Expansion and diversification of wastewater-based epidemiology strategies in pandemic conditions to serve immediate public health goals

Wastewater-based epidemiology (WBE) has become a prominent public health tool for monitoring the COVID-19 pandemic by detecting SARS-CoV-2 RNA in community sewage. Discussed herein is a culmination of work that includes: (i) offering flexibility in reporting RT-qPCR data to communities; (ii) changes in reporting between assays (single-gene vs. multiple-gene); (iii) challenges in translating WBE data into estimates of active infections in a given sewershed; (iv) solutions for comingled wastewaters with sub-sewershed monitoring; (v) variability in quantities of SARS-CoV-2 as a function of field collection methods; (vi) ethical considerations with changing geographic resolution and targets; and (vii) future development of WBE between academic, governmental, and commercial entities. These lessons should serve as guidelines as the field continues to evolve into novel areas in support of addressing immediate public health needs.