Making waves: Wastewater surveillance of SARS-CoV-2 for population-based health management

Worldwide, clinical data remain the gold standard for disease surveillance and tracking. However, such data are limited due to factors such as reporting bias and inability to track asymptomatic disease carriers. Disease agents are excreted in the urine and feces of infected individuals regardless of disease symptom severity. Wastewater surveillance – that is, monitoring disease via human effluent – represents a valuable complement to clinical approaches. Because wastewater is relatively inexpensive and easy to collect and can be monitored at different levels of population aggregation as needed, wastewater surveillance can offer a real-time, cost-effective view of a community's health that is independent of biases associated with case-reporting. For SARS-CoV-2 and other disease-causing agents we envision an aggregate wastewater-monitoring system at the level of a wastewater treatment plant and exploratory or confirmatory monitoring of the sewerage system at the neighborhood scale to identify or confirm clusters of infection or assess impact of control measures where transmission has been established. Implementation will require constructing a framework with collaborating government agencies, public or private utilities, and civil society organizations for appropriate use of data collected from wastewater, identification of an appropriate scale of sample collection and aggregation to balance privacy concerns and risk of stigmatization with public health preservation, and consideration of the social implications of wastewater surveillance.Fil: Thompson, Janelle R. Nanyang Technological University.; SingapurFil: Nancharaiah, Yarlagadda V. Bhabha Atomic Research Centre; IndiaFil: Gu, Xiaoqiong. National University of Singapore; SingapurFil: Lee, Wei Lin. National University of Singapore; SingapurFil: Rajal, Verónica Beatriz. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Salta. Instituto de Investigaciones para la Industria Química. Universidad Nacional de Salta. Facultad de Ingeniería. Instituto de Investigaciones para la Industria Química; ArgentinaFil: Haines, Monamie B. Campus For Research Excellence And Technological Enterp; SingapurFil: Girones, Rosina. Universidad de Barcelona. Facultad de Biología; EspañaFil: Ng, Lee Ching. Environmental Health Institute; SingapurFil: Alm, Eric J. National University of Singapore; Singapur. Massachusetts Institute of Technology; Estados UnidosFil: Wuertz, Stefan. Nanyang Technological University. Singapore Centre For Environmental Life Sciences Engineering.; Singapu