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Site Specific Relationships between COVID-19 Cases and SARS-CoV-2 Viral Load in Wastewater Treatment Plant Influent

Lookup NU author(s): Professor David GrahamORCiD, Marcos Quintela-Baluja



This is the authors' accepted manuscript of an article that has been published in its final definitive form by American Chemical Society, 2021.

For re-use rights please refer to the publisher's terms and conditions.


Wastewater based epidemiology (WBE) has become an important tool during the COVID-19 pandemic, however the relationship between SARS-CoV-2 RNA in wastewater treatment plant influent (WWTP) and cases in the community is not well defined. We report here the development of a national WBE program across 28 WWTPs serving 50% of the population of Scotland, including large conurbations, as well as low-density rural and remote island communities. For each WWTP catchment area, we quantified spatial and temporal relationships between SARSCoV-2 RNA in wastewater and COVID-19 cases. Daily WWTP SARS-CoV-2 influent viral RNA load, calculated using daily influent flow rates, had the strongest correlation (ρ > 0.9) with COVID-19 cases within a catchment. As the incidence of COVID19 cases within a community increased, a linear relationship emerged between cases and influent viral RNA load. There were significant differences between WWTPs in their capacity to predict case numbers based on influent viral RNA load, with the limit of detection ranging from 25 cases for larger plants to a single case in smaller plants. SARS-CoV-2 viral RNA load can be used to predict the number of cases detected in the WWTP catchment area, with a clear statistically significant relationship observed above site-specific case thresholds.

Publication metadata

Author(s): Fitzgerald SF, Rossi G, Low AS, McAteer SP, O'Keefe B, Findlay D, Cameron GJ, Pollard P, Singleton PTR, Ponton G, Singer AC, Farkas K, Jones D, Graham DW, Quintela-Baluja M, Tait-Burkard C, Gally DL, Kao R, Corbishley A

Publication type: Article

Publication status: Published

Journal: Environmental Science & Technology

Year: 2021

Volume: 55

Issue: 22

Pages: 15276-15286

Print publication date: 16/11/2021

Online publication date: 05/11/2021

Acceptance date: 26/10/2021

Date deposited: 14/02/2022

ISSN (print): 0013-936X

ISSN (electronic): 1520-5851

Publisher: American Chemical Society


DOI: 10.1021/acs.est.1c05029


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