City-level SARS-CoV-2 sewage surveillance

Karin Yaniv, Marilou Shagan, Yair E. Lewis, Esti Kramarsky-Winter, Merav Weil, Victoria Indenbaum, Michal Elul, Oran Erster, Alin Sela Brown, Ella Mendelson, Batya Mannasse, Rachel Shirazi, Satish Lakkakula, Oren Miron, Ehud Rinott, Ricardo Gilead Baibich, Iris Bigler, Matan Malul, Rotem Rishti, Asher BrennerEran Friedler, Yael Gilboa, Sara Sabach, Yuval Alfiya, Uta Cheruti, davidovich Nadav davidovich, Jacob Moran-Gilad, Yakir Berchenko, Itay Bar-Or*, Ariel Kushmaro*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


The COVID-19 pandemic created a global crisis impacting not only healthcare systems, but also economics and society. Therefore, it is important to find novel methods for monitoring disease activity. Recent data have indicated that fecal shedding of SARS-CoV-2 is common, and that viral RNA can be detected in wastewater. This suggests that wastewater monitoring is a potentially efficient tool for both epidemiological surveillance, and early warning for SARS-CoV-2 circulation at the population level. In this study we sampled an urban wastewater infrastructure in the city of Ashkelon (̴ 150,000 population), Israel, during the end of the first COVID-19 wave in May 2020 when the number of infections seemed to be waning. We were able to show varying presence of SARS-CoV-2 RNA in wastewater from several locations in the city during two sampling periods, before the resurgence was clinically apparent. This was expressed with a new index, Normalized Viral Load (NVL) which can be used in different area scales to define levels of virus activity such as red (high) or green (no), and to follow morbidity in the population at the tested area. The rise in viral load between the two sampling periods (one week apart) indicated an increase in morbidity that was evident two weeks to a month later in the population. Thus, this methodology may provide an early indication for SARS-CoV-2 infection outbreak in a population before an outbreak is clinically apparent.

Original languageEnglish
Article number131194
StatePublished - Nov 2021


  • Early warning
  • Normalized viral load
  • Population monitoring
  • SARS-CoV-2
  • Wastewater epidemiology


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