Community case study: an academia-industry-government partnership that monitors and predicts outbreaks in Tri-County Detroit area since 2017.

The Tri-County Detroit Area (TCDA) is the 12th most populous metropolitan area in the United States with over three million people. Multiple communicable diseases are endemic in the TCDA. In 2017, to explore innovative methods that may provide early warnings of outbreaks affecting populations in the TCDA, an exploratory partnership that was funded by a U.S. National Science Foundation Early-concept Grant for Exploratory Research (EAGER) began. Since 2017, a project team including the College of Engineering at Michigan State University (MSU), the City of Detroit, the Great Lakes Water Authority (GLWA), industry, and local government and health departments, has been testing municipal wastewater from the TCDA to survey and predict surges in communicable diseases in the area. This ongoing effort started years before wastewater-based epidemiology became a widespread method in public health practice, due to the COVID-19 pandemic, and is now supported by the U.S. Centers for Disease Control and Prevention (CDC). The work of the partnership led to significant breakthroughs in the field of wastewater surveillance/wastewater epidemiology. The results of our surveillance efforts are used to assist local health departments in their understanding and response efforts for health issues in the TCDA, facilitating public health messaging for local awareness, targeted clinical testing, and increased vaccination efforts. Our data are available to the local health departments, and our methodological advancements are published and have been used by other communities nationwide and beyond. This paper describes the partnership, lessons learned, significant achievements, and provides a look into the future. The successful implementations and advancements of wastewater surveillance in the TCDA advocate the importance of frequent communications and interactions within the partnership, idea generations from each stakeholder for decision-making, maintenance of scientific rigor, ethical awareness, and more.