Regressing SARS-CoV-2 Sewage Measurements Onto COVID-19 Burden in the Population: A Proof-of-Concept for Quantitative Environmental Surveillance

Itay Bar-Or, Karin Yaniv, Marilou Shagan, Eden Ozer, Merav Weil, Victoria Indenbaum, Michal Elul, Oran Erster, Ella Mendelson, Batya Mannasse, Rachel Shirazi, Esti Kramarsky-Winter, Oded Nir, Hala Abu-Ali, Zeev Ronen, Ehud Rinott, Yair E. Lewis, Eran Friedler, Eden Bitkover, Yossi PaitanYakir Berchenko*, Ariel Kushmaro*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

22 Scopus citations


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is an RNA virus, a member of the coronavirus family of respiratory viruses that includes severe acute respiratory syndrome coronavirus 1 (SARS-CoV-1) and the Middle East respiratory syndrome (MERS). It has had an acute and dramatic impact on health care systems, economies, and societies of affected countries during the past 8 months. Widespread testing and tracing efforts are being employed in many countries in attempts to contain and mitigate this pandemic. Recent data has indicated that fecal shedding of SARS-CoV-2 is common and that the virus RNA can be detected in wastewater. This indicates that wastewater monitoring may provide a potentially efficient tool for the epidemiological surveillance of SARS-CoV-2 infection in large populations at relevant scales. In particular, this provides important means of (i) estimating the extent of outbreaks and their spatial distributions, based primarily on in-sewer measurements, (ii) managing the early-warning system quantitatively and efficiently, and (iii) verifying disease elimination. Here we report different virus concentration methods using polyethylene glycol (PEG), alum, or filtration techniques as well as different RNA extraction methodologies, providing important insights regarding the detection of SARS-CoV-2 RNA in sewage. Virus RNA particles were detected in wastewater in several geographic locations in Israel. In addition, a correlation of virus RNA concentration to morbidity was detected in Bnei-Barak city during April 2020. This study presents a proof of concept for the use of direct raw sewage-associated virus data, during the pandemic in the country as a potential epidemiological tool.

Original languageEnglish
Article number561710
JournalFrontiers in Public Health
StatePublished - 3 Jan 2022


FundersFunder number
Ben Gurion University
Corona Challenge Covid-19
Ministry of Health, State of Israel


    • COVID-19
    • SARS-CoV-2
    • corona
    • sewage
    • surveillance
    • virus concentration
    • wastewater based epidemiology


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