Water recycling goes mainstreamPurified: How Recycled Sewage Is Transforming Our Water Peter Annin Island Press, 2023. 248 pp.

Public health and public relations are key to successful potable water reuse programs.

The dynamic relationship between COVID-19 cases and SARS-CoV-2 wastewater concentrations across time and space: Considerations for model training data sets.

During the COVID-19 pandemic, wastewater-based surveillance has been used alongside diagnostic testing to monitor infection rates. With the decline in cases reported to public health departments due to at-home testing, wastewater data may serve as the primary input for epidemiological models, but training these models is not straightforward. We explored factors affecting noise and bias in the ratio between wastewater and case data collected in 26 sewersheds in California from October 2020 to March 2022. The strength of the relationship between wastewater and case data appeared dependent on sampling frequency and population size, but was not increased by wastewater normalization to flow rate or case count normalization to testing rates. Additionally, the lead and lag times between wastewater and case data varied over time and space, and the ratio of log-transformed individual cases to wastewater concentrations changed over time. This ratio decreased between the Epsilon/Alpha and Delta variant surges of COVID-19 and increased during the Omicron BA.1 variant surge, and was also related to the diagnostic testing rate. Based on this analysis, we present a framework of scenarios describing the dynamics of the case to wastewater ratio to aid in data handling decisions for ongoing modeling efforts.

Wastewater Surveillance to Inform Public Health Decision Making in Residential Institutions.

Testing sewage (wastewater-based surveillance, or WBS) for pathogens is an increasingly important tool for monitoring the health of populations. During the COVID-19 pandemic, some residential institutions including colleges, prisons, and skilled nursing facilities used facility-level wastewater data to inform their pandemic responses. To understand how these early adopters used WBS data in decision making, we conducted in-depth, semistructured interviews with multiple decision makers at 6 residential institutions in the United States (universities, prisons, and nursing homes) encompassing a total of more than 70 000 residents and staff about interpretation, uses, and limitations of these data. We found that WBS data were used in extremely diverse ways. WBS combined with clinical surveillance informed a wide range of public health actions at residential institutions, including transmission reduction measures, public health communications, and allocation of resources. WBS also served other institutional purposes, such as maintaining relationships with external stakeholders and helping alleviate decision makers' pervasive stress. Recognizing these diverse ways of using WBS data can inform expansion of this practice among institutions as well as development of community-scale systems.

Tools for interpretation of wastewater SARS-CoV-2 temporal and spatial trends demonstrated with data collected in the San Francisco Bay Area.

Wastewater surveillance for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA can be integrated with COVID-19 case data to inform timely pandemic response. However, more research is needed to apply and develop systematic methods to interpret the true SARS-CoV-2 signal from noise introduced in wastewater samples (e.g., from sewer conditions, sampling and extraction methods, etc.). In this study, raw wastewater was collected weekly from five sewersheds and one residential facility. The concentrations of SARS-CoV-2 in wastewater samples were compared to geocoded COVID-19 clinical testing data. SARS-CoV-2 was reliably detected (95% positivity) in frozen wastewater samples when reported daily new COVID-19 cases were 2.4 or more per 100,000 people. To adjust for variation in sample fecal content, four normalization biomarkers were evaluated: crAssphage, pepper mild mottle virus, Bacteroides ribosomal RNA (rRNA), and human 18S rRNA. Of these, crAssphage displayed the least spatial and temporal variability. Both unnormalized SARS-CoV-2 RNA signal and signal normalized to crAssphage had positive and significant correlation with clinical testing data (Kendall's Tau-b (τ)=0.43 and 0.38, respectively), but no normalization biomarker strengthened the correlation with clinical testing data. Locational dependencies and the date associated with testing data impacted the lead time of wastewater for clinical trends, and no lead time was observed when the sample collection date (versus the result date) was used for both wastewater and clinical testing data. This study supports that trends in wastewater surveillance data reflect trends in COVID-19 disease occurrence and presents tools that could be applied to make wastewater signal more interpretable and comparable across studies.

Wastewater Surveillance for SARS-CoV-2 on College Campuses: Initial Efforts, Lessons Learned, and Research Needs.

Wastewater surveillance for the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an emerging approach to help identify the risk of a coronavirus disease (COVID-19) outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, and nursing homes) scales. This paper explores the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. We present the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resources, and impacts from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Our analysis suggests that wastewater monitoring at colleges requires consideration of local information needs, sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members.

Wastewater surveillance for SARS-CoV-2 on college campuses: Initial efforts, lessons learned and research needs.

Background: Wastewater surveillance for SARS-CoV-2 is an emerging approach to help identify the risk of a COVID-19 outbreak. This tool can contribute to public health surveillance at both community (wastewater treatment system) and institutional (e.g., colleges, prisons, nursing homes) scales. Objectives: This research aims to understand the successes, challenges, and lessons learned from initial wastewater surveillance efforts at colleges and university systems to inform future research, development and implementation. Methods: This paper presents the experiences of 25 college and university systems in the United States that monitored campus wastewater for SARS-CoV-2 during the fall 2020 academic period. We describe the broad range of approaches, findings, resource needs, and lessons learned from these initial efforts. These institutions range in size, social and political geographies, and include both public and private institutions. Discussion: Our analysis suggests that wastewater monitoring at colleges requires consideration of information needs, local sewage infrastructure, resources for sampling and analysis, college and community dynamics, approaches to interpretation and communication of results, and follow-up actions. Most colleges reported that a learning process of experimentation, evaluation, and adaptation was key to progress. This process requires ongoing collaboration among diverse stakeholders including decision-makers, researchers, faculty, facilities staff, students, and community members.

A mixed-methods approach to strategic planning for multi-benefit regional water infrastructure.

Finding regional solutions for water infrastructure and other environmental management challenges requires coordination, communication, and a shared understanding among different stakeholders. To develop a more versatile and collaborative decision-making process for nutrient management in the San Francisco Bay Area, we used a mixed-methods approach consisting of stakeholder analysis with cluster analysis, multi-criteria decision analysis (MCDA), and scenario planning. These methods allowed us to identify agreements and disagreements in stakeholder objectives and preferences, clarify ways in which different options could meet the goals of diverse stakeholders, and elucidate how scientific uncertainty about technical performance and future conditions could affect management strategies. Results of the analysis indicate that several non-conventional nutrient management options like constructed wetlands and increased water recycling for irrigation met the goals of many stakeholders under a variety of future scenarios. A comparison of MCDA results with a more traditional 'cost-efficiency' measure (i.e., optimizing for the lowest cost per mass of nutrients removed) revealed little correlation between the two methods for stakeholders who expressed a preference for co-benefits of management options such as increased water supply and nutrient recovery for fertilizer use. The method also allowed us to identify key areas of disagreement (e.g., the relative importance of constructing infrastructure that would not be affected by sea level rise) that should find regulatory or professional consensus before advancing with decision-making. This mixed-methods approach is time-consuming and requires specific expertise that is not always available to stakeholders. The development of more efficient preference elicitation and interaction procedures would increase the likelihood that decision-makers would make the extra effort required to use this potentially powerful method. Nonetheless, the mixed-methods approach had several important advantages over more traditional strategic planning methods including its ability to stimulate discussions amongst stakeholders who do not regularly interact, support collaborative planning, and encourage multi-benefit solutions.

Beyond User Acceptance: A Legitimacy Framework for Potable Water Reuse in California.

Water resource managers often tout the potential of potable water reuse to provide a reliable, local source of drinking water in water-scarce regions. Despite data documenting the ability of advanced treatment technologies to treat municipal wastewater effluent to meet existing drinking water quality standards, many utilities face skepticism from the public about potable water reuse. Prior research on this topic has mainly focused on marketing strategies for garnering public acceptance of the process. This study takes a broader perspective on the adoption of potable water reuse based on concepts of societal legitimacy, which is the generalized perception or assumption that a technology is desirable or appropriate within its social context. To assess why some potable reuse projects were successfully implemented while others faced fierce public opposition, we performed a series of 20 expert interviews and reviewed in-depth case studies from potable reuse projects in California. Results show that proponents of a legitimated potable water reuse project in Orange County, California engaged in a portfolio of strategies that addressed three main dimensions of legitimacy. In contrast, other proposed projects that faced extensive public opposition relied on a smaller set of legitimation strategies that focused near-exclusively on the development of robust water treatment technology. Widespread legitimation of potable water reuse projects, including direct potable water reuse, may require the establishment of a portfolio of standards, procedures, and possibly new institutions.