Abstract
During the COVID-19 pandemic schools closed due to concerns over disease spread resulting in lost learning opportunities. One approach for documenting disease spread includes wastewater (WW) surveillance of the virus that causes COVID-19 (Severe Acute Respiratory Syndrome Coronavirus 2, SARS-CoV-2) and other infectious pathogens. The objective of this study was to evaluate whether wastewater can be used to track children's health at grade schools in an underserved community, which was vulnerable due to limited health-based data and difficulties in implementing mitigation measures. The 18-month study was initiated during January 2022 at 9 grade schools (3 high, 2 middle, and 4 elementary schools) characterized as low income. Children's health was evaluated through absenteeism due to difficulties in attaining representative clinical diagnoses through school-based clinics. Wastewater measurements of SARS-CoV-2 were available weekly through grab sample collection and RNA extraction followed by quantification using qPCR. The average absenteeism rate was 7.1%, ranging from 4.6% to 12.5% per school. Fraction of WW samples positive for SARS-CoV-2 was 38% with SARS-Cov-2 levels ranging from detection limits (100 gc/L) to a maximum of 10.2 million gc/L. When data were aggregated across all schools, a statistically significant association was observed between weekly absenteeism rates and WW SARS-CoV-2 with a one percent increase in the log(e) WW SARS-CoV-2 associated with a 1.4% increase in student absence (p < 0.05). When evaluating the data by individual school, this association was strongest at schools with enclosed architecture characterized by limited natural ventilation. For schools with limited resources for clinical diagnosis of illnesses, school absenteeism coupled with wastewater-based monitoring should be utilized for assessing overall health of student populations. Strategies to maintain schools open during pandemics should include consideration of school architecture along with appropriate messaging of WW monitoring results to inform administrators and families.