Correlation Study between Civilian SARS-CoV-2 Wastewater Concentration and COVID-19 Cases among U.S. Military Health System Beneficiaries

Wastewater-based epidemiology has emerged as a new near real-time tool for population-wide COVID-19 surveillance. This study examined the statistical correlation between county-level civilian SARS-CoV-2 wastewater concentration and COVID-19 cases among beneficiaries of the U.S. Military Health System (MHS) from April 2024 to April 2025 in the continental United States. The analysis revealed an overall high correlation for both MHS beneficiaries ( rs = 0.797; 95% CI: 0.626–0.893) and active-duty service members ( rs = 0.800; 95% CI: 0.633–0.892). Further, an assessment of external factors suggested that correlations were stronger in regions with higher MHS populations. Our findings indicated that civilian SARS-CoV-2 wastewater served as a robust early indicator for COVID-19 trends among MHS beneficiaries and that integrating civilian wastewater data may enhance near real-time Department of War health surveillance monitoring of COVID-19.