ABSTRACT
We aimed to estimate the lead time and infection prevalence from SARS-CoV-2 wastewater (WW) monitoring compared with clinical surveillance data in Mexico to generate evidence about the feasibility of a large-scale WW surveillance system. We selected 10 WW treatment plants (WWTP) and 5 COVID-19 hospitals in major urban conglomerates in Mexico and collected biweekly 24-h flow-adjusted composite samples during October-November 2020. We concentrated WW samples by polyethylene glycol precipitation and employed quantitative PCR (RT-qPCR) assays, targeting the nucleoprotein (N1 and N2) genes. We detected and quantified SARS-CoV-2 RNA in 88% and 58% of the raw WW samples from WWTPs and COVID-19 hospitals, respectively. The WW RNA daily loads lead the active cases by more than one month in large and medium WWTP sites. WW estimated that cases were 2 to 20-fold higher than registered active cases. Developing a continuous monitoring surveillance system for SARS-CoV-2 community transmission through WW is feasible, informative, and recognizes three main challenges: (1) WW system data (catchment area, population served), (2) capacity to maintain the cold-chain and process samples, and (3) supplies and personnel to ensure standardized procedures.