key: cord-275660-zdw50gt2
authors: Mao, Kang; Zhang, Hua; Yang, Zhugen
title: The potential of an integrated biosensor system with mobile health and wastewater-based epidemiology (iBMW) for the prevention, surveillance, monitoring and intervention of the COVID-19 pandemic
date: 2020-09-16
journal: Biosens Bioelectron
DOI: 10.1016/j.bios.2020.112617
sha: 
doc_id: 275660
cord_uid: zdw50gt2

The outbreak of novel coronavirus pneumonia (COVID-19) has caused a significant public health challenge worldwide. A lack of effective methods for screening potential patients, rapidly diagnosing suspected cases, and accurately monitoring the epidemic in real time to prevent the rapid spread of COVID-19 raises significant difficulties in mitigating the epidemic in many countries. As effective point-of-care diagnosis tools, simple, low-cost and rapid sensors have the potential to greatly accelerate the screening and diagnosis of suspected patients to improve their treatment and care. In particular, there is evidence that multiple pathogens have been detected in sewage, including SARS-CoV-2, providing significant opportunities for the development of advanced sensors for wastewater-based epidemiology that provide an early warning of the pandemic within the population. Sensors could be used to screen potential carriers, provide real-time monitoring and control of the epidemic, and even support targeted drug screening and delivery within the integration of emerging mobile health (mHealth) technology. In this communication, we discuss the feasibility of an integrated point-of-care biosensor system with mobile health for wastewater-based epidemiology (iBMW) for early warning of COVID-19, screening and diagnosis of potential infectors, and improving health care and public health. The iBMW will provide an effective approach to prevent, evaluate and intervene in a fast, affordable and reliable way, thus enabling real-time guidance for the government in providing effective intervention and evaluating the effectiveness of intervention.

The COVID-19 pandemic caused by a novel coronavirus (SARS-CoV-2) has spread rapidly 44 throughout more than 200 countries and has led to a worldwide disaster. Some dilemmas are 45 associated with COVID-19 care and management from the initial outbreak to the present situation, 46 some of which have been resolved and some of which have not (more detailed description is seen in 47

Tab. S1). A good understanding of these dilemmas and putting forward solutions will help us face 48 COVID-19 and novel infectious disease epidemics in the future. It is critical to adopt strict and 49 accurate public health measures for COVID-19 care to address these difficulties and risks in the 50 processes of prevention, diagnosis, intervention, and even therapy (Dowell et al. 2016) . 51

Point-of-care (POC) biosensors may achieve the intended goal, enabling the convenient acquisition 52 of both pathogen information and host-response information in almost any location in a short time, 53 which has the potential to facilitate prevention and rapid diagnosis and intervention for COVID-19 54 when combined with other useful technologies. We discuss the feasibility of an integrated POC 55 biosensor system with mobile health for wastewater-based epidemiology (iBMW) for early warning 56 of COVID-19, screening and diagnosis of potential infectors, improving patient health care and 57 monitoring public health. 58 2. iBMW for the prevention, surveillance, monitoring and intervention of the COVID-19 59 pandemic 60

The first crucial step is the rapid and accurate diagnosis of COVID-19 to screen potential patients, 62 confirm suspected cases, provide timely health care/treatment, monitor and manage the epidemic 63 (Udugama et al. 2020) . Biosensors offer great potential to meet diagnostic requirements (Part S1) and 64

can be used to detect COVID-19-related indicators (Russell et al. 2020 devices that perform real-time diagnosis and detection; these include thermometers to measure body 76 temperature and blood glucose meters to measure blood glucose and other conventional indexes. 77

There are significant opportunities for biosensors to contribute to the rapid diagnosis and screening of 78 infectious disease, in particular together with nanotechnology with an ultrasensitive detection of a 79 range of disease markers (Bhalla et al. 2020 ). However, the main difficulty is the need to quickly and 80 effectively detect specific indicators of infectious diseases, such as pathogens. The results of these 81 indicators will aid in the diagnosis of suspected and potential cases. biomarker quantification. A negative test is finished by adding the same channel and reaction cavity as the 98 sample test process (seen in Fig. S3 ).

An integrated biosensor has the potential to rapidly diagnose pathogens and efficiently monitor 101 infection transmission through self-tests performed outside the hospital. Device integration can 102 integrate all the steps of the biosensor into a small portable device, which is conducive to complex 103 real-time diagnosis (Kozel and Burnham-Marusich 2017) . Recent advances in microfluidic 104 technology (including paper microfluidic device) and nanotechnology have brought us closer than 105 ever to the realization of simple yet highly sensitive and specific biosensors that can be used in min. Their multiplex assay could concurrently detect four targets using a low sample volume in a 130 resource-limited setting. These studies demonstrate that paper-based biosensors with the ability to 131 perform fast, precise and high-quality diagnostics enable multiplex, sensitive, and selective analysis 132 of infectious diseases and pathogens. 133

In resource-limited areas, health care services may be overwhelmed; therefore, it is important to 134 develop testing kits with the capability for self-detection. Biosensors provide an important 135 opportunity for family and community monitoring and have the potential to alleviate the current 136 dilemma. At the same time, the use of biosensors to quantify host immune biomarkers in patients will 137 aid in determining the severity of patients' symptoms, detecting the state of the host's immune system 138 and identifying organ disorders, and this information can be applied to strategically allocate resources 139 to optimize health care by adapting the classification process, the requirement for admission or effectiveness, and small sample requirements (Yang et al. 2017 ). Therefore, community sewage 168 biosensors can be used to collect timely information about COVID-19 for the whole community and 169 report results to health institutions, facilitating early prevention measures and effects (Fig. 2) . If 170 SARS-CoV-2 can be detected in the local community at an early stage through a community sewage 171 biosensor, an effective intervention can be implemented in a real-time fashion, and restrictions on 172 SARS-CoV-2 transmission will minimize the spread of the disease and the threat to public health. 173 Potential patients will also benefit from the community sewage sensor tracing of SARS-CoV-2 174 sources, which will provide information for accurate and timely treatment. Patients report their self-test results to the hospital and public health management department through 193 the mobile health system; then, the hospital puts forward diagnosis and treatment suggestions 194 depending on the patient's actual situation (Fig. 3) . setting has abundant or limited resources, the application scope and capability of smartphones and 204 their related technologies are increasing. Currently, these smartphones offer low-cost sensing and 205 processing capabilities comparable to expensive "high-end" devices. In addition, the mHealth system 206 can also promote efficiency by improving the automation of inventory and supply chain management 207 systems, reducing the workload and errors related to paper reports, and preventing materials from 208 running out (Namisango et al. 2016) . can monitor the epidemic with the real-time mHealth system and take appropriate measures, such as 233 regional isolation and the allocation of strategic materials. All participants in the mobile system, 234

including potential patients, medical staff and public health departments, can quickly understand the 235 mobile health system, which can facilitate the diagnosis and treatment of potential patients. Medical 236 J o u r n a l P r e -p r o o f staff can better guide patients' health care, and public health departments can better monitor the 237 epidemic and implement interventions such as the timely isolation of confirmed patients, protection of 238 healthy people, and allocation of public resources. Mobile systems, in combination with 239 internet-connected diagnostic biosensors, provide new methods for the diagnosis, tracking, and 240 control of infectious diseases while improving the efficiency of the health system (Fig. 3) . 241

In addition, microfluidics sensing technology for effective drug screening and delivery holds the 242 potential for therapy of SARS-CoV-2. Microfluidic chips afford considerable advantages in drug 243 release, such as precise and multi-dosing release, targeted precise release, sustainable control of 244 delivery, and small side effects, etc., which are important assets for drug delivery systems (see Part 245 S3). Microfluidic technology has been gradually applied to the preparation of drug carriers, direct 246 drug delivery systems, drug preparation and fixation. Inexpensive and easily manufactured materials 247 are rich substrates that naturally integrate multiple functions, which include filtration, storage, 248 transport, valves, multiplexing, and concentration. Microfluidics has great potential to be used in the 249 research of COVID-19 therapies to avoid ineffectiveness and health risks. 250

Effective prevention, monitoring, and interventions are important for slowing the spread of the 252 disease and reducing the prevalence of COVID-19. We have proposed to use iBMW to provide an 253 ideal framework to manage pandemics, from the perspectives of prevention, detection and 254 intervention. The innovative miniaturization and portability of community sewage biosensors provide 255 the possibility to trace potential sources in the field, and iBMW can directly identify pathogens and 256 provide required biomarker data in a short period of time through self-testing. The real-time data 257 collected and transmitted by the iBMW not only provide timely health care and treatment for patients 258 but also allow for the timely implementation of epidemic control measures. COVID-19 can be 259 accurately controlled by public health prevention measures according to the epidemic situation in 260 different regions. Considering this timely information regarding the SARS-CoV-2 infection status and 261 host reactions, the mHealth system can be used to monitor and control the epidemic. Hence, the use of 262 iBMW could reduce the time from the onset of infection to the appropriate therapeutics. In addition, 263 the fast growth of microfluidic sensing technology has provided new opportunities for effective drug 264 screening and drug release in in vitro tests, which will be beneficial for the development of effective 265 therapeutic drugs and vaccines without a safety risk. The authors declare no competing financial interest. 279

Influenza Other Respir

The authors declare no competing financial interest.J o u r n a l P r e -p r o o f