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An infographic that explains what wastewater surveillance is, how it works, and its benefits.

Wastewater Surveillance

What’s SARS-CoV-2 got to do with it?

Did You Know?
1. SARS-CoV-2, the virus that causes COVID-19, can be shed in the feces of both symptomatic and asymptomatic individuals.
2. Wastewater surveillance can be used as a tool to test for RNA from SARS-CoV-2.
3. There is no information to date that anyone has become sick with COVID-19 because of direct exposure to treated or untreated wastewater.

How it Works
The following diagram depicts a series of events:
Asymptomatic and symptomatic individuals
SARS-CoV-2 shed in feces
Feces transported in the sewage system
Wastewater samples taken at the treatment plant
Analysis of wastewater influent for SARS-CoV-2
Wastewater data used to inform public health actions

Public Health Benefits
Wastewater surveillance of SARS-CoV-2 can:
1. Serve as an early warning system
2. Help direct resources
3. Provide information on an entire community
4. Calculate metrics to monitor disease over time
5. Evaluate intervention effectiveness
6. Track known variants
7. Improve disease monitoring of underserved communities
8. Contextualize other COVID-19 metrics

Advantages of SARS-CoV-2 Wastewater Surveillance
Non-invasive, Inexpensive, Scalable, Unbiased, Large data pool of individuals, Inclusive (both asymptomatic and symptomatic individuals), Data for communities where individual testing is underutilized or unavailable, Indicator of changes in community-level infection, Complements existing COVID-19 surveillance systems

Key Partnerships
Partnerships are key for a successful wastewater surveillance program.
State, local, tribal, and territorial governments, particularly public health departments
Wastewater utility companies
Laboratories: Public health, environmental, academic, and/or commercial

Success in the Field—Spotlight on Tempe, AZ
2018 Began their wastewater surveillance program to collect data on local opioid use. 2018 Began monitoring for the SARS-CoV-2 virus.
March 2020 Began monitoring for the SARS-CoV-2 virus.
The City of Tempe’s water division collects wastewater samples and sends them to Arizona State University for processing.
The city analyzes the university’s data and makes it publicly available in their Community Health Bio-Intel System.
Using wastewater data alongside equity and inclusion data has enabled the city to prioritize COVID-19 services.
Tempe is hoping to expand their existing program by breaking down collection basins into smaller, more localized areas, and expand biomarkers monitored through their wastewater surveillance program.

Steps to Get YOUR Health Department Involved!
1. Communication & Data Sharing:
Host open forums to address questions and concerns from the public.
Provide regular updates via press releases, social media, etc.
Make data publicly available and understandable to the general public.
Connect with the CDC National Wastewater Surveillance System at NWSS@cdc.gov
2. Identify Public Health Data Needs:
Based on the local disease status and other available health indicators, wastewater surveillance can help detect the presence of COVID-19 cases and monitor trends* within a sewershed. *Wastewater surveillance cannot currently be used to determine the total number of infected persons or percent of the population that is infected.
3. Assess Wastewater Sampling & Testing Capacity:
Identify and connect with local partners (e.g., laboratories, academic institutions) to assess sampling and testing capacity in your community.
Convene stakeholders and share information on wastewater surveillance.
4. Develop a Sampling Plan:
Make sure to address:
Where to sample
How often to sample
What to sample
How to sample
How to safely collect, store, and ship samples

Based on CDC’s National Wastewater Surveillance System

Resources:
National Wastewater Surveillance System (CDC)
Detecting and Monitoring SARS-CoV-2 in Wastewater (EPA)
Recommendations from the Water Research Foundation

Contact Information
Email: WASH@naccho.org
Webpage: naccho.org/wash

This publication was supported by cooperative agreement 6 NU38OT000306-02-10 awarded to the National Association of County and City Health Officials and funded by the Centers for Disease Control and Prevention. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention or the U.S. Department of Health and Human Services.