Surveillance of SARS-CoV-2 in Wastewater at the Population Level: Insights into the Implementation of Non-invasive Targeted Monitoring in Singapore and the USA

Early in the ongoing COVID-19 pandemic, the occurrence of SARS-CoV-2 RNA in communal sewage was identified all around the world. Its surveillance in wastewater treatment plants or along the sewerage system has since then been proposed and practiced as a non-invasive, robust, and convenient means of monitoring the spread of COVID-19 in the population, independent of the onset of symptoms. While not suitable for diagnostic purposes on an individual level, wastewater surveillance (WWS) could be shown to successfully trace local outbreaks and map general longitudinal transmission trends. While case studies from across all continents have demonstrated the applicability of this surveillance strategy, challenges remain significant. Difficulties in implementing monitoring programs are mainly associated with sampling workflows and procedures, limitations of molecular assays as well as the legal and ethical implications of data obtained and communicated. In the following chapter, we will discuss perspectives and problems that have been identified for WWS and showcase best practices for its implementation on community surveillance in places such as university campuses, residential buildings, and under low resource conditions.