt reporting of results (48 hours). As vaccination and seasonal changes decrease the level of COVID-19 in the community, weekly wastewater monitoring results for SARS-CoV-2 and its variants, when present, have proven useful for detecting when a new outbreak is beginning. With the addition of variant sequencing we are also able to identify if new variants are causing the new outbreaks. When data indicate the circulation of the virus at any given location(s), we have the network-liaison infrastructure in place with the DHD and the Wayne State University Administration to develop an appropriate public health response. Title: Monitoring SARS CoV-2 markers to support wastewater-based epidemiology to inform public health actions (Wayne State University and Detroit MI)
Title, Full author list, Acknowledgements, and Cited Publications for our Abstract for the Water Environment Federation meeting, Atlanta, GA August 12 & 13, 2024
Title: Wastewater-case study: Putative identification of an individual human patient infected with a rare SARS-CoV-2 variant in a sewershed with thousands of potential community inputs.
Complete author list:
Jeffrey L. Ram, Department of Physiology, Wayne State University
Md Alamin, Department of Physiology, Wayne State University
Azadeh Bahmani, Department of Physiology, Wayne State University
Lance Gable, School of Law, Wayne State University
Sneha Ghosh, Department of Physiology, Wayne State University
Katherine Gurdziel, Genome Sciences Core, Wayne State University
James Hartrick, LimnoTech
Natasha Islam, Department of Physiology, Wayne State University
Paul E. Kilgore, Department of Pharmacy Practice, Wayne State University
Anthony T. Lagina, Department of Emergency Medicine, Wayne State University
Michael Mossing, Department of Biochemistry, Microbiology, and Immunology, Wayne State University
Armin Namayandeh, Department of Physiology, Wayne State University
Pelumi M. Oladipo, Department of Biochemistry, Microbiology, and Immunology, Wayne State University
Natalie Ram, Carey School of Law, University of Maryland
Rola Raychouni, Pharmaceutical Sciences, Wayne State University
William Shuster, Department of Civil and Environmental Engineering, Wayne State University
Geehan Suleyman, Department of Internal Medicine, Wayne State University
Carrie L. Turner, LimnoTech
Benjamin Wasinski, Department of Pathology, Wayne State University
Thameena Yusuf, Department of Physiology, Wayne State University
Marcus Zervos, Department of Medicine and Infectious Diseases, Wayne State University
Xiangmin Zhang, Pharmaceutical Sciences, Wayne State University
Wanqing Liu, Department of Pharmaceutical Sciences, Wayne State University
Funding: Funding for this work was provided by Project ELCSNP-WS Wastewater Network Project of the Coronavirus Response Support Program – 2023 & 2024, entitled “SARS-CoV-2 Epidemiology – Wastewater Evaluation and Reporting (SEWER) Network” (Principal Investigators: Jeffrey L. Ram and William Shuster) from the Michigan Department of Health and Human Services, using Federal Financial Assistance from the U.S. Department of Treasury under the Epidemiology and Laboratory Capacity: Enhancing Detection Expansion through Coronavirus Response and Relief (CRR) Supplemental Appropriations Act of 2021 (P.L. 116-260).
References cited:
Alamin, M., P. Oladipo, J. Hartrick, N. Islam, A. Bahmani, C. Turner, W. Shuster and J. Ram. "Improved passive sampling methods for wastewater to enable more sensitive detection of sars-cov-2 and its variants." SSRN Electronic Journal preprint https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4813370 (2024). Now published as Science of the Total Environment 27 July 2024, 175044 pre-proof: https://doi.org/10.1016/j.scitotenv.2024.175044 (2024)
Gable, L., N. Ram and J. L. Ram. "Legal and ethical implications of wastewater sars-cov-2 monitoring for covid-19 surveillance." Journal of Law and the Biosciences 7 (2020): 11 pages, https://doi.org/10.1093/jlb/lsaa039.
Ram, J. L., W. Shuster, L. Gable, C. L. Turner, J. Hartrick, A. A. Vasquez, N. W. West, A. Bahmani and R. E. David. "Wastewater monitoring for infectious disease: Intentional relationships between academia, the private sector, and local health departments for public health preparedness." Int J Environ Res Public Health 20 (2023): 1-21 + supplement 22-26. 10.3390/ijerph20176651. https://doi.org/10.3390/ijerph20176651
Shafer, M. M., M. J. Bobholz, W. C. Vuyk, D. A. Gregory, A. Roguet, L. A. Haddock Soto, C. Rushford, K. H. Janssen, I. E. Emmen, H. J. Ries, et al. "Tracing the origin of sars-cov-2 omicron-like spike sequences detected in an urban sewershed: A targeted, longitudinal surveillance study of a cryptic wastewater lineage." The Lancet Microbe 5 (2024): e335-e344. 10.1016/s2666-5247(23)00372-5. https://dx.doi.org/10.1016/s2666-5247(23)00372-5.
Wang, Y., D. Wang, L. Zhang, W. Sun, Z. Zhang, W. Chen, A. Zhu, Y. Huang, F. Xiao, J. Yao, et al. "Intra-host variation and evolutionary dynamics of sars-cov-2 populations in covid-19 patients." Genome Med 13 (2021): 30. https://doi.org/10.1186/s13073-021-00847-5doi.org/10.1186/s13073-021-00847-5.
Full abstract:
Wastewater-case study: Putative identification of an individual human patient infected with a rare SARS-CoV-2 variant in a sewershed with thousands of potential community inputs
Jeffrey L. Ram, [multiple coauthors in alphabetical order. See list above], and Wanqing Liu
Wayne State University, Detroit, MI
Background: Wastewater-based epidemiology is used to monitor community health without collecting samples directly from individuals. With inputs from many people in a sewershed, health information of individuals is presumed to be technically inaccessible, thereby avoiding ethical issues of privacy However, we have suggested that somewhere between a large sewershed and the drainage from a single house the expectation that wastewater lacks the resolution for identifying the health of a particular person breaks down (doi:10.1093/jlb/lsaa039). Indeed, the granularity obtained through viral variant analysis may challenge the assumption of technical inaccessibility. We describe here a case of detecting a rare variant in a sewershed of thousands, possibly enabling a specific infected individual to be identified. The poignancy of the identification (and the reason the source and sample dates are described only in broad terms) was brought home to us by the fact that the patient infected by the variant died shortly after being discharged from the hospital.
Methods: The RamLab samples weekly from 22 sewersheds in Detroit, including 3 hospital-sewersheds with thousands of staff and patients. GT Molecular analyzed samples for variants during 2023. After variant identification, sequences were compared to clinical sample sequences based on genomic regions with highest-quality (>10X coverage/nucleotide with >100 continuous nucleotides).
Results: In 2023, wastewater samples contained mostly Omicron lineages. However, for several weeks a hospital sewershed had high SARS-CoV-2 that was >80% Delta (lineage AY.25), even though Delta had rarely been seen globally since replacement by Omicron in early 2022. At the time, the hospital had no variant data from the 11 people who were then COVID-19 patients, but a search in 2024 of a Wayne State University SARS-CoV-2 Genomic Surveillance variant database for 2023 of nasal swab clinical isolates revealed a single patient with an AY.25 Delta variant. The patient’s presence in the hospital directly coincided with the rise and fall of Delta variants in the hospital’s wastewater. The Delta sequences in the nasal sample and in wastewater were very similar though not identical, possibly reflecting intrahost genetic variation between gastrointestinal tract and respiratory system (doi:10.1186/s13073-021-00847-5).
Discussion: Circumstantially, it seems likely that we detected, as contributor to >80% of our SARS-CoV-2 wastewater signal, the input from a single patient. The evidence that the Delta variant came from a single patient depends not only on the similarity of the variant sequences, but also on the rarity of the variant, and that the high SARS-CoV-2 levels in the wastewater coincided with the admission and discharge of this patient. The patient gave consent upon admission to analysis of the infective virus for both treatment and research. Did that consent imply consent to detection in wastewater? We will discuss other circumstances in which wastewater may yield data about individuals, though without correlative data to identify who it is. What are the ethics of making such data, even from a sewershed that contains thousands of individuals, public? Are there specific data types (variants, for example) that should be screened out or kept confidential?
Title: Wastewater-case study: Putative identification of an individual human patient infected with a rare SARS-CoV-2 variant in a sewershed with thousands of potential community inputs.
Complete author list:
Jeffrey L. Ram, Department of Physiology, Wayne State University
Md Alamin, Department of Physiology, Wayne State University
Azadeh Bahmani, Department of Physiology, Wayne State University
Lance Gable, School of Law, Wayne State University
Sneha Ghosh, Department of Physiology, Wayne State University
Katherine Gurdziel, Genome Sciences Core, Wayne State University
James Hartrick, LimnoTech
Natasha Islam, Department of Physiology, Wayne State University
Paul E. Kilgore, Department of Pharmacy Practice, Wayne State University
Anthony T. Lagina, Department of Emergency Medicine, Wayne State University
Michael Mossing, Department of Biochemistry, Microbiology, and Immunology, Wayne State University
Armin Namayandeh, Department of Physiology, Wayne State University
Pelumi M. Oladipo, Department of Biochemistry, Microbiology, and Immunology, Wayne State University
Natalie Ram, Carey School of Law, University of Maryland
Rola Raychouni, Pharmaceutical Sciences, Wayne State University
William Shuster, Department of Civil and Environmental Engineering, Wayne State University
Geehan Suleyman, Department of Internal Medicine, Wayne State University
Carrie L. Turner, LimnoTech
Benjamin Wasinski, Department of Pathology, Wayne State University
Thameena Yusuf, Department of Physiology, Wayne State University
Marcus Zervos, Department of Medicine and Infectious Diseases, Wayne State University
Xiangmin Zhang, Pharmaceutical Sciences, Wayne State University
Wanqing Liu, Department of Pharmaceutical Sciences, Wayne State University
Funding: Funding for this work was provided by Project ELCSNP-WS Wastewater Network Project of the Coronavirus Response Support Program – 2023 & 2024, entitled “SARS-CoV-2 Epidemiology – Wastewater Evaluation and Reporting (SEWER) Network” (Principal Investigators: Jeffrey L. Ram and William Shuster) from the Michigan Department of Health and Human Services, using Federal Financial Assistance from the U.S. Department of Treasury under the Epidemiology and Laboratory Capacity: Enhancing Detection Expansion through Coronavirus Response and Relief (CRR) Supplemental Appropriations Act of 2021 (P.L. 116-260).
References cited:
Alamin, M., P. Oladipo, J. Hartrick, N. Islam, A. Bahmani, C. Turner, W. Shuster and J. Ram. "Improved passive sampling methods for wastewater to enable more sensitive detection of sars-cov-2 and its variants." SSRN Electronic Journal preprint https://papers.ssrn.com/sol3/papers.cfm?abstract_id=4813370 (2024). Now published as Science of the Total Environment 27 July 2024, 175044 pre-proof: https://doi.org/10.1016/j.scitotenv.2024.175044 (2024)
Gable, L., N. Ram and J. L. Ram. "Legal and ethical implications of wastewater sars-cov-2 monitoring for covid-19 surveillance." Journal of Law and the Biosciences 7 (2020): 11 pages, https://doi.org/10.1093/jlb/lsaa039.
Ram, J. L., W. Shuster, L. Gable, C. L. Turner, J. Hartrick, A. A. Vasquez, N. W. West, A. Bahmani and R. E. David. "Wastewater monitoring for infectious disease: Intentional relationships between academia, the private sector, and local health departments for public health preparedness." Int J Environ Res Public Health 20 (2023): 1-21 + supplement 22-26. 10.3390/ijerph20176651. https://doi.org/10.3390/ijerph20176651
Shafer, M. M., M. J. Bobholz, W. C. Vuyk, D. A. Gregory, A. Roguet, L. A. Haddock Soto, C. Rushford, K. H. Janssen, I. E. Emmen, H. J. Ries, et al. "Tracing the origin of sars-cov-2 omicron-like spike sequences detected in an urban sewershed: A targeted, longitudinal surveillance study of a cryptic wastewater lineage." The Lancet Microbe 5 (2024): e335-e344. 10.1016/s2666-5247(23)00372-5. https://dx.doi.org/10.1016/s2666-5247(23)00372-5.
Wang, Y., D. Wang, L. Zhang, W. Sun, Z. Zhang, W. Chen, A. Zhu, Y. Huang, F. Xiao, J. Yao, et al. "Intra-host variation and evolutionary dynamics of sars-cov-2 populations in covid-19 patients." Genome Med 13 (2021): 30. https://doi.org/10.1186/s13073-021-00847-5doi.org/10.1186/s13073-021-00847-5.
Full abstract:
Wastewater-case study: Putative identification of an individual human patient infected with a rare SARS-CoV-2 variant in a sewershed with thousands of potential community inputs
Jeffrey L. Ram, [multiple coauthors in alphabetical order. See list above], and Wanqing Liu
Wayne State University, Detroit, MI
Background: Wastewater-based epidemiology is used to monitor community health without collecting samples directly from individuals. With inputs from many people in a sewershed, health information of individuals is presumed to be technically inaccessible, thereby avoiding ethical issues of privacy However, we have suggested that somewhere between a large sewershed and the drainage from a single house the expectation that wastewater lacks the resolution for identifying the health of a particular person breaks down (doi:10.1093/jlb/lsaa039). Indeed, the granularity obtained through viral variant analysis may challenge the assumption of technical inaccessibility. We describe here a case of detecting a rare variant in a sewershed of thousands, possibly enabling a specific infected individual to be identified. The poignancy of the identification (and the reason the source and sample dates are described only in broad terms) was brought home to us by the fact that the patient infected by the variant died shortly after being discharged from the hospital.
Methods: The RamLab samples weekly from 22 sewersheds in Detroit, including 3 hospital-sewersheds with thousands of staff and patients. GT Molecular analyzed samples for variants during 2023. After variant identification, sequences were compared to clinical sample sequences based on genomic regions with highest-quality (>10X coverage/nucleotide with >100 continuous nucleotides).
Results: In 2023, wastewater samples contained mostly Omicron lineages. However, for several weeks a hospital sewershed had high SARS-CoV-2 that was >80% Delta (lineage AY.25), even though Delta had rarely been seen globally since replacement by Omicron in early 2022. At the time, the hospital had no variant data from the 11 people who were then COVID-19 patients, but a search in 2024 of a Wayne State University SARS-CoV-2 Genomic Surveillance variant database for 2023 of nasal swab clinical isolates revealed a single patient with an AY.25 Delta variant. The patient’s presence in the hospital directly coincided with the rise and fall of Delta variants in the hospital’s wastewater. The Delta sequences in the nasal sample and in wastewater were very similar though not identical, possibly reflecting intrahost genetic variation between gastrointestinal tract and respiratory system (doi:10.1186/s13073-021-00847-5).
Discussion: Circumstantially, it seems likely that we detected, as contributor to >80% of our SARS-CoV-2 wastewater signal, the input from a single patient. The evidence that the Delta variant came from a single patient depends not only on the similarity of the variant sequences, but also on the rarity of the variant, and that the high SARS-CoV-2 levels in the wastewater coincided with the admission and discharge of this patient. The patient gave consent upon admission to analysis of the infective virus for both treatment and research. Did that consent imply consent to detection in wastewater? We will discuss other circumstances in which wastewater may yield data about individuals, though without correlative data to identify who it is. What are the ethics of making such data, even from a sewershed that contains thousands of individuals, public? Are there specific data types (variants, for example) that should be screened out or kept confidential?
POSTER<==click here to see the poster