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Volume 27, Number 9—September 2021
Online Report

SARS-CoV-2 Wastewater Surveillance for Public Health Action

Jill S. McClary-Gutierrez1, Mia C. Mattioli, Perrine Marcenac, Andrea I. Silverman, Alexandria B. Boehm, Kyle Bibby, Michael Balliet, Francis L. de los Reyes, Daniel Gerrity, John F. Griffith, Patricia A. Holden, Dimitrios Katehis, Greg Kester, Nathan LaCross, Erin K. Lipp, Jonathan Meiman, Rachel T. Noble, Dominique BrossardComments to Author , and Sandra L. McLellanComments to Author 
Author affiliations: University of Wisconsin–Milwaukee School of Freshwater Sciences, Milwaukee, Wisconsin, USA (J.S. McClary-Gutierrez, S.L. McLellan); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (M.C. Mattioli, P. Marcenac); University Tandon School of Engineering, Department of Civil and Urban Engineering, Brooklyn, New York, USA (A.I. Silverman); Stanford University Department of Civil and Environmental Engineering, Stanford, California, USA (A.B. Boehm); University of Notre Dame Department of Civil and Environmental Engineering and Earth Sciences, Notre Dame, Indiana, USA (K. Bibby); County of Santa Clara Department of Environmental Health, San Jose, California, USA (M. Balliet); North Carolina State University Department of Civil, Construction, and Environmental Engineering, Raleigh, North Carolina, USA (F.L. de los Reyes III); Southern Nevada Water Authority Applied Research and Development Center, Las Vegas, Nevada, USA (D. Gerrity); Southern California Coastal Water Research Project, Costa Mesa, California, USA (J.F. Griffith); University of California Bren School of Environmental Science and Management, Santa Barbara, California, USA (P.A. Holden); New York City Department of Environmental Protection, New York, New York, USA (D. Katehis); California Association of Sanitation Agencies, Sacramento, California, USA (G. Kester); Utah Department of Health, Salt Lake City, Utah, USA (N. LaCross); University of Georgia Department of Environmental Health Science, Athens, Georgia, USA (E.K. Lipp); Wisconsin Department of Health Services, Madison, Wisconsin, USA (J. Meiman); University of North Carolina at Chapel Hill Institute of Marine Sciences, Morehead City, North Carolina, USA (R.T. Noble); University of Wisconsin–Madison Department of Life Sciences Communication, Madison (D. Brossard); University of Wisconsin–Madison Morgridge Institute for Research, Madison (D. Brossard)

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Table 2

Examples of how SARS-CoV-2 wastewater data have been used by public health departments to support their COVID-19 response, United States*

Location Description
Santa Clara County, California
The County of Santa Clara Emergency Operations Center and Public Health Department engaged in early evaluation of wastewater surveillance for SARS-CoV-2 in partnership with Stanford University researchers. A monitoring approach was developed to analyze SARS-CoV-2 RNA in settled solids at all 4 wastewater treatment plants in the county, accounting for >95% of the county’s total estimated population of 2 million. The county has observed trends in measured SARS-CoV-2 RNA from solids to generally track with positive COVID-19 case data. Evaluation is ongoing to understand what public health actions might be implemented in response.
Utah’s SARS-CoV-2 wastewater monitoring program began with in March 2020 as a collaboration between the Utah Department of Environmental Quality, Utah Department of Health, and 4 academic laboratories, which extended to wastewater facilities statewide by July 2020. The wastewater surveillance data have been used to help direct mobile testing teams to areas with low prevalence of clinical testing, determine where to send mask-wearing compliance observers, and assist the interpretation of other surveillance data. Consistently decreasing SARS-CoV-2 RNA concentrations in wastewater supported the conclusion that the observed declining case rates were real. Utah developed a public dashboard (
Wisconsin The Wisconsin Department of Health Services initiated a statewide SARS-CoV-2 wastewater testing program in collaboration with the Wisconsin State Laboratory of Hygiene and the University of Wisconsin–Milwaukee. This program has monitored SARS-CoV-2 RNA concentrations in samples collected from 70 municipal wastewater treatment plants that cover 50% of the state population. Sample collection for select locations began in August 2020 and captured the pre-Thanksgiving surge in COVID-19 cases in northeastern Wisconsin. Local health departments have used these data to confirm health trends identified through clinical testing, particularly in rural areas of the state with limited testing access. Data are publicly available (

*Examples were provided by public health practitioners from the expert group. A detailed description of these activities is provided in the Appendix. COVID-19, coronavirus disease; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

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1Current affiliation: University of Notre Dame Department of Civil and Environmental Engineering and Earth Sciences, Notre Dame, Indiana, USA

Page created: July 09, 2021
Page updated: August 18, 2021
Page reviewed: August 18, 2021
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.