Wastewater Analysis of SARS-CoV-2 as a Predictive Metric of Positivity Rate for a Major Metropolis

Wastewater monitoring for SARS-CoV-2 has been suggested as an epidemiological indicator of community infection dynamics and disease prevalence. We report wastewater viral RNA levels of SARS-CoV-2 in a major metropolis serving over 3.6 million people geographically spread over 39 distinct sampling sites. Viral RNA levels were followed weekly for 22 weeks, both before, during, and after a major surge in cases, and simultaneously by two independent laboratories. We found SARS-CoV-2 RNA wastewater levels were a strong predictive indicator of trends in the nasal positivity rate two-weeks in advance. Furthermore, wastewater viral RNA loads demonstrated robust tracking of positivity rate for populations served by individual treatment plants, findings which were used in real-time to make public health interventions, including deployment of testing and education strike teams. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This work was supported by the Houston Health Department and grants from the National Science Foundation (CBET 2029025) and seed funds from Rice University and Baylor College of Medicine. P.K. was funded by a Johnson & Johnson WiSTEM2D award. Z.W.L. was funded by an Environmental Research & Education Foundation scholarship and Rice University. P.A. was funded by a National Science Foundation award (CBET 1932000). T.C. was funded by the National Academies of Science, Engineering, and Medicine Gulf Research Early Career Research Fellowship. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: NA All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable. Yes Data has been submitted for publication on the Kinder Institute Urban Data Platform (https://www.kinderudp.org/). Once accepted, data will be issued a DOI and data will be accessible following government procedures.