key: cord-0816893-4b9dao3z
authors: Giacobbo, Alexandre; Rodrigues, Marco Antônio Siqueira; Ferreira, Jane Zoppas; Bernardes, Andréa Moura; de Pinho, Maria Norberta
title: A critical review on SARS-CoV-2 infectivity in water and wastewater. What do we know?
date: 2021-02-09
journal: Sci Total Environ
DOI: 10.1016/j.scitotenv.2021.145721
sha: b26c66e84c015004b5eee7a8255b12fc6dc8cb7c
doc_id: 816893
cord_uid: 4b9dao3z

The COVID-19 outbreak circulating the world is far from being controlled, and possible contamination routes are still being studied. There are no confirmed cases yet, but little is known about the infection possibility via contact with sewage or contaminated water as well as with aerosols generated during the pumping and treatment of these aqueous matrices. Therefore, this article presents a literature review on the detection of SARS-CoV-2 in human excreta and its pathways through the sewer system and wastewater treatment plants until it reaches the water bodies, highlighting their occurrence and infectivity in sewage and natural water. Research lines are still indicated, which we believe are important for improving the detection, quantification, and mainly the infectivity analyzes of SARS-CoV-2 and other enveloped viruses in sewage and natural water. In fact, up till now, no case of transmission via contact with sewage or contaminated water has been reported and the few studies conducted with these aqueous matrices have not detected infectious viruses. On the other hand, studies are showing that SARS-CoV-2 can remain viable, i.e., infectious, for up to 4.3 and 6 days in sewage and water, respectively, and that other species of coronavirus may remain viable in these aqueous matrices for more than one year, depending on the sample conditions. These are strong pieces of evidence that the contamination mediated by contact with sewage or contaminated water cannot be ruled out, even because other more resistant and infectious mutations of SARS-CoV-2 may appear.

glycoproteins, highly expressed in organs like lungs, arteries, kidney, heart, but in the human body their highest expression is observed in intestinal enterocytes, being these organs the most affected by SARS-CoV-2 infections (Bhowmick et al., 2019; V. Kumar et al., 2020; Premkumar et al., 2020) . More details on SARS-CoV-2 infection, replication cycle and assembly of virions can be found at Gralinski and Menachery (2020), Yuan Huang et al. (2020) , Ortiz-Prado et al. (2020) , and Sternberg and Naujokat (2020) . The mechanism of infection of the SARS-CoV-2 into human cells is represented on Figure 2 . CoV-2 S protein binds with the ACE2 receptor on the host cell and is subsequently cleaved at the S1/S2 and S2' sites by the TMPRSS2 protease. This activates the S2 subunit and leads to a fusion between the viral membrane and that of the host cell.

Adapted from Hartenian et al. (2020) . Created with BioRender.com.

The SARS-CoV-2 has been detected in blood, respiratory secretions, sputum, tears, gastric juices, breast milk, semen, vaginal secretion, urine, and feces from symptomatic patients (Groß et al., 2020; Yongbo Huang et al., 2020; Lo et al., in the feces after the pharyngeal swabs turned negative, being 6-10 days the duration of viral shedding from the feces after negative conversion in pharyngeal swabs, regardless of the disease severity. Later, other authors also reported similar fecal detection rates between patients with mild and severe COVID-19 disease .

Y. reported that in 55% of the 74 infected patients studied, fecal samples remained positive for SARS-CoV-2 RNA for an average of 11.2 days after the respiratory tract samples became negative, indicating that the virus is replicating actively in the patients' gastrointestinal tract. The authors also highlight the possibility of prolonged duration of viral shedding in feces, for until five weeks after patients' respiratory samples have been negative for SARS-CoV-2 RNA, which suggests that after viral clearance in the respiratory system, fecal-oral transmission may possibly occur. Other researchers have also endorsed this approach (Hindson, 2020; Patel, 2020;  A. Xing et al., 2020; . In another study, X. observed that the median duration of positive SARS-CoV-2 RNA in fecal samples was approximately nine days longer than in oropharyngeal swabs, and one patient persistently tested positive in fecal samples for 33 days after the oropharyngeal swabs tests became negative. Also, Mesoraca et al. (2020) observed patients having fecal samples positive test 25 days longer than their respiratory tract test. Recently, in a study on clinical samples from 20 patients infected with SARS-CoV-2, He et al. (2020) reported that one patient remained positive for viral RNA in the sputum and feces for billions of SARS-CoV-2 genomic copies in wastewater at once (Trottier et al., 2020) .

Nevertheless, a reduction in viral load is expected when feces and other human excreta reach the sewer system, not only due to the dilution effect, but also related to the inactivation of the viruses by environmental conditions (temperature, pH, solids content), as well as by the presence of antagonists germs (Escherichia coli, Enterococcus spp., Bacillus spp., Clostridium spp., etc.), and chemicals (detergents, disinfectants) in the sewage (Carraturo et al., 2020; Foladori et al., 2020; La Rosa et al., 2020a; Larsen and Wigginton, 2020; Race et al., 2020) . Incidentally, due to the recommendations for maintaining good hygiene and minimizing the number of infections, chemicals are being used in quantities far above normal. This increase achieved such a point that there are already studies (Espejo et al., 2020; Horn et al., 2020; Usman et al., 2020; Zambrano-Monserrate et al., 2020; reporting the possible impacts of these chemicals on the environment.

Thanks to the hard work developed by researchers around the world, nowadays there are already studies not only detecting but also quantifying by reverse transcriptionquantitative polymerase chain reaction (RT-qPCR) the SARS-CoV-2 RNA in sewage from different countries, in which were found up to 10 4 copies/L in Montana (Nemudryi et al., 2020) , from 10 4 to 10 5 copies/L in Detroit (Brijen et al., 2020) , up to 10 6 copies/L in Massachusetts (Schmidt, 2020; , and up to 10 7 copies/L in Virginia from a penitentiary and health care facilities in Chillan, a city in Southern Chile, while Gonçalves et al. (2020) found up to 10 7 copies/L in a hospital wastewater in Ljubljana, Slovenia. In fact, reported viral concentrations vary by several orders of magnitude, which may possibly be related to the level of infections and other specific sewage conditions (Pecson et al., 2020) , such as the area served and the resulting balance between industrial, stormwater, domestic and healthcare facilities inputs.

Interestingly, there are also studies reporting the presence of SARS-CoV-2 RNA in sewage samples prior to documentation of the COVID-19 cases at the site. In that case, by re-analyzing stored samples of raw sewage that were collected between October 2019 and February 2020 in five WWTPs in northern Italy, La Rosa et al. (2021) found viral loads of 1.2 × 10 3 , 4.1 × 10 3 , and 2.9 × 10 4 copies/L in Turin, Milan and Bologna, respectively, on 10-18 December 2019. Importantly, the first autochthonous Italian case of COVID-19 was documented just on 21 February 2020. On 11 February 2020, Martin et al. (2020) detected SARS-CoV-2 RNA in sewage samples collected at a WWTP in South East England, i.e., three days before the first case was reported in that area. Randazzo et al. (2020a) detected SARS-CoV-2 RNA in WWTPs from the metropolitan Region of Valencia, Spain, in late February, when confirmed COVID-19 cases in that region were only incipient. In the same way, on 17 February 2020, Lodder and de Roda Husman (2020) detected SARS-CoV-2 RNA in sewage at Schiphol airport in Tilburg, the Netherlands, only four days after the first case of COVID-19 was confirmed in the samples (Mlejnkova et al., 2020) . In summary, currently, reports from different parts of the planet like Australia (Ahmed et al., 2020a) , Brazil , Canada (D'Aoust et al., 2021) , Germany (Westhaus et al., 2021) , the United Arab Emirates (Albastaki et al., 2020) , Sweden (Saguti et al., 2021) , and the United States Sherchan et al., 2020) have shown the feasibility of detecting viral RNA in sewage and WWTP sludge, and the possibility of using these data for environmental surveillance, i.e., to monitor the prevalence of infections among the population via wastewater-based epidemiology (WBE).

Papers reported up till now indicate that coronaviruses remained active in sewage for a few hours-days (Barcelo, 2020; Hart and Halden, 2020; Heller et al., 2020; Michael-Kordatou et al., 2020; Randazzo et al., 2020a) , but, depending on the environmental conditions, may persist for up to 14 days, as reported by X. W. after cell culture testes. Thus, whereas the wastewater residence time in sewer systems is typically less than 24 h (Ye et al., 2016) , a substantial viral RNA load can reach the WWTPs. In this sense, Foladori et al. (2020) reported a viral RNA load in the sewage entering a WWTP with a range from 20 to 10 6 copies/L, which depends on the level of the epidemic. Recently, Zaneti et al. (2021) employed a quantitative microbial risk assessment (QMRA) approach to investigate the potential health risks of SARS-CoV-2 in sewage to WWTPs workers for three COVID-19 pandemic scenarios (moderate, aggressive, and extreme). The study estimated a viral RNA load in the sewage entering population is infected with SARS-CoV-2, Dada and Gyawali (2020) determined that the average disease risks for low-grade, moderate, and aggressive outbreak scenarios, respectively, are 0.036, 0.32, and 3.21 cases of disease per 1000 exposed WWTP workers.

WWTPs generally adopt conventional treatment processes, usually at a secondary or tertiary level, which, depending on the process and operational conditions, may be sufficient for the elimination of viruses. Typically, a 1.5 to 2 log 10 reduction can be expected for viruses in most activated sludge processes, which depends on the solids retention time; while, in the disinfection process, inactivation of 2, 3, and 4 log 10 can be Italy. In a more recent study, Guerrero-Latorre et al. (2020) detected SARS-CoV-2 RNA in rivers from urban streams from Quito, Ecuador, where sewage is discharged directly into natural waters. On 5 June 2020, during the peak case of COVID-19, the authors have found extraordinary high SARS-CoV-2 RNA loads, ranging from 2.07 × 10 5 to 3.19 × 10 6 copies/L. Unfortunately, in low-incoming countries, many areas still lack adequate sanitary infrastructure and wastewater treatment facilities, as well as still practice open defecation, resulting in fecal contamination of the environment and drinking water sources (Adelodun et al., 2019; Bain et al., 2014; Odih et al., 2020; Street et al., 2020) .

Therefore, the presence of SARS-CoV-2 in natural water may have different origins, such as inefficiency of WWTP (Rimoldi et al., 2020) ; release of a fraction of raw sewage into surface water, due to the lack of separation of urban runoff water from sewage, leading to combined sewage overflows (Farkas et al., 2020b; Rimoldi et al., 2020) ; or discharge of raw sewage directly into water bodies, which is a common practice in many parts of the world (Al Huraimel et al., 2020) , as in the case of Quito -Ecuador (Guerrero-Latorre et al., 2020), Nicaragua (Vammen and Guillen, 2020), Brazil (de Freitas et al., 2020; Gomes et al., 2020; Stepping, 2016) , and in the vast majority of low-income countries (Bastaraud et al., 2020) .

The presence of SARS-CoV-2 in sewage may also be an additional concern in communities or regions served by combined sewer systems, as urban flooding, a Miller et al., 2020) , where there is a need to share sanitary facilities, such as latrines, and due to the difficulty of maintaining a good hygiene and to access safe water. Yet, due to the disposal of sewage without proper treatment in nature, there are studies indicating recreational water as a potential transmission route for SARS-CoV-2 to humans (Cahill and Morris, 2020; Montagna et al., 2020) , and also a potential transmission of SARS-CoV-2 to aquatic mammals (Mathavarajah et al., 2020; . In fact, appropriate attention should be given to the treatment of sewage, principally when the recovery and (or) reuse of such water is desired (D'Alessandro et al., 2020) . The use of sewage either un-, partially or treated, for irrigationa common practice in developing countriesis also a matter of concern (Siddiqui et al., 2020), since the virus could still be present in the treated sewage if it has not been appropriately treated. So, in view of the current situation regarding the COVID-19 pandemic, a deeper discussion on the infectivity of the SARS-CoV-2 from sewage and contaminated water, as well as on possible fecal-oral and fecal-nasal transmissions, is urgent and mandatory. Figure 3 illustrates the main routes for SARS-CoV-2 to reach the watercourses. 

As earlier introduced, the occurrence of SARS-CoV-2 RNA in sewage and natural water is a reality covering the planet. The detection and quantification of SARS-CoV-2 J o u r n a l P r e -p r o o f Journal Pre-proof in environmental samples such as water and wastewater is mostly performed by using PCR based methods (Barcelo, 2020). Nevertheless, these methods are supported on nucleic acid amplification and the presence of fragments of the viral genome can be sufficient for the detection and even quantification of SARS-CoV-2 RNA (Corpuz et al., 2020; Xu, 2020) . However, the key issue is no longer about the detection or quantification of SARS-CoV-2 RNA, but about the infectivity of these viruses when present in water matrices like natural water and sewage. Therefore, the remaining question is, are they infectious or not? Virus (TGEV), assayed in delayed brain tumor and swine testicular culture cells, of 17 and 22 days, respectively, whereas in pasteurized settled sewage the values were even smaller, 7 and 9 days. On the other hand, at 4 °C, the reduction in infectivity was less than 1-log 10 after four weeks, regardless of the aqueous matrix and for both studied J o u r n a l P r e -p r o o f Journal Pre-proof coronaviruses. X. W. noted that SARS-CoV, assayed in Vero E6 cells, may survive in the sewage for 2 days at 20 °C and up to 14 days at 4 °C. In addition, viral RNA may be detected for more than 6 days after virus inactivation. Other authors also endorsed that the viral RNA can persist longer than infectious viral particles in different aqueous matrices (Bivins et al., 2020; . Ahmed et al. (2020b) observed 90% RNA reduction of MHV at 4-37 °C after 7.4-56.6 days in raw sewage, 5.6-43.1 days in autoclaved sewage, and 10.9-43.9 days in tap water, while the times for 90% RNA reduction of SARS-CoV-2 was 8.0-27.8 days in raw sewage, 5.7-43.2 days in autoclaved sewage, and 9.4-58.6 days in tap water. More recently, by using SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) isolated from a clinical patient diagnosed with COVID-19 and assaying on high-passage Vero E6 cells, Bivins et al. (2020) demonstrated that the SARS-CoV-2 can survive longer in tap water than in sewage, showing times for 1-log 10 reduction (90% reduction (T 90 ) of infectious virus particles) of 1.7 and 1.5 day, at room temperature, respectively. The authors also observed that SARS-CoV-2 remained infectious for three days in the low-titer (10 3 TCID 50 /mL) tests and for the entire seven days duration of the high-titer (10 5 TCID 50 /mL) tests. In another study, In fact, most human viruses are very difficult to maintain in vitro and their culture requires specialized equipment and trained personnel; hence, infectivity analyzes are rarely carried out on sewage or natural water samples (Farkas et al., 2020a; Maal-Bared et al., 2020) . Unfortunately, to our knowledge, there are only two studies addressing the infectivity of SARS-CoV-2 from raw and treated sewage and (or) natural water (Rimoldi et al., 2020; Westhaus et al., 2021) and one study assessing the infectivity of SARS-CoV in sewage (X. W. . As already mentioned, Rimoldi et al. It is of common knowledge that to carry out virus analysis the samples must be pretreated, especially those from environmental nature, and that filtration in a 0.22 μm pore-size filter is a routine practice. Conversely, it is also well known that the practices were established for analysis of non-enveloped viruses and are being adapted for enveloped viruses La Rosa et al., 2020b; Lu et al., 2020; Venugopal et al., 2020; , as is occurring with SARS-CoV-2. In addition, studies indicate that filtration through 0.22 μm pore-size filters can reduce the viral load and, thus, impair the infectivity analysis of enveloped viruses, especially those from the Coronaviridae family. Considering the cautiousness necessary to preserve the integrity of enveloped viruses such as SARS-CoV-2 in infectivity analyzes, the choice of the filter to be used in the sample pre-treatment seems to have an important role in this type of analysis. Besides, microfiltration is expected to remove the viral load by up to 2-log 10 (Asano et al., 2007) . Therefore, selecting a filter with a pore size of 0.45 µm instead of 0.22 µm seems to be more appropriate, when the main objective is the analysis of the infectivity of SARS-CoV-2 in water and sewage. However, these two filters can remove not only the sample suspended solids but also the virus fraction that is adsorbed to sample solids, as reported by Ye et al. (2016) . The 0.22 µm pore-size filter, being narrower, has a greater capacity for retaining the virus fraction that is not adsorbed to solids, because, as previously reported, SARS-CoV-2 has a particle size of 100-200 nm, which is very close to the pore size of the filter, which in this case is 220 nm. Moreover, it is also important to Xiao et al., 2020; and human airway epithelial cells . These studies, therefore, show that, despite being more laborious and expensive, by using TEM it is possible to visualize the virions and thus guarantee whether they are infectious or not. In fact, it is well known that cell culture is the gold standard for testing viral viability, but due to the capsid weakness of enveloped viruses, electron microscopy could or even (https://phil.cdc.gov/Details.aspx?pid=15523), respectively.

The available literature on the pathways for spread and infectivity of SARS-CoV-2 in environmental aqueous matrices (natural water and sewage) investigated to date were reviewed, indicating a wide availability of documentation on dissemination but just two papers addressing the infectivity of SARS-CoV-2 on sewage and (or) natural water samples. Despite the lack of data on the survival and infectivity of SARS-CoV-2 in water and sewage and the unconfirmed contagion via these aqueous matrices, the infectivity of these viruses must be thoroughly investigated to assess potential health risks, mainly regarding the possible transmission via fecal-oral and virus-laden aerosol borne-routes. This information would be extremely important, especially for communities with poor sanitation, where people are likely to be exposed to contaminated water or even raw sewage.

In fact, the humanity is building the knowledge about the infectivity of SARS-CoV-2, what is very important to combat, control, and mitigate the COVID-19 pandemic effects, for both purposes: to save lives and the global economy. Otherwise, the J o u r n a l P r e -p r o o f pandemic could last for a long time, causing much greater impacts than it has already caused. In the meantime, we must fight the ongoing pandemic by acting quickly but cautiously, assessing all possible routes of transmission. In the particular case of infectivity of SARS-CoV-2 in sewage and water, we believe that subsequent studies should address the following points:

 Assess the behavior of different filters in the pre-filtration stage of the sample, monitoring the pressure applied to determine the shear rate. Hence, choosing the filter that allows the passage of the largest fraction of live enveloped viruses, but that is also capable of removing the suspended solids from the sample. 

Wastewaterbased epidemiology pilot study to examine drug use in the Western United States

Persistence of SARS-CoV-2 in water and wastewater

Proteomics of SARS-CoV-2-infected host cells reveals therapy targets

SARS-CoV-2 in Detroit wastewater

Recreational waters -A potential transmission route for SARS-CoV-2 to humans?

Making Waves: Coronavirus detection, presence and persistence in the water environment: State of

Pre-labor anorectal swab for SARS-CoV-2 in COVID-19 pregnant patients: is it time to think about it?

Persistence of SARS-CoV-2 in the environment and COVID-19 transmission risk from environmental matrices and surfaces

Survival of surrogate coronaviruses in water

Overview of lethal human coronaviruses

COVID-19 infection: the China and Italy perspectives

Mutations strengthened SARS

Detection of SARS-CoV-2 in human breastmilk

Preparing for outbreaks -Implications for resilient water utility operations and services

SARS-CoV-2 in river water: Implications in low sanitation countries

Survival of coronaviruses in water and wastewater

SARS-CoV-2 RNA more readily detected in induced sputum than in throat swabs of convalescent COVID-19 patients

Urban flooding events pose risks of virus spread during the novel

Viral RNA load in mildly symptomatic and asymptomatic children with COVID-19

First environmental surveillance for the presence of SARS-CoV-2 RNA in wastewater and river water in Japan

Testing wastewater to detect severe acute respiratory syndrome coronavirus 2 in communities

Computational analysis of SARS-CoV-2/COVID-19 surveillance by wastewater-based epidemiology locally and globally: Feasibility, economy, opportunities and challenges

Value of viral nucleic acid in sputum and feces and specific IgM/IgG in serum for the diagnosis of Coronavirus Disease

COVID-19 faecal-oral transmission: Are we asking the right questions?

COVID-19: what is next for public health?

COVID-19: faecal-oral transmission?

Impact of potential COVID-19 treatment on South African water sources already threatened by pharmaceutical pollution

SARS-CoV-2 viral load in clinical samples from critically ill COVID-19

Viable SARS-CoV-2 in various specimens from COVID-19 patients

Aligning SARS-CoV-2 indicators via an epidemic model: application to hospital admissions and RNA detection in sewage sludge

The potential impact of water quality on the spread and control of COVID-19 in Syrian refugee camps in Lebanon

Detection and isolation of SARS-CoV-2 in serum, urine, and stool specimens of COVID-19 patients from the Republic of Coronavirus in water environments: Occurrence, persistence and concentration methods -A scoping review

First detection of SARS-CoV-2 in untreated wastewaters in Italy

SARS-CoV-2 has been circulating in northern Italy since

Survival of severe acute respiratory syndrome coronavirus

Tracking COVID-19 with wastewater

Persistence and clearance of viral RNA in 2019 novel coronavirus disease rehabilitation patients

Potential secondary transmission of SARS-CoV-2 via wastewater

Emerging study on the transmission of the Novel Coronavirus (COVID-19) from urban perspective: Evidence from China

Pit latrines may be a potential risk in rural China and low-income countries when dealing with COVID-19

Dynamic surveillance of SARS-CoV-2 shedding and neutralizing antibody in children with COVID-19

health risk, but also data source

Primary concentration -The critical step in implementing the wastewater based epidemiology for the COVID-19 pandemic: A mini-review

Implications of SARS-CoV-2 on current and future operation and management of wastewater systems

Coronavirus persistence on a plastic carrier under refrigeration conditions and its reduction using wet wiping technique, with respect to food safety

Tracking SARS-CoV-2 in sewage: Evidence of changes in virus variant predominance during COVID-19 pandemic

prevalence in the early stage of the epidemic in The Netherlands

Alert for SARS-CoV-2 infection caused by fecal aerosols in rural areas in China

Evaluation of SARS-CoV-2 viral RNA in fecal samples

Sewage analysis as a tool for the COVID-19 pandemic response and management: the urgent need for optimised protocols for SARS-CoV-2 detection and quantification

COVID-19 in Latin America: Novel transmission dynamics for a global pandemic?

Preliminary study of SARS-CoV-2 occurrence in wastewater in the Czech

Can beaches and bathing environments represent a risk of spreading COVID-19?

Risk of COVID-19 pneumonia in aquatic mammals

Detecting viral outbreaks in future using enhanced environmental surveillance

Editorial Perspectives: 2019 novel coronavirus (SARS-CoV-2): what is its fate in urban water cycle and how can the water research community respond?

Temporal detection and phylogenetic assessment of SARS-CoV-2 in municipal wastewater

Considerations for the waste and wastewater services sector. Case Stud

Cautious handling of urine from moderate to severe COVID-19 patients

Comment The challenges of informative wastewater sampling for SARS-CoV-2 must be met: lessons from polio eradication

Could water and sanitation shortfalls exacerbate SARS-CoV-2 transmission risks? Am

Ticking bomb: Prolonged faecal shedding of novel coronavirus (2019-nCoV) and environmental implications

Viral load of SARS-CoV-2 in clinical samples

Prolonged infectivity of SARS-CoV-2 in fomites

Faecal shedding of SARS-CoV-2: considerations for hospital settings

Sexual transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): A new possible route of infection?

Measurement of SARS-CoV-2 RNA in wastewater tracks community infection dynamics

SARS-CoV-2 can be detected in urine, blood, anal swabs, and oropharyngeal swabs specimens

Making waves: Wastewater-based epidemiology for COVID-19 -approaches and challenges for surveillance and prediction

Preliminary results of SARS-CoV-2 detection in sewerage system in Niterói municipality

The receptor binding domain of the viral spike protein is an immunodominant and highly specific target

Exploring challenges in safe water availability and accessibility in preventing COVID-19 in refugee settlements

Water Int. 1-6

Metropolitan wastewater analysis for COVID-19 epidemiological surveillance

SARS-CoV-2 RNA in wastewater anticipated COVID-19 occurrence in a low prevalence area

Presence and infectivity of SARS-CoV-2 virus in wastewaters and rivers

Aerosol and surface contamination of SARS-CoV-2 observed in quarantine and isolation care

Watcher in the wastewater

First detection of SARS-CoV-2 RNA in wastewater in North America: A study in Louisiana

Quantifying the risk of indoor drainage system in multi-unit apartment building as a transmission route of SARS-CoV-2

Irrigation system and COVID-19 recurrence: A potential risk factor in the transmission of SARS-CoV-2

Aerosol persistence in relation to possible transmission of SARS-CoV-2

Urban sewage in Brazil: drivers of and obstacles to wastewater treatment and reuse

Structural features of coronavirus SARS-CoV-2 spike protein: Targets for vaccination

Wastewater surveillance for Covid-19: An African perspective

Isolation of infectious SARS-CoV-2 from urine of a COVID-19 patient

Detection of novel coronavirus by RT-PCR in stool specimen from asymptomatic child

Aerosol transmission of J o u r n a l P r e -p r o o f SARS-CoV-2? Evidence, prevention and control

Making waves: Wastewater surveillance of SARS-CoV-2 for population-based health management

Necessity for detection of SARS-CoV-2 RNA in multiple types of specimens for the discharge of the patients with COVID-19

SARS-CoV-2 genomic variations associated with mortality rate of COVID-19

Post-lockdown detection of SARS-CoV-2 RNA in the wastewater of Montpellier, France. One Heal

Environmental side effects of the injudicious use of antimicrobials in the era of COVID-19

Water resources of Nicaragua and COVID-19: Between panic and apathy? Brazilian

Novel wastewater surveillance strategy for early detection of coronavirus disease 2019 hotspots

COVID-19 may transmit through aerosol. Ir

Disinfection technology of hospital wastes and wastewater: Suggestions for disinfection strategy during coronavirus Disease 2019 (COVID-19 ) pandemic in China

Detection of SARS-CoV-2 in different types of clinical specimens

Fecal viral shedding in COVID-19 patients: Clinical significance, viral load dynamics and survival analysis

Concentration and of the Chinese People's Liberation Army

Concentration and detection of SARS coronavirus in sewage from Xiao Tang Shan Hospital and the 309th Hospital

Understanding air and water borne transmission and survival of coronavirus: Insights and way forward for SARS-CoV-2

Diarrhea is associated with prolonged symptoms and viral carriage in Corona Virus Disease

Detection of SARS-CoV-2 in raw and treated wastewater in Germany -Suitability for COVID

Virological assessment of hospitalized patients with COVID-2019

Weekly operational update on COVID-19

SARS-CoV-2 titers in wastewater are higher than expected from clinically confirmed cases

Prolonged presence of SARS-CoV-2 viral RNA in faecal samples

Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection

Infectious SARS-CoV-2 in feces of patient with severe COVID-19

Prolonged viral shedding in feces of pediatric patients with coronavirus disease 2019

Persistent shedding of viable SARS-CoV in urine and stool of SARS patients during the convalescent phase

Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission

Can the novel coronavirus be transmitted via RNAs without protein capsids?

Structural basis for the recognition of SARS-CoV-2 by full-length human ACE2. Science (80-. )

Estimation of the potential spread risk of COVID-19: Occurrence assessment along the Yangtze, Han, and Fu River basins in Hubei

The potential exposure and transmission risk of SARS-CoV-2 through sludge treatment and disposal

Survivability, partitioning, and recovery of enveloped viruses in untreated municipal wastewater

Enteric involvement of coronaviruses: is faecaloral transmission of SARS-CoV-2 possible?

Quantitative detection and viral load analysis of SARS-CoV-2 in infected patients

Sewage as a possible transmission vehicle during a Coronavirus Disease 2019 outbreak in a densely populated community

Indirect effects of COVID-19 on the environment

QMRA of SARS-CoV-2 for workers in wastewater treatment plants

Potential spreading risks and disinfection challenges of medical wastewater by the presence of Severe Acute Respiratory Syndrome Coronavirus

RNA in septic tanks of Fangcang Hospital

Disinfection threatens aquatic ecosystems. Science (80-. )

Isolation of 2019-nCoV from a stool specimen of a laboratory-confirmed case of the coronavirus disease 2019 (COVID-19)

Transportation characteristics of bisphenol A on ultrafiltration membrane with low molecule weight cut-off

Viral load dynamics and disease severity in patients infected with SARS-CoV-2 in Zhejiang province

The authors gratefully acknowledge to the Brazilian funding agencies (CAPES, CNPq, 

☒ The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. ☐The authors declare the following financial interests/personal relationships which may be considered as potential competing interests:J o u r n a l P r e -p r o o f