Public health policy impact evaluation: A potential use case for longitudinal monitoring of viruses in wastewater at small geographic scales

Elana M. G. Chan, A. Bidwell, Zongxi Li, S. Tilmans, A. Boehm
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Abstract

Public health policy impact evaluation is challenging to study because randomized controlled experiments are infeasible to conduct, and policy changes often coincide with non-policy events. Quasi-experiments do not use randomization and can provide useful knowledge for causal inference. Here we demonstrate how longitudinal wastewater monitoring of viruses at a small geographic scale may be used in a quasi-experimental design to evaluate the impact of COVID-19 public health policies on the spread of COVID-19 among a university population. We first evaluated the correlation between incident, reported COVID-19 cases and wastewater SARS-CoV-2 RNA concentrations and observed changes to the correlation over time, likely due to changes in testing requirements and testing options. Using a difference-in-differences approach, we then evaluated the association between university COVID-19 public health policy changes and levels of SARS-CoV-2 RNA concentrations in wastewater. We did not observe changes in SARS-CoV-2 RNA concentrations associated with most policy changes. Policy changes associated with a significant change in campus wastewater SARS-CoV-2 RNA concentrations included changes to face covering recommendations, indoor gathering bans, and routine surveillance testing requirements and availability.
公共卫生政策影响评估:小地理范围内废水中病毒纵向监测的潜在应用案例
公共卫生政策影响评估研究具有挑战性,因为进行随机对照实验是不可行的,而且政策变化往往与非政策事件同时发生。准实验不使用随机化,可以为因果推断提供有用的知识。在此,我们展示了如何在准实验设计中使用小地理范围内的纵向病毒废水监测来评估 COVID-19 公共卫生政策对 COVID-19 在大学人群中传播的影响。我们首先评估了事件、报告的 COVID-19 病例与废水中 SARS-CoV-2 RNA 浓度之间的相关性,并观察到相关性随着时间的推移而变化,这可能是由于检测要求和检测方案的变化所致。然后,我们采用差分法评估了大学 COVID-19 公共卫生政策变化与废水中 SARS-CoV-2 RNA 浓度水平之间的关联。我们没有观察到与大多数政策变化相关的 SARS-CoV-2 RNA 浓度变化。与校园废水中 SARS-CoV-2 RNA 浓度的重大变化相关的政策变化包括遮盖面部建议、室内集会禁令以及常规监测检测要求和可用性的变化。
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