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Monitoring SARS-CoV-2 Using Infoveillance, National Reporting Data and Wastewater in Wales, UK

Lookup NU author(s): Dr Jordan CuffORCiD



This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Background: The COVID-19 pandemic necessitated rapid real-time surveillance of epidemiological data to advise governments and the public, but the accuracy of these data depend on myriad auxiliary assumptions, not least accurate reporting of cases by the public. Wastewater monitoring has emerged internationally as an accurate and objective means for assessing disease prevalence with reduced latency and less dependence on public vigilance, reliability, and engagement. How public interest aligns with COVID-19 personal testing data and wastewater monitoring is, however, very poorly characterised. Objectives: This study assesses the associations between internet search volume data relevant to COVID-19, public healthcare statistics and national-scale wastewater monitoring of SARS-CoV-2 across South Wales, UK over time to investigate how interest in the pandemic may reflect the prevalence of SARS-CoV-2, as detected by national testing and wastewater monitoring, and how these data could be used to predict case numbers. Methods: Relative search volume data from Google Trends for search terms linked to the COVID-19 pandemic were extracted and compared against government-reported COVID-19 statistics and RT-qPCR SARS-CoV-2 data generated from wastewater in South Wales, UK, using multivariate linear models, correlation analysis and predictions from linear models. Results: Wastewater monitoring and infoveillance both show potential for epidemiological surveillance, but their efficacy changes over time. Google search volumes surrounding the COVID-19 pandemic decreased across the study period, suggesting a reduction in public interest which may be reflected in lower volumes of self-testing and reporting with subsequent loss of accuracy of national reporting data. Conclusions: Wastewater monitoring presents a valuable means for assessing population-level prevalence of SARS-CoV-2 and could be integrated with other data types such as infoveillance for increasingly accurate inference of virus prevalence. The importance of such monitoring is increasingly clear as a means of objectively assessing the prevalence of SARS-CoV-2 to circumvent the dynamic interest and participation of the public. Increased accessibility of wastewater monitoring data to the public, as is the case for other national data, may enhance public engagement with these forms of monitoring.

Publication metadata

Author(s): Cuff JP, Dighe SN, Watson SE, Badell-Grau RA, Weightman AJ, Jones DL, Kille P

Publication type: Article

Publication status: Published

Journal: JMIR Infodemiology

Year: 2023

Volume: 3

Online publication date: 23/11/2023

Acceptance date: 30/09/2023

Date deposited: 05/10/2023

ISSN (electronic): 2564-1891

Publisher: Journal of Medical Internet Research


DOI: 10.2196/43891


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Funder referenceFunder name
Welsh Wastewater Programme