New COVID-19 early warning system could avert future lockdowns

Wastewater samples, analysis of sars-cov-2 virus in patients infected by human coronavirus

Credit: digicomphoto/GettyImages

Scientists are combining wastewater testing and COVID-19 vaccine uptake data to develop a coronavirus early warning system that could prevent future lockdowns.

Academics at the universities of Edinburgh, Glasgow and Stirling are working with the  Scottish Environment Protection Agency (SEPA) and Scottish Water to develop the system.

The project is funded by the Economic and Social Research Council (ESRC) as part of UK Research and Innovation (UKRI)’s rapid response to COVID-19.

Identifying strategies

Professor Rowland Kao, Chair of Veterinary Epidemiology and Data Science at University of Edinburgh’s Roslin Institute, said:

This partnership aims to identify strategies where, by rapidly picking up outbreaks and introducing local control measures such as ‘surge testing’ and intensive contact tracing.

While we can all hope for eradication of COVID-19 this summer, a more realistic possibility is that we find ways of dealing with regular localised outbreaks.

How does the warning system work to avert lockdown?

  1. The wastewater monitoring programme run by SEPA and Scottish Water already identifies when genetic fragments from the COVID-19 virus are present in wastewater. So that’s wastewater present in our sewage system.
  2. While these genetic fragments present no known risk of infecting people with COVID-19, researchers can link these data to specific areas.
  3. These data highlight where infections are increasing or decreasing, helping to understand the prevalence and distribution of the virus.The wastewater monitoring system tests large numbers of people in one go. It is both cheaper and potentially provides more rapid detection of outbreaks compared to a reliance on mass testing or individuals reporting infection.
  4. The project also utilises data from Public Health Scotland that provides up-to-date information on vaccine uptake, and results of COVID-19 testing that tell of the number of cases. This data is broken down by individual areas of Scotland.
  5. Estimating how numbers of vaccinated individuals are likely to vary geographically in the future will help develop models to predict how severe possible future outbreaks of COVID-19 might be. These models will also predict how quickly wastewater surveillance is likely to identify any such outbreaks. It will enable the implementation of localised measures such as surge testing or vaccination (should boosters be necessary) or possibly temporary local restrictions. The models will help to tell us how large an area and how successful such measures would have to be to prevent the need for more general lockdowns.
  6. As future outbreaks occur, the research team will then use the real time health data and combine it with the wastewater markers to crucially:
    • understand the virus spread and then
    • adapt their existing models of COVID-19 spread and improve short- and medium-term forecasts.
  7. These models can then be used by government health bodies to evaluate different strategies to control COVID-19 outbreaks without the need for further lockdowns.

UK-wide monitoring

The Scotland-led project parallels with a UK-wide wastewater project already underway. The models, while developed with Scottish data, will be open sourced and should be applicable to England and Wales provided similar data are used to populate it.

The National Wastewater Epidemiology Surveillance Programme (N-WESP) brings together scientists and collaborators from 23 organisations looking into the presence and infectivity of COVID-19 in wastewater.

This research will help develop wastewater surveillance methods and findings could help identify future disease hotspots across the UK. This programme is funded by the Natural Environment Research Council (NERC) as part of UKRI’s rapid response to COVID-19.

The research programme, which is now under way and will last until October 2021, is being led by the UK Centre for Ecology & Hydrology (UKCEH).

It also involves researchers from the universities of:

  • Bangor
  • Bath
  • Edinburgh
  • Cranfield
  • Lancaster
  • Newcastle
  • Oxford
  • Sheffield

plus the London School of Hygiene and Tropical Medicine.

Read more about NWESPs UK-wide system for estimating COVID-19 cases from wastewater (UKCEH website).

Forecasting ahead

The Scottish project will allow experts to identify potential hotspots early, forecast stresses on hospitals and ICUs, and create more focused access to vaccines.

Professor Rowland Kao said:

A key to this is to understand how the numbers of people being vaccinated may vary geographically, as any local clusters with larger numbers of unprotected individuals could drive local outbreaks.

In a winter where resources will also be strained by flu and other seasonal infections, controlling those outbreaks, if they occur, could be crucial to avoiding further lockdowns.

Long-term forecasts will be possible as more data becomes available on vaccine-induced and natural immunity, loss of immunity and areas where vaccine uptake has been low.

The teams from the universities of Edinburgh and Stirling will conduct a survey to gauge attitudes towards and ease of access to vaccines. They will examine how the results relate to the Scottish index of multiple deprivation.

Areas of high deprivation have been disproportionately affected by COVID-19 and previous surveys have indicated they are more likely to experience low vaccine uptake.

This four-pronged approach will allow the building of so-called ‘vaccination games’ – simulations to see how various scenarios involving differing rates of vaccine uptake in communities play out.

Preventing further national lockdown – next steps

The next stage is to enable more localised preventative measures, therefore avoiding national lockdowns.

Researchers are hoping to adapt the Scottish partnership project via NWESP monitoring, using upstreaming and national data to help pinpoint local COVID-19 hotspots.

Professor Rowland Kao explained:

Upstreaming is where we have identified the virus in the waste system in one, say, densely populated location.

By then travelling up the waste system, we can pinpoint where in that area the virus is actually originating. This information will alert authorities, allowing them to swiftly employ measures other than national lockdown, for example, to contain the virus.

We’re currently in conversation with the Joint Biosecurity Centre (JBC) about how we can now further develop the upstreaming stage.

Last updated: 3 June 2021

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