@article{kotlarz_holcomb_pasha_reckling_kays_lai_daly_palani_bailey_guidry_et al._2023, title={Timing and Trends for Municipal Wastewater, Lab-Confirmed Case , and Syndromic Case Surveillance of COVID-19 in Raleigh, North Carolina}, volume={113}, ISSN={["1541-0048"]}, url={https://publons.com/wos-op/publon/54927766/}, DOI={10.2105/AJPH.2022.307108}, abstractNote={Objectives. To compare 4 COVID-19 surveillance metrics in a major metropolitan area. Methods. We analyzed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater influent and primary solids in Raleigh, North Carolina, from April 10 through December 13, 2020. We compared wastewater results with lab-confirmed COVID-19 cases and syndromic COVID-like illness (CLI) cases to answer 3 questions: (1) Did they correlate? (2) What was the temporal alignment of the different surveillance systems? (3) Did periods of significant change (i.e., trends) align? Results. In the Raleigh sewershed, wastewater influent, wastewater primary solids, lab-confirmed cases, and CLI were strongly or moderately correlated. Trends in lab-confirmed cases and wastewater influent were observed earlier, followed by CLI and, lastly, wastewater primary solids. All 4 metrics showed sustained increases in COVID-19 in June, July, and November 2020 and sustained decreases in August and September 2020. Conclusions. In a major metropolitan area in 2020, the timing of and trends in municipal wastewater, lab-confirmed case, and syndromic case surveillance of COVID-19 were in general agreement. Public Health Implications. Our results provide evidence for investment in SARS-CoV-2 wastewater and CLI surveillance to complement information provided through lab-confirmed cases. (Am J Public Health. Published online ahead of print November 10, 2022:e1-e11. https://doi.org/10.2105/AJPH.2022.307108).}, number={1}, journal={AMERICAN JOURNAL OF PUBLIC HEALTH}, publisher={American Public Health Association}, author={Kotlarz, Nadine and Holcomb, David A. and Pasha, Tanvir and Reckling, Stacie and Kays, Judith and Lai, Yi-Chun and Daly, Sean and Palani, Sivaranjani and Bailey, Erika and Guidry, Virginia T. and et al.}, year={2023}, month={Jan}, pages={79–88} }