Beyond clinical data: the role of sewage monitoring in tracking pandemic trends of SARS-CoV-2

Our study demonstrates that effluent genomic surveillance is a rapid, sensitive, and scalable method. It enables the timely identification of SARS-CoV-2 variants and the detection of hidden transmission. It can be applied to SARS-CoV-2 early warning as well as epidemiologic surveillance. However, this study has certain limitations. First, due to financial constraints, only a limited number of clinical samples were analyzed, which may have underestimated the diversity of SARS-CoV-2 lineages in the patient population. Second, the absence of information on the physicochemical characteristics of sewage may have limited our understanding of environmental factors affecting viral stability and detection efficiency.