SARS-Coronavirus-2 in sewage in the Netherlands

SARS-Coronavirus-2 in sewage in the Netherlands. Jefferson T,  Heneghan C.

Published on July 2, 2020

Reference Medema G, Heijnen L, Elsinga G, Italiaander R, Brouwer A. Presence of SARS-Coronavirus-2 in sewage.  medRxiv. 2020:2020.03.29.20045880. 2020
Study type
Country Netherlands
Setting Public, cities and airport
Funding Details KWR Water Research Institute
Transmission mode Orofecal

Bottom Line

SARS-CoV-2 was detected in the sewage of five sites a week after the first COVID-19 case in the Netherlands. Even at low COVID-19 prevalence sewage surveillance could be a sensitive tool to monitor the viral circulation.

Evidence Summary

Signal (identification of viral antigens) in sewage samples occurred when the observed COVID-19 prevalence was around or even below 1.0 case per 100,000 people. Stronger signals where observed when the prevalence was 3.5 case per 100,000 people or more.

What did they do?

Before the onset of the epidemic in the Netherlands, wastewater treatment plants (WWTP) were selected that served two large and three medium-sized cities and Schiphol airport. The operators of the WWTP sampled a 24h flow-dependent composite sample of 250 mL that was stored at 4 C during sampling. Samples were taken in 2020, on February 5th, 6th  and 7th, three weeks before the first COVID-19 case was identified in The Netherlands on March the 4th and 5th. One more WWTP in one of the most affected areas was included in the sampling frame.

The paper describes concentration and testing in detail (data not extracted).

Study reliability

The authors point out that none of the isolates are likely to be viable and the testing method needs refining. More correlation studies are required.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes No Yes No Yes

What else should I consider?

This is a preliminary proof of concept study which needs relocation with SARS-CoV-2 and other viruses.

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Tom Jefferson

Tom Jefferson, epidemiologist.