Variability of Clinical Metrics in Small Population Communities Drive Perceived Wastewater and Environmental Surveillance Data Quality: Ontario, Canada-Wide Study

• DOI: 10.1021/acsestwater.4c00958
• Publication Date: 2025-03-08T00:35:26Z
• Authors: Nada Hegazy; K. Ken Peng; Patrick M. D’Aoust; Lakshmi Pisharody; Elisabeth Mercier; Nathan Thomas Ramsay; Md Pervez Kabir; Tram Bich Nguyen; Emma Tomalty; Felix Addo; Chandler Hayying ...; Shen Wan; Joan Hu; Charmaine Dean; Minqing Ivy Yang; Hadi Dhiyebi; Elizabeth A. Edwards; Mark R. Servos; Gustavo Ybazeta; Marc Habash; Lawrence Goodridge; Art F. Y. Poon; Eric J. Arts; Stephen Brown; Sarah Jane Payne; Andrea Kirkwood; Denina Bobbie Daw...; Jean-Paul Desauln...; Banu Ormeci; Christopher Kyle; David Bulir; Trevor Charles; R. Michael McKay; K. A. Gilbride; Claire Jocelyn Os...; Hui Peng; Christopher DeGroot; ; Elizabeth Renouf; Robert Delatolla

The emergence of COVID-19 in Canada has led to over 4.9 million cases and 59,000 deaths by May 2024. Traditional clinical surveillance metrics (hospital admissions laboratory-positive cases) were complemented with wastewater environmental monitoring (WEM) monitor SARS-CoV-2 incidence. However, challenges public health integration WEM persist due perceived limitations data quality, potentially driving inconsistent correlations variability lead times. This study investigates how factors like population size, measurement magnitude, site isolation status, hospital admissions, affect Ontario. analysis uncovers a direct relationship between the size surveyed sewersheds, while magnitude was not directly impacted size. Higher observed smaller likely reducing correlation strength for inferring Population significantly influenced thresholds identified at ∼66,000 inhabitants strong WEM-hospital ∼68,000 WEM-laboratory-positive during waned vaccination periods Ontario (the Omicron BA.1 wave). During significant immunization BA.2 wave), these increased ∼187,000 238,000, respectively. These findings highlight benefit strategic interventions, especially communities. provides insights enhancing decision making disease through WEM, applicable other diseases.