Tori L Cowger,Nicholas B Link,Justin D Hart,Madeline T Sharp,Shoba Nair,Ruchita Balasubramanian,Soroush Moallef,Jarvis Chen,William P Hanage,Loni Philip Tabb,Kathryn T Hall,Bisola O Ojikutu,Nancy Krieger,Mary T Bassett
{"title":"可视化邻里 COVID-19 水平、趋势和废水中的不平等现象:以公平为中心的方法以及与 CDC 方法的比较。","authors":"Tori L Cowger,Nicholas B Link,Justin D Hart,Madeline T Sharp,Shoba Nair,Ruchita Balasubramanian,Soroush Moallef,Jarvis Chen,William P Hanage,Loni Philip Tabb,Kathryn T Hall,Bisola O Ojikutu,Nancy Krieger,Mary T Bassett","doi":"10.1097/phh.0000000000002049","DOIUrl":null,"url":null,"abstract":"CONTEXT\r\nMonitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level \"wastewater viral activity levels.\"\r\n\r\nPROGRAM\r\nIn October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.\r\n\r\nAPPROACH AND IMPLEMENTATION\r\nTo produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.\r\n\r\nEVALUATION\r\nCOVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with \"Very High\" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for \"High\" or \"Low,\" obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.\r\n\r\nDISCUSSION\r\nOur methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.","PeriodicalId":520109,"journal":{"name":"Journal of Public Health Management & Practice","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods.\",\"authors\":\"Tori L Cowger,Nicholas B Link,Justin D Hart,Madeline T Sharp,Shoba Nair,Ruchita Balasubramanian,Soroush Moallef,Jarvis Chen,William P Hanage,Loni Philip Tabb,Kathryn T Hall,Bisola O Ojikutu,Nancy Krieger,Mary T Bassett\",\"doi\":\"10.1097/phh.0000000000002049\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"CONTEXT\\r\\nMonitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level \\\"wastewater viral activity levels.\\\"\\r\\n\\r\\nPROGRAM\\r\\nIn October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.\\r\\n\\r\\nAPPROACH AND IMPLEMENTATION\\r\\nTo produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.\\r\\n\\r\\nEVALUATION\\r\\nCOVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with \\\"Very High\\\" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for \\\"High\\\" or \\\"Low,\\\" obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.\\r\\n\\r\\nDISCUSSION\\r\\nOur methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. 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Visualizing Neighborhood COVID-19 Levels, Trends, and Inequities in Wastewater: An Equity-Centered Approach and Comparison to CDC Methods.
CONTEXT
Monitoring neighborhood-level SARS-CoV-2 wastewater concentrations can help guide public health interventions and provide early warning ahead of lagging COVID-19 clinical indicators. To date, however, U.S. Centers for Disease Control and Prevention's (CDC) National Wastewater Surveillance System (NWSS) has provided methodology solely for communicating national and state-level "wastewater viral activity levels."
PROGRAM
In October 2022, the Boston Public Health Commission (BPHC) began routinely sampling wastewater at 11 neighborhood sites to better understand COVID-19 epidemiology and inequities across neighborhoods, which vary widely in sociodemographic and socioeconomic characteristics. We developed equity-centered methods to routinely report interpretable and actionable descriptions of COVID-19 wastewater levels, trends, and neighborhood-level inequities.
APPROACH AND IMPLEMENTATION
To produce these data visualizations, spanning October 2022 to December 2023, we followed four general steps: (1) smoothing raw values; (2) classifying current COVID-19 wastewater levels; (3) classifying current trends; and (4) reporting and visualizing results.
EVALUATION
COVID-19 wastewater levels corresponded well with lagged COVID-19 hospitalizations and deaths over time, with "Very High" wastewater levels coinciding with winter surges. When citywide COVID-19 levels were at the highest and lowest points, levels and trends tended to be consistent across sites. In contrast, when citywide levels were moderate, neighborhood levels and trends were more variable, revealing inequities across neighborhoods, emphasizing the importance of neighborhood-level results. Applying CDC/NWSS state-level methodology to neighborhood sites resulted in vastly different neighborhood-specific wastewater cut points for "High" or "Low," obscured inequities between neighborhoods, and systematically underestimated COVID-19 levels during surge periods in neighborhoods with the highest COVID-19 morbidity and mortality.
DISCUSSION
Our methods offer an approach that other local jurisdictions can use for routinely monitoring, comparing, and communicating neighborhood-level wastewater levels, trends, and inequities. Applying CDC/NWSS methodology at the neighborhood-level can obscure and perpetuate COVID-19 inequities. We recommend jurisdictions adopt equity-focused approaches in neighborhood-level wastewater surveillance for valid community comparisons.