WHO COVID-19 dashboard
WHO Health Emergencies Programme
SARS-CoV-2 wastewater surveillance data
Wastewater environmental surveillance
Environmental surveillance (ES) in wastewater for SARS-CoV-2 is an effective approach to monitor community level circulation of the virus as a complementary method to COVID-19 public health surveillance strategies.
Excretion of the virus from an infected person starts before symptom onset and has been valuable as an early warning system of potential increases in cases and hospital admissions that lag behind by one to four weeks, as well as, contributing to the monitoring of the changes in SARS-CoV-2 circulation intensity and existing variants. This is especially valuable information, where there is limited clinical testing.
The outputs of environmental surveillance in wastewater should be evaluated together with the indicators from other surveillance systems, such as those presented on the WHO COVID-19 dashboard. WHO recommends countries to maintain/strengthen their SARS-CoV-2 surveillance with complementary surveillance methods like environmental surveillance and make the results publicly available.
SARS-CoV-2 environmental surveillance guidance
Global wastewater monitoring sources for SARS-CoV-2 (COVID-19 virus)
Publicly available wastewater surveillance outputs available from official government websites and dashboards:
All links to national websites correct as of time of publishing.
WHO African Region
WHO South-East Asia Region
Questions and Answers
How can environmental surveillance of wastewater help during disease outbreaks?
Wastewater and environmental surveillance have a long history of use in public health. It provides additional information on circulation at the population level that may not be seen via clinical testing. Environmental surveillance has proven very useful to detect and respond to asymptomatic poliovirus infection in high-risk settings as well as in places thought to be polio free. It has also been used for monitoring typhoid and antimicrobial resistance and research is underway for a wide range of other pathogens where environmental surveillance may be able to complement traditional forms of clinical surveillance.
How is wastewater testing used for COVID-19?
Wastewater testing can be used to monitor the trends of SARS-CoV-2 virus in untreated sewage. Several countries are monitoring wastewater for SARS-CoV-2 virus, the virus that causes COVID-19, in a range of locations for different purposes. These include:
- cost effective and sensitive monitoring of trends and changes in viral circulation and variants,
- early indication of a change in incidence and as an input for modelling future infection trends,
- guiding clinical testing and vaccination priorities to areas with high environmental surveillance results,
- early warning of emergence in low prevalence or localized contexts or in the absence of evidence from clinical testing,
- communication of results to the public to reinforce risk reduction behaviours in the community,
- monitor the impact of public health measures.
Some countries are also analysing archived wastewater samples for evidence of past SARS-CoV-2 circulation.
What does it mean when SARS-COV-2 is detected in wastewater?
Molecular tests such as polymerase chain reaction (PCR) tests can detect the presence of the SARS-CoV-2 virus via fragments of genetic material (RNA) in wastewater. Monitoring the concentration levels of SARS-CoV-2 genetic material in wastewater by time could indicate the changes in intensity of the virus circulation in communities. However, the wastewater test does not identify who was or is infected or indicate if the persons excreting the virus are still infectious to others.
Can I get sick with COVID-19 through contact with urine, faeces, or sewage?
No. While fragments of SARS-CoV-2 genetic material (RNA) have been detected in the urine or faeces of some patients, there have been no reports to date of transmission of COVID-19 through faeces or urine. It remains important to protect yourself with personal protective equipment whenever contact with bodily fluids may occur and to clean your hands frequently.
Infectious SARS-CoV-2 has also not been detected in wastewater, suggesting transmission through contact or contamination with sewage is highly unlikely.
Further guidance for water, sanitation, hygiene and waste management can be found in Water, sanitation, hygiene, and waste management for SARS-CoV-2, the virus that causes COVID-19 guidance.
Can wastewater testing be conducted in low-resource settings?
Yes, there are some evidence of arrangements that have shown promise and do not require highly experienced laboratory technicians, and these may lead to expanded options at remote locations and in low resource contexts. By adapting the strategies and approaches to suit local contexts, wastewater testing can be conducted effectively in low-resource settings, providing valuable data for public health, environmental monitoring, and decision-making.
Wastewater testing shouldn’t replace the clinical testing and epidemiological surveillance but rather planned as a complementary strategy to other surveillance methods. Water, sanitation and hygiene (WASH) activities are also top public health priorities, such as ensuring access to hand washing facilities for all. The cost-benefit of wastewater testing relative to other public health measures should be carefully evaluated.
Does WHO recommend environmental surveillance of wastewater for COVID-19?
According to a growing body of experience, SARS-CoV-2 environmental surveillance in wastewater (from sewage, or environmental waters contaminated with human excreta and secreta) can provide additional value to routine COVID-19 clinical surveillance and lends itself to an integrated respiratory surveillance. WHO encourages efforts to continue to explore potential uses of wastewater testing and recognizes its potential as an emerging tool for improving control of COVID-19. Detailed guidance on what situations environmental surveillance has been shown to add value to public health decision making, capacity needed to plan and coordinate an effective environmental surveillance programme and how to carry out data collection, analysis, interpretation and communication of results is available here.
Metadata
Glossary and definitions
| Wastewater | Water that has been in contact with people (e.g., for washing) or used for cleansing and sanitation (e.g., for flushing away faecal matter), and is discharged via sewers or other sanitation systems.
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| Sewage | Wastewater that has been used for sanitation (e.g., for flushing away faecal matter), and is discharged via sewers or other sanitation systems
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| Wastewater surveillance | Sampling and testing of wastewater by a methodological approach to analyse and interpret of the results including assessing the presence or concentration of pathogens and substances, all aimed at enhancing our understanding of disease dynamics within a community.
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| Environmental Surveillance | Environmental surveillance involves the systematic monitoring and assessment of various aspects of the environment, including air, water, soil, and biodiversity.
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