Wastewater surveillance as an early warning system for COVID-19 in low- and middle-income countries: A scoping review
Creators: name: Ravishankar, Anusha
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Public Health
subject: Medicine and Health Sciences
subject: advantages
subject: COVID-19
subject: limitations
subject: LMIC
subject: low- and middle-income countries
subject: SARS-CoV-2
subject: wastewater-based epidemiology
subject: wastewater surveillance

description: Wastewater surveillance refers to monitoring sewage systems in a community for the presence of pathogens. It detects fragment biomarkers from the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the sewage water samples collected by applying clinical diagnostic tests to the collective profile of whole communities. Therefore, it can rapidly establish the presence of COVID-19 cases in an entire population before symptoms appear. This low-cost technology may allow for early detection of the virus as well as the identification of potential hotspots. WHO has even released a set of guidelines on implementing wastewater surveillance. However, neither epidemiologists nor public health officials have widely embraced this tool method. It is still only utilised in a few nations, but it has the potential to be employed in the rest to combat the pandemic. This scoping review seeks to explore the advantages and limitations of using wastewater surveillance in LMICs as an early warning system to locate hotspots so that necessary steps may be implemented to contain the virus in advance. This literature mapping may be a foundation for future studies to address the limitations and build on the advantages. The study can also provide new insights for policymakers to plan and implement this method effectively to make it scalable and sustainable. This will hopefully pave the way for the adoption of wastewater surveillance as an essential tool in all nations to contain the virus and any other new variants that may emerge. The JBI August 2020 guidelines were used to perform this study. Before the study, a protocol was established that included the research question, database selection, search strategy (including search terms), referencing tools, and an outline of the Scoping review steps. As a result, research questions were developed to map the literature on wastewater surveillance in LMICs. Three databases were used: PubMed, Scopus, and Google Scholar. Evidence generated was imported into the software "Rayyan". The study was carried out according to the steps outlined in the guideline: removing the duplicates, abstract title screening, screening by the second reviewer in the case of confusion, and full-text screening. The screening process was done after converting the evidence into CSV format in Microsoft Excel, followed by data extraction, analysis, and presentation of results. Providing an early warning to public health authorities, wastewater surveillance will be a vital tool for boosting existing public health initiatives, particularly in LMICs, to successfully prevent COVID-19 transmission in the community. The study mainly found information on the pertinence, feasibility, global coherence, interoperability, permanence, current dynamics, validity and reliability, and cost-effectiveness of wastewater surveillance. Establishing a wastewater surveillance system helps improve the people's health and the betterment of the sewage system infrastructure or sanitation network. This is in alignment with SDGs 3 and 6.