Wastewater Coronavirus Levels and Critical Care Demand
Alex T Dunn1, Danika K Evans1, Jillian K Wothe2, Zachary R Bergman2, Ramiro Saavedra-Romero3, John K Bohman4, Melissa E Brunsvold2, Matthew E Prekker1
1Hennepin County Medicaal Center, 2University of Minnesota Medical School, 3Abbott Northwestern Hospital, 4Mayo Clinic
Introduction
The COVID-19 pandemic led to increased use of veno-venous extracorporeal membrane oxygengation (VV-ECMO) for severe respiratory failure1. Wastewater surveillance is a known early indicator of COVID-19 hospital burden2, but its predictive value for interventions like VV-ECMO remains unclear. Systems that identify early warning signs for ECMO demand could help improve equitable care distribution.
Aims and Objectives
To determine whether increases in SARS-CoV-2 wastewater viral loads correlate with subsequent surges in VV-ECMO utilization in Minnesota, especially during periods dominated by specific COVID-19 variants.
Methods
ECMO Consortium Data (4 centers)
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Identify COVID-19 ARDS patients on VV-ECMO
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Gather wastewater SARS-CoV-2 viral load data (Twin Cities metropolitan area)
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Define variant periods:
alpha/beta/gamma, delta, omicron
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Pre-whitening to account for autocorrelation3
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Cross-correlation analysis
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Compare wastewater load vs VV-ECMO utilization
Results
Patient Demographics & Clinical Outcomes | |
Patients | 109 |
Mean Age (years) | 46 |
Male (%) | 72% |
Mean ECMO Duration (days) | 33 |
Survival Rate (%) | 54% |
Variant Period | Approximate Lag Time |
Alpha/Beta/Gamma | 3 weeks |
Delta | 3 weeks |
Omicron | None observed |
FIG. 1. Veno-venous extracorporeal membrane oxygenation (VV-ECMO) cases and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) wastewater viral load by pandemic week. The daily census of adults with coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) receiving VV-ECMO in Minnesota (gray solid), and the daily copies of SARS-CoV-2 variants in wastewater surveillance in one metropolitan sewershed district in Minnesota (a/b/g variants, dark blue; d variant, brown; BA.1 variant, red; BA.2 [excluding BA.2.12.1], light blue; BA.2.12.1, green) are plotted per pandemic week from January 15, 2021 until May 13, 2022.4
Conclusions
While visual inspection suggested a potential correlation during more virulent variant periods, statistical analysis did not confirm this relationship. The pattern was inconsistent, with one delta-period ECMO surge lacking a preceding wastewater peak and omicron-period wastewater peaks not leading to increased ECMO use. Study limitations included a relatively modest statewide VV-ECMO cases. Overall, wastewater SARS-CoV-2 surveillance was not consistently associated with VV-ECMO utilization patterns for COVID-19 patients in Minnesota. Future studies with larger datasets and additional variables may better clarify how we can anticipate and prepare for ECMO resource allocation in future pandemics.
References
1. Supady A, Badulak J, Evans L, et al. Should we ration extracorporeal membrane oxygenation during the COVID-19 pandemic? Lancet Respir Med 2021;9(4):326–328
2. Nattino G, Castiglioni S, Cereda D, et al. Association
between SARS-CoV-2 viral load in wastewater and reported cases, hospitalizations, and vaccinations in Milan, March 2020 to November 2021. JAMA 2022;e327(19):1922–1924
3. Box GEP, Jenkins GM, Reinsel GC, Ljung GM. Time Series Analysis: Forecasting and Control. 5th ed. Hoboken, NJ: Wiley; 2015.
4. Evans DK, Wothe JK, Dunn A, Bergman ZR, Saavedra-Romero R, Bohman JK, Brunsvold ME, Prekker ME. Letter to the Editor: Correlation of Spikes in Wastewater Severe Acute Respiratory Syndrome Coronavirus-2 Viral Load With Veno-Venous Extracorporeal Membrane Oxygenation Use for Coronavirus Disease 2019 in Minnesota. Surg Infect (Larchmt). 2024 Apr;25(3):255-256.
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