Wastewater-Informed Public Health Intervention Playbook

Early in pandemic Louisville Metro’s Department of Public Health and Wellness (LMPHW) designed a “3-legged stool” testing program to gain much needed knowledge of the scope of infection within Louisville Metro-Jefferson County. The three legs of the testing stool were testing for vulnerable and symptomatic populations, free public testing for potentially asymptomatic individuals, and randomized community testing through the Envirome Institute’s Co-Immunity Project. Adequate testing for vulnerable and symptomatic individuals was a difficult task to complete early in the pandemic due to limited testing capabilities and supply chain interruptions. However, later in the pandemic such constraints eased. Testing for potentially asymptomatic individuals allowed for estimations of infection that were not included in the clinical case load. This testing was focused on minority communities and those who were disproportionately affected by the outbreak including individuals in high-risk jobs (e.g., as healthcare professionals and those at meatpacking warehouses or within other essential functions). Working the Envirome Institute’s Co-Immunity Project, “community testing insight” through randomized community testing, the only way to capture true incidence and prevalence rates. Randomized testing allowed for better understanding of how widespread COVID-19 was within Louisville. LMPHW’s COVID-19 Consultant commented that the Co-Immunity Project enabled LMPHW to make generalizations about the extent of virus spread considering both active positive cases and resolved cases. By partnering in the Co-Immunity Project, LMPHW gained access to scientific data and supplemental metrics to make more evidence-informed policy judgments. Additionally, the University of Louisville met with LMPHW leadership weekly to provide qualitative and quantitative data and research translation services that helped to guide the city’s decision-making processes. This activity later became the Wastewater-Informed Public Health Intervention Project.