LAUSR

Wastewater-based surveillance (WBS) for infectious disease has signi fi cantly expanded during the COVID-19 pandemic. Huisman et al. add signi fi cantly to the use case for WBS by demonstrating that it can provide an independent basis for predicting disease transmission. 1 The authors show that the e ff ective reproductive number ( R e ) for SARS-CoV-2 can be estimated from WBS, poten-tially more cost e ff ectively and rapidly than estimates based on clinical data, particularly when there are low rates of infection or disparities in clinical testing within a population. This paper is a timely contribution as the COVID-19 pandemic recedes, at-home COVID-19 test kits become more accessible, and clinical surveillance declines.Aspublichealth systems consider institutionalizing WBS for the longer term, successful implementation will require additional development of several key elements. These elements include a ) sustaining institutional partnerships to support use of WBS data, b ) clarifying the integration of WBS and clinical data in pandemic surveillance systems, and c ) expanding meaningful community engagement around WBS priorities, communications, ethics, and equity concerns (Figure 1).