Four Models of Wastewater-Based Surveillance for SARS-CoV-2 in Jail Settings: How Monitoring Wastewater Complements Individual Screening

OBJECTIVE: To describe four unique models of implementing Wastewater Based Surveillance (WBS) for SARS-CoV-2 in jails of graduated sizes and differing architectural designs. METHODS: This study summarizes how jails of Cook County (Illinois, average daily population [ADP] 6000), Fulton County (Georgia, ADP 3000, Washington DC (ADP 1600) and Middlesex County (Massachusetts, ADP 875) initiated WBS between 2020 and 2023. RESULTS: Positive signal for SARS-CoV-2 via WBS can herald new onset of infection in a previously uninfected housing unit of a jail. Challenges in implementing WBS included political will and realized value, funding, understanding of the building architecture, and the need for granularity in the findings. CONCLUSIONS: WBS has been effective for detecting outbreaks of SARS-CoV-2 in differing sized jails, both those with dorm-based and cell-based architectural design. POLICY IMPLICATIONS: Given its effectiveness in monitoring SARS-CoV-2, WBS provides a model for population-based surveillance in carceral facilities for future infectious disease outbreaks.