KANNAPOLIS — Data collected by Duke University researchers in Kannapolis is helping with a statewide study tracking the presence of coronavirus in what people flush down their toilets.

After Gov. Roy Cooper in April tasked several of North Carolina’s higher education institutions with tracking COVID-19, Duke University responded by launching the MURDOCK Cabarrus County COVID-19 Prevalence and Immunity (C3PI) Study in June. 

The new research is part of the larger MURDOCK study, which is headquartered at the N.C. Research Campus and aimed at identifying linkages across major diseases and disorders to help defeat some of today’s leading causes of illness and death. For the new study, researchers have been tracking 1,400 volunteers in Cabarrus County who have been completing online, biweekly surveys about their health. A smaller subgroup of 300 volunteers have been continuously tested for COVID-19 infection and for antibodies that indicate prior infection and potential immunity. 

Now, Duke researchers are sharing the data they are collecting from those 300 subjects in the new study with the N.C. Wastewater Pathogen Tracking Research Network, which is currently monitoring wastewater across the state for the coronavirus and linking sewer system surveillance data to COVID-19 infections.

People shed the coronavirus through their stool even before they show symptoms of COVID-19. Therefore, studying wastewater in sewer systems can serve as a way to monitor the prevalence of the virus in a community even though many people may be asymptomatic or haven’t been tested.

“The idea is that, as cases in the community goes up, as prevalence goes up, you would expect the concentration of the virus to increase proportionally,” said Dr. David Holcomb, a postdoctoral investigator trainee in environmental epidemiology at UNC and an investigator in the pathogen tracking network.

Monitoring excrement flushed down the toilet for early signs of a COVID-19 outbreak has become a common tactic on several college campuses across the country, including at Appalachian State.

Investigators with the pathogen tracking network are currently taking samples from two wastewater from two treatment facilities in Cabarrus County.

The data provided by MURDOCK researchers about the 300 Cabarrus residents will help pathogen tracking network researchers better understand how well wastewater surveillance helps with monitoring COVID-19 disease activity.

“What’s really great about the work that Duke is doing with the study in Kannapolis is that they’re testing everybody in the cohort, all 300 people, every two weeks,” Holcomb said. “We don’t have a bias towards people with symptoms in that cohort. If someone gets it even with no symptoms they will still show up in the data set as a case. Having that information and then being able to pair it with the waste water samples in Cabarrus County will basically give us more accurate numbers to work with.”

Dr. Larry Engel, an epidemiologist at UNC-Chapel Hill involved in the pathogen tracking network, said the data from the Duke University study will be combined with public health data “to better estimate the true prevalence of infection.”

Dr. L. Kristin Newby, principal investigator for the Kannapolis-based MURDOCK Study, said in a news release she is excited to collaborate with pathogen tracking network investigators.

“This work goes straight to the mission of the broader MURDOCK Study to advance community-based clinical research and improve human health,” Newby said.

The wastewater sites being monitored in Cabarrus County are two of 20 being surveyed by the pathogen tracking network in North Carolina. The samples collected from the Cabarrus locations are being analyzed by a team at UNC-Charlotte in Civil and Environmental Engineering led by Dr. Mariya Munir.

Holcomb said that he hopes the system built by the ongoing pathogen tracking network study could be used to help public health officials in North Carolina and across the country make more informed decisions about COVID-19 and any future widespread infectious diseases.

Dr. Rachel Noble, a microbiologist at UNC Institute of Marine Sciences and lead investigator on the pathogen tracking network project, said in a news release the data collected could have an even greater impact.

“We benefited greatly from the support from the NC Collaboratory throughout 2020 by building laboratory capacity, spinning up advanced molecular diagnostic methods, and collaborating with municipalities,” Noble said. “Now it’s time to begin connecting the dots and contribute data to the national surveillance system through collaboration with state and federal agencies.”

More information about the MURDOCK study can be found online at murdock-study.com.