{"doi":"10.3390/systems13121093","title":"Wastewater Infrastructure as a Public Health Tool: Agent-Based Modeling of Surveillance Strategies in a COVID-19 Context","abstract":"Wastewater-based epidemiology (WBE) played a vital role during the COVID-19 pandemic by providing early warnings of outbreaks through SARS-CoV-2 RNA detection in sewage. Many rural communities did not benefit from WBE because limited centralized sewer infrastructure challenged conventional WBE surveillance strategies. We present a multi-agent computer model simulating COVID-19 spread in a U.S. county with both sewered and non-sewered zones to assess the performance of WBE in this setting. We evaluate how the sewage service status of the first SARS-CoV-2 carrier, cross-zone community mobility, and WBE detection thresholds influence outbreak detection timing at the county’s wastewater treatment plant under basic reproduction numbers (R0) of 4 and 8. Our key findings include that (1) a detection threshold of 10 gc/mL can identify outbreaks up to six days earlier than a threshold of 50 gc/mL; (2) outbreaks originating in non-sewered zones are detected 1–2 days later, compared with outbreaks in sewered zones; and (3) cross-zone community mobility impacts detection timing only when outbreaks begin in non-sewered zones. Furthermore, once detected, disease prevalence can increase by five- to eleven-fold within the following week. These results underscore the importance of WBE sensitivity and tailored surveillance strategies in both sewered and non-sewered zones of a community. Strengthening WBE capabilities at local treatment facilities can improve early outbreak detection, thereby supporting timely public health interventions.","journal":"Systems","year":2025,"id":535634,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":2,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9476,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":375691,"name":"James W. Keck","orcid":"0000-0001-7193-065X","position":1,"is_corresponding":false},{"id":1419759,"name":"James Gallimore","orcid":null,"position":2,"is_corresponding":false},{"id":1419760,"name":"Amirmohammad Sakhaei","orcid":null,"position":3,"is_corresponding":false},{"id":1419761,"name":"Elizabeth H. Loh","orcid":null,"position":4,"is_corresponding":false},{"id":1065669,"name":"Scott M. Berry","orcid":"0000-0001-7403-9264","position":5,"is_corresponding":false},{"id":1419253,"name":"Lin Xiang","orcid":"0000-0003-0470-143X","position":0,"is_corresponding":true}],"reference_count":50,"raw_metadata":null,"created_at":"2026-07-19T02:51:56.297114Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}