Wastewater Surveillance of SARS-CoV-2 across 40 U.S. states from February to June 2020

Wu, Fuqing; Xiao, Amy; Jian, b.; Moniz, Katya; Endo, Noriko; Armas, Federica; Bushman, Mary; Chai, Peter R; Duvallet, Claire; Erickson, Timothy B; Foppe, Katelyn; Ghaeli, Newsha; Gu, Xiaoqiong; Hanage, William P; Huang, Katherine H; Lee, Wei Lin; McElroy, Kyle A; Rhode, Steven F; Matus, Mariana; Wuertz, Stefan; Thompson, Janelle; Alm, Eric J

Wastewater-based disease surveillance is a promising approach for monitoring community outbreaks. Here we describe a nationwide campaign to monitor SARS-CoV-2 in the wastewater of 159 counties in 40 U.S. states, covering 13% of the U.S. population from February 18 to June 2, 2020. Out of 1,751 total samples analyzed, 846 samples were positive for SARS-CoV-2 RNA, with overall viral concentrations declining from April to May. Wastewater viral titers were consistent with, and appeared to precede, clinical COVID-19 surveillance indicators, including daily new cases. Wastewater surveillance had a high detection rate (>80%) of SARS-CoV-2 when the daily incidence exceeded 13 per 100,000 people. Detection rates were positively associated with wastewater treatment plant catchment size. To our knowledge, this work represents the largest-scale wastewater-based SARS-CoV-2 monitoring campaign to date, encompassing a wide diversity of wastewater treatment facilities and geographic locations. Our findings demonstrate that a national wastewater-based approach to disease surveillance may be feasible and effective.