SARS-CoV-2 Titers in Wastewater Are Higher than Expected from Clinically Confirmed Cases

Wastewater-based surveillance is a promising approach for proactive outbreak monitoring. SARS-CoV-2 is shed in stool early in the clinical course and infects a large asymptomatic population, making it an ideal target for wastewater-based monitoring. In this study, we develop a laboratory protocol to quantify viral titers in raw sewage via qPCR analysis and validate results with sequencing analysis. Our results suggest that the number of positive cases estimated from wastewater viral titers is orders of magnitude greater than the number of confirmed clinical cases and therefore may significantly impact efforts to understand the case fatality rate and progression of disease. These data may help inform decisions…

• UO
  University of Notre Dame
• BI
  Broad Institute
• MC
  Massachusetts Consortium on Pathogen Readiness
• NI
  National Institute of General Medical Sciences