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Correlation analysis was used to explore the correlation between the SARS-CoV-2 RNA levels in wastewater and the number of reported COVID-19 cases. Linear regression and random forest models were used to analyze the predictive function of SARS-CoV-2 in wastewater on human COVID-19 cases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 2,026 wastewater samples were collected. The positive rate of SARS-CoV-2 in wastewater was 82.0%. The positive rates of target Genes ORFlab and N were 71.7% and 81.4%, respectively. In the same period, 70,525 cases of COVID-19 were reported. The concentrations of target genes ORFlab and N in wastewater exhibited consistent trends (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.95, 95% CI: 0.93\u20130.97) and were positively correlated with the number of reported COVID-19 cases (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.79, 95% CI: 0.70\u20130.86;\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.77, 95% CI: 0.67\u20130.84). The linear regression model showed that the coefficients of determination between the number of reported COVID-19 cases and the levels of SARS-CoV-2 RNA (ORFlab, N) in wastewater were 0.63 and 0.59, respectively. In the test set, the random forest model indicated that the correlation coefficients between the number of reported COVID-19 cases and the predicted cases based on the concentration of target Gene ORFlab, target gene N and their combined concentration in wastewater were 0.89 (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.77,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05), 0.88 (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.75,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05) and 0.90 (\n                      <jats:italic>R<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u2009=\u20090.77,\n                      <jats:italic>P<\/jats:italic>\n                      \u2009&lt;\u20090.05), respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Wastewater-based monitoring holds significant application value for trend prediction for COVID-19 cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12879-025-11633-8","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T12:14:06Z","timestamp":1760012046000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Association between SARS-CoV-2 levels in urban wastewater and reported COVID-19 cases in Changsha, Central China"],"prefix":"10.1186","volume":"25","author":[{"given":"Ling-Shuang","family":"Lv","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiu-Ying","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian-Lai","family":"Sun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Fu","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi-Wen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ning-Yuan","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"11633_CR1","doi-asserted-by":"crossref","unstructured":"Safiabadi Tali SH, LeBlanc JJ, Sadiq Z, Oyewunmi OD, Camargo C, Nikpour B, Armanfard N, Sagan SM, Jahanshahi-Anbuhi S. 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