ArticleThe Science of the total environment2023
Detection of SARS-CoV-2 RNA in wastewater and comparison to COVID-19 cases in two sewersheds, North Carolina, USA.
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 12 papers, 2 of them syntheses that pooled it.
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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.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- A Systematic Review of Methodological Approaches to SARS-CoV-2 Wastewater Surveillance.Viruses · 2026Pooled it
- Current state and future perspectives on de facto population markers for normalization in wastewater-based epidemiology: A systematic literature review.The Science of the total environment · 2024Pooled it
- Wastewater-Based Surveillance of SARS-CoV-2 for Early Warning of COVID-19 Infection Dynamics.Viruses · 2026Article
- Article
- Article
- Wastewater-Based Surveillance of SARS-CoV-2 and Modeling of COVID-19 Infection Trends.Tropical medicine and infectious disease · 2025Article
- Inclusion of Physical-Chemical Water Quality Measurements Can Improve Associations between SARS-CoV-2 RNA Levels in Wastewater and COVID-19 Cases within Smaller Sewersheds.Journal of environmental engineering (New York, N.Y.) · 2025Article
- Estimating rates of change to interpret quantitative wastewater surveillance of disease trends.The Science of the total environment · 2024Article
- Monitoring SARS-CoV-2 RNA in wastewater from a shared septic system and sub-sewershed sites to expand COVID-19 disease surveillance.Journal of water and health · 2024Article
- Characterizing Spatial Information Loss for Wastewater Surveillance Using crAssphage: Effect of Decay, Temperature, and Population Mobility.Environmental science & technology · 2023Article
- Use of Wastewater Metrics to Track COVID-19 in the US.JAMA network open · 2023Observational
- Towards Effective, Sustainable Solution for Hospital Wastewater Treatment to Cope with the Post-Pandemic Era.International journal of environmental research and public health · 2023Review
Corrections and comments
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Authors and funding
13 authors.
Funding
Abstract
Wastewater surveillance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be useful for monitoring population-wide coronavirus disease 2019 (COVID-19) infections, especially given asymptomatic infections and limitations in diagnostic testing. We aimed to detect SARS-CoV-2 RNA in wastewater and compare viral concentrations to COVID-19 case numbers in the respective counties and sewersheds. Influent 24-hour composite wastewater samples were collected from July to December 2020 from two municipal wastewater treatment plants serving different population sizes in Orange and Chatham Counties in North Carolina. After a concentration step via HA filtration, SARS-CoV-2 RNA was detected and quantified by reverse transcription droplet digital polymerase chain reaction (RT-ddPCR) and quantitative PCR (RT-qPCR), targeting the N1 and N2 nucleocapsid genes. SARS-CoV-2 RNA was detected by RT-ddPCR in 100 % (24/24) and 79 % (19/24) of influent wastewater samples from the larger and smaller plants, respectively. In comparison, viral RNA was detected by RT-qPCR in 41.7 % (10/24) and 8.3 % (2/24) of samples from the larger and smaller plants, respectively. Positivity rates and method agreement further increased for the RT-qPCR assay when samples with positive signals below the limit of detection were counted as positive. The wastewater data from the larger plant generally correlated (⍴ ~0.5, p < 0.05) with, and even anticipated, the trends in reported COVID-19 cases, with a notable spike in measured viral RNA preceding a spike in cases when students returned to a college campus in the Orange County sewershed. Correlations were generally higher when using estimates of sewershed-level case data rather than county-level data. This work supports use of wastewater surveillance for tracking COVID-19 disease trends, especially in identifying spikes in cases. Wastewater-based epidemiology can be a valuable resource for tracking disease trends, allocating resources, and evaluating policy in the fight against current and future pandemics.
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Registered trials
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