Table 2.

Application of SARS-CoV-2 wastewater surveillance to policy making at different governmental levels in Australia

	Early wastewater surveillance phase		Established wastewater surveillance phase
	Policy implications	Public health action	Policy implications	Public health action
Local level	Early warning system	Continuation of existing public health strategies; supplementary confirmation of presence or absence of positive cases; targeted public health messaging encouraging symptomatic people to get tested	Highlights new areas of concern; detects viral shedding after release from isolation; identifies multiple chains of infection and proves cessation of local transmission; allows for epidemiological investigation to identify at-risk locations	Targets public health messaging; supplementary confirmation of presence or absence of positive cases; identifies at-risk locations; targeted public health messaging encourages symptomatic people to get tested
State level	Epidemiological assessment; supplementary confirmation of presence or absence of positive cases in communities, regions, and states	Targeted messaging and testing (new testing sites and laboratory surge); implementation or lifting of lockdowns	Leading indicator; indicates geographical spread of the virus; targets delivery of vaccines	Targeted messaging and testing (new testing sites and laboratory surge); restriction of travel to regional or remote communities; implementation or lifting of lockdowns
National level	Contributes to epidemiological and risk assessments	Adapting national responses	Contributes to epidemiological and risk assessments	Adapted national responses, including vaccination strategy
Other jurisdictions	Contributes to daily risk assessments	Implementation of controlled border arrangements; identification of high-risk locations; response measures in high-risk areas	Contributes to daily risk assessments of possible incursions from other states; implementation of controlled border arrangements	Implementation of controlled border arrangements; response measures in high-risk areas

Policy implications and public health actions applicable to other settings with a low prevalence of COVID-19.