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Testing the Waters

Two years ago, a team of scientists, researchers and engineers began tracking COVID-19 trends on campus by testing the wastewater. Now, that team is tracking other infectious diseases across the state, which could help predict outbreaks of RSV, influenza and more.

What began as a WVU-led effort to track COVID-19 in Monongalia County, WV, is now a statewide operation that could soon help public health officials anticipate and respond to outbreaks of common seasonal illnesses.

Back in 2020, when the pandemic was new, we learned that when people use the bathroom, they shed COVID-19 virus particles. So a team of WVU researchers decided to test the wastewater on campus for the presence of those particles. Their methods were modest: they dipped a bottle down a manhole cover into the wastewater stream, sealed it up and transported it to the lab via a cooler for testing.

Once they got the sample back to the lab, they tested for the presence of SARS-CoV-2, which causes COVID-19, using droplet digital polymerase chain reaction (ddPCR) testing. PCR testing extracts the virus’s RNA – its unique genetic material.

The wastewater testing team included biology professor Timothy Driscoll , laboratory manager Josh Lambert, laboratory technician Dr. Amy Jones and colleagues, Gordon Smith and Brian Hendricks with the School of Public Health, and civil and environmental engineering professor Emily Garner. They banded together after Smith and Hendricks, who had been developing studies of the presence of opioids in wastewater, began to wonder if such methods could be used to study COVID-19.

“One of the first things we saw with those initial tests was when sports teams were quarantining in a single building on campus and we tested those buildings,” said Driscoll. “We saw the wastewater signal increase just a little bit in advance of when there was an outbreak of clinical cases, so the University got very excited. We got very excited.”

Testing efforts garnered support from Senior Associate Vice President of Academic and Public Strategy Rochelle "Rocky" Goodwin, the WVU Research Office , Eberly College and WVU Health Sciences.

In 2020, the team branched out and started testing at a local wastewater treatment plant to see if their efforts were feasible on a larger scale. Once they concluded their tests worked, the team began reaching out to locations across the state to expand their testing area. If they could test in West Virginia’s communities, they thought they might be able to inform public health officials of negative trends in their areas.

One year later, with $2.9 million in funding and support from the CDC and the West Virginia Dept. of Health and Human Resources, the Wastewater Testing for Community Health in West Virginia (WaTCH-WV) Project was born.

“Early on, we would just present our data to WVU campus officials and its COVID response team and say ‘we're seeing an increase in signal in this area’ and they would increase testing there to try to pick up pre-symptomatic or asymptomatic students,” said Driscoll. “That has since matured with the development of the National Wastewater Surveillance system at CDC. And so now, we collect, we do some analysis and we provide those analyses and data to the State’s leadership.”

The WaTCH-WV project provided the opportunity for the team to test wastewater throughout West Virginia. The team reported its data to the State, which reported it to the CDC, which helped identify communities of concern for COVID-19. The network monitored sewage at wastewater plants, as well as in high-risk settings like college campuses. Collaborators at Marshall University also conducted wastewater testing in communities around the Huntington area.

WaTCH-WV featured an online dashboard that updated COVID-19 trends across the state on a daily basis. The partnering sites regularly sent in wastewater samples from their locations to the testing lab at WVU, so the dashboard stayed up-to-date and became a timely resource for monitoring COVID-19 trends in West Virginia.

“Our wastewater monitoring is really helpful for health officials in West Virginia,” said Lambert, who manages WVU’s Zoonotic Pathogen Testing Laboratory for Wastewater Based Epidemiology. “Because we understand the molecular basis of disease and why it spreads the way it does, we can predict a spike in COVID cases in a certain area from the wastewater before they would have clinical data. In smaller communities, we wanted to help hospitals prepare for an upcoming spike or help people protect themselves by masking or avoiding gatherings, especially if they didn’t get the vaccine.”

At WVU, the team began using a small robot called an autosampler to collect their wastewater, thanks to Garner’s engineering expertise – it was a higher tech alternative to their previous dip-and-chill-in-a-cooler method, and it could be programmed to collect samples on-site every 20 minutes.

They don’t test all their previous sites on campus anymore. Instead, they test a few sites that Driscoll feels encompasses campus pretty well, in addition to their testing sites at wastewater facilities around Monongalia County. Their lab setup has also grown with the project, which has allowed them to test an increasing amount samples sent in from wastewater sites across the state.

Photo of waste water vials being tested

“Now, we have built a pathogen testing lab which automates most of the process from wastewater testing to data generation and visualization, so we can turn around our samples easily within 24 hours of receiving it,” Driscoll explained. “At a minimum, it would take us about eight hours to report findings to leadership in an emergency situation.”

As the pandemic slowed in 2022, the project prepared to expand its testing efforts to help address other public health concerns in West Virginia. Lambert has recently started testing water samples for respiratory syncytial virus (RSV) in addition to COVID. The lab team will begin testing for Monkey Pox soon, as well. When flu season begins, they will test for influenza.

Monkey Pox has been spreading slowly throughout the world lately – as of June 2022, there were around 175 cases in the United States. In Europe and elsewhere, though, cases are on the rise. Because Monkey Pox could potentially pose a threat to American public health, it was the perfect chance for the testing lab to begin testing for it in West Virginia. Monkey Pox testing efforts would also help determine how quickly researchers can theoretically begin testing an area for an illness once it pops up elsewhere in the world.

“It seems like Monkey Pox testing could turn around in a couple weeks, which I think is incredible,” Lambert said. “This is a kind of case study, as well. We will get a lot of useful information out of this project in terms of how quickly we can test wastewater for new viruses before tests are approved for people.”

The team’s testing efforts should be more streamlined by the end of the summer, according to Lambert, because of new equipment that will test for multiple illnesses at once. This means that when a testing site sends in its samples, the lab can report back to them quickly if that area is seeing multiple cases of a certain illness. When health officials are notified, they then have the opportunity to mitigate the outbreak by encouraging vaccines in their community, delivering guidance to healthcare workers and more.

“In the future, this project is going to help West Virginia communities keep people healthy. It's also going to be something future generations can look back on and build from we have learned,” he said. “In this way, we can change the way that people are looking at modern epidemiology and public health.”