ENVIRONMENTAL HEALTH
Considerations for Implementing Wastewater Surveillance in Rural Communities
by Aparna Keshaviah , MSc , principal researcher and director , Wastewater Research , Mathematica ; Allison Wheeler , MSPH , manager , Wastewater Surveillance Unit , Colorado Department of Public Health and the Environment ; and Erin Morin , MHS , specialist , Environmental Health
Implementing effective wastewater surveillance for SARS-CoV-2 in rural communities requires additional considerations such as ensuring privacy while sampling in smaller populations , limited laboratory and utility capacity due to fewer personnel and resources , access to representative clinical data for interpretation , and transparent , timely and targeted communications . However , when these factors are considered and addressed , wastewater surveillance can aid in decreasing health inequities in rural communities and serve as a valuable public health tool by providing beneficial information about community health trends .
In summer 2020 , Mathematica secured funding to launch wastewater surveillance for SARS-CoV-2 in Jackson County , North Carolina . With a population of approximately 43,000 residents , Jackson County is a rural area located in the Southern Appalachian Mountains . Mathematica ’ s goals were to provide local officials with a more comprehensive picture of COVID-19 exposure risk and create a pathway for sustainable monitoring through inclusion in the North Carolina Wastewater Monitoring Network .
The Colorado Department of Public Health and the Environment ( CDPHE ) also implemented wastewater surveillance for SARS-CoV-2 at the pandemic ’ s start , collaborating with both urban and rural areas . A rural utility in Ouray County serving approximately 1,000 people , began collecting wastewater samples for SARS-CoV-2 testing in February 2022 as a participant in the Colorado Wastewater Surveillance Program . Both Jackson and Ouray Counties considered the following factors to successfully initiate wastewater surveillance in their communities .
Privacy Concerns
Due to the small population of rural communities , privacy concerns can be more prevalent compared to an urban area and reporting practices should be adjusted if monitoring small utilities . Sewershed level-sampling results in pooled community wastewater samples , which allows for the anonymity of residents . Additionally , Colorado does not publicly release data for small populations of 1,000 people or less .
Capacity
The lack of a nearby laboratory caused problems for Mathematica that would have likely been less pronounced in an urban area . This resource constraint forced them to ship their samples to be tested at another laboratory , which caused an information lag . However , by developing a strong partnership with an out-of-state laboratory , data were reliably gathered within a usable timeframe . When the utility in Colorado could no longer sample due to limited staff capacity , the Ouray County Public Health Agency volunteered to assume the responsibility .
An example of the social media posts that were distributed by Ouray County and CDPHE . Photo : CDPHE
They continued collecting samples and communicating the results to ensure the community did not have a break in information .
Data Interpretation and Access to Representative Clinical Data
In rural communities , individuals are less likely to have medical insurance compared to their urban counterparts , leading to decreased healthcare-seeking behavior and data gaps . 1 Wastewater surveillance data can help to fill this
This article was 100 % funded with federal funds from a federal program of $ $ 1,708,762 . The production of this article was supported by Cooperative Agreement # NU60OE000104 , funded by the US Centers for Disease Control and Prevention ( CDC ). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of , nor an endorsement by , CDC , HHS or the US Government .
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