Columbia University researchers led an inventive three-year study at a university-affiliated hospital, taking wastewater surveillance to an entirely new level.
Traditionally, wastewater testing has been used at municipal treatment plants to track the spread of diseases like COVID-19 across large populations. While powerful, this approach paints with a broad brush. It’s great for seeing big trends, but not so great for pinpointing where to act. That’s where building-level testing comes in.
By zooming in to the hospital level, the Columbia team showed how wastewater surveillance can offer a more precise, actionable view of pathogen spread, allowing for targeted interventions right where they’re needed most.
Using advanced tools like the Concentrating Pipette™ and next-generation sequencing, the team fine-tuned their lab techniques and sampling schedule to get the most accurate picture possible. They collected samples frequently and matched them with patient data from electronic medical records. The result? Predictive models that could forecast spikes in COVID-19 cases, sometimes up to a week before they showed up in clinical testing.
What made this even more impressive was how localized the data could get. By sampling different hospital quadrants—each with distinct patient populations—the researchers were able to spot unique viral trends in each area. That level of detail simply isn't possible with city-wide wastewater data.
One major takeaway: frequency matters. To maintain strong correlations between wastewater data and actual case counts, the team found that at least three samples per week were needed. While that might sound like a lot, it’s still far more efficient and cost-effective than testing every individual patient.
Another standout finding: wastewater testing picked up on new variants before they were detected in clinical samples. And in buildings where getting accurate case numbers is tough, like mixed-use or non-residential spaces, even a simple “positive/negative” readout from wastewater proved useful for identifying times of high transmission.
This study makes a compelling case for scaling up building-level, non-municipal wastewater testing, especially in high-risk, high-traffic environments like hospitals. Not only does it help catch outbreaks early, but it also offers a smart, scalable alternative to labor-intensive clinical testing. When paired with digital health records, wastewater data becomes a powerful tool for managing infectious disease threats with speed and precision. The authors have expanded this research and are monitoring multiple targets, including antibiotic-resistant bacteria, to help mitigate hospital-acquired infections.
Read the Publication:
Hospital wastewater surveillance for SARS-CoV-2 identifies intra-hospital dynamics of viral transmission and evolution, Medini K. Annavajhala et al. MedRXiv 2025.
