City-level SARS-CoV-2 sewage surveillance

The COVID-19 pandemic created a global crisis impacting not only healthcare systems, but also world economies and society. Recent data have indicated that fecal shedding of SARS-CoV-2 is common, and that viral RNA can be detected in wastewater. This suggests that wastewater monitoring is a potentially efficient tool for both epidemiological surveillance, and early warning for SARS-CoV-2 circulation at the population level. In this study we sampled an urban wastewater infrastructure in the city of Ashkelon, Israel, during the end of the first COVID-19 wave in May 2020 when the number of infections seemed to be waning. We were able to show varying presence of SARS-CoV-2 RNA in wastewater from several locations in the city during two sampling periods. This was expressed as a new index, Normalized Viral Load (NVL), which can be used in different area scales to define levels of virus activity such as red (high) or green (no), and to follow morbidity in the population at tested area. Our index showed the rise in viral load between the two sampling periods (one week apart) and indicated an increase in morbidity that was evident a month later in the population. Thus, this methodology may provide an early indication for SARS-CoV-2 infection outbreak in a population before an outbreak is clinically apparent. HIGHLIGHTSO_LIDetecting the presence of SARS-CoV-2 virus RNA in urban wastewater C_LIO_LIThe city sewer system may provide an early indication for SARS-CoV-2 infection and may be used as early warning for SARS-CoV-2 outbreaks C_LIO_LINVL index defines various infected urban zones from red (high) to green (low) C_LI Graphical abstract O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=128 SRC="FIGDIR/small/20215244v1_ufig1.gif" ALT="Figure 1"> View larger version (54K): org.highwire.dtl.DTLVardef@c35f17org.highwire.dtl.DTLVardef@97f1dcorg.highwire.dtl.DTLVardef@187ae1aorg.highwire.dtl.DTLVardef@b756c7_HPS_FORMAT_FIGEXP M_FIG C_FIG