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This pre-print is available under a Creative Commons License (Attribution 4.0 International), CC BY 4.0, as described at http://creativecommons.org/licenses/by/4.0/" /> <meta name="DC.AccessRights" content="restricted" /> <meta name="DC.Description" content="Wastewater surveillance may represent a complementary approach to measure the presence and even prevalence of infectious diseases when the capacity for clinical testing is limited. Moreover, aggregate, population-wide data can help inform modeling efforts. We tested wastewater collected at a major urban treatment facility in Massachusetts and found the presence of SARS-CoV-2 at high titers in the period from March 18 - 25 using RT-qPCR. We then confirmed the identity of the PCR product by direct DNA sequencing. Viral titers observed were significantly higher than expected based on clinically confirmed cases in Massachusetts as of March 25. The reason for the discrepancy is not yet clear, and until further experiments are complete, these data do not necessarily indicate that clinical estimates are incorrect. Our approach is scalable and may be useful in modeling the SARS-CoV-2 pandemic and future outbreaks. ### Competing Interest Statement MM and NG are cofounders of Biobot Analytics. EJA is advisor to Biobot. NE and CD are employees at Biobot. All these authors hold shares in the company. ### Funding Statement WPH was supported by the National Institute of General Medical Sciences. This work was supported by the Center for Microbiome Informatics and Therapeutics and Intra-CREATE Thematic Grant (Cities) grant NRF2019-THE001-0003a to JT and EJA. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.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 Detailed methods available upon request." /> <meta name="DC.Contributor" content="FQ Wu" /> <meta name="DC.Contributor" content="A Xiao" /> <meta name="DC.Contributor" content="JB Zhang" /> <meta name="DC.Contributor" content="XQ Gu" /> <meta name="DC.Contributor" content="WL Lee" /> <meta name="DC.Contributor" content="K Kauffman" /> <meta name="DC.Contributor" content="WP Hanage" /> <meta name="DC.Contributor" content="M Matus" /> <meta name="DC.Contributor" content="N Ghaeli" /> <meta name="DC.Contributor" content="N Endo" /> <meta name="DC.Contributor" content="C Duvallet" /> <meta name="DC.Contributor" content="K Moniz" /> <meta name="DC.Contributor" content="TB Erickson" /> <meta name="DC.Contributor" content="PR Chai" /> <meta name="DC.Contributor" content="J Thompson" /> <meta name="DC.Contributor" content="EJ Alm" /> <meta name="article:published_time" content="2020-04-07" /> <meta name="citation_title" content="SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases" /> <meta name="citation_abstract" lang="en" content="<h3>Abstract</h3> <p>Wastewater surveillance may represent a complementary approach to measure the presence and even prevalence of infectious diseases when the capacity for clinical testing is limited. Moreover, aggregate, population-wide data can help inform modeling efforts. We tested wastewater collected at a major urban treatment facility in Massachusetts and found the presence of SARS-CoV-2 at high titers in the period from March 18 - 25 using RT-qPCR. We then confirmed the identity of the PCR product by direct DNA sequencing. Viral titers observed were significantly higher than expected based on clinically confirmed cases in Massachusetts as of March 25. The reason for the discrepancy is not yet clear, and until further experiments are complete, these data do not necessarily indicate that clinical estimates are incorrect. Our approach is scalable and may be useful in modeling the SARS-CoV-2 pandemic and future outbreaks.</p>" /> <meta name="citation_journal_title" content="medRxiv" /> <meta name="citation_publisher" content="Cold Spring Harbor Laboratory Press" /> <meta name="citation_publication_date" content="2020/01/01" /> <meta name="citation_mjid" content="medrxiv;2020.04.05.20051540v1" /> <meta name="citation_id" content="2020.04.05.20051540v1" /> <meta name="citation_public_url" content="https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1" /> <meta name="citation_abstract_html_url" content="https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1.abstract" /> <meta name="citation_full_html_url" content="https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1.full" /> <meta name="citation_pdf_url" content="https://www.medrxiv.org/content/medrxiv/early/2020/04/07/2020.04.05.20051540.full.pdf" /> <meta name="citation_doi" content="10.1101/2020.04.05.20051540" /> <meta name="citation_num_pages" content="14" /> <meta name="citation_article_type" content="Article" /> <meta name="citation_firstpage" content="2020.04.05.20051540" /> <meta name="citation_author" content="FQ Wu" /> <meta name="citation_author_institution" content="Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology" /> <meta name="citation_author" content="A Xiao" /> <meta name="citation_author_institution" content="Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology" /> <meta name="citation_author" content="JB Zhang" /> <meta name="citation_author_institution" content="Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology" /> <meta name="citation_author" content="XQ Gu" /> <meta name="citation_author_institution" content="Singapore-MIT Alliance for Research and Technology, National University of Singapore" /> <meta name="citation_author" content="WL Lee" /> <meta name="citation_author_institution" content="Singapore-MIT Alliance for Research and Technology, National University of Singapore" /> <meta name="citation_author" content="K Kauffman" /> <meta name="citation_author_institution" content="University at Buffalo, The State University of New York" /> <meta name="citation_author" content="WP Hanage" /> <meta name="citation_author_institution" content="Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. H. Chan School of Public Health" /> <meta name="citation_author" content="M Matus" /> <meta name="citation_author_institution" content="Biobot Analytics" /> <meta name="citation_author" content="N Ghaeli" /> <meta name="citation_author_institution" content="Biobot Analytics" /> <meta name="citation_author" content="N Endo" /> <meta name="citation_author_institution" content="Biobot Analytics" /> <meta name="citation_author" content="C Duvallet" /> <meta name="citation_author_institution" content="Biobot Analytics" /> <meta name="citation_author" content="K Moniz" /> <meta name="citation_author_institution" content="Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology" /> <meta name="citation_author" content="TB Erickson" /> <meta name="citation_author_institution" content="Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital" /> <meta name="citation_author" content="PR Chai" /> <meta name="citation_author_institution" content="Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital" /> <meta name="citation_author" content="J Thompson" /> <meta name="citation_author_institution" content="Singapore Center for Environmental Life Sciences Engineering, Asian School of the Environment, Nanyang Technological University" /> <meta name="citation_author" content="EJ Alm" /> <meta name="citation_author_institution" content="Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology" /> <meta name="citation_author_institution" content="Singapore-MIT Alliance for Research and Technology, National University of Singapore" /> <meta name="citation_author_institution" content="Biobot Analytics" /> <meta name="citation_author_email" content="ejalm@mit.edu" /> <meta name="citation_reference" content="Y. 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Moreover, aggregate, population-wide data can help inform modeling efforts. We tested wastewater collected at a major urban treatment facility in Massachusetts and found the presence of SARS-CoV-2 at high titers in the period from March 18 - 25 using RT-qPCR. We then confirmed the identity of the PCR product by direct DNA sequencing. Viral titers observed were significantly higher than expected based on clinically confirmed cases in Massachusetts as of March 25. The reason for the discrepancy is not yet clear, and until further experiments are complete, these data do not necessarily indicate that clinical estimates are incorrect. Our approach is scalable and may be useful in modeling the SARS-CoV-2 pandemic and future outbreaks. ### Competing Interest Statement MM and NG are cofounders of Biobot Analytics. EJA is advisor to Biobot. NE and CD are employees at Biobot. All these authors hold shares in the company. ### Funding Statement WPH was supported by the National Institute of General Medical Sciences. This work was supported by the Center for Microbiome Informatics and Therapeutics and Intra-CREATE Thematic Grant (Cities) grant NRF2019-THE001-0003a to JT and EJA. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes 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 Detailed methods available upon request." /> <meta name="og-title" property="og:title" content="SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases" /> <meta name="og-url" property="og:url" content="https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1" /> <meta name="og-site-name" property="og:site_name" content="medRxiv" /> <meta name="og-description" property="og:description" content="Wastewater surveillance may represent a complementary approach to measure the presence and even prevalence of infectious diseases when the capacity for clinical testing is limited. Moreover, aggregate, population-wide data can help inform modeling efforts. We tested wastewater collected at a major urban treatment facility in Massachusetts and found the presence of SARS-CoV-2 at high titers in the period from March 18 - 25 using RT-qPCR. We then confirmed the identity of the PCR product by direct DNA sequencing. Viral titers observed were significantly higher than expected based on clinically confirmed cases in Massachusetts as of March 25. The reason for the discrepancy is not yet clear, and until further experiments are complete, these data do not necessarily indicate that clinical estimates are incorrect. Our approach is scalable and may be useful in modeling the SARS-CoV-2 pandemic and future outbreaks. ### Competing Interest Statement MM and NG are cofounders of Biobot Analytics. EJA is advisor to Biobot. NE and CD are employees at Biobot. All these authors hold shares in the company. ### Funding Statement WPH was supported by the National Institute of General Medical Sciences. This work was supported by the Center for Microbiome Informatics and Therapeutics and Intra-CREATE Thematic Grant (Cities) grant NRF2019-THE001-0003a to JT and EJA. ### Author Declarations All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript. Yes 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 Detailed methods available upon request." /> <meta name="og-type" property="og:type" content="article" /> <meta name="og-image" property="og:image" content="https://www.medrxiv.org/sites/default/files/images/medrxiv_logo_homepage7-5-small-test-up.png" /> <meta name="citation_date" content="2020-04-07" /> <link rel="alternate" type="text/plain" title="Full Text (Plain)" href="/content/10.1101/2020.04.05.20051540v1.full.txt" /> <link rel="alternate" type="application/vnd.ms-powerpoint" title="Powerpoint" href="/content/10.1101/2020.04.05.20051540v1.ppt" /> <link rel="alternate" type="application/pdf" title="Full Text (PDF)" href="/content/10.1101/2020.04.05.20051540v1.full.pdf" /> <meta name="description" content="medRxiv - The Preprint Server for Health Sciences" /> <meta name="generator" content="Drupal 7 (http://drupal.org)" /> <link rel="canonical" href="https://www.medrxiv.org/content/10.1101/2020.04.05.20051540v1" /> <link rel="shortlink" 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class="highwire-article-citation highwire-citation-type-highwire-article node75493" data-node-nid="75493" id="node-75493--2802240075" data-pisa="medrxiv;2020.04.05.20051540v1" data-pisa-master="medrxiv;2020.04.05.20051540" data-apath="/medrxiv/early/2020/04/07/2020.04.05.20051540.atom" data-hw-author-tooltip-instance=""><div class="highwire-cite highwire-cite-highwire-article highwire-citation-medrxiv-article-top clearfix has-author-tooltip" > <h1 class="highwire-cite-title" id="page-title">SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases</h1> <div class="highwire-cite-authors" ><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">FQ</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A</span> <span class="nlm-surname">Xiao</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">JB</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">XQ</span> <span class="nlm-surname">Gu</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">WL</span> <span class="nlm-surname">Lee</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">K</span> <span class="nlm-surname">Kauffman</span></span>, <span class="highwire-citation-author" data-delta="6"><span class="nlm-given-names">WP</span> <span class="nlm-surname">Hanage</span></span>, <span class="highwire-citation-author" data-delta="7"><span class="nlm-given-names">M</span> <span class="nlm-surname">Matus</span></span>, <span class="highwire-citation-author" data-delta="8"><span class="nlm-given-names">N</span> <span class="nlm-surname">Ghaeli</span></span>, <span class="highwire-citation-author" data-delta="9"><span class="nlm-given-names">N</span> <span class="nlm-surname">Endo</span></span>, <span class="highwire-citation-author" data-delta="10"><span class="nlm-given-names">C</span> <span class="nlm-surname">Duvallet</span></span>, <span class="highwire-citation-author" data-delta="11"><span class="nlm-given-names">K</span> <span class="nlm-surname">Moniz</span></span>, <span class="highwire-citation-author" data-delta="12"><span class="nlm-given-names">TB</span> <span class="nlm-surname">Erickson</span></span>, <span class="highwire-citation-author" data-delta="13"><span class="nlm-given-names">PR</span> <span class="nlm-surname">Chai</span></span>, <span class="highwire-citation-author" data-delta="14"><span class="nlm-given-names">J</span> <span class="nlm-surname">Thompson</span></span>, <span class="highwire-citation-author" data-delta="15"><span class="nlm-given-names">EJ</span> <span class="nlm-surname">Alm</span></span></span></div> <div class="highwire-cite-metadata" ><span class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">doi:</span> https://doi.org/10.1101/2020.04.05.20051540 </span></div> </div> <div id="hw-article-author-popups-node-75493--2802240075" style="display: none;"><div class="author-tooltip-0"><div class="author-tooltip-name">FQ Wu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=FQ%2BWu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Wu%20F&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AFQ%2BWu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-1"><div class="author-tooltip-name">A Xiao </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=A%2BXiao%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Xiao%20A&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AA%2BXiao%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-2"><div class="author-tooltip-name">JB Zhang </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=JB%2BZhang%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Zhang%20J&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AJB%2BZhang%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-3"><div class="author-tooltip-name">XQ Gu </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>2</span><span class='nlm-institution'>Singapore-MIT Alliance for Research and Technology, National University of Singapore</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=XQ%2BGu%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Gu%20X&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AXQ%2BGu%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-4"><div class="author-tooltip-name">WL Lee </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>2</span><span class='nlm-institution'>Singapore-MIT Alliance for Research and Technology, National University of Singapore</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=WL%2BLee%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Lee%20W&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AWL%2BLee%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-5"><div class="author-tooltip-name">K Kauffman </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>3</span><span class='nlm-institution'>University at Buffalo, The State University of New York</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=K%2BKauffman%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Kauffman%20K&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK%2BKauffman%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-6"><div class="author-tooltip-name">WP Hanage </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>4</span><span class='nlm-institution'>Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard T. 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Chan School of Public Health</span>, Boston</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=WP%2BHanage%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Hanage%20W&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AWP%2BHanage%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-7"><div class="author-tooltip-name">M Matus </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>5</span><span class='nlm-institution'>Biobot Analytics</span>, Cambridge MA</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=M%2BMatus%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Matus%20M&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AM%2BMatus%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-8"><div class="author-tooltip-name">N Ghaeli </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>5</span><span class='nlm-institution'>Biobot Analytics</span>, Cambridge MA</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=N%2BGhaeli%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Ghaeli%20N&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AN%2BGhaeli%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-9"><div class="author-tooltip-name">N Endo </div><div class="author-tooltip-affiliation"><span 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class="author-tooltip-name">K Moniz </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>1</span><span class='nlm-institution'>Center for Microbiome Informatics and Therapeutics, Departments of Biological Engineering and Civil & Environmental Engineering, Massachusetts Institute of Technology</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=K%2BMoniz%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Moniz%20K&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3AK%2BMoniz%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-12"><div class="author-tooltip-name">TB Erickson </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>6</span><span class='nlm-institution'>Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=TB%2BErickson%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Erickson%20T&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link last"><a href="/search/author1%3ATB%2BErickson%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li></ul></div><div class="author-tooltip-13"><div class="author-tooltip-name">PR Chai </div><div class="author-tooltip-affiliation"><span class="author-tooltip-text"><div class='author-affiliation'><span class='nlm-sup'>6</span><span class='nlm-institution'>Division of Medical Toxicology, Department of Emergency Medicine, Brigham and Women’s Hospital</span></div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=PR%2BChai%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Chai%20P&link_type=AUTHORSEARCH" 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class='nlm-institution'>Singapore-MIT Alliance for Research and Technology, National University of Singapore</span></div><div class='author-affiliation'><span class='nlm-sup'>5</span><span class='nlm-institution'>Biobot Analytics</span>, Cambridge MA</div></span></div><ul class="author-tooltip-find-more"><li class="author-tooltip-gs-link first"><a href="/lookup/google-scholar?link_type=googlescholar&gs_type=author&author%5B0%5D=EJ%2BAlm%2B" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on Google Scholar</a></li><li class="author-tooltip-pubmed-link"><a href="/lookup/external-ref?access_num=Alm%20E&link_type=AUTHORSEARCH" target="_blank" class="" data-icon-position="" data-hide-link-title="0">Find this author on PubMed</a></li><li class="author-site-search-link"><a href="/search/author1%3AEJ%2BAlm%2B" rel="nofollow" class="" data-icon-position="" data-hide-link-title="0">Search for this author on this site</a></li><li class="author-corresp-email-link last"><span>For correspondence: <a href="mailto:ejalm@mit.edu" class="" data-icon-position="" data-hide-link-title="0">ejalm@mit.edu</a></span></li></ul></div></div></div> </div> </div> <div class="panel-separator"></div><div class="panel-pane pane-highwire-panel-tabs pane-panels-ajax-tab-tabs" > <div class="pane-content"> <div class="item-list"><ul class="tabs inline panels-ajax-tab"><li class="first"><a href="/content/10.1101/2020.04.05.20051540v1" class="panels-ajax-tab-tab" data-panel-name="biorxiv_tab_art" data-target-id="highwire_article_tabs" data-entity-context="node:75493" data-trigger="" data-url-enabled="1">Abstract</a><a href="/panels_ajax_tab/biorxiv_tab_art/node:75493/1" rel="nofollow" style="display:none" class="js-crawler-link"></a></li><li><a href="/content/10.1101/2020.04.05.20051540v1.full-text" class="panels-ajax-tab-tab" data-panel-name="article_tab_full_text" data-target-id="highwire_article_tabs" data-entity-context="node:75493" 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data-panels-ajax-tab-preloaded="biorxiv_tab_art" id="panels-ajax-tab-container-highwire_article_tabs" class="panels-ajax-tab-container"><div class="panels-ajax-tab-loading" style ="display:none"><img class="loading" src="https://www.medrxiv.org/sites/all/modules/contrib/panels_ajax_tab/images/loading.gif" alt="Loading" title="Loading" /></div><div class="panels-ajax-tab-wrap-biorxiv_tab_art"><div class="panel-display panel-1col clearfix" > <div class="panel-panel panel-col"> <div><div class="panel-pane pane-highwire-markup" > <div class="pane-content"> <div class="highwire-markup"><div xmlns="http://www.w3.org/1999/xhtml" data-highwire-cite-ref-tooltip-instance="highwire_reflinks_tooltip" class="content-block-markup" xmlns:xhtml="http://www.w3.org/1999/xhtml"><div class="article abstract-view "><span class="highwire-journal-article-marker-start"></span><div class="section abstract" id="abstract-1"><h2 class="">Abstract</h2><p id="p-2">Wastewater surveillance may represent a complementary approach to measure the presence and even prevalence of infectious diseases when the capacity for clinical testing is limited. Moreover, aggregate, population-wide data can help inform modeling efforts. We tested wastewater collected at a major urban treatment facility in Massachusetts and found the presence of SARS-CoV-2 at high titers in the period from March 18 - 25 using RT-qPCR. We then confirmed the identity of the PCR product by direct DNA sequencing. Viral titers observed were significantly higher than expected based on clinically confirmed cases in Massachusetts as of March 25. The reason for the discrepancy is not yet clear, and until further experiments are complete, these data do not necessarily indicate that clinical estimates are incorrect. Our approach is scalable and may be useful in modeling the SARS-CoV-2 pandemic and future outbreaks.</p></div><h3>Competing Interest Statement</h3><p id="p-3">MM and NG are cofounders of Biobot Analytics. EJA is advisor to Biobot. NE and CD are employees at Biobot. All these authors hold shares in the company.</p><h3>Funding Statement</h3><p id="p-4">WPH was supported by the National Institute of General Medical Sciences. This work was supported by the Center for Microbiome Informatics and Therapeutics and Intra-CREATE Thematic Grant (Cities) grant NRF2019-THE001-0003a to JT and EJA.</p><h3>Author Declarations</h3><p id="p-5">All relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.</p><p id="p-6">Yes</p><p id="p-7">All necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.</p><p id="p-8">Yes</p><p id="p-9">I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. 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class="highwire-cite highwire-cite-highwire-article highwire-citation-biorxiv-article-pap-list clearfix" > <div class="highwire-cite-title" > <div class="highwire-cite-title">SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases</div> </div> <div class="highwire-cite-authors" ><span class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">FQ</span> <span class="nlm-surname">Wu</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">A</span> <span class="nlm-surname">Xiao</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">JB</span> <span class="nlm-surname">Zhang</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">XQ</span> <span class="nlm-surname">Gu</span></span>, <span class="highwire-citation-author" data-delta="4"><span 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