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

Author:

Wu Fuqing123ORCID,Zhang Jianbo12,Xiao Amy123,Gu Xiaoqiong45,Lee Wei Lin45,Armas Federica45,Kauffman Kathryn6,Hanage William7,Matus Mariana8,Ghaeli Newsha8,Endo Noriko8,Duvallet Claire8,Poyet Mathilde123,Moniz Katya123,Washburne Alex D.9,Erickson Timothy B.1011,Chai Peter R.101213,Thompson Janelle14155,Alm Eric J.148165ORCID

Affiliation:

1. Center for Microbiome Informatics and Therapeutics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

2. Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

3. Department of Civil and Environmental Engineering, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

4. Singapore-MIT Alliance for Research and Technology, National University of Singapore, Singapore

5. Campus for Research Excellence and Technological Enterprise, Singapore

6. University at Buffalo, The State University of New York, Buffalo, New York, USA

7. Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA

8. Biobot Analytics, Inc., Cambridge, Massachusetts, USA

9. Selva Analytics, LLC, Bozeman, Montana, USA

10. Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA

11. Harvard Humanitarian Institute, Cambridge, Massachusetts, USA

12. The Fenway Institute, Boston, Massachusetts, USA

13. The Koch Institute for Integrated Cancer Research, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA

14. Singapore Center for Environmental Life Sciences Engineering, Nanyang Technological University, Singapore

15. Asian School of the Environment, Nanyang Technological University, Singapore

16. Broad Institute of MIT and Harvard, Cambridge, Massachusetts, USA

Abstract

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 surrounding the advancement or scale-back of social distancing and quarantine efforts based on dynamic wastewater catchment-level estimations of prevalence.

Funder

Intra-create thematic grant

Center for microbiome innformatics and therapeutics

Massachusetts consortium on Pathogen Readiness (MassCPR) and China Evergrande Group

Intra-CREATE Thematic grant

Massachusetts Consortium on Pathogen Readiness (MassCPR) and China Evergrande Group

Publisher

American Society for Microbiology

Subject

Computer Science Applications,Genetics,Molecular Biology,Modelling and Simulation,Ecology, Evolution, Behavior and Systematics,Biochemistry,Physiology,Microbiology

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