Applying learnings from COVID-19 to respiratory disease monitoring

We learned so much during the COVID-19 pandemic. Social distancing, remote learning, contact tracing, P.P.E., isolation, superspreader – these words became part of our standard vernacular. As a society, we were forced to change the ways in which we did just about everything. And we were confronted with harsh realities about health disparities, unequal access to healthcare, mental health burden, and a lack of systematic pandemic readiness.

We’ve also learned that when battling a pandemic, data is absolutely critical – and COVID-19 showed us that traditional clinical and public health monitoring methods didn’t provide a complete picture of the true disease burden. Without accurate and timely data on prevalence, hospitalizations, and mortality, our response capabilities were severely hampered. Inadequate access to testing meant that case counts were grossly underestimated. Outdated methods for data collection left public health departments without the tools or funds to collect and report accurately. And decentralized, nonstandardized public health reporting systems across cities, counties, and states resulted in spotty, out-of-date snapshots of data.

The power of wastewater: from pre-pandemic through pandemic recovery and beyond

Here at Biobot, we’ve learned a tremendous amount from the COVID-19 pandemic. We started out in 2017 monitoring wastewater for opioids but, in March of 2020, we quickly pivoted and became pioneers in the field of wastewater epidemiology and COVID-19 surveillance. We grew rapidly and learned as we went, and we’re now applying what we’ve learned to other respiratory diseases. Here, we’ll share some of our most important takeaways from the pandemic:

• Wastewater data is an incredibly reliable way to monitor for respiratory disease. Wastewater tracks closely with test positivity and hospitalization data – but while those are lagging indicators, wastewater serves as an early warning system. Our research has shown that wastewater data can predict new hospital admissions up to four weeks in advance. We’ve also learned that wastewater can be used to monitor many other respiratory viruses, including influenza and RSV, and can illuminate trends on community, regional, and national trends.

• Data is power – but only if it’s relevant and actionable. Early in the pandemic, we were often asked “This data is amazing, but what should we do with it?” Our partners and customers have used wastewater in a variety of ways, including:
  • Empowering citizens: Providing localized, timely data on COVID-19 in communities helped people to make informed decisions for themselves and their families around masking, socializing, travel, and more.
  • Issuing public health advisories: Wastewater data helped municipalities to develop policies, such as masking advisories, that were evidence-based. 
  • Informing targeted neighborhood-level public health strategies: Our partners were able to strategically deploy resources and strategies, such as mobile testing units and pop-up vaccination clinics, using wastewater data to target areas of greatest need.
  • Supporting healthcare systems operations and planning: Hospitals and healthcare facilities used wastewater data to brace for COVID-19 upticks by clearing capacity and postponing elective procedures. These procedures could then be rescheduled when the data indicated that case counts were declining.
  • Informing school and university operations: Schools and educational institutions used wastewater data to make decisions about moving between remote, hybrid, and in-person learning. College campuses could predict and pinpoint outbreaks, and communicate and respond appropriately.

• Public-private partnerships are important. During the pandemic, Biobot offered its wastewater testing to hundreds of communities and wastewater treatment plants around the country at no cost. Our first partner, the Massachusetts Water Research Authority (MWRA), made Biobot wastewater data publicly available, and this data served as a vital community risk indicator during the Omicron wave. 
• Early warning systems can save lives. The pandemic highlighted the fact that current public health monitoring systems simply aren’t enough. The U.S. relies upon a complex patchwork of data streams, including hospitalization, death, testing, outpatient, genomic, and wastewater data. Surveillance systems differ across the country. And in 2022, COVID-19 clinical case reporting diminished despite virus circulating in wastewater. Wastewater data provides an early warning system that helps us:
  • Direct resources. Targeting programs and interventions to where they’ll have the greatest impact can save money – and lives.
  • Evaluate intervention effectiveness. Wastewater data allows us to evaluate baseline information against timely, accurate post-intervention data in order to determine efficacy.
  • Track known variants. Wastewater data enables us to keep tabs on known variants across the country, and rapidly identify new variants as they emerge.
  • Improve disease monitoring of underserved communities. Traditional surveillance methods capture those who have access to healthcare. Wastewater intelligence is equitable – it includes everyone who uses a toilet. We can identify areas of highest risk and need, regardless of healthcare utilization levels, and target interventions appropriately.

COVID-19, influenza, and RSV are here to stay, and they’ll likely continue to wage a staggering societal and economic toll. With the end of the Public Health Emergency in May 2023, we have been particularly aware of how important ongoing collection of wastewater data is to ensuring our communities are alert and aware of pathogen spread in their communities. We’ve learned that data is our most powerful tool as we attempt to quantify, understand, and manage the impact of these illnesses, and wastewater monitoring is increasingly being recognized as the preeminent source of timely, accurate, and comprehensive infectious disease data. Wastewater data illuminates trends at the national level as well as on a much more granular scale – states, cities, campuses, companies, and even single buildings can monitor respiratory disease spread. Wastewater data can alert us to shifts in seasonal trends, helps determine resource allocation, and inform outbreak mitigation strategies to prevent and respond to infection.

Monitoring for all three respiratory illnesses using wastewater data provides a more complete picture that closes gaps in existing clinical and surveillance systems. You can learn more about our Respiratory Panel here.