COVID-19 has been detected in the sewage of Moree, Baradine, Brewarrina and Bonny Hills despite no known cases in the communities.
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Sewage testing released on Saturday confirmed the communities may contain unidentified coronavirus cases.
Dr Jeremy McAnulty strongly encouraged people from the communities to be on alert.
The detections are of particular concern because there are no known cases in the communities.
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The sewage testing is very effective in identifying a positive virus case, Dr McAnulty said.
"We are urging people in those communities to come forward for testing if you have even the mildest of symptoms," he said on Saturday.
"It is so important that we find cases in these areas so we can help control the spread."
Moree positive sewage test was taken on Tuesday August 24, with Baradine's and Bonny Hills' both taken on Wednesday.
The virus was also detected in Tamworth sewage taken on Tuesday last week.
Results of additional testing conducted on Thursday, which are expected on Saturday, have yet to be released.
The city recorded no cases in updated figures on Saturday after a virus outbreak scare earlier this month.
The city has remained free of the virus since April last year.
The Hunter New England Health district recorded three new cases in the latest statistics, which cover to 8pm on Friday night.
The state recorded 1,035 new locally acquired cases of the virus.
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