Early warning of COVID-19 via wastewater-based epidemiology: potential and bottlenecks

Yifan Zhu, Wakana Oishi, Chikako Maruo, Mayuko Saito, Rong Chen, Masaaki Kitajima, Daisuke Sano

Research output: Contribution to journalReview articlepeer-review

97 Citations (Scopus)


An effective early warning tool is of great administrative and social significance to the containment and control of an epidemic. Facing the unprecedented global public health crisis caused by COVID-19, wastewater-based epidemiology (WBE) has been given high expectations as a promising surveillance complement to clinical testing which had been plagued by limited capacity and turnaround time. In particular, recent studies have highlighted the role WBE may play in being a part of the early warning system. In this study, we briefly discussed the basics of the concept, the benefits and critical points of such an application, the challenges faced by the scientific community, the progress made so far, and what awaits to be addressed by future studies to make the concept work. We identified that the shedding dynamics of infected individuals, especially in the form of a mathematical shedding model, and the back-calculation of the number of active shedders from observed viral load are the major bottlenecks of WBE application in the COVID-19 pandemic that deserve more attention, and the sampling strategy (location, timing, and interval) needs to be optimized to fit the purpose and scope of the WBE project.

Original languageEnglish
Article number145124
JournalScience of the Total Environment
Publication statusPublished - 2021 May 1


  • COVID-19 surveillance
  • Epidemic early warning
  • Fecal shedding
  • Virus genome recovery
  • Wastewater-based epidemiology


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