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GAO-22-105841 1 (2022-04-11)

handle is hein.gao/gaomyn0001 and id is 1 raw text is: Science, Technology Assessment, GAO Iand Analytics SCIENCE & TECH SPOTLIGHT: WASTEWATER SURVEILLANCE What is it? Wastewater surveillance, also known as wastewater-based epidemiology, is the monitoring of pathogens (e.g., viruses), as well as pharmaceuticals and toxic or other chemicals by testing sewage (see fig. 1). Public health officials can use this approach to monitor for outbreaks, identify threats (e.g., antibiotic-resistant bacteria), and, in response, sup- port the mobilization of resources. PhVirg s PATHOGENS~ CHMCr Sources: GAO analysis of World Bank information (data); Alexandra GL/Blankstock/stock.adobecom (images) (GAO-22-105841 Figur 1. Use o Awastewater teting. Pathogens and chemicals can enter sewer systems through human waste. Wastewater surveillance programs collect sewage samples from these systems and treatment plants and send them to laboratories for testing. Officials can use test data, for example, to assess whether there is a viral outbreak or increasing drug use and then decide what actions to take to protect public health. These actions might include increased clinical testing in an area, or alerting local clinics and hospitals to prepare for an increase in patients. How is it used? For many years, the U.S. and other countries have used wastewater surveillance to monitor for pathogen and chemical levels in their communities. Australia, for example, is using a wastewater surveil- lance program to track the amounts of illicit drug use in the population to estimate the effectiveness of law enforcement efforts to seize drugs. In the U.S., federal and local governments, universities, and compa- nies have recently increased investments in wastewater surveillance in response to the COVID-19 pandemic. As of February 2022, health departments in 43 jurisdictions, representing about 16 percent of the U.S. population, were using funds distributed by the Centers for Disease Control and Prevention (CDC) to support wastewater surveillance efforts. The CDC works with these 43 jurisdictions to collect data that track SARS- CoV-2 levels and make these data publically available through its National Wastewater Surveillance System (NWSS) website. Nearly 80 percent of the U.S. population is served by municipal sewer systems that could be monitored through such programs. Wastewater surveillance can serve many purposes (see fig. 2). For example, it can provide an early warning for infectious disease outbreaks so a community can take action. It can detect low levels of SARS-CoV-2 in human waste before symptoms appear, as early as 1 to 2 weeks before an infected person may seek clinical testing. It can also detect SARS- CoV-2 from asymptomatic individuals who make up about 70 percent of cases and may not seek clinical testing. Sources: GAO analysis of World Bank information (data); Rogatnev/VectorMine/stock.adobe.com (images). I GAO-22-105841 Some U.S. universities have used wastewater surveillance to identify buildings, such as dormitories, with potentially high or increasing infection rates among student residents and subsequently target clinical testing and quarantine efforts to avert outbreaks on campus. For example, in the fall of 2020, one university used wastewater surveillance to detect nearly 85 percent of COVID-19 cases that were later confirmed through clinical testing. What are some qaps? Wastewater surveillance may have enormous potential as a public health tool, but some aspects of the science may GAO-22-105841 Wastewater Surveillance

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