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    Scene ofthe Tt ave 74 (2020) 40046 Science of the Total Environment ELSEVIER journal homepage: www. Contents ists available at ScioneoDirect sevier.com/locate/scitoteny Review SARS-CoV-2 in the environment: Modes of transmission, early detection and potential role of pollutions Khaled Al Huraimel, Mohamed Alhosani, Shabana Kunhabdulla, Mohammed Hashem Stietiya * ison of Conan Reseach maar (Ct), Sharh Envroamen Company eeu, haya, Une Arab Emiaes HIGHLIGHTS + Environmental knowledge on SARS- CoV-2 can be beneficial in establishing efloctve policies fr curing fure pane ‘emi + Robust evidence is needed to validate SSARS-CoV-2 transmission via aerosol and foecaForal routes. + SARS-CoV suvelance by wastewater- ‘sed epidemiology can be efectve in aly detection of COVID-19 within a population + Robust evidence i needed to astess (COVID-19 spread a impacted by ap lution and sewage contamination of water bodies. ARTICLE INFO ‘le sy Received 27 May 2020 Receive neve fern 2 one 2020, ‘cep 11 uly 2000 ‘lite onine 15 ay 2020 tor: Eva Koreiewska evo coup.19 Enwronment content Wastewater epdeilogy Airpation ates of tani GRAPHICAL ABSTRACT 7 Fro * ronenege? g e fe = Covi Seem cart ABSTRACT ‘he coronavirus disease 2019 (COVID-19) is spreading globally having a profound elect on lives of milion of peo- ‘le, causing worldwide economic spon. Curing the spread of COVID-19 and future pandemics may be accom ‘lished through understanding the envionnenal context of severe acute respiratory syarome corosvirs 2 (SARS-CoV-2) and adoption of fetve detection ols and mitigation polices. This arte aims to amine the at- ‘stinvestigatons on SARS-CoV 2 plausbe envronmeatl transmission mades employment of wastewater suvel- lance for early detection of COVID-19, and clucdatng the rl of solid waste water, and atmospheric quality on Vial infectivity Transmission of SARS-CoV via faea-oal or bo-aerosols lacks robust evidence and remains debatable. However, improper disinfection and defected plumbing ystems in ndor environments sch 2s hospitals and high- tise towers may acitate the transport of vrs-laden droplets of wastewater causing infection Clinical and epi ‘miologial tues are needed! to present robust evidence that SARS-CaV-2 is ransmissible via serosal, though ‘quantification of vru-laden aerosols 2 low concentrations presents a challenge. Wastewater surveillance of ‘SARS CoV-2.can bean effective tol in early detection of outbreak and determination of COVD-19 prevalence within 12 population, complementing clinical testing and providing decision makers guidance on restricting or relaxing ‘movement. While oor ar quality increases suscepti to dseases, evidence for ar pollution impact on COVID- 19 infective isnot avaiable as infections are dynamically changing worldwide. Solid waste generated by house- holds with infected individual uring the loceown period may fitate the spread of COVID-19 via fom tans- mission route but has recive ite attention frm the scientific enmmunity, Wate bdies receiving raw sewage ‘may pose riskofinfecion bur thishasnotbeen investigated to date Overal or understanding ofthe environmental perspective of SARS-CoV-2 is imperative to detecting autreak and pedi pandemic severity, allowing usto be “equipped wih height Cols ocr any future pandemic (©2020 The Authors Published by Elsevier BV. This isan open access article under he CCBY-NC-ND license (tp _ceativecommonsorgficensesoy-nend A) + Corespnding autor Division of Constancy Resch notion, The Sho Evanment Co, Bah, oie Rab Shah Unie Arab ates ‘Pod aduese msejaotecahoe (MH Stet) iaps:dtong 101016) score 20201946 (aA 987962000 Te ators ub by Else BN. Tiss an open acess arte under the CCBY-NCND iene (tp resecommonsongcmnsesty--n 40), 2 Atari ca Sec othe Tt Enonmen 744 (2020) 40505, contents 1. Introduction... 2. Modes of ervizonmental transmission. 2, SARS-CoV-2 in stool & sewage 22. SARS-CoN-2 in airenvionment 22:1, _ Indoor environment 222: Outdoor environment. 223. _Airpolhion and CoviD-19 23, SARS-CoV-2 in slid wast, 2, SARS-CoV-2in natural water 3. Wastewater surveillance for environmental detection of COVID-19 infections 4. Strategies to combat fture pandemics 41, Wastenater suncllace 42. Acqua indoors and outdoors 43. Solid waste 5. Limitations 5 Conclusion Acknowledgments « References 1. Introduction ‘The outbreak ofthe navel coronavirus SARS-CoV-2 was reported in, ‘Wuhan, China atthe end of December 2019 where cases of pneumonia in people associated with the wet market had been confirmed as cases ofthe novel coronavirus (Holshue etal, 2020)-Shortly after, it was de- clared as a pandemic by the World Health Organization (WHO) with over 87 million COVID-19 confirmed cases as of june 21, 2020 (WHO, 2020c). The spread ofthe pandemic resulted in worldwide lockdowns ineffort to “fatten the curve" and not overwhelm health care institu- tions (Lauet a, 2020). The key to interrupting the chain of transmission is isolating infected people and tracing back those who they have interacted with (Khanna et al, 2020; Larsen et al, 2020), Human-to- human transmission occurs during the virus incubation period of 2-10 days with spread being facilitated through droplets, contaminated hhands and surfaces (Enyoht etal, 2020; Kampf etal, 2020). An inter- personal distance of at least 2 m was prescribed to minimize the risk ‘of contagion through the droplets (CDC, 2020; Sett etal, 20200), ‘Numerous research articles have been recently published assessing the plausible modes of environmental transmission of SARS-CoV-2 and spread of COVID-19 through environmental analysis. There is no Conclusive evidence for aerosol oF faecal-oral transmission of SARS- oV-2 despite several researchers considering them as plausible routes that may explain the high infectivity and global spread of COVID-19 (Chen etal, 2020; van Doremalen etal, 2020; Wang etal, 2020a).Ad- ditionally, environmental parameters have been utilized to assess the spread of COVID-19 within a population through wastewater surve lance as well as attempts to predict the severity of the pandemic through analysis of atmospheric pollution of cites. Solid waste manage- ‘ment is another aspect of paramount importance that may contribute to the spread ofthe pandemic within the community but that has not re- ceived much attention within the scientific community. Only two stud- jes were found analyzing SARS-CoV-2 RNA in natural water bodies receiving raw or treated sewage waters with difering results, and its ‘unclear i there is any isk of infection, particularly in rereational wa- ters where people are in frequent contact (Guerrero-Latorte etal 2020; Odih etal, 2020; Usman etal, 2020), From the literature studied, concems of COVID-19 infection through environmental contact pertain ‘mainly to ateas that lack proper sanitation and wastewater treatment, lack adequate solid waste management infrastructure in areas where raw sewage is discharged directly into natural water bodies and in cit- ies where ar pollution is problematic. Although there has not been any evidence presented that validates environmental transmission routes, the lack of sanitary and waste infrastructure is likely to increase the probability of human contact with contaminated material the impact ‘of whichis yet tobe investigate. ‘The importance of the understanding of SARS-CoV-2 within the en- vironmental contexts to assist in establishing effective polices for mit- igating the transmission of the disease and combating future pandemics. Only a stall numberof published articles have investigated the environmental perspective of COVID-19, Barcelo (2020) presented ‘an opinion paper summarizing environmental and health aspects re- lated to the monitoring fate, and treatment solutions for COVID-19. “The objectives of this review are to present the latest investigations on SARS.CoV-2 plausible environmental transmission modes (aerosol and faecal-oral pathways) and employment of environmental tools for carly detection of COVID-19 (wastewater surveillance) and prediction ‘of severity of viral infections through associations with atmospheric pollution. The overall aim isto assist in setting policy priorities for mit- ligating the current and future pandemics through environmental un- derstanding of SARS-CoV-2. 2. Modes of environmental transmission “The major mode of transmission of SARS viruses i through exposure to droplets of respiratory secretions from an infected person (5 um), indirectly through forte transmission from contact wit contaminated ‘objects, or possibly by faecaloral routes and air borne transmission (Wang etal, 2005: Ye etal, 2016; Kitajima etal, 2020; Naddeo and Liu, 2020), Faeca-oral routes and aerosol transmission have not been validated as exposure routes as there is not enough evidence to prove that SARS-CoV-2 transmission is possible by aerosol or wastewater. However, alarming infection incidents among health care workers, ‘ruise-ship and airplane passengers point tothe likelihood of addtional transmission mechanisms in confined spaces with dense populations (Nghiem et al, 2020). Wu etal. (2020b) agreed that potential faecal- ‘oral transmission may pose risk in cruise ships, public transportation, hostels and dormitories but unlikely in hospitals or quarantine facilities. Although Grunig tal (2020) concluded that faecal-oral transmission had likely played a role in amplifying the pandemic in Wuhan (Grunig ‘etal, 2020), the datas based on literature review of SARS-CoV not on research investigation, On that basis, itis plausible that sewage could serve as vectors for coronavirus (Ye et al, 2016; Zhang etal, 2020). Re- searchers have also postulated thatthe spread of COVID-19 solely by re- spiratory droplets and close contact did not seem to explain the vast spread of the disease in various parts of the world such as Italy, and thus airborne transmission has been investigated (Sett etal, 2020c). Cleat, the alarming infection rate of SARS-CoV-2 may suggest several ‘Altria a See ofthe Tt moenent 7442020) 140506 a plausible transmission mechanisms. Table 1 summarizes the latest re- search articles proposing various modes of SARS-CoV-2 transmission and arguments presented. 2.1, SARS-CoV.2in stool & sewage Coronavirus RNA has been detected inthe stool of symptomatic and asymptomatic SARS and COVID-19 patients, indicating that transmis- sion may be possible via the raw sewage network (facal-oral) (Wang, et al, 2005; Gundy et al, 2009; Ahmed et al, 2020; Holshue et al, 2020, Wang etal, 20202; Wolfe etal, 2020; Wu etal, 20200; Zhang, etal, 2020). Te incidence of diarrhea in SARS cases raised concern about its potential environmental transmission where viruses are ‘more stable in diarrheal stool due to the higher pH, reaching upto 4 days as opposed to 1-2 days for normal stool (Gundy et al, 2008) Nevertheless, live SARS-CoV-2 was observed in stol of 2 patients who «lid not have diarrhea (Wang et al, 2020a). SARS-CoV can persist in sewage for 14days at 4 and for2 days at20°C, and its RNA can be de- tected for 8 days. (Gundy etal, 2009; Wang.et al, 2005), SARS-CoV RNA ‘was detected in 97% ofstol samples from patients infected with SARS (eiris etal, 2003), while detected in 57% of samples in another study by He etal (2004) "Numerous researchers have attempted 10 assess whether sewage systems were plausible transmission pathways of coronavirus (Barcelo, 2020; Gormley eta, 2020; Grunig et al, 2020). Ics unlikely for SARS-CoV-2 tobe transmitted via wastewater or present any signi ‘cant risk of infection due to viral sensitivity to disinfectants and poor stability in environmental conditions (Randazzo et al. 20200; Rimoldi etal, 2020). Coronavituses are enveloped viruses that have lipid bi- layer membrane outside the viral protein capsid, which contains pro- teins or glycoproteins. The structural difference with nonenveloped Viruses may have an impact on their survival in aqueous environments, ‘where their lip layers are sensitive tothe detergents and organic sok vents (Ye et al. 2016). Gundy et al. (2008) found that coronavirus dies off very rapidly in wastewater, with a 99.9% reduetion in 2-3 days due toaction of solvents and detergents. Thus, while genetic fragments re- ‘main detectable in wastewater, the virus likely becomes non-viable ‘once the envelope is damaged (Ye etal, 2016; Nghiem et al. 2020) {At two hospitals receiving SARS patients in Beijing. China, SARS-CoV. RNA was detectable in concentrates of sewage prior to, and occasionally after disinfection by chlorine but there was no live SARS-CoV (Wang, etal, 2005), SARS-CoV-2 was detected in faeces (Wang etal, 2020) and its RNA was detected in both faeces and urine (Sun et al, 2020; Xigo et al, 2020), while other attempts failed to cultivate the virus from faeces (Wolel etal, 2020) or treated wastewater (Rimoldi et a 2020). Raw sewage with improper disinfection in hospitals containing patients’ excrements may be a possible transmission path (Wang ct al, 2005). However, accidental contact with treated wastewater through aerosols or droplets should not call for public concem as poten- tial risk of infection seems to be negligible (Rimoldi et al, 2020). Contact with raw wastewater particularly in areas with poor sanitation may be potential routes of transmission posing risk of infection (Grunig eta, 2020; Loder and Husman, 2020; Rimoldi et al, 2020). In fact, contact with, and contamination by sewage water has been reported to be ‘rbier Repos possible modes of wansmsson of COVD-19. “sais Propo mode of Presented auc “Sonora al (2020); van Dorenulen eral Fone wansmission (2020) Eyota. (2020) Ma ap Clas (2020; Nghiem ea. (2020) Femi (tansmison via soi wast banding) ‘Wang ea. 20206) Posy of eal ~ ral routes vet (2020) Pause fara naz ct (20200) Until facl- ra (orastnater Pasi ara ‘hen et a (2020) an ea (2020) Pasi ea ra eter tal 2020): Niet (2020) 08 fet al (2020) Wong etal 2620); Enyoh et ak Psi foal routes (ansmison va seas) (220) ‘an Doremalen tal (2020) ‘Aerosol ransmision Murelo (2020) Aerosols (wastewater ‘reament) occa (2020) ‘retin to human Frooteraet al (2020) ‘peta to human ormiey ea 2020, ers ranmisson (transmission vis engnered water systems) eet a (20208) erst borne ransom Mansa and Co (2020) Samaria et a (2020) Detected SARS-CoV on sues icling personal Hens et, oom sacs and floor sures lst sans ste copper and cardboatd up today Fersistece on animate ses sche wood rami lamin sas Waste containers, bags or days. Detected ie SARS CoV-2n fees, suggesting possible fac rl ansmison Informacion on how fregumy vale vrs is present inpatient tooland the ange of tira eads were ot present Rtl sab wasted postive with SARSCoV-2 RNA prs when esate nasopharyngeal sts were oe idence of epltion-competent vrs in faecal swabs was not reset. Disinfection elects hy to nactateSAR-COV-2 COVID-19 with postive ress of is cc acd na fac specimen ae neatve results on mali parnge and sputum spe ‘The si dd ne report presence ive SARS CoV 2 vrs and other evidences prove the ranmision ath, Showed angiotensin onvesting enzyme (ACE2 8 abundantly expressed in he indus cells a gst, duodenal and rectal eithe hvough mmcauaresceat ining of gastrnntestal atoes Dao SARS-CaV2 le vars ws publ. Precise mechanisms By which SARSCoV2 neat with the stronetnl ar was ot presented Review tes postulating hat presence of SARS-CoV in sewage aso could ead {o pone ea orl ananissen va sersaizton rm allt stg. sky umbing system et lar wo SARS-CoV Detected vale SARS-CoV n aero for ours with ess echo SARS CoN. stud aerosol eansmisio by pod SARS-CoV 2s in tol and probable exposure wacrsol Flan cteswitymre ar pli a higher numberof ifctedindeas, 23 mean conection in reas of China ad aly ost alte by COVID-19, ha vastly excedthe hourly standard o75 we erosazton rom defecive plumbing 5m with wastewater conning Wal ad veto ntereonectednes ol prs ofthe Bldg by the wastewater plumbing Detection of SARS-CaV-2 RNA on atic mater. Review tay posting the eral transmis on esearch on SARS CO2 simary with SARS-COV, dope dynamics and alow in bugs. Detection of SAR CoV nai samples both inthe ooms andi he hallway spaces of OVID =19 patent rooms 4 Atari ca Sec othe Tt Enonmen 744 (2020) 40505, responsible for an outbreak of SARS CoV-1. The outbreak occurred in Hong Kong in 2003 involving 341 patients and 42 deaths due toa faulty wastewater plumbing system in a high-rise building (Peri etal, 2003). “The defected plumbing system facilitated the transport of virus laden , NOs and CO (Wang eal, 2020b). Similarly, Sharma eta. (2020) re ported a deci in AQ and reductonin concentrations polltansex- ect for 60> when comparing March and April of 2020 with previous years. In these studies, it was reported that O: concentrations had in creased during the COVID-18 control period possibly due to reduction of PM concentrations causing more suit to passthrough the atm sphere encouraging more higher 0; production (Sharma eta. 2020). Otner researches have reported that concentrations of PM, exhibited significant reduction in several cites in China, ut not enough to avoid Severe air pollution events during lockdown likely atibutd to unfa- vorable meteorological conditions Wang eal, 2020). The decrease Jnaiepollation may have reduced the number of non-communicable cliseases and fatalities, where 6% reduction in mortality was postulated due to aie pollution reduction, equivalent to saving 100,000 lives in Ghina alone (Datel eta, 2020). ‘Air pollution hasbeen linked to SARS. CoV.2 viral infections through ‘the impacto poor ir quality on human health and susceptibility viral infection (Wu eal 2020), and evidence s not available for pollutant pails suchas PM and NO, acting as vectors despite suggested by some researcvers (Panini and Fornaca, 2020). Ar polation i known {o cause inlammatin, cellular damage tespittory diseases and may suppres ealy immune response to infection (Wet al, 2020) For ex- ample PMyoand PM, have been linked to pneumonia an chronic pul- ‘monary diseases (Pansini and Fornacca, 2020: Wu etal, 2020¢). Numerous investigations have attempted o assess the relationship be- ‘ween air pollution and severity of COVID-19 around the word. Some studies show that people living in pollute areas are more vulnerable to SARS-CoV-2 infections and induced mortality as they are more prone to developing chronic respiratory conditions (Conticini etal, 2020; Margante etal, 2020; Pansini and Fomnacca, 2020; Zn etal, 2020). Concentrations of PM exceeding limits may increase the suscep” ‘ibility of COVID-19 infected individuals to respiratory complications ‘while oxidant pollutants may impair the efficiency of lungs to clear the viru (Quetal, 2020), Several studies have investigated exceedance Cf PM and its corrlation with COVID-19 infectivity and lethality. ust small increases of long-term exposure 0 PM (1 ugim? increase) were found tobe associated with an 8% increase in the COVID-19 death atein the US (Wu etal, 2020c).One ofthe worlds mosh oun- {wie with COVID-19 cases an ftaitiesis aly and several studies have Jnvestigated the correlation between cases and air pollution, The re- sions of Lombardy and Emilia Romagna ae one of Europe's most pol- Juted areas and have exhibited the highest level of virus lethality in the world (Contin eal, 2020), Some researchers eported correlation between COVID-19 incidents and air pollution (Coci, 2020; Sete al, 20203), witile others found thatthe correlation was not evident (Hontempi, 2020). For example, Sett et a. (2020a) reported that exceedancein daily PM beyond limits appeared tobe significant pre- dictor of infection with COVID-19. Similarly, the number of infected people was higher in Italian cities with 100 days exceeding limits set for PMo or ozone, having alow wind speed and lower temperature (Coccia,2020).On the other hand, Bontempi (2020) reported that ditect Correlations between high concentrations of PMyo and diffusion of CCOVID-19 virus in Lombery and Piedmont, Italy were not evident. In particular, cities with highest PM pollution (Torino and Alessandria) hha low infections cases, while Bergamo which exceeded PM} concen- tration only few times, exhibited the highest infectious cases (Bontempi, 2020). Like PM, several studies have linked vial infectivity twexceedances in the other criteria pollutants, SARS.CoV-2 viral infec- tions in China USA, and tay were found to be higher in areas aficted by carbon monoxide (CO) and nitrogen dioxide (NO2), while higher ‘mortality rates were found tobe in areas corvelated with high particu- late matter (PMz3).CO, and NOs (Pansini and Fornacca, 2020). Zhu etal (2020) observed positive associations of PMs, PMio. CO, NO>, and 0} with COVID-19 confirmed cases, and that short-term exposure to these pollutants is associated with increased risk of infection with covib-19. {In terms of interpretation of how air pollution may enhance the spread of COVID-19, there are several point of view based on reasoning rather than on robust evidence. Several researchers view that the extent to which COVID-19 has spread in many countries cannot be solely ex- plained by just exposure to droplets of respiratory secretions from an in- fected person or through fomite transmission from contact with contaminated objects. Setti et al.(2020b) postulated that through at- borne transmission, PM could act as a droplet carver, triggering the spread ofthe virus. However, the capability of this coronavirus to bind particulate matters remains tobe established, but could be through ad- sorption (Fattorini and Regoli, 2020; Qu etal, 2020). Air borne trans- ‘mission of SARS-CaV-2 has been postulated by Morawska and Cao (2020) as explanation to the trend in the increase of infections, and that air transmission should be seriously considered during the course ofthis pandemic. Under high PM concentration and atmospheric stabil ity, viruses may create clusters with the PM reducing thei diffusion co- elicient and enhancing abundance into the atmosphere (Setti et a. 2020¢), Sett etal. (2020c) presents the frst evidence of SARS-COV-2 RNA presence on outdoor PM through analysis of 34 PM,o samples of ‘outdoorarborne PMo from an industrial site of Bergamo Province. However, correlation between the presence of virus on PM and COVID-19 outbreak progression has not been confirmed in tha study, and links between air pollutants and the pandemic has not been val- dated (Seti etal, 20200), 23, SARS-CoV-2in solid waste Few review articles were found on coronavirus oF SARS-CoV.2 in ‘municipal slid waste materials while no experimental esearch articles were found The reason maybe that SARS-COV-2 infected wastes typi- Cally generated from medical centers and hospitals which ae then in- Cinerated. However, with the worldwide lockdown and sel- «quarantine measures, solid waste containing viable SARS-CoV-2 are likely generated tthe household level rom COVID-19 infected indvid- uals posing sk of infection to front ine waste workers (Nghiem eta 2020), In that regard, Mol and Calas (2020) report tat spread a the Coronavirus may be increased by inadequate waste management ‘through poor handing conditions particulary in developing countries with poor waste management strategies. Khael (2020) reported that 3s many ofthe coronavirus patent in Nepal ar asymptomatic con {aminaed solid waste may result in transmission to waste collectors and pickers and then retransmission back othe community. Adition- lly, some of the waste materials are old in informal markets to poor people, posing addtional risk of infection (Kharel, 2020). n Nigeria, Soll wastes are dumped in poorly managed dumpsites which are scav- enged for recyclable materials and food for livestock, posing isk of 6 Atari ca Sec othe Tt Enonmen 744 (2020) 40505, Infection with COVID-19 and exacerbating its spread within the com- ‘munity (Nzediegwu and Chang, 2020) Even in developed nations the ‘generation of glove and medical mask waste from households poses risk of infection and environmental poution considering thatthe sut- Vival time of SARS-CaV-2 on hard surface and plastics inthe order of days (Nghiem et al, 2020; Saadat et al, 2020). There is not any pub- lished evidence for transmission of SARS-CoV-2 via solid waste route and the topic has not received attention from the scientific commarity ‘What is currently present in the literature relates to the fomite trans ‘mission route of SARS-CoV-2 rather than solid waste and management as plausible routes of transmission. in that regard, Aboubakr etl. (2020) presents the latest investigations on persistence of SARS-CoV-2 in non-porous surfaces (plastic, metal, glass, metals) and porous sut- faces (paper, cardboard), which may assist in understanding the viral persistence ofthe same material in solid waste. SARS-CoV-2 for exam- ple was reported to survive longer on surfaces of higher porosity suchas surgical masks than on surfaces of lower porosity such as paper (Aboubakr etal, 2020), providing insight on viral persistence on gloves and mask waste generated from households during the lockdown pe- fiod, SARS-CoV-2 was also found to be more stable on plastic and stain- less steel than on copper and cardboard and! despite it high stability in favorable environments itis nevertheless susceptible to standard disin- fection methods (Chin etal, 2020; van Doremalen et al, 2020; Kampf et al, 2020), Much ofthe information on SARS-CoV-2 persistence on solid surfaces is deduced from previous coronavirus studies (Aboubakr etal, 2020; Kampf et al, 2020). The limited available data on SARS- CoV-2 persistence on solid surfaces and solid waste materials cals for the need to elucidate solid waste and its management practices with COVID-19 spread. 24 SARS-CoV-2 in natural water Itisimportant to understand the fate of SARS-CoV-2in the water en- vironment to ensure public health protection measures are suitably set in place (Naddeo and Liu, 2020). However, there is currently limited dala on the presence and viability of SARS-CoV-2 in water bodies (Cahill and Morris, 2020). Aboubakr etal (2020) presented a review of studies on persistence of coronaviruses in chlorinated and dechilorinated water, which may help to understand the persistence of SARS-CoV-2 in waters, SARS-CoV-2 in the water environment may Find its origin in the discharge of raw sewage into water bodies which is common practice in many pats of the world lack of basic sanitation resulting in contamination of drinking water sources, accidental con- tamination by raw sewage, or where performance of sewage treatment plants is sub optimal (Guerrero-Latorre etal, 2020; Odih et al, 2020; Usman etal, 2020). Guerrero-Latorre etal, 2020 detected vial loads of SARS-CoV-2 from rivers in urban streams of Quito, Ecuador where wastewater is discharged into river streams. On the other hand, Haramoto etal. (2020) did not detect SARS-CoV-2 RNA in river water samples in Japan despite its detection in secondary treated wastewater. “The risk of SARS-CoV-2 presence in sewage water cannot he neglected (WHO, 2020a), and contracting the virus via water sources is unknown and has not been investigated to date. The need to investigate is high particulary in developing countries with poor water and sewage infta- structure where the probability of faecal material reaching natural ‘water bodies is high. There is also no evidence of potential aerosolized SARS-CoV-2 originating from wastewater used for irrigation (Usman etal, 2020), With research progres, the implications of research find- ings on SARS-CoV-2 in the water environment will assist public health oficial in devising the proper mechanisms to protect the general pub- lic. There ae alot of aspects to be taken care of starting from the dis fection atthe source, proper distribution, collection and safe practices for storage. Conventional treatment systems lke chlorination and UV Aisinfection are expected to remediate COVID-19 presence in water sys- {ems similar to other coronaviruses (Peeson et al, 2020; WHO, 2020a). 3. Wastewater surveillance for environmental detection of COVID- 19 infections Since wastewater contains viruses excrete from infected individ- uals in a given wastewater treatment plant catchment population, ‘wastewater surveillance and quantification of SARS-CoV-2 en be ane fective olin estimating the number of infections ina community atan aly stage ofthe outbreak (Ahmed eal, 2020; Mallapay, 2020; Wu etal, 20203). Te early detection and determination of SARS-CoV-2 prevalence in a population can assist policy makers in formulating the appropriate mitigation policies and help to ensure healthcare institu- tions are no overwhelmed (Mao et a, 2020; W et a, 20203). SARS- (CoV-2 RNA is detected in wastewater using Real-Time Reverse- “Transcriptase-Polymerase-Chain-Reaction Testing (RT-qPCR) (Loder and Husman, 2020; Mao etal, 2020; Randazzo et al, 2020), Wastewa- ter RT-gPCR was reported tobe a sensitive and reliable technique for «aly detection of SARS-CoV-2 outbreaks (Randazzo etal, 20205). Iis itmpostant to note that RNA detection in wastewater i ot indicative ‘of viable virus that is transmissible (Nghiem etal, 2020; WHO, 20203, 20200). Genetic material of SARS-CoV-2 has alteady been detected in ‘wastewater samples from the Region of Valencia, Spain (Randazzo eal, 2020a). Amsterdam Aiport Schiphol, Netherands (Loder and Husman, 2020), Australia (Ahmed et al, 2020), Massachusetts, USA (Wuet al, 2620) France (Wurtzer etl, 2020), Milan, Italy (LaRosa etal, 2020; Rimoldi etal, 2020, Istanbul, Turkey (Kocamemi etal, 2020) and China (Wang et al, 2020). The fact that wastewater samples at Amsterdam Airport Schiphol and in Tiburg, Netherlands tested pos- itive for viral RNA by quantitative RI-PCR methadology only days after the confirmed cases of COVID-19 in the country shows the sensitivity of this surveillance sytem and how it can serve a an early warning tool (Lodder and Husman, 2020). Randazzo etal. (2020a, 20206) re- ported detection of SARS-CoV-2 RNA in wastewater when only 0-76 ‘cases were reported in Valencia and 12-16 days before COVID-19 ‘cases were delared in 3 out of 6 municipalities in Spain. However, there isa lack of standardized protocol forte detection of SARS-CoV- 2in wastewater with discrepancies among KT-qPCR NI, N2 and N33s- Says: Masive population tests should be the fist choice but wastewater monitorization may provide a reliable picture ofthe situation (Kajima etal, 2020; Randazzo eta, 20206). Wastewater surveillance may serv as a complementary approach to clinical testing campaigns fr assessing the prevalence of COVID-19 in a community (Wa etal, 2020) One wastewater teatment plant «an capture wastewater fom more than a milion residents providing, ‘an estimate ofthe prevalence of COVID-19 within a large population (Mallapaty, 2020), Wastewater-baed epidemiology (WEE) has some benefits over clinical testing particularly fr poor nations with limited resources and may serve as an ealy detection too, but cannot Fly re- place clinical testing which should be considered as the ist choice (Ilart and Halden, 2020; Randazzo etal, 20200). Clinica screening ‘comes with the challenges of undertaking a massive time-consuming, ‘and labor-intensive process constrained by availablity of testing tech- nologies (Mao etal, 2020), Wastewater survellance on the other hand can account for individuals who have not been tested, or are asymptomatic potentially symptomatic presymptomaic or only have mile symptoms (Lodder and Husman, 2020; Mallapaty. 2020). Adli- tionally ferent cinical diagnostic esting methods and assays makes ‘country comparisons dificult (Kitajima eta, 2020). Te importance ‘of WBE is also highlighted by its ablity to detec law levels of viruses, ‘specaly important at earl stages ofan outbreak or when infection levels are decreasing following intervention (Kitajima et al, 2020). Monitoring programs for coronavirus in wastewater treatment plants shouldbe established to assess thei fate during water and wastewater tweatment (Naido and Liv, 2020), Researchers can determine the abundance of COVID-19 in a popula- tion from wastewater samples by how much viral RNA s excreted in faeces and extrapolate the number of infected people trom ‘Altria a See ofthe Tt moenent 7442020) 140506 7 concentrations of vital RNA in wastewater (Mallapaty, 2020). SARS- CCoV-2 RNA is first concentrated from wastewater, viral RNA copies are enumerated using RT-gPCR, and the estimated RNA copy numbers are then used to estimate the numberof infected individuals in catchment (Ahmed et a, 2020). Thee are limitations to wastewater-based epide- ‘miology in establishing quantitative predictions from viral RNA "resulting in severe over or underestimation of infected case. These in- clude the complexity of wastewater matrices, the dilute nature of bio- _marer in wastewater, inability to pinpoint specific locations, need for effective sampling techniques, need to develop effective virus concen- tration methods, and need for robust and sensitive RT-qPCR assays in such complex matrices (Ahmed et al, 2020; Hart and Halden, 20; ‘Mao etal, 2020), ‘Wueet al (2020a) tested wastewater collected ata wastewater treat- ‘ment plant in Massachusetts, confirmed the presence of SARS-CoV-2 using RT-qPCR, but found that viral titers were significantly higher than expected based on the clinically confirmed cases. On the other hand, Alnmed et al. (2020) detected SARS-CoV-2 RNA in untreated ‘wastewater and estimated the number of infected individuals in rea- sonable agreement with clinical observations (Ahmed et al, 2020; Kitajima etal, 2020), The reasons for the discrepancy between con- firmed cases and observed viral titers could be due to inaccurate as- sumptions of vital lad in stool or loss assumptions in viral titer due to degradation, and presence of asymptomatic patients (Wu et al, 20202). There is lack ofa standardized protocol fr the detection and ‘quantification of SARS-CoV-2 in wastewater (Kitajima et al, 2020), ‘where proper quantification of the scale of COVID-19 infection ina pop” ulation from wastewater analysis requires overcoming challenges cluding: 1) determination of the quantities of viral RNA excreted in faeces, 2) ensuring samples are representative of population excretions ‘ver time period, 3) ability of test to detect viruses at low levels.) un- derstanding the variability of viral shedding rates between people, 5) the establishment of quantitative predictions of the actual number (of cases in a population from determined RNA concentrations, and 6) need to develop effective enveloped virus concentration methods (Ahmed et al. 2020; Mallapaty, 2020; Nghiem etal, 2020). Or etal (2020) presented a preliminary a proof-of-concept for viral concentra tion method using polyethylene glycol or alum precipitation forthe de- tection of SARS-CoV-2 RNA in sewage. 4, Strategies to combat future pandemics ‘Based on this presented review of COVID-19 infectivity and relation ‘to environmental factors, strategies may be adopted to combat future pandemic by ability to asses its distribution and spread frem environ- ‘mental indicators 4.1, Wastewaer surveilance There is need for development ofa standardized protocol for quan tification of SARS-CoV-2 in wastewater and overcoming existing chal- Tenges discussed previously (Kitajima et al, 2020). Wastewater surveillance may then serve as an important and quick tool to determin- ing the spread of COVID-19 within a community and can assist policy ‘makers in early detection of outbreak through analysis of SARS-CoV-2 RRNA in wastewater samples. The information obtained can assist in identifying areas where transmission is occurring (Kitajima et al, 2020; Larsen etal, 2020), provide guidance on when to relax restric- tions on population movement (Nghiem etal, 2020), assist in contain ing the pandemic once the curve is flattened, and help to prevent escalation where infections are minimal (Larsen e al, 2020) 42. Ar quality indoors and outdoors From our limited understanding of atmospheric pollution impact on COVID-19 spread and severity, integration of air quality protection and climate change mitigation within nations’ sustainable development strategies may assist in curbing future viral outbreaks (Fattorini and Regol,2020; Pans and Fornacca, 2020; Wu etal, 2020e)-Thereisem- _Bhasized importance on continued enforcement of ar pollution regula- tions to protect heath during and after ths pandemic as wel as in the event of future outbreaks (Wu etal, 2020¢). The pandemic is ongoing and the status of infections in the world is dynamically changing. “Thus, the links between air pollution and COVID-19 infectivity and le thalty are not established at this stage. Any future development in that regard may serve as a tool for policy makers in setting proactive strategies to face future pandemics. For example, if future robust evi- dence is made available linking air pollution to COVID-19 spread, then it may actully be plausible to predict pandemic impacts based on the ‘number of days cities exceed pollutant limits (Coccia, 2020). Govern- ‘ments would be then able to prioritize regions with high pollutant con- centrations and take proactive action to reduce atmospheric pollution. Interms of protection against spread of viral infectivity in indoor envi- ronments, attention should be given to building design that ensures in- creased ventilation rates, natural ventilation, proper ar circulation, as \well-engineered sanitary plumbing systems that minimize the potential for virus-laden aerosol to spread within the building (Gormley et a 2020; Livet al, 2020a; Maravwska and Cao, 2020). sour understanding fof aerosol transmission of SARS-CoV-2 is limited, futher investigations are needed to devise methodologies for sampling and quantification of SSARS.CoV-2 in aerosols (Lu et al, 2020a; Morawska and Cao, 2020), 43,Solid waste Despite limited research on SARS-CoV-2 in municipal solid wast, the best waste management strategies should be implemented to limit workers" exposure to waste contaminated with viable virus likely {generated by households with symptomatic and non-symptomaticin- dividuals, Practices may include separate collection services for infected households, delaying waste collection beyond the lifespan of the virus (72h), and direct transport of collected waste to incinerators or landfills avoiding waste segregation at material recovery facilities (Nghiem etal 2020), 5. Limitations There are limitations to our current understanding of the environ- ‘mental transmission of SARS-CoV-2 and links between environmental pollution and COVID-19 infectivity and spread. The research is moving at quick pace and the changing dynamics of infections worldwide pre- sents challenges to establishing robust evidence inking environmen tal conditions such as air pollution with COVID-19 infections. Experimental research on validation of faeal-oral and aerosol transmis- sion of SARS-CoV-2 is also met with challenges, where robust evidence Js yet to be presented through in-depth research efforts. ther areas of cenvironmental research have not received attention such as COVID-19 transmission in solid waste, Several of the presented articles are pre- prints undergoing peer-review, which limits comparison of evidence with other published research, There needs tobe caution in interpreting, the existing findings and the results presented herein i a snapshot of the current understanding of the environmental related aspects of SARS-CoV 6.Conelusion Knowledge on SARS-CoV-2 within the environmental context, ‘maybe beneficial in establishing effective policies for mitigating the transmission ofthe disease and combating future pandemics. arly de- tection of COVID-19 and prevalence within a population can be achieved through surveillance of SARS-CoV-2 RNA in wastewaters, aiding decision makers in choosing the right times fr tightening or re- laxation of restrictions among other measures, Should future robust ® Atari ca Sec othe Tt Enonment 744 (2020) 40505 evidence be available on links between atmospheric pollution and CCOVID-19 spread, air quality maybe another tool of importance that can be employed to assess infectivity of COVID-19 and Future infections ‘This may allow policy makers to establish proactive strategies to face fu ture pandemics, prioritizing regions with high atmospheric pollution. Since air pollution mitigation actions during a viral outbreak may be of limited effectiveness, long-term strategies for air quality protection and regulatory enforcement are of major importance. Evidence is ‘needed to validate transmission of SARS-CoV-2 via faecal-ral or aerosol pathways, which would immensely help our understanding on the in- fectivity and vast spread ofthe pandemic. Prevention of viral outbreak or spread within indoor environments such as hospitals or high-rise buildings due to circulation of vieus-laden aerosol may be achieved by ensuring well-engineered sanitary plumbing systems and adequate air ventilation. Solid waste management and impact on COVID-19 spread has received litle attention and there is need to assess the spread of the pandemic through waste materials specially in developing nations where inadequate practices may act to promote the spread of the pan- «demic within communities. Research is also needed to assess the impact of raw sewage discharge into water bodies, a topic that has received lit- tle attention. Overall, our understanding ofthe environment perspec- tive of SARS-CoV-2 may help in detecting vital outbreak at early stages and assessing pandemic severity in effort to be equipped with the right tools to curb any future pandemic. Declaration of competing interest ‘The authors forthe submitted manuscript "SARS-CoV-2 in the envi- ronment: modes of transmission, early detection and potential role of pollution” certify that they have no affllations with or involvement in any organization or entity with any financial interest (such as hono- ‘aria; educational grants; participation in speakers’ bureaus; member- ship, employment, consultancies, stock ownership, or other equity interest and expert testimony or patent-licensing arrangements), or ‘non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript. ‘Acknowledgments This work was supported by the Division of Consultancy, Research, and Innovation (CR), Sharjah Environment Company - Bee References Avoubaks,M. sharfelln, TA. Goyal SM. 202, Stability of SARS-COV2 ad other ‘oronanfscsm the environment andl on cmon touch surace. 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