ArticlePloS one2026
Addressing gaps in surveillance: Use of emergency department accessibility and social vulnerability to identify potential wastewater surveillance sites in North Carolina.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe North Carolina Division of Public Health relies on multiple complementary surveillance systems, including emergency department (ED) and wastewater surveillance, to track disease trends across the state. Despite having comprehensive statewide ED coverage, several areas have limited access to ED facilities and concurrent higher social vulnerability. In this analysis, we demonstrate complementarity between North Carolina ED and wastewater surveillance and assess geographic gaps in coverage to identify potential new wastewater monitoring sites in low-coverage, high social vulnerability areas.
methodsWeekly wastewater SARS-CoV-2 viral concentrations and percentage of COVID-like Illness (CLI) ED visits across current wastewater sites geographically overlapping with hospitals, were compared using a Spearman's rank-order correlation analysis for the period of November 2021 to August 2024. A drive-time analysis was conducted for 133 hospitals to identify areas within a 20-60-minute commute time to any ED facility. Out of a statewide sewershed polygon dataset, sewersheds serving a population greater than 1200 (n = 220) were selected for further investigation. ED service areas were then examined for overlap with sewersheds, and Social Vulnerability Index (SVI) rankings were compared for sites with a majority geographic overlap (>=50%).
resultsOf the 28 overlapping hospitals, 26 show a moderate to strong correlation (rho = 0.303-0.718) with their respective sewersheds, demonstrating complementarity between the two systems. Of the 220 potential sewersheds examined, 40 overlapped with the 20-60-minute drive times to EDs. Of these, 26 wastewater sites had an overall SVI greater than 0.5 and were identified as priority additions to North Carolina's wastewater surveillance network, including 13 with an overall SVI greater than 0.75.
conclusionWe used a novel geospatial approach to identify 26 priority wastewater sites with moderate to high social vulnerability and low ED accessibility. Additionally, this work further supports complementarity between ED and wastewater surveillance systems.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.