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Emergency Medical Minute


May 24, 2022

Contributor: Jared Scott, MD

Educational Pearls:

  • About 50% of those infected with SARS-CoV-2 will shed the virus in their feces  
  • Wastewater surveillance can be used to track COVID burden, which may be easier than collating test data from multiple hospitals across a region 
  • Viral shedding begins 5-7 days prior to symptom onset, so wastewater data can be used to anticipate outbreaks and inform policy and public health initiatives 
  • Some existing limitations to wastewater surveillance include:
  • Reporting by counties were water sources may be mixed
  • Septic tanks and other closed water systems will not be counted
  • Not all those infected will shed the virus


Weidhaas J, Aanderud ZT, Roper DK, et al. Correlation of SARS-CoV-2 RNA in wastewater with COVID-19 disease burden in sewersheds. Sci Total Environ. 2021;775:145790. doi:10.1016/j.scitotenv.2021.145790

Kirby AE, Walters MS, Jennings WC, et al. Using Wastewater Surveillance Data to Support the COVID-19 Response — United States, 2020–2021. MMWR Morb Mortal Wkly Rep 2021;70:1242–1244. DOI:

Covid-19 monitoring in wastewater. Colorado COVID-19 Updates. Accessed May 21, 2022.

Summarized by Kirsten Hughes, MS4 | Edited by John Spartz, MD, MPH & Erik Verzemnieks, MD


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