Wastewater Monitoring: A Vital Tool for Early Detection of COVID-19 in Senior Living Facilities

The COVID-19 pandemic presented senior living facilities with the formidable task of protecting their vulnerable residents while maintaining a sense of community. However, by embracing the latest advances in testing methods, including building-level wastewater monitoring, facilities like New Horizons at Marlborough found an effective solution to support the health and well-being of their residents. Nevertheless, the pandemic clarified that a layered protection approach is crucial to stay informed about the health of residents. 

The U.S. Census Bureau reports that over 56 million adults 65 and older account for about 17 percent of the population. By 2030, with the aging of baby boomers, the number of older adults is expected to reach 73 million people. However, rural and suburban communities present challenges for the aging population due to less robust health infrastructure than urban centers— a problem that the COVID-19 pandemic has magnified, where 81 percent of COVID-related deaths in the U.S. in 2020 were among people over age 65.

With the early days of the pandemic in the rearview mirror, methods for early detection of pathogens like flu and COVID-19, such as wastewater monitoring, can help facilities such as senior living centers better manage the health of their residents. Passive monitoring can give facility directors detailed insights for investments and services, as well the data to make more informed health decisions for their senior living communities and facilities. While some states and major cities have successfully established wastewater surveillance networks, rural and suburban communities not connected to municipal programs remain unmonitored. Due to a lack of this biosecurity infrastructure, a significant portion of the population has been left out of surveillance systems, including a large swath of American seniors. 

So does passive surveillance, like wastewater monitoring, work? Wastewater includes sewage from toilets, showers, and sinks. At Ginkgo Biosecurity, we provide a customized end-to-end monitoring solution that begins with a site survey and installation of wastewater devices (autosamplers) tailored to each community’s needs. Autosamplers capture a comprehensive picture of the building-level population, and lab analyses use next-generation sequencing and bioinformatics to identify potential risks. We then report the results to building managers, providing insights into pathogen prevalence and trends, empowering communities to make data-driven public health decisions. 

In a study by Rockefeller Foundation’s Pandemic Prevention Institute and Mathematica, which included 12 state and 194 local public health agencies, roughly half of the agencies with passive surveillance programs reported the importance of  wastewater data in pandemic management decisions. This data “informed decisions to coordinate response with other agencies, tailor communications to the public, and target clinical testing.”

Wastewater monitoring is a cost-effective approach that does not require individual testing. Many pathogens appear in wastewater before individuals show symptoms, providing an early warning of an infection. Additionally, by collecting the genetic sequences of a virus, officials can track new and evolving variants. For example, wastewater monitoring has already proven successful in identifying other emerging threats to public health, such as poliovirus in New York and the spread of monkeypox in London. As interest among state and local agencies continues to grow, many are exploring the future of wastewater monitoring in providing data on new pathogens.

A recent study from the Office of Inspector General revealed that nursing homes in the country were inadequately prepared for the COVID-19 pandemic, resulting in over a thousand facilities experiencing infection rates of 75 percent or higher during 2020 and an average overall mortality rate near 20 percent. Researchers from NORC at the University of Chicago identified that the death rates in senior housing during the pandemic were proportional to the severity of residents’ health conditions, age, and complexity of care requirements. According to the National Academies’ recent report on wastewater surveillance, building level or community passive monitoring programs provide the opportunity for scientists to complement other forms of disease monitoring and public health data, from analyzing diseases in different age groups, seasonal patterns of the flu, vaccine effectiveness, and the spread of disease regionally. 

Building-level wastewater monitoring is non-invasive, cost efficient, and can be carried out seamlessly in the background of everyday activities, allowing management to track the spread of pathogens and identify trends within their facilities. The early detection of viruses through wastewater analysis can help give operators a head start in managing health risks before symptoms may manifest.