| Abstract |
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Wastewater surveillance system for SARS-CoV-2 RNA has been established in many high-income countries and piloted in a few low-and middle-income countries (LMICs) and has been linked to the community’s burden of disease. Currently, this is being explored as a mechanism to inform COVID-19 control strategies – including as an early warning system to flag community outbreaks. In LMICs where testing of individuals to determine community burden of COVID-19 is impractical and/or unaffordable, the assessment of community burden by testing of wastewater may be a cost-effective option.
Determining the burden of disease in low-and middle-income countries has been challenging and is likely under-reported due to logistical barriers in detecting, tracking, and tracing the spread of COVID-19 and practical barriers to the isolation of cases and to community lockdowns. Yet, being able to accurately measure the spread of the virus is critically important to inform the public health response.
SARS-CoV-2 infects the gastrointestinal tract and can be detected in the stool of symptomatic and asymptomatic infected individuals. As there is a lag between exposure and initiation of infection followed by the development of symptoms that triggers the patient presenting for testing, wastewater surveillance for SARS-CoV-2 has been proposed as an early warning system for COVID-19 within a community. However, the cost-effectiveness of such methods, particularly in low-and middle-income countries has not been adequately evaluated.
Indonesia has become the major epicenter of the COVID-19 pandemic in July 2021 surpassing India, with more than 49,000 confirmed daily cases and a 2.6?tality rate. During this same period, we started this wastewater surveillance of SARS-CoV-2 in three regencies in Yogyakarta province which were among the highest COVID-19 cases in Indonesia. Our surveillance was able to detect SARS-CoV-2 presence in wastewater and soil samples with 73 % positivity rate. The current ongoing project is a proof of concept and feasibility for wastewater surveillance for early warning system SARS-CoV-2 in the Indonesia setting.
The proposed project will evaluate the cost of setting up such surveillance systems and the possibility to further scale up at the regional and national level. The proposed project would be able to provide information on infection trends without relying on the availability of and access to clinical testing resources or health-seeking behavior. The cost-effectiveness results would also be able to inform if such surveillance systems could be expanded to regions and countries with similar characteristics as it would inform the aspects of its implementation in similar settings. The wastewater surveillance system could also ameliorate long-term surveillance as Indonesia moves to COVID-19 endemic status. The wastewater surveillance also has the potential to be expanded for other purposes, for example, Salmonella, antimicrobial resistance, and other public health purposes.
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