In this study, wastewater-based surveillance was carried out to establish the correlation between SARS-CoV-2 viral RNA concentrations in wastewater and the incidence of corona virus disease 2019 (COVID-19) from clinical testing. The influent wastewater of three major water reclamation facilities (WRFs) in Northern Nevada, serving a population of 390,750, was monitored for SARS-CoV-2 viral RNA gene markers, N1 and N2, from June 2020 through September 2021. A total of 614 samples were collected and analyzed. The SARS-CoV-2 concentrations in wastewater were observed to peak twice during the study period. A moderate correlation trend between coronavirus disease 2019 (COVID-19) incidence data from clinical testing and SARS-CoV-2 viral RNA concentrations in wastewater was observed (Spearman r = 0.533). This correlation improved when using weekly average SARS-CoV-2 marker concentrations of wastewater and clinical case data (Spearman r = 0.790), presumably by mitigating the inherent variability of the environmental dataset and the effects of clinical testing artifacts (e.g., reporting lags). The research also demonstrated the value of wastewater-based surveillance as an early warning signal for early detection of trends in COVID-19 incidence. This was accomplished by identifying that the reported clinical cases had a stronger correlation to SARS-CoV-2 wastewater monitoring data when they were estimated to lag 7-days behind the wastewater data. The results aided local decision makers in developing strategies to manage COVID-19 in the region and provide a framework for how wastewater-based surveillance can be applied across localities to enhance the public health monitoring of the ongoing pandemic.

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There have been multiple reports of COVID-19 virus, SARS-CoV-2 RNA presence in influent wastewater of water reclamation facilities (WRFs) across the world. In this study, the removal of SARS-CoV-2 RNA was investigated in a WRF by collecting samples from various stages relayed to hydraulic retention time (HRT) and analyzed for viral RNA (N1 and N2) gene markers and wastewater characteristics. SARS-CoV-2 RNA was detected in 28 out of 28 influent wastewater and primary effluent samples. Secondary effluent showed 4 out of 9 positive samples, and all tertiary and final effluent samples were below the detection limit for the viral markers. The reduction was significant (p value < 0.005, one-way analysis of variance [ANOVA] test) in secondary treatment, ranging from 1.4 to 2.0 log 10 removal. Adjusted N1 viral marker had a positive correlation with total suspended solids, total Kjeldahl nitrogen, and ammonia concentrations (Spearman's ρ = 0.61, 0.67, and 0.53, respectively, p value < 0.05), while demonstrating a strongly negative correlation with HRT (Spearman's ρ = À0.58, p value < 0.01). Practitioner points• Viral RNA was present in all samples taken from influent and primary effluent of a WRF.• SARS-CoV-2 gene marker was detected in secondary effluent in 4 out of 9 samples.• Tertiary and final effluent samples tested nondetect for SARS-CoV-2 gene markers.• Up to 0.5 and 2.0 log 10 virus removal values were achieved by primary and secondary treatment, respectively.

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