ArticleThe Science of the total environment2023
Citywide wastewater SARS-CoV-2 levels strongly correlated with multiple disease surveillance indicators and outcomes over three COVID-19 waves.
Article in The Science of the total environment, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers.
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Who cites it
30 citing papers in PubMed, 61 citations in OpenAlex.
- Statewide multi-year wastewater sequencing reveals dual origins of HIV-1 signal.Nature communications · 2026Article
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- Implementation of SARS-CoV-2 Wastewater Surveillance Systems in Germany-Pilot Study in the Federal State of Thuringia.Microorganisms · 2026Article
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- Presence of Microorganisms in the Environment: One Health Approach.Microorganisms · 2025Review
- Identifying real time surveillance indicators to estimate COVID-19 hospital admissions in Colorado during and after the public health emergency.Scientific reports · 2025Article
- Application of joinpoint regression to SARS-CoV-2 wastewater-based epidemiology in Las Vegas, Nevada, USA.Epidemiology and infection · 2025Article
- Optimal sampling frequency and site selection for wastewater and environmental surveillance of infectious pathogens: A value of information assessment.PLoS computational biology · 2025Article
- Dynamics of SARS-CoV-2 variants in southwest Ohio municipal wastewater.Environmental science : water research & technology · 2025Article
- The potential of long-term wastewater-based surveillance to predict COVID-19 waves peak in Mexico.Water environment research : a research publication of the Water Environment Federation · 2025Article
- The use of wastewater surveillance to estimate SARS-CoV-2 fecal viral shedding pattern and identify time periods with intensified transmission.BMC public health · 2025Article
- Turning analysis into action: opportunities and challenges in implementing wastewater science for public health decision-making.Frontiers in public health · 2025Article
- Estimating rates of change to interpret quantitative wastewater surveillance of disease trends.The Science of the total environment · 2024Article
- Human pathogen nucleic acids in wastewater solids from 191 wastewater treatment plants in the United States.Scientific data · 2024Article
- Correlation between Viral Wastewater Concentration and Respiratory Tests, Oregon, USA.Emerging infectious diseases · 2024Article
- Article
- SARS-CoV-2 wastewater surveillance at two university campuses: lessons learned and insights on intervention strategies for public health guidance.Journal of water and health · 2024Article
- Temporal assessment of SARS-CoV-2 detection in wastewater and its epidemiological implications in COVID-19 case dynamics.Heliyon · 2024Article
- Online trend estimation and detection of trend deviations in sub-sewershed time series of SARS-CoV-2 RNA measured in wastewater.Scientific reports · 2024Article
- Identifying spatiotemporal trends of SARS-CoV-2 RNA in wastewater: from the perspective of upstream and downstream wastewater-based epidemiology (WBE).Environmental science and pollution research international · 2024Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Public health surveillance systems for COVID-19 are multifaceted and include multiple indicators reflective of different aspects of the burden and spread of the disease in a community. With the emergence of wastewater disease surveillance as a powerful tool to track infection dynamics of SARS-CoV-2, there is a need to integrate and validate wastewater information with existing disease surveillance systems and demonstrate how it can be used as a routine surveillance tool. A first step toward integration is showing how it relates to other disease surveillance indicators and outcomes, such as case positivity rates, syndromic surveillance data, and hospital bed use rates. Here, we present an 86-week long surveillance study that covers three major COVID-19 surges. City-wide SARS-CoV-2 RNA viral loads in wastewater were measured across 39 wastewater treatment plants and compared to other disease metrics for the city of Houston, TX. We show that wastewater levels are strongly correlated with positivity rate, syndromic surveillance rates of COVID-19 visits, and COVID-19-related general bed use rates at hospitals. We show that the relative timing of wastewater relative to each indicator shifted across the pandemic, likely due to a multitude of factors including testing availability, health-seeking behavior, and changes in viral variants. Next, we show that individual WWTPs led city-wide changes in SARS-CoV-2 viral loads, indicating a distributed monitoring system could be used to enhance the early-warning capability of a wastewater monitoring system. Finally, we describe how the results were used in real-time to inform public health response and resource allocation.
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