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Show us the Data: Global COVID-19 Wastewater Monitoring Efforts, Equity,
and Gaps
Colleen C. Naughton*
1
, Fernando A. Roman, Jr.
1
, Ana Grace F. Alvarado
1
, Arianna Q. Tariqi
1
,
Matthew A. Deeming
1
, Kyle Bibby
2
, Aaron Bivins
2
, Joan B. Rose
3
, Gertjan Medema
456
, Warish
Ahmed
7
, Panagis Katsivelis
8
, Vajra Allan
9
, Ryan Sinclair
10
, Yihan Zhang
11
, Maureen N.
Kinyua
11
*Corresponding Author cnaughton2@ucmerced.edu
1
Department of Civil and Environmental Engineering, University of California at Merced,
Merced, CA 95343, USA
2
Department of Civil & Environmental Engineering & Earth Science, University of Notre Dame,
156 Fitzpatrick Hall, Notre Dame, IN, 46556, USA.
3
Department of Fisheries and Wildlife, Michigan State University, East Lansing, Michigan
48824, USA
4
KWR Water Research Institute, Groningenhaven 7, Nieuwegein, 3433 PE, the Netherlands
4
Delft University of Technology, Stevinweg 1, Delft, 2628 CN, the Netherlands
6
Michigan State University, 1405 S Harrison Rd, East-Lansing, Michigan, 48823, USA
7
CSIRO Land and Water, Ecosciences Precinct, 41 Boggo Road, QLD 4102, Australia.
8
Venthic Technologies, Kipoupoleos 129, Peristeri, Athens, Greece
9
PATH 2201Westlake Avenue, Suite 200 Seattle, WA 98121, USA
10
Schools of Public Health and Earth and Biological Sciences, Loma Linda University Loma
Linda, CA 92350, USA
11
Department of Civil and Environmental Engineering, University of California at Davis, Davis,
CA 95616, USA
Abstract (200 words)
A year since the declaration of the global coronavirus disease 2019 (COVID-19)
pandemic there have been over 110 million cases and 2.5 million deaths. Using methods to track
community spread of other viruses such as poliovirus, environmental virologists and those in the
wastewater based epidemiology (WBE) field quickly adapted their existing methods to detect
SARS-CoV-2 RNA in wastewater. Unlike COVID-19 case and mortality data, there was not a
global dashboard to track wastewater monitoring of SARS-CoV-2 RNA worldwide. This study
describes the development of the “COVIDPoops19” dashboard to disseminate information
regarding sites, universities, research institutions and private laboratories in countries that are
involved in WBE for SARS-CoV-2. Methods to assemble the dashboard combined standard
literature review, direct submissions, and daily, social media keyword searches. Over 200
universities, 1,000 sites, and 50 countries with 59 dashboards monitor wastewater for SARS-
CoV-2 RNA. However, monitoring is inequitably distributed in high-income countries and data
are not widely shared publicly or accessible to researchers to inform public health actions, meta-
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.14.21253564doi: medRxiv preprint
NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice.
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analysis, better coordinate, and determine equitable distribution of monitoring sites. For WBE to
be used to its full potential during COVID-19 and beyond, show us the data.
1. Introduction
In one year, the coronavirus disease 2019 (COVID-19) pandemic has resulted in 110
million cases and 2.5 million deaths worldwide (Dong et al., 2020). When the novel coronavirus
strain (SARS-CoV-2) that causes COVID-19 emerged in late 2019, environmental virologists
began rapidly adapting their methods from other pathogens wastewater survey work
(https://www.pathogens.org/) including use of public health elements to address concerns
associated with monitoring SARS-CoV-2 in wastewater. Some of the first major monitoring
efforts for SARS-CoV-2 in wastewater were in the Netherlands (Medema et al., 2020a),
Australia (Ahmed et al., 2020), Italy (La Rosa et al., 2020), and the United States (Sherchan et
al., 2020). A global coordination effort was proposed to share and standardize sampling
strategies, virus methodologies and data for WBE for SARS-CoV-2 (Bivins et al., 2020).
COVID-19 Wastewater Based Epidemiology (WBE) is now being used to describe this effort
and has grown from just a few countries in March 2020 to at least 50 countries and over 200
universities a year later (https://arcg.is/1aummW).
Both the growth and recognition of WBE for SARS-CoV-2 monitoring has been rapid
and widespread. Wastewater monitoring to address epidemiological questions has been used
historically to track enteric viruses and other pathogens (Waterpathogens.org) including the
poliovirus vaccine and wildtype strains (Ranta et al., 2001), norovirus, and others (Li et al.,
2019; Schmidt, 2020) and drugs such as opioids (Burgard et al., 2014) but at generally smaller
scales. Due to the COVID-19 pandemic, at least six countries (Finland, Hungary, Luxembourg,
Netherlands, Spain, Turkey) have nationalized wastewater monitoring for SARS-CoV-2
(Terveyden ja hyvinvoinnin laitos, 2021, Nemzeti Népegészségügyi Központ, 2021,
Luxembourg Institute of Science and Technology, 2021, Rijksoverheid, 2021, VATar COVID-
19, 2021, Kocamemi et al., 2020). The United States and Canada have established national
coordination networks/systems (CDC, 2021a, Canadian Water Network, 2020). At least five
countries have regional level monitoring (Australia, Brazil, France, South Africa, Switzerland,
United Kingdom) (Victoria State Government, 2021, Queensland Government, 2021, ANA,
2020, Obépine, 2021, SAMRC, 2021, EAWAG, 2021a, EAWAG 2021b, SEPA, 2021). There
have been numerous popular news stories in print, online, and on television as well as calls by
politicians at all levels for widespread application of wastewater testing. However, while
COVID-19 case and death data has been widely available globally, for example, through the
Johns Hopkins University dashboard (Dong et al., 2020), even the locations of COVID-19
wastewater testing are less available and difficult to track.
Though challenges exist to standardize wastewater testing methods and data
normalization (Medema et al., 2020b), public health departments, utilities, scientists and
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.14.21253564doi: medRxiv preprint
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engineers have an ethical obligation, especially during a pandemic, to provide this information to
the public (Canadian Water Network, 2020). The goal of this study is to provide a global
dashboard and analysis of SARS-CoV-2 wastewater testing to inform the public (general
population, public health departments, municipalities, and researchers) where this type of testing
is taking place and provide links to available data for decision making and better coordination.
This study uses the “COVIDPoops19” dashboard to identify gaps in wastewater monitoring, to
make recommendations for science communication of wastewater data and as a call to action for
more forthcoming and transparent open data sharing.
2. Materials and Methods
To create a global dashboard of reported wastewater monitoring efforts, six different data
sources were used (see Figure 1): (1) the COVID-19 WBE website (COVID19 WBE
Collaborative, 2021), (2) webinars, (3) Google form submissions, (4) literature searches, (5)
Twitter keyword searches, and (6) Google keyword searches. ArcGIS Online Dashboards was
chosen as the host platform (ESRI Online, 2020). First, points were added from the COVID-19
WBE collaborative publication map as country points (COVID-19 WBE Collaborative, 2021). A
link to a Google form was made available at the bottom of the COVIDPoops19 dashboard for
users to submit public data points. A Twitter account (@COVIDPoops19) was created for the
dashboard and the UC Merced co-authors performed key word searches daily for ‘wastewater
based epidemiology’ and six combinations of ‘wastewater’ or ‘sewage’ and ‘COVID19’ or
‘COVID-19’ or ‘SARS-CoV-2’.
From advertisements on Twitter and the United States National Science Foundation (NSF)
COVID-19 WBE Research Coordination Network (RCN), the co-authors regularly attended
webinars to learn about different monitoring efforts. Only publicly reported locations and data
from websites and news articles were added to the dashboard. Google was used to check for
missing U.S. states and territories. For example, a combination of “South Dakota” and
“wastewater”, “sewage”, “monitoring” and “COVID-19” and “SARS-CoV-2” keywords were
used to see if there were missing articles that were not found by the daily keyword searches on
Twitter.
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.14.21253564doi: medRxiv preprint
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Figure 1. COVIDPoops19 dashboard data workflow
After collection of reported wastewater monitoring locations for SARS-CoV-2, news articles,
publications, Google form submissions, dashboard/data and other web links were sorted into four
categories: (1) dashboard/data, (2) university, (3) country, and (4) sites to post on the dashboard
with their geographic location. GPS coordinates in WGS 84 coordinate system for the dashboard
were either directly extracted if provided or approximated from the location mentioned in the
source. If a city, county, or country were found testing their wastewater for SARS-CoV-2
without specific sampling sites mentioned, a point was placed near the centroid of the mentioned
area tested to associate the testing site with a location. When public dashboards for wastewater
testing efforts provided coordinates for their sampled sites, those were downloaded and utilized
as site points on the dashboard. The dashboard was usually updated weekly depending on the
number of points gathered and submitted.
Although keyword and literature searches are predominantly in English, the dashboard team
includes English, French, and Spanish speakers and the dashboard had a broad submission from
international stakeholders via the Google form as well as engagement during international
webinars. Many researchers in other countries also publish in and post in English.
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
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After the collection of sites, universities, countries, the spatial distribution of wastewater
monitoring was analyzed. Countries were sorted based on the World Bank income classifications
(high-income, upper middle income, lower middle income, and low income) (World Bank,
2021). ArcGIS Pro 2.6.1 was used to map the number of sites and universities monitoring
wastewater for SARS-CoV-2 globally. With a large number of sites and universities monitoring
SARS-CoV-2 in the wastewater, the United States was chosen to further classify based on the
fifty states and five inhabited territories. The U.S. Centers for Disease Control and Prevention
(CDC) rankings based on COVID-19 cases, hospitalization, and deaths were compared to entities
without wastewater monitoring for SARS-CoV-2 (CDC, 2021b).
Dashboards were categorized based on their presentation, communication style, and data
availability. Results of SARS-CoV-2 testing in wastewater were presented as maps, graphs, a
small written description or solely by color (demonstrating an increase or decrease of trend).
Dashboard communication style categories were: video, FAQ page, a short written format (less
than three paragraphs), longer descriptions (three or more paragraphs), and no form of written
communication. The simplicity of the communication was also determined by whether the
description given was: (1) technical, more specifics on the science behind SARS-CoV-2
wastewater testing (included information on lab processes), (2) a simpler form of communication
that would be understandable to the general public (used general vocabulary to inform as to why
wastewater is being used to test for SARS-CoV-2). Dashboards were checked if they provided
downloadable data, the file type, and variables available.
3. Results and Discussion
As of March 8th, 2021, the COVIDPoops19 global dashboard for wastewater monitoring
of SARS-CoV-2 included 235 universities, 59 dashboards, 1,488 sites in 50 countries. Between
September 2020 and March 8th, 2021, there were 60 submissions on the Google form linked to
the COVIDPoops19 dashboard. Since the dashboard was published publicly in September 2021,
there have been 25,679 visits. The COVIDPoops19 twitter account has acquired over 2,000
followers between May 2020 and March 2021.
Of the 195 countries in the world (U.S. Department of State, 2021), 50 contain
wastewater monitoring. Of these 50, 36 (72%) are in high-income countries, 10 (20%) are upper
middle income, 6 (12%) are lower middle income, and 0% are low income countries. See Figure
2 for distribution of wastewater monitoring of SARS-CoV-2 globally. Similar to COVID-19
individual testing and Personal Protective Equipment (PPE) (Kavanagh et al., 2020; McMahon et
al., 2020) and vaccination efforts (Lancet Commission, 2021), access to wastewater testing is
also more widely available in High-Income Countries.
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(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.
The copyright holder for this preprintthis version posted March 17, 2021. ; https://doi.org/10.1101/2021.03.14.21253564doi: medRxiv preprint
