Publication Type: Journal Article Author: Pallavi Gahlot, Kelly D. Alley, Sudipti Arora, Sukanya Das, Aditi Nag, Vinay Kumar Tyagi Abstract: Wastewater-based surveillance can be used as an early warning system to identify COVID-19 outbreaks because the viral load can be observed in sewage before it is clinically verified. Wastewater surveillance of SARS-CoV-2 can trace the transmission dynamics of infection in communities when using the scale of a wastewater diversion and treatment system. Using this early detection method can help protect human health and mitigate socio-economic losses. It can help quantify the epidemiological data of a given population in real-time and circumvent the need for other epidemiological indicators. There are challenges in using this technique in areas with underdeveloped sewerage infrastructure. It is especially the case in developing nations where uniform protocols for viral detection are lacking, and wastewater is heterogeneous because of environmental and operational conditions. This article explains the need for and importance of wastewater-based surveillance for SARS-CoV-2. It lays out the most recent methodological approaches for detecting SARS-CoV-2 in municipal wastewater and outlines the main challenges associated with wastewater-based epidemiology (WBE). The article includes a case study of surveillance work across India to demonstrate how a developing nation manages research and locational challenges. The socio-economic, ethical, and policy dimensions of WBE for SARS-CoV-2 are also discussed.