Title : Equities and inequities inherent in wastewater surveillance systems for public health
Abstract:
Objective: To examine the equity and inequity inherent in wastewater surveillance systems under different design specifications, using New York State as a case study.
Methods: In addition to evaluating the equity of inclusion, we introduce two novel measures of equity in infectious disease surveillance: 1) equity of outbreak detection and 2) equity of disease forecasting. We considered equity in terms of demographics, environmental justice, and social vulnerability.
Results: Communities with higher social and environmental vulnerabilities are included in the NYS wastewater surveillance network; however, these same communities are often served by larger wastewater treatment plants resulting in inequity in outbreak detection as outbreaks must grow larger in these communities before they can be detected in their wastewater. Conversely, regions with smaller populations or a higher proportion of households not connected to public sewer may experience an inequity in disease forecasting.
Conclusions: This assessment of equity and inequity, including outbreak detection and disease forecasting, can be applied to improve both the design of wastewater surveillance systems and the understanding of infectious disease risk derived from wastewater surveillance.
