An opinion on Wastewater-Based Epidemiological Monitoring (WBEM) with Clinical Diagnostic Test (CDT) for detecting high-prevalence areas of community COVID-19 infections

Wastewater-Based Epidemiological Monitoring (WBEM) is an efficient surveillance tool during the COVID-19 pandemic as it meets all requirements of a complete monitoring system including early warning, tracking the current trend, prevalence of the disease, detection of genetic diversity as well as the upsurging SARS-CoV-2 new variants with mutations from the wastewater samples. Subsequently, Clinical Diagnostic Test (CDT) is widely acknowledged as the global gold standard method for disease monitoring, despite several drawbacks such as high diagnosis cost, reporting bias, and the difficulty of tracking asymptomatic patients (silent spreaders of the COVID-19 infection who manifest no symptoms of the disease). In this current review and opinion-based study, we first propose a combined approach for detecting COVID-19 infection in communities using wastewater and clinical sample testing, which may be feasible and effective as an emerging public health tool for the long-term nationwide surveillance system. The viral concentrations in wastewater samples can be used as indicators to monitor ongoing SARS-CoV-2 trends, predict asymptomatic carriers, and detect COVID-19 hotspot areas, while clinical samples help in detecting mostly symptomatic individuals for isolating positive cases in communities and validate WBEM protocol for mass vaccination including booster doses for COVID-19.

Automated summary

Wastewater-Based Epidemiological Monitoring (WBEM) is a highly efficient surveillance tool during the COVID-19 pandemic. It can be used to track the disease's prevalence, genetic diversity, and emerging variants. However, it is complemented by Clinical Diagnostic Tests (CDTs) which are considered the global gold standard for disease monitoring but have limitations in tracking asymptomatic patients. This study proposes a combined approach using both wastewater and clinical samples for detecting COVID-19 infection in communities, which can be a feasible and effective long-term nationwide surveillance system.