Abstract
The COVID-19 pandemic has disproportionately affected vulnerable populations, including residents of assisted living facilities (ALFs). This study investigates the impact of non-pharmaceutical interventions (NPIs) and mass vaccination campaigns on SARS-CoV-2 transmission dynamics within four ALFs in Maricopa County, Arizona, United States from January to April 2021. Initial observations reveal a significant SARS-CoV-2 prevalence in Maricopa County, with 7452 new COVID-19 cases reported on 4 January 2021. Wastewater surveillance indicates elevated viral loads within ALFs with peak concentrations reaching 1.35 × 10(7) genome copies/L at Facility 1 and 4.68 × 10(5) copies/L at Facility 2. The implementation of NPIs, including isolation protocols, resulted in a rapid decline in viral loads in wastewater. Following mass vaccination campaigns, viral loads reduced across all facilities, except Facility 4. Facility 1 demonstrated a mean viral load decrease from 1.65 × 10(6) copies/L to 1.04 × 10(3) copies/L post-vaccination, with a statistically significant U-statistic of 28.0 (p-value = 0.0027). Similar trends are observed in Facilities 2 and 3, albeit with varying degrees of statistical significance. In conclusion, this study provides evidence supporting the role of NPIs and vaccination campaigns in controlling SARS-CoV-2 transmission within ALFs.