Comparison of high-frequency in-pipe SARS-CoV-2 wastewater-based surveillance to concurrent COVID-19 random clinical testing on a public U.S. university campus

Wastewater-based epidemiology (WBE) is utilized globally as a tool for quantifying the amount of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within communities, yet the efficacy of community-level wastewater monitoring has yet to be directly compared to random Coronavirus Disease of 2019 (COVID-19) clinical testing; the best-supported method of virus surveillance within a single population. This study evaluated the relationship between SARS-CoV-2 RNA in raw wastewater and random COVID-19 clinical testing on a large university campus in the Southwestern United States during the Fall 2020 semester. Daily composites of wastewater (24-hour samples) were collected three times per week at two campus locations from 16 August 2020 to 1 January 2021 (n = 95) and analyzed by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) targeting the SARS-CoV-2 E gene. Campus populations were estimated using campus resident information and anonymized, unique user Wi-Fi connections. Resultant trends of SARS-CoV-2 RNA levels in wastewater were consistent with local and nationwide pandemic trends showing peaks in infections at the start of the Fall semester in mid-August 2020 and mid-to-late December 2020. A strong positive correlation (r = 0.71 (p < 0.01); n = 15) was identified between random COVID-19 clinical testing and WBE surveillance methods, suggesting that wastewater surveillance has a predictive power similar to that of random clinical testing. Additionally, a comparative cost analysis between wastewater and clinical methods conducted here show that WBE was more cost effective, providing data at 1.7% of the total cost of clinical testing ($6042 versus $338,000, respectively). We conclude that wastewater monitoring of SARS-CoV-2 performed in tandem with random clinical testing can strengthen campus health surveillance, and its economic advantages are maximized when performed routinely as a primary surveillance method, with random clinical testing reserved for an active outbreak situation.