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Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods
Journal article   Open access   Peer reviewed

Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods

Tori L. Cowger, Nicholas B. Link, Justin D. Hart, Madeline T. Sharp, Shoba Nair, Ruchita Balasubramanian, Soroush Moallef, Jarvis Chen, William P. Hanage, Loni Philip Tabb, …
Journal of public health management and practice, v 31(2), pp 270-282
Mar 2025
DOI: https://doi.org/10.1097/PHH.0000000000002049
PMID: 39254302
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1097/PHH.0000000000002049View
Published, Version of Record (VoR) Open

Abstract

Life Sciences & Biomedicine Public, Environmental & Occupational Health Science & Technology
Context:Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level "wastewater viral activity levels."Program:In October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.Approach and Implementation:To produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.Evaluation:COVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with "Very High" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for "High" or "Low," obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.Discussion:Our methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.

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6 Record Views
3 citations in Web of Science
2 citations in Scopus

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UN Sustainable Development Goals (SDGs)

This publication has contributed to the advancement of the following goals:

#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
Web of Science research areas
Public, Environmental & Occupational Health
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