Wastewater and surface monitoring to detect COVID-19 in elementary school settings: The Safer at School Early Alert project

Fielding-Miller, R. K.; Karthikeyan, S.; Gaines, T.; Garfein, R. S.; Salido, R. A.; Cantu, V.; Kohn, L.; Wijaya, F. C.; Flores, M.; Omaleki, V.; Majnoonian, A.; Martin, N. K.; Austin, D.; Laurent, L. C.; Gonzalez-Zuniga, P.; Nguyen, M.; Vo, A. V.; Le, T. T.; Duong, D.; Hassani, A.; Tweeten, S.; Jepsen, K.; Henson, B.; Hakim, A.; Birmingham, A.; Mark, A. M.; Nasamran, C. A.; Rosenthal, S. B.; Moshiri, N.; Fisch, K. M.; Humphrey, G.; Farmer, S.; Tubb, H.; Valles, T.; Morris, J.; Kang, J.; Khaleghi, B.; Young, C.; Akel, A. D.; Eilert, S.; Eno, J.; Curewitz, K.; Rosing, T.; SEARCH,; Knight, R.

Schools are high-risk settings for SARS-CoV-2 transmission, but necessary for children's educational and social-emotional wellbeing. While wastewater monitoring has been implemented to mitigate outbreak risk in universities and residential settings, its effectiveness in community K-12 sites is unknown. We implemented a wastewater and surface monitoring system to detect SARS-CoV-2 in nine elementary schools in San Diego County. Ninety-three percent of identified cases were associated with either a positive wastewater or surface sample; 67% were associated with a positive wastewater sample, and 40% were associated with a positive surface sample. The techniques we utilized allowed for near-complete genomic sequencing of wastewater and surface samples. Passive environmental surveillance can complement approaches that require individual consent, particularly in communities with limited access and/or high rates of testing hesitancy.