ArticleWater research2023
Prediction of COVID-19 positive cases, a nation-wide SARS-CoV-2 wastewater-based epidemiology study.
Article in Water research, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed, 28 citations in OpenAlex.
- Risk Factors for Cardiovascular Disease: Epidemiology, Screening, Prevention, and Therapeutic Interventions.MedComm · 2026Review
- A dual-branch deep learning framework for tiered early warning of COVID-19 utilizing wastewater data.Journal of water and health · 2026Article
- Persistence of human Aichi virus infectivity from raw surface water to drinking water.Applied and environmental microbiology · 2025Article
- The impact of signal variability on COVID-19 epidemic growth rate estimation from wastewater surveillance data.PloS one · 2025Article
- Public health actions in response to pathogen detection in wastewater and the environment: a scoping review.Frontiers in public health · 2025Article
- Multisite community-scale monitoring of respiratory and enteric viruses in the effluent of a nursing home and in the inlet of the local wastewater treatment plant.Applied and environmental microbiology · 2024Article
- Jointly estimating epidemiological dynamics of Covid-19 from case and wastewater data in Aotearoa New Zealand.Communications medicine · 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
- Integrating wastewater and randomised prevalence survey data for national COVID surveillance.Scientific reports · 2024Article
- Leveraging environmental microbial indicators in wastewater for data-driven disease diagnostics.Frontiers in bioengineering and biotechnology · 2024Article
Corrections and comments
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Authors and funding
12 authors at 5 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Taking advantage of Estonia's small size and population, we have employed wastewater-based epidemiology approach to monitor the spread of SARS-CoV-2, releasing weekly nation-wide updates. In this study we report results obtained between August 2020 and December 2021. Weekly 24 h composite samples were collected from wastewater treatment plants of larger towns already covered 65% of the total population that was complemented up to 40 additional grab samples from smaller towns/villages and the specific sites of concern. The N3 gene abundance was quantified by RT-qPCR. The N3 gene copy number (concentration) in wastewater fluctuated in accordance with the SARS-CoV-2 spread within the total population, with N3 abundance starting to increase 1.25 weeks (9 days) (95% CI: [1.10, 1.41]) before a rise in COVID-19 positive cases. Statistical model between the load of virus in wastewater and number of infected people validated with the Alpha variant wave (B.1.1.17) could be used to predict the order of magnitude in incidence numbers in Delta wave (B.1.617.2) in fall 2021. Targeted testing of student dormitories, retirement and nursing homes and prisons resulted in successful early discovery of outbreaks. We put forward a SARS-CoV-2 Wastewater Index (SARS2-WI) indicator of normalized virus load as COVID-19 infection metric to complement the other metrics currently used in disease control and prevention: dynamics of effective reproduction number (Re), 7-day mean of new cases, and a sum of new cases within last 14 days. In conclusion, an efficient surveillance system that combines analysis of composite and grab samples was established in Estonia. There is considerable discussion how the viral load in wastewater correlates with the number of infected people. Here we show that this correlation can be found. Moreover, we confirm that an increased signal in wastewater is observed before the increase in the number of infections. The surveillance system helped to inform public health policy and place direct interventions during the COVID-19 pandemic in Estonia via early warning of epidemic spread in various regions of the country.
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