Wastewater Measures of SARS-CoV-2 Accurately Predict Frequency of Symptomatic Infections in the Community

Background. Widespread immunity through vaccination or natural infection has altered the predictive ability of wastewater for hospitalization and mortality. Methods. Between January 2022 and August 2024, we conducted a longitudinal observational study that aimed to examine the correlation between symptomatic COVID-19 in health care employees and SARS-CoV-2 wastewater community levels. Wastewater was analyzed by quantitative reverse transcription polymerase chain reaction for detection of SARS-CoV-2. The Fairview Employee Occupational Health office provided deidentified data. Results. We collected 215 wastewater samples from the Twin Cities Wastewater Treatment Plant over a 32-month interval. Over that period, there were 6879 positive SARS-CoV-2 test results reported to Fairview Employee Health from individuals who lived in the wastewater catchment area. We found that SARS-CoV-2 levels in wastewater accurately predicted the subsequent COVID-19 case count the following week in the community (P = .001). Conclusions. These data demonstrate the utility of SARS-CoV-2 wastewater surveillance as it accurately predicts the frequency of symptomatic infection in the community.